Objective To explore the findings and clinical value of bedside ultrasonography in superior vena cava(SVC) syndrome in children after cardiac operations for congenital heart disease. Methods Bedside ultrasonography was performed on 6 children suspected of SVC syndrome after 5-38 hours[(22?11) hours] postoperatively,to view the structure and blood flow of SVC and its main branches. All the patients were reoperated as soon as diagnosed. Results Five children got severe SVC obstruction, marked with stenosis, turbulent, continuous and high velocity in SVC. Color Doppler flow imaging presented almost absence of flow due to nearly complete occlusion of the innominate vein in 1 child. Ultrasonographic diagnosis was confirmed by the reoperative findings. All the patients were cured by reoperation and discharged with normal ultrasonographic results. Conclusions Bedside ultrasonography can provide early and accurate diagnosis in children with SVC syndrome after cardiac operation.

OBJECTIVE: To establish a new method for identification of Angelica sinensis from its adulterants by analyzing trnL-F and rpoC1 sequences. METHODS: The plastid trnL-F and rpoC1 of 25 samples of A. sinensis and its adulterants were amplified, sequenced, and analyzed. The K-2-P distances of A. sinensis and its adulterants were calculated, and the phylogenetic trees were constructed. RESULTS: The trnL-F sequence showed significantly larger length variation range, numbers of variable sites and informative sites, and evolutionary distance than rpoC1 sequence. There were significant differences between A. sinensis and the adulterants based on the trnL-F sequences. One SNP site and one repeated base A region could be used as specific authenticable sites. The distance of A. sinensis and its adulterants ranged from 0.002-0.231 as shown by trnL-F sequences. Phylogeny tree reconstruction using MP analysis based on trnL-F sequences could effectively distinguish A. sinensis from adulterants. However, analysis of the rpoC1 sequences could not identify A. sinensis and its adulterants. CONCLUSION: The rpoC1 sequence has poor capability for identification of A. sinensis and its adulterants. The trnL-F sequence could be used as an efficient molecular marker for authenticating A. sinensis from its adulterants.

Objedtve To summarize the experience of single-stage repair of coarctation of aorta(CoA) or interrupted aortic arch (IAA)and associated intracardiac defects through median stemotomy.Methods From Jan 2007 to Jul 2008,a total of 24 pa-tients with CoA or IAA and associated intracardisc defects were surgically repaired in single-stage through median stermotomy,inchud-ing 9 coanctation of aorta,12 coarctation with aortic arch hypoplasia,and 3 interrupted aorlic arch,.The associated intracardiac de-fects were Taussing-Bing anomaly 4,non-restricted VSD 22,subaortic stenosis 1 and pulmonary vein stenosis 1.The age ranged form 1 to 99 months (average 16 months) and the body weight ranged from 4 to 19 kg(average 9.3 kg).Aortic arch reconstruction was performed by hypothermic continuous low flow bypass using regional perfusion for all patients.Three patients with LAA and 9 patients with CoA underwent end-to-end ansetomosis.Of the 12 patients with coarctation and aortic arch hyipoplasia,8 patiellts underwent ex-tended end-to-end anastomosis,2 patients underwent end-to-side anastomosis and 2 patients underwent aortoplasfy.Results 2 cases were dead. One infant with Taussig-Bing type heart was dead of severe infection after 47 days postoperative,the other one who associ-ated with LAA and VSD dead of pulmonary hypertension crisis due to pneumonia after 15 days postoperative.No patient presented neu-rdogieal complication and renal insufficiency during the perioperation.2 cases presented recurrent respiratory problem.During the 18months follow-up,no patient presented with recoarctation except one with pressure gradient more than 20 mm Hg.Conclusion Pa-tients with coarctation of aorta or interrupted aortic arch and associsted intracardisc defects should be surgically treated as early as pos-sible when diagnosis was mode.Single-stage sortic arch reconstruction through median stemotomy using continuous regional perfusion is an effective and safe procedurd.Sufficient resection of ductus,extensive dissection of thoracic vessels and optimal tissus-tissue anas-tomosis techmique are very important for successful repair and avoiding recoarctation.

OBJECTIVETo evaluate the effect of perioperative continuous epidural morphine administration on plasma D-dimer level in patients undergoing total hip replacement.

