Central Nervous System ; physiopathology ; Facial Nerve Injuries ; physiopathology ; Humans ; Neuronal Plasticity ; Synapses ; physiology

Air Pollutants, Occupational ; analysis ; Gas Chromatography-Mass Spectrometry ; Halogenated Diphenyl Ethers ; analysis ; Workplace

Objective To summarize the clinical characteristics and causes of ischemic cerebrovascular disease(ICD)in children.Methods A retrospective analysis was conducted on the clinical data of 53 cases with ICD from Feb.2002 to Jun.2008 at the department of neurology in Wuhan Children's Hospital.The self-designed questionnaire of children with ICD was used,whose items included patients' age,gender,personal history,clinical features,cerebrospinal fluid examination,neurological imaging,immunologic examination,metabolic examination,and so on.Results Of 53 children with ICD,30 cases(56.6%)were male,and 23 cases(43.4%)were female.Patients' age varied from 9 months to 12 years old,in which 45 cases(84.9%)were less than 6 years old.Patients from rural area(60.4%)were more than those from city(39.6%).Ratio of limb paralysis was 75.5%(40 cases)in first clinical symptomatology of children with ICD,including hemiplegia in 32 cases(60.4%),alternate hemiplegia in 5 cases(9.4%)and monoplegia in 3 cases(5.7%).Skull CT/MRI scan was performed to reveal 27 cases(50.9%)with basal ganglia region infarction and secondly 15 cases(28.3%)with multi-lobar infarction.Forty cases were found in abnormal cerebrovascular image by means of magnetic resonance angiography/digital subtraction angiography,in which middle cerebral artery and its branches were involved in 21 cases(52.5%).There were 41 cases(77.4%)of patients to be found with clear causes,of which 13 cases(24.5%)were of infections,8 cases(15.1%)of moyamoya disease,5 cases(9.4%)of cerebral vascular malformations,4 cases(7.5%)of head trauma.However,another 12 cases(22.6%)of patients had unknown etiology.Conclusions Children with ICD had characteristics themselves.The limb paralysis was mostly the first symptoms,and the middle cerebral artery and its branches lesions were the most common locations in children with ICD,and next the internal carotid artery involvement,anterior cerebral artery involvement,posterior cerebral artery involvement,cerebral vascular malformations,and so on.Their major cause was infection,followed by Moyamoya disease,cerebrovascular malformations and head trauma,and there were still some unknown causes.

Objective To explore the feasibility,advantages and disadvantages of combined trans- gastric and transcolonic routes for NOTES.Methods A female swine was used in this study.Transgastric entrance was the first,followed by transeolonie entrance.A dual-channel endoscope was inserted through the porcine mouth into the gastric cavity and penetrated into the peritoneal cavity through the puncture and bal- loon dilatation of the gastric wall.Then under direct visualization through the transgastric approach,the other endoseope was advanced into the peritoneum.Using the two endoscopes inside the peritoneal cavity,collabo- rative peritoneoseopy was performed by the two endoscopists.After the examination the incisions in the stom- ach and the colon wall were closed with Endoclips.The animal was sacrificed for post-mortem examination with particular attention to the entrance sites and presence of any complications related to the access or to ma- nipulations inside the peritoneal cavity.Results No hemorrhage oecurred during the puneture and balloon dilatation or bow-knife cutting of the gastric wall or the eolonic wall.The liver was damaged while a needle knife penetrated the gastric wall.On the contrary,no organs were damaged during the needle knife penetra- ted the eolonic wall under direet visualization through the transgastric approach.It was difficult to find the gallbladder or the oviduct with a"single arm",but it was easy to see them with the double routes.It was easier to close the colonic incision than to close the gastrie wall with Endoclips.Conclusion Combined transgastric and transcolonic route for NOTES is feasible and it seems to be easier to show a target compared with a single route.

OBJECTIVETo investigate extracellular splitting pattern of mitochondria and the depressant effects of CsA on the process and explore the mechanism of post-traumatic SIRS and its therapeutic strategy.

METHODSTen male SD rats with 60 to 70 days age and 240 to 280 g weight were used for mitochondrial isolation. Freshly isolated mitochondria were randomly divided into two groups, which were cultured in blood plasma with or without CsA respectively for 8 h. COX and MDH were assayed by ELISA every 30 min. Meanwhile, Rat macrophage cell line NR8383 were treated as follows, control (group A): cultivation with normal medium; NR8383+CsA co-culture group (group B): culture medium was supplemented with CsA of 10 mmol/L; NR8383+intact mitochondria co-culture group (group C): culture medium was supplemented with intact mitochondria (mtDNA=5 g/ml); NR8383+intact mitochondria+CsA co-culture group (group D): culture medium was supplemented with intact mitochondria (mtDNA=5 μg/ml)and CsA of 10 mmol/L; NR8383+disrupted mitochondria co-culture group (group E): culture medium was supplemented with disrupted mitochondria (mtDNA=5 μg/ml); NR8383+disrupted mitochondria+CsA co-culture group (group F): culture medium was supplemented with disrupted mitochondria (mtDNA=5 μg/ml)and CsA of 10 mmol/L. TNF-α and IL-6 concentrations in supernatant were assessed at 1, 3, 5 h after culture.

