Objective The tissue-engineered composite graft was formed with induced marrow-derived stromal cells (MSCs)and PLGA double-layer scaffold. The effectiveness of this graft for the repair of osteochondral defects in the knee of rabbits was investigated. Methods MSCs were isolated from 20 adult rabbits with density gradient centrifugation and was divided into two groups. In group A, the MSCs were cultivated with regular medium. In group B they were cultivated with chondrogenic differentiation medium. The mRNA of MSCs and articular cartilage cells were extracted, and the expression of mRNA for type Ⅰ and Ⅱ collagen was tested by RT-PCR. The distribution and compound of MSCs with PLGA double-layer scaffold was examined with scanning electron microscopy. 28 adult rabbits were divided into 3 groups, osteochondral defect of 3.5 mm in diameter and 3 to 4 mm in depth were created in the patellar groove. Group A (10 rabbits), the MSCs cultivated with regular medium was grafted into the defects. In group B (10 rabbits), the MSCs cultivated with chondrogenic differentiation medium was grafted into the defects. In group C (8 rabbits), the defects were repaired with autologous osteochondral grafts as control. Specimens were harvested at 4th, 8th, 16th and 24th week post operation respectively, histological examination was performed and graded. Results For the MSCs cultivated with regular medium, the expression of mRNA for type Ⅰ collagen was found with RT-PCR, but no expression for Ⅱ collagen was found. For the induced MSCs, the expression of mRNA both for type Ⅰ and type Ⅱ collagen were found. The adhesion and growth of MSCs on the PLGA double-layer scaffold were well visualized with scanning electron microscopy, and some cells were found in the deep porotic area. For the specimens of group B, no significant difference was found comparing with normal cartilage at 24th week, and the specimens were defined as matured hyaline-like cartilage(4/6)with histological examination, superior to those specimens of group A (1/4). Conclusion The MSCs have osteogenic and chondrogenic potentiality. Combined with PLGA double-layer scaffold, it can be served as seeded cell to form tissue-engineered composite grafts, which can be used to repair osteochondral defects in rabbit models.

Objective To investigate the intelligence level and characters in children with cerebral palsy of 4~6 years old, and the factors related with their intelligence. Methods 215 cerebral palsy children of 4~6 years old were assessed with Wechsler Intelligence Scale for children,Gross Motor Function Classification System (GMFCS). Results 210 children finished their intelligence test, and 113 presented mental retardation. The intelligence level was higher in the children with spastic diaplegia, hemiplegia and dyskinetic type than those with quadriplegia and ataxia type. The difference was significant between VIQ and PIQ in the spastic diplegia (P<0.05). The mental retardation was more frequent in the children with GMFCS Ⅳ~Ⅴ, or with epilepsy or microcephaly than those with GMFCS Ⅰ~Ⅲ or without the complications (P<0.05). Conclusion The incidence of mental retardation in children with cerebral palsy was related with the neurotypes, motor function and complications.

ObjectiveTo compare the CT features of retroperitoneal ganglioneuroblastoma (GNB) and neuroblastoma (NB) in children,and summarize the differentiations between them.Methods From November 2007 to November 2011,19 patients with GNB and 21 patients with NB proven pathologically were enrolled in the study.The CT data of GNB and NB were analyzed retrospectively.These tumor parameters in CT included lesion location,size,shape,margin,calcification,across central line,style of contrast enhancement,degree of contrast enhancement,presence of small vessels in or around the tumor arranged in clumps or in line,tumor embolus,adjacent organs invasion or metastasis,lymph node metastasis,and relationship between tumor and surrounding great vessels.These parameters of both groups were compared by x2 and t test.ResultsIn GNB group,11 patients were located in adrenal gland and 8 patients in the retroperitoneal sympathetic chain; however,in NB group,18 patients were located in adrenal gland and 3 patients in the retroperitoneal sympathetic chain. The difference were statistical significances in the incidence rate of regular morphology,clear border,vessel encased by tumor,vessels displaced,presence of small vessels in /around the tumor arranged in clumps or in line,adjacent organs invasion or viscera metastasis,lymph node metastasis between NB (6/21,7/21,14/21,7/21,11/21,10/21,and 11/21,respectively) and GNB ( 12/19,13/19,6/19,13/19,4/19,3/19 and 4/19,respectively) ( P ＜ 0.05 ).However,there was no statistical significance in size,calcification,across central line,contrast enhancement type,contrast enhancement degree between them ( P ＞ 0.05 ).ConclusionsNB are more likely located at adrenal gland and presented a higher incidence rate of presence of small vessels in or around the tumor which arranged in clumps or in line,vessel encased by tumor,adjacent organs invasion or metastasis and lymph node metastasis.Regular morphology,clear border and vessels displaced are more frequently observed in GNB.