METHODSForty ASA I-II patients undergoing total hip replacement under epidural anesthesia were randomized into two groups. In one group, the patients were given epidural administration of morphine 15 min before operation at 4 mg (in 10 ml normal saline) and for 48 h after the operation at 80 microg/h, while those in the other group received epidural injection of the same amount of normal saline before operation and 0.15% ropivacaine 2.0 ml/h for 48 h in the same manner after operation. Blood samples were taken before anesthesia (T(0)), at the end of operation (T(1)), and 24 h and 48 h after operation (T(2) and T(3)) for determination of plasma IL-6 and D-dimer levels.

RESULTSIn both groups plasma IL-6 and D-dimer levels showed significant increase at T(1), T(2) and T(3) in comparison with those at T(0), and their levels were significantly lower in morphine group than in ropivacaine group at T(1), T(2) and T(3).

CONCLUSIONEpidural morphine can lower plasma IL-6 and D-dimer levels and correct blood hypercoagulability in patients undergoing total hip replacement.

Aged ; Arthroplasty, Replacement, Hip ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Humans ; Injections, Epidural ; Interleukin-6 ; blood ; Male ; Middle Aged ; Morphine ; administration & dosage ; Perioperative Care ; Postoperative Period

Objective To evaluate the clinical characteristics,outcome and prognostic factom of adolescent nasopharyngeal carcinoma.Methods Between Jan 1990 and Dec 2009,totally 148 pathological confirmed nasopharyngeal carcinoma(NPC)patients with age≤20 years were treated in our hospital,including stage Ⅱ 8,stage Ⅲ 58,stage Ⅳ 81,and unknown 1 when restaged by TNM system(UICC 2002),ninty-four(63.5%)patients were treated with radiotherapy alone,54(36.5%)patients were treated with radiotherapy combined with cisplatin-based chemotherapy.Results The median follow-up time for all patients was 44.5 months.The 5-year overall survival(OS),local-regional control(LRC)and distant metastasis-free survival(DMFS)rateswere 82.9%,85.1%and 78.6%.There were 42 patients(28.4%)failed with 16 regional recurrence and 29 distant metastasis,and 3 with both;bone metastasis was the most common site of distant metastasis(22/29).In univariate analysis,the adverse prognostic factors for OS were stage T4(X2=5.61,P=0.018),radiation dose<70 Gy(X2=5.30,P=0.021),for LRC was radiation dose<70 Gy and for distant metastasis-free survival was the disease history≥6month(X2=4.24,P=0.039).In multivariate analysis,radiation dose<70 Gy and stage T4 were the independent prognostic factors for OS(X2=5.73、5.56,P=0.017、0.018),for LRC was radiation dose<70 Gy(X2=5.81,P=0.016).Conclusions The outcome of the present series was excellent,total nagopharyngeal radiation dose less than 70 Gy is inappropriate.Reduce the distant metastasis and late toxicities were the future direction for the treatment of adolescent nasopharyngeal carcinoma.

CD55 Antigens ; Complement Activation ; Humans ; Membrane Cofactor Protein ; Pemphigoid, Bullous ; Recombinant Fusion Proteins

Objective To investigate the Raman spectral characteristics of oral squamous cell carcinoma,high-grade epithelial dysplasia and normal mucosa.Methods Fifty-six fresh samples of oral carcinoma,50 of high-grade epithelial dysplasia and 32 of normal mucosa were collected.The i-Raman spectrometer with an optical fiber tube was applied to acquire Raman spectrum.The diagnostic model established by principle component analysis(PCA) and discriminant function analysis(DFA) was used to analyze and classify the spectra of different samples.Results There were significant differences among the Raman spectra of these samples.Compared with the spectra of normal mucosa,the spectra of oral carcinoma and dysplasia showed strong peaks which were contributed to nucleic acids,proteins and lipids.The diagnostic models established by PCA-DFA could successfully classify these Raman spectra of different samples with a high accuracy of 96.4％ (133/138).The model was evaluated by 'Leave one out' crossvalidation and reached a high accuracy of 92.8％(128/138).Conclusions The proliferation and metabolism of oral squamous cell carcinoma and epithelial high-grade dysplasia are more active than normal mucosa.The diagnostic models established by PCA-DFA can classify these Raman spectra of different samples with a high accuracy.

The development status quo of Shanghai's medical device industry was described.By using SWOT analysis method the influencing factors of the industry were analyzed and the key influencing factors were determined.A SWOT strategy matrix was constructed with considerations on the strengths,weaknesses,opportunities and threats of the key influencing factors.Some suggestions were put forward based on the SWOT strategy matrix and weak links of Shanghai's medical device industry to promote the development of the industry,and references were provided for the development of Shanghai's medical device industry.[Chinese Medical Equipment Journal,2024,45(6):77-82]

OBJECTIVETo study the clinical efficacy of three kinds of hybrid bioartificial liver support systems (HBLSS) in treating chronic severe hepatitis.

