Objective To discuss the CT features and the prognosis of hypoxic ischemic encephalopathy (HIE) with intracranial hemorrhages in neonates.Methods The CT features of the HIE with intracranial hemorrhage were analyzed and follow-up studied in 64 cases.Results Of all the 64 cases with HIE, 53 cases were associated with subarachnoid hemorrhage (SAH), and all cases were normal in the follow-up study after 1 month. 1 case was associated with intraventricle hemorrhage (IVH), 10 cases were associated with mixed bleeding (SAH+IVH in 3 cases, IVH+IPH in 1 case, SAH+IPH in 2 cases, SAH+SHE in 2 cases, SAH+SDH in 2 cases). Of the follow-up studies on 10 mixed bleeding cases, 1 was normal, 1 was dead, and the others were cerebromalacia, cerebral atrophy, porencephaly and calcium.Conclusion Different intracranial hemorrhages results in different prognosis.

ObjectiveTo evaluate and compare the curative effect and the safety of sclerotherapy of venous malformation in children using absolute ethanol and pingyangmycin.MethodsEighty children with venous malformation were treated by sclerotherapy with absolute ethanol or pingyangmycin under general anesthesia during February of 2009 to May of 2011. Diagnostic criteria included the presence of a bluecolored lesion at birth,with gradual increase in its size associated with a positive postural test.MRI showed characteristic imaging features.Eighty patients were divided into two groups by randomization.Forty patients were treated with absolute ethanol,and the remaining 40 patients with pingyangmycin. The therapeutic effects and side effects were observed and recorded during a follow-up period of 6 to 24 months ( average 15 months).Treatment results weredividedinto four categories: cure, basiccure, effective, and ineffective,and the former three categories were considered effective in treatment.Chi-square test was used to compare the rate of effective treatment and rate of complications in these two groups.ResultsThe effective patients treated with absolute ethanol was 38 (95.0％,38/40),and the effective patients with pingyangmycin was 26(65.0％,26/40),x2 test ( x2 =11.25,P ＜ 0.01 ) difference was statistically significant.Eight patients developed skin necrosis; 4 patients serious local swelling,2 patients muscle fibrosis,1 patient cerebral embolism in the absolute alcohol group.Two patients developed postoperative fever and vomiting and 2 skin necrosis in the pingyangmycin group,the difference was statistically significant (x2 =12.29,P ＜0.01 ). ConclusionsSclerotherapyiseffectiveforthetreatmentofvenousmalformationsin children.Absolute ethanol is more effective,but associated with more complications,such as skin necrosis or as serious as cerebral embolism,than pingyangmycin.

Objective To explore the effect and safty of interventional embolization of congenital arteriovenous fistula (CAVF) in the common femoral profounda artery in children.Methods Eight children (aged 6 to 14 years ;6 males and 2 females) with CAVF underwent interventional embolization From January 2006 and December 2010.Color Doppler sonography and DSA were performed on all patients.Arterial duplex imaging revealed the arteriovenous fistula in the common femoral profounda artery and DSA further confirmed the presence of an AVF over the common femoral profounda artery via the other vein.All children were treated with interventional embolization therapy by the injection ofcoils or ethanol through a microcather.It was necessary to performed repeated interventional embolization if the lesion was not obliterated in 4 weeks.All patients were followed-up from 6 months to 2 years and the clinical symptoms were observed.Results Arteriograpy can clearly demonstrate the femoral profounda artery and its branches as well as the fistula.Ten interventional embolization procedures were performed.Forty seven coils were deployedduring the procedure and seven ethanol embolization procedures were performed.Post-procedural angiography revealed complete occlusion in 8 patients.No major complications such as ectopic coil embolization,tissue necrosis,peripheral nerve palsy or cardio-pulmonary collapse were found.The abnormal AVFs were embolized completely in 7 cases after only one therapy and there was no recurrent disease in the 6 months to 2 years follow-up.Some tiny AVFs were still found in another case which underwent three additional treatments.However,the clinical symptoms were under control.Conclusion Interventional embolization is a safe and effective therapeutic method for CAVF of the common femoral profounda artery in children and it might become the primary treatment option.

Objective To evaluate the safety and efficacy of percutaneous ethanol embolization (PEE) in treating arteriovenous malformation (AVM) of foot in children.Methods The clinical data of 11 sick children with arteriovenous malformation of foot,who were treated with PEE in authors' department during the period from January 2007 to January 2016,were retrospectively analyzed.The clinical symptoms,the type of tumor nidus,the therapeutic effect and the postoperative complications were analyzed.Results The 11 sick children included 6 boys and 5 girls,with a mean age of 9 years.Foot mass was seen in 8 children,pain in 8 children,claudication in 3 children and ischemic skin ulcer in one child.Cho Ⅲ b type was observed in 10 children and Cho Ⅱ type in one child;Yakes Ⅳ type was found in 10 children and Ⅱa type in one child.A total of 30 PEE procedures were performed,with an average of 2.7 times per case.The children were followed up for 6-48 months,with a mean of 24 months.Evaluation of curative effect showed that complete cure was achieved in 7 children and partial remission in 3 children,the effective rate was 90.9％.Treatment failure (showing no remission) was seen in one child,and no deterioration of disease was observed.Complications included transient blood oxygen decrease in operation (n=1),toe ischemia (n=1),postoperativeblister (n=1) and local skin ulcer (n=l),no severe complications were observed.Conclusion PEE is a safe and effective treatment for arteriovenous malformation of foot in children.