RESULTSIn the mitochondria plasma cultures, MDH and COX levels were increased with the time and peaked at about 3 h and 3.5 h; CsA can delay the appearance of peak to 4.5 h. Among different treated groups,there was no significant difference in TNF-α and IL-6 between group A and group B; there was significant difference in TNF-α and IL-6 other groups. After 1 h culture, compared with group C, no significant difference of TNF-α and IL-6 was observed in group D, while TNF-α and IL-6 were significant higher in group E; after 3 h culture, compared with group C, TNF-α and IL-6 were significantly lower in group D, while TNF-α and IL-6 were significantly higher in group E; after 5 h culture, compared with group C, TNF-α and IL-6 were significantly lower in group D, while no significant difference of TNF-α and IL-6 were observed in group E. At each time point, there was no significant difference in TNF-α and IL-6 between group F and group E.

CONCLUSIONMitochondria can split in serum with time, which will further activate macrophages. CsA has depressant effect to mitochondrial splitting on the process and will therefore inhibit the activation of macrophages.

Animals ; Cells, Cultured ; Cyclosporine ; pharmacology ; Interleukin-6 ; secretion ; Male ; Mitochondria ; drug effects ; Prostaglandin-Endoperoxide Synthases ; analysis ; Rats ; Rats, Sprague-Dawley ; Systemic Inflammatory Response Syndrome ; drug therapy ; etiology ; Tumor Necrosis Factor-alpha ; secretion

Objective To evaluate the efficacy of endoscopic metal stent implantation for afferent limb obstruction after pancreaticoduodenectomy(PD). Methods A retrospective analysis of 5 patients with afferent limb obstruction after PD treated by endoscopic metal stent implantation was performed.Data of each patient was reviewed including the records of the endoscopic procedure,the complications and the clinical outcomes. Results All the metal stents were implanted successfully in the 5 patients. The abdominal disten-sion and cholangeitis were well relieved in all the patients. The liver function improved in all the patients in 3 to 5 days.No abdominal discomfort,bleeding,perforation,or stent dislocation occurred.CT scan showed that all stents were well expanded.The survival time of the 5 patients were 3 to 8 months,and 4. 6 months on av-erage. There was no recurrence of afferent limb obstruction. Conclusion For afferent limb obstruction after PD,endoscopic metal stent implantation is effective in relieving obstruction,the symptoms,and improving the quality of life.

Objective:To evaluate the current situation and trend of anti-infection drug usage in 11 hospitals of Shanghai during 2003-2005.Methods:Using the cost ranking approach,we analyzed the anti-infection drug usage in 11 major hospitals of Shanghai during 2003-2005.The drug species,consumption,cost,manufacturer,etc,were analyzed by Excel 2000 software. Results:It was found that the cost of anti-infection drugs in the 11 hospitals occupied 22.65% of the total drug expenditure during 2003-2005 and the expenditure decreased at an annual rate of 4.02%.We also found that 80% of the anti-infection drugs were antibiotics.The consumption of?-lactamase inhibitor valued 44.120 5,73.696 7 and 95.163 0 million Yuan in 2003,2004 and 2005,respectively(with a yearly growth of 46.86%),ranking the 3rd in 2003 and the 2nd in both 2004 and 2005.The consumption of cephalosporins ranked the first during 2003-2005.The top 20 anti-infection drugs occupied nearly 80% of the total consumption;the consumption of sulbactam sodium/cefoperazone raised from the 17th in 2003 to the 5th in 2004 and to the first in 2005.Conclusion:The consumption of anti-infection drugs has been restrained;cephalosporins are still the major drugs in clinical practice;and the consumption of sulbactam sodium/cefoperazone is on the rise year by year.

Objective To evaluate the clinical effects and safety of double-channel forward-view endoscopy for lower-position biliary obstruction after Billroth-Ⅱ gastrectomy.Methods A total of 18 patients with lower-position biliary obstruction after Billroth-Ⅱ gastrectomy were enrolled and treated with doublechannel forward-view endoscopy.The process and the outcomes were recorded.Effectiveness and safety were evaluated.Results Double-channel forward-view endoscopic treatment was successfully performed in 13 of the 18 patients (72％),with stone removal or stents implantion to resolve biliary obstruction.The procedure failed in 5 patients,who were transferred to surgery or underwent percutaneous transhepatic cholangial drainage.Delayed bleeding occurred in 1 patient,and pancreatitis in 2,who were cured after standard treatments.Conclusion Double-channel forward-view endoscopy is effective and safe for lower-position biliary obstruction in patients after Billroth-Ⅱ gastrectomy.

Objective To evaluate the short-term safety and efficacy of endoscopic implantation of self-expandable metallic stent (SEMs) for malignant colorectal obstruction.Methods A total of 208 patients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2012 to May 2014 at the endoscopy center of Shengjing hospital were enrolled.The technical and clinical success rate and the complications were reviewed.Results The technical and clinical success rates were 99.04％ (206/208) and 96.15％ (200/208), respectively.Abdominal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 13.46％ (28/208), 2.88％ (6/208), 1.92％ (4/208), respectively.The abdominal pain in most patients was self-relieving except for 6 patients with perforation of colon.Patients with perforation were cured by emergency surgery.One patient with intraperitoneal hemorrhage was also cured by emergency surgery, the other patients developing bleeding recovered themselves.Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study.As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effective and safe for malignant colorectal obstruction.

BACKGROUND: With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia (VAP) has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children. METHODS: From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children's Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS: A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli (G-) were the most (65.55％), followed by fungi (21.01％) and gram-positive cocci (G+, 13.45％). Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G+ to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G+ to vancomycin, teicoplanin and linezolid were 100％. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION: In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.