METHODSA bioartificial liver support system (BAL), comprising porcine hepatocytes and fiber tube style bioreactor, was constructed. Then three kinds of HBLSS were constructed: Molecular absorbent recirculating system (MARS) plus BAL; slow plasma exchange (SPE) plus continuous hemodiafiltration (CHDF) and BAL; and SPE plus hemoperfusion (HP) and BAL. One hundred-twenty patients in middle or late stages of chronic severe hepatitis were enrolled in this study. They were randomly divided into 6 groups: H1 group was treated with BAL+MARS, H2 with BAL+SPE+CHDF and H3 with BAL+SPE+HP (as treatment groups); C1 group was treated with MARS, C2 with SPE+CHDF and C3 with SPE+HP (as control groups). The changes in the clinical symptoms, in the hepatic encephalopathy stages, and in the serum total bilirubin (TBIL), the serum albumin (ALB), the prothrombin activities (PTA), endotoxin, ammonia, creatinine and a-fetal protein (AFP) were all observed before the treatment, right after it and 72 hours later. The improving and curing rates and the rates of side effect occurrences in each group were observed.

RESULTSIn all 6 groups, the patients' clinical symptoms ameliorated; their TBIL, endotoxin and ammonia levels decreased (P<0.05), and their PTA and AFP levels lowered significantly (P<0.05). But in the H1, H2 and H3 groups they were more distinctive than in the control groups. In H1 and H2 groups creatinine and ammonia levels were decreased more significantly than in the H3 group (P<0.05). The improving and curing rates of each group were 65 % (13/20), 60% (12/20), 45% (9/20), 45% (9/20), 40% (8/20) and 20% (4/20) respectively. No serious side effects were observed during the treatment.

CONCLUSIONIn treating middle and late stage chronic severe hepatitis, the measures used in H1, H2 and H3 are better than those in C1, C2 and C3. Furthermore, H1 and H2 treatments can ameliorate hepatic and renal functions, prevent the development of multiple organ dysfunction syndrome, and are better than those used in H3.

Adult ; Aged ; Animals ; Bioreactors ; Critical Illness ; Female ; Hemodiafiltration ; Hepatic Encephalopathy ; blood ; therapy ; Hepatitis, Viral, Human ; therapy ; Humans ; Liver ; cytology ; Liver Failure, Acute ; therapy ; Liver, Artificial ; Male ; Middle Aged ; Plasma Exchange ; Swine

BACKGROUND: All-trans retinoic acid (ATRA) promotes the osteogenic differentiation induced by bone morphogenetic protein 9 (BMP9), but the intrinsic relationship between BMP9 and ATRA keeps unknown. Herein, we investigated the effect of Cyp26b1, a critical enzyme of ATRA degradation, on the BMP9-induced osteogenic differentiation in mesenchymal stem cells (MSCs), and unveiled possible mechanism through which BMP9 regulates the expression of Cyp26b1. METHODS: ATRA content was detected with ELISA and HPLC–MS/MS. PCR, Western blot, and histochemical staining were used to assay the osteogenic markers. Fetal limbs culture, cranial defect repair model, and micro–computed tomographic were used to evaluate the quality of bone formation. IP and ChIP assay were used to explore possible mechanism. RESULTS: We found that the protein level of Cyp26b1 was increased with age, whereas the ATRA content decreased. The osteogenic markers induced by BMP9 were increased by inhibiting or silencing Cyp26b1 but reduced by exogenous Cyp26b1. The BMP9-induced bone formation was enhanced by inhibiting Cyp26b1. The cranial defect repair was promoted by BMP9, which was strengthened by silencing Cyp26b1 and reduced by exogenous Cyp26b1. Mechanically, Cyp26b1 was reduced by BMP9, which was enhanced by activating Wnt/b-catenin, and reduced by inhibiting this pathway. b-catenin interacts with Smad1/5/9, and both were recruited at the promoter of Cyp26b1. CONCLUSIONS Our findings suggested the BMP9-induced osteoblastic differentiation was mediated by activating retinoic acid signalling, viadown-regulating Cyp26b1. Meanwhile, Cyp26b1 may be a novel potential therapeutic target for the treatment of bone-related diseases or accelerating bone-tissue engineering.