Objective To evaluate the efficacy and safety of interventional sclerotherapy for intraorbital venous malformation in children. Methods A retrospective analysis of 12 cases with intraorbital venous malformation from March 2007 to July 2013 in our department was made. Twelve lesions including 7 in left eyes and 5 in right eyes were evaluated. Three patients had surgical resection before interventional treatment. Sclerosing agent such as sclerosant foam or pingyangmycin was injected into the lesions guided by DSA. Interventional sclerotherapy was performed once every month until no blood return was observed. Then MRI was used to detect the lesions 1 month after operation. If there were residual lesions in MRI images, then repeat treatment was performed. Postoperative observation included patients' general situation and adverse reactions of eye after each treatment. Results Interventional sclerotherapy were performed to all patients for a total of 42 times (mean time 3.5 ± 1.0 per patient). After a follow?up of 24months, 7 cases were cured, 3 cases improved significantly and 2 cases with partial remission. Postoperative adverse reactions: transient exophthalmos in 39 case?times , peri?orbital and maxillofacial tissue swelling in 32 case?times. No severe complications were observed. Conclusion Interventional sclerotherapy is an easy, safe and effective method for treatment of intraorbital venous malformation.

Objective To compare and analyze clinical effects of extended thymectomy for the treatment of thymoma with myasthenia gravis(MG) between subxiphoid and subcostal arch thoracoscopic resection(SR) and the median sternotomy(MS) with a propensity-matched analysis.Methods We retrospectively analyzed 528 patients presented with MG and admitted in Tangdu Hospital of Air Force Military Medical University from December 2011 to December 2016,among whom 402 underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy(SR group) and 126 median sternotomy(MS group).Another 126 patients were produced by a propensity-matched analysis in these 402 patients,to match with MS group.Perioperative outcomes were compared between SR group and MS group.Results All operations were accomplished successfully,without conversion to thoracotomy in SR group.Most postoperative outcomes were equal in remission of MG and postoperative complication between the two groups(P ＞ 0.05).There were statistical differences between MS group and SR group in operation time [(106.3 ±32.7)min vs.(533.2 ±37.3) min],intraoperative blood loss[(138.2 ±26.7)ml vs.(38.2 ± 10.3) ml],chest drainage duration[(3.3 ± 1.6) days vs.0 day],hospital length of stay [(5.0 ± 2.5) days vs.(2.5 ± 1.8) days],patients'satisfaction level(6.1 ±2.3 vs.8.9 ± 1.2),the incidence of postoperative wound infections(4.8％ vs.0.8％),the incidence of myasthenic crisis(7.1％ vs.1.6％)and pain scores,all P ＜0.05.Conclusion Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for tmanagement of MG with thymoma.

Objective:To figure out variety of the plasma level of Alpha-1-Antitrypsin(α1-AT) in patients who undergo AKI following cardiopulmonary bypass(CPB), and whether this biomarker serve as a competent predictor.Methods:We recruited 75 patients undergoing cardiac surgery with CPB from January 2018 to January 2019. Patients were categorized into two groups according to the development of AKI. The relationship between plasma concentration of α1-AT and renal injury in two groups was analyzed.Results:27 patients in the AKI group were aged (54.3±12.2)years old, including 15 males and 12 females, the time of cardiopulmonary bypass was(133.5±34.7)min. In the non-AKI group, 48 cases were aged(47.7±11.3)years old, including 26 males and 22 females, and the time of cardiopulmonary bypass was(133.5±34.7)min. α1-AT was significantly decreased in AKI group at 1 h after operation[(0.53±0.53)g/L vs. (1.46±0.91)g/L, P<0.05]compared with the non-AKI group. The sensitivity and specificity of α1-antitrypsin level at 1h after operation was the highest when α1-AT was 0.675 g/L. CPB time ( OR=5.890, 95% CI: 1.078-32.173) and age ( OR=4.427, 95% CI: 1.113-17.614) were independent risk factors for AKI after surgery, and α1-AT at 1h after CPB ( OR=0.084, 95% CI: 0.021-0.333) were protective factors after operation. Conclusion:Increased concentration of α1-AT after cardiopulmonary bypass at early time is a protective factor for AKI and the concentration of α1-AT in plasma could be used as an early biomarker of AKI after CPB.

OBJECTIVETo study the effect of adenosine preconditioning on cell apoptosis and expressions of glucose-regulated protein (GRP-78) and cysteinyl aspartate-specific protease 12 (caspase-12) in rats with spinal cord ischemia-reperfusion injury.

METHODSTwenty-seven rats were randomized into 3 equal groups and subjected to sham operation (group A), spinal cord ischemia-reperfusion injury (group B), or ischemia-reperfusion injury with adenosine treatment. Spinal cord ischemia-reperfusion injury was induced by cross-clamping of the abdominal aorta inferior to the left renal artery. The spinal cord function was assessed using the Modified Tarlov Scale at 6, 12, and 24 h after reperfusion. At 24 h after reperfusion, histological analysis was carried out with HE staining; cell apoptosis and viability were determined with TUNEL staining, and the expressions of GRP-78 and caspase-12 proteins were determined with Western blotting.

RESULTSHE staining of the spinal cord showed extensive spinal cord injury such as cell edema in group B as compared with group C. Compared with group A, group B showed a significantly increased number of apoptotic cells; the number of apoptotic cells in group B was greater than that in group C. Compared with group B, group C showed significantly increased GRP-78 expression (P<0.01) and decreased caspase-12 expression (P<0.01).

CONCLUSIONAdenosine can up-regulate GRP-78 expression and down-regulate caspase-12 expression, and protects the spinal cord against ischemia-reperfusion injury by inhibiting cell apoptosis.

Adenosine ; pharmacology ; Animals ; Apoptosis ; drug effects ; Caspase 12 ; metabolism ; Heat-Shock Proteins ; metabolism ; Ischemic Preconditioning ; methods ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; metabolism ; Spinal Cord Ischemia ; metabolism

Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.

Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.