Objective To investigate the efficacy of adductor canal block (ACB) under the guidance of ultrasound for postoperative analgesia in the pediatric patients undergoing knee operation.Methods Sixty pediatric patients,aged 3-12 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 12-35 kg,scheduled for elective unilateral knee operation,were selected and randomly divided into 2 equal groups using a random number table:ultrasound-guided ACB group (group ACB) and ultrasound-guided femoral nerve block (FNB) group (group FNB).After induction of general anesthesia,ACB or FNB was performed under the guidance of ultrasound,and 0.3％ ropivacaine 1 ml/kg was injected.Anesthesia was maintained with intravenous infusion of remifentanil combined with propofol,and bispectral index value was maintained at 40-60.Immediately after injection of local anesthetics (T0),and at 4,8,12 and 24 h after injection (T1-4),analgesic efficacy was assessed using the FLACC pain scale,and quadriceps strength was assessed by manual muscle testing.Satisfactory analgesia was defined as FLACC score ≤ 3,and obvious quadriceps weakness was defined as manual muscle testing grade 0-2.The complications associated with nerve block (such as local anesthetic toxicity,bleeding at the puncture site,hematoma),and occurrence of postoperative nausea and vomiting and delayed emergence were recorded.Results There was no significant difference between two groups in the rate of satisfactory analgesia at T1-T4 (P＞ 0.05).Compared with group FNB,the incidence of obvious quadriceps weakness was significantly lower at T1-T3 (P＜0.05),and no significant change was found at T4 in group ACB (P＞0.05).There was no significant difference in the incidence of nausea or retching between two groups (P＞0.05).Complications associated with nerve block,vomiting and delayed emergence were not observed in the two groups.Conclusion Ultrasound-guided ACB can be safely and effectively used for postoperative analgesia in the pediatric patients undergoing knee operation,and it has less influence on the quadriceps strength than FNB.

Objective To study the protective effect of redix astragail on intestinal mucosa barrier in infant rabbits with intestinal ischemiareperfusion.Methods Twenty male infant rabbits were divided into 4 groups randomly:sham control group,intestinal ischemia reperfusion(IIR) group(model group),redix astragail group,control group.Redix astragail group and control group intraperitonerlly injected redix astragail 6 mg/(kg?d)or sodium chloride preoperative.Intestinal mucosa and blood plasma superoxide dismutase(SOD) activity,intestinal mucosa tissue degree of injury were observed in infant rabbits with IIR.Meanwhile,the effect of redix astragail on them was studied.Results After IIR,SOD activity in intestinal mucosa and blood plasma obviously decreased,and intestinal mucosa tissue morphous and intestinal mucosa barrier lesion were progressively aggravated.Redix astragail might increase blood plasma and intestinal tissue SDD activity significantly.Conclusion Redix astragail plays an important role in protecting intestinal mucosa barrier in infant rabbits with IIR.

Objective To explore the pathological basis and clinical characteristics of children with congenital choledochal cyst(CCC) combined with liver damage.Methods According to the age,38 patients with CCC were divided into 2 groups:group A had 24 cases(ranged 6 months to 3 years old);group B had 14 cases(ranged 4 to 14 years old).A comparative analysis of them was conducted retrospectively in the clinical characteristics,hepatic pathological changes,perioperatively liver function and operation.Results Group A was obvious higher than group B in jaundice,white bole stool and abdominal mass,but group B was more in stomachache.Group A was obvious higher than group B in liver function lesion,alkaline phosphatase,bilirubin increase and blood coagulation disfunction(Pa

Objective To explore the effects of earlier oral-motor exercise on swallowing and feeding capability of children with cerebral palsy. Methods 36 children accepted oral-motor exercise performed by speech-language therapist once a day for 3 months. They were assessed for oral motor and feeding before and after treatment, and compared with other 36 controls matched with age and type. Results The oral motor in treatment group improved significantly （t=2.184,P<0.05） after treatment, but merely in control. The difference of scores of oral motor before and after treatment was (9.89±4.33) in treatment group, and (3.38±1.56) in control group (t=7.423, P<0.01). Conclusion Early oral-motor exercises is effective to improve oral motor function and feeding capability.

Objective To evaluate the reliability of ultrasound for rapid identification of esophageal intubation in the patients with difficult airway.Methods Twenty-one patients requiring orotracheal intubation, aged 20-75 yr, with body mass index of 25-32 kg/m2, of ASA physical status Ⅰ or Ⅱ , Cormack-Lehane grade Ⅲ or Ⅳ under direct laryngoscope, undergoing elective general anesthesia, were selected.The carotid artery, trachea and esophagus were identified by ultrasonic scanning at suprasternal notch before induction of anesthesia.After induction of anesthesia, tracheal intubation was performed.During intubation, ultrasound was performed to detect esophageal intubation.After intubation, mechanical ventilation was performed.Auscultation of bilateral breath sounds was carried out to evaluate the tube position.The position of the tube was subsequendy determined through partial pressure of end-tidal CO2 monitoring.Results The sensitivity and specificity of ultrasound in identifying esophageal intubation were both 100％ in the patients with difficult airway.Conclusion Ultrasound can rapidly and effectively identify esophageal intubation in the patients with difficult airway.

Objective To investigate the clinical characteristics of speech disorders in children with cerebral palsy (CP) and any relationship between those characteristics and cranial magnetic resonance images.Methods A sample of 138 children with CP were given the ＜ s-s ＞ language development test,a Chinese-language articulation test and oral motor scores to quantify their functional speech and articulation.The characteristics of their speech disorders,articulation and oral motor dysfunction were then related with abnormalities in their cranial magnetic resonance images (MRIs).Results Of the 138 MRIs,only 9 were normal.Three showed non-specific abnormalities (delayed myelination and/or broadening of the space outside the brain) and 122 (91％) showed specific abnormalities.Among the children with specific abnormalities,51.6％ had speech reception delay and 74.6％ had speech expression delays.The dysarthria rate was 71.3％,including 8.7％ with no speech ability at all.The main MRI abnormalities were lesions of the basal ganglia (23％),lesions of the cerebellum (11.5％),periventricular leukomalacia (PVL) (47.5％),extensive cortical or subcortical lesions (6.6％) and focal cerebral injury (11.5 ％).The corresponding oral motor scores increased successively.The children with lesions of the basal ganglia or cerebellum were most likely to manifest speech expression delay and dysarthria.The children with cortical or subcortical lesions or PVL also showed speech expression delay and dysarthria.However,the children who had a focal cerebral injury generally performed well on the speech ability assessment.Twelve children had no speaking ability at all,and in 7 of them the lesions were of the basal ganglia.Conclusions The probability and severity of speech disorders in children with cerebral palsy relate with specific abnormalities detectable with cranial MRI.Those with lesions of the basal ganglia or cerebellum will be more likely to show more severe speech disorders.

Objective To evaluate the value of ultrasound-measured quantification of anterior neck soft tissue in predicting the difficult laryngoscopy in the obese patients.Methods Ninety-six patients,with body mass index ≥ 28 kg/m2,aged 22-60 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia with endotracheal intubation,were selected.Assessment methods of modified Mallampati grade (method M) and anterior neck soft tissue quantification measured by ultrasound (method U) were performed before anesthesia.The level of vocal cords was selected using ultrasound scanning for anterior neck.The positive result was greater than 20 mm in method U,and was grade Ⅲ or Ⅳ in method M.Direct laryngoscope was placed after induction of anesthesia.Difficult laryngoscopy was defined as Cormack-Lehane grade Ⅲ or Ⅳ,or in whom laryngoscope could not be placed.The sensitivity,specificity and accuracy of the two assessment methods for predicting the difficult laryngoscopy were calculated.Results Twenty-two patients were found to have difficult laryngoscopy,and the anterior neck soft tissue quantification was (23.0±3.0) mm,which was significantly thicker than that in the patients of non-difficult laryngoscopy ((1.9±2.2) mm).The sensitivity,specificity and accuracy of method U were 91％,92％ and 92％,respectively,and of method M were 77％,81％ and 80％,respectively,and there was significant difference between the two methods.There was no significant difference in the parameters of difficult laryngoscopy which were predicted using method U between the patients of different ages or gender.Conclusion It can accurately predict the difficult laryngoscopy in the obese patients when the ultrasound-measured quantification of anterior neck soft tissue is greater than 20 mm.