Objective To discuss the methods of selecting different shapes occluder and to evaluate the feasibility,safety and efficacy of them in transcatheter closures of congenital ventricular septal defect (VSD) in children.Methods Transcatheter closures were performed in 226 children with congenital VSD,age ranging from 2 to 14 years(mean 5.62 years) under the guidance of transthoracic echocardiography(TTE) and fluoroscopy.There were 14 patients with intracristal VSD,209 patients with perimembranous VSD and 3 patients with muscular VSD.Left ventriculography and transthoracic echocardiography were performed repeatedly after the procedure to assess the effect of occlusion.The echocardiography and electrocardiography were scheduled before discharge,1,6 and 12 months for the follow-up.Results The occluders were deployed successfully in 211 patients.The successful rate was 93.4%.Thin waist shape occluders,were deployed in 7 patients;equal side shape occluders,were deployed in 191 patients;eccentric shape occluders were deployed in 12 patients,and muscular defect occluders were deployed in 1 patient.There were no complications encountered during or after closure.Conclusions It is very important in transcatheter closure of congenital in children to select different shape occluder according to pathologic characteristics.In general,equal side shape occluder is suita-ble for a large number of defect and it is easy for deployment.In some conditions,the other shape occluder may be necessary.

Background Researches demonstrated that dendritic cells(DCs) are uniformly immature in the central cornea but mature in the peripheral region of cornea.So an important question is which factor impact the maturation of DCs,especially in terms of corneal transplant rejection and the known roles of DCs in the development and persistence of some corneal diseases.Objective This study aimed to examine whether corneal stroma cells (CSCs) inhibit DCs maturation through secreting transforming growth factor beta 2 (TGF-β2) and prostaglandin E2 (PGE2).Methods DCs,T cells and CSCs were isolated and cultured from clean BALB/c and C57BL/6 mice.The level of PGE2 and TGF-β2in CSCs culture supernatant and the fresh RPMI 1640 medium were then analyzed by enzyme linked immunosorbent assay (ELISA).During the DCs maturation stage,the neutralizing TGF-β2 antibody and the EP2 receptor antagonist AH6809 were added in the CSCs culture supernatant respectively.According to the different treatment,cultured cells were assigned to different groups as follows:control group,CSCs culture supernatant group,AH6809 group,TGF-β2 antibody group,AH6809 +TGF-β2 antibody group.Subsequently,the cellular surface markers for DCs,including CD11c,CD80,CD86,and MHC- Ⅱ,were analyzed by flow cytometry.The capability of stimulating the proliferation of T lymphocytes was evaluated by allogeneic mixed lymphocyte reactions,and the function of endocytosis was assessed by fluorescein isothiocyanate-dextran(FITC) uptake.Results The data of ELISA showed a higher concentration of TGF-β2 and PGE2 in murine CSCs culture supernatant than in the fresh RPMI 1640 medium.Compared with the CSCs culture supernatant group,the expression of CD80,CD86,and MHC- Ⅱ was up-regulated ( P ＜ 0.05 ),the expression of dextran was down-regulated ( P ＜ 0.05 ),and the stimulate index was increased( P＜ 0.05 ) in the TGF-β2 antibody group; the expression of CD86,and MHC-Ⅱ was up-regulated (P＜0.05),the expression of dextran was down-regulated ( F =13.740,P =0.006 ),and the stimulate index was increased(P＜0.05) in the AH6809 group;the expression of MHC-Ⅱ was up-regulated and the stimulate index was increased with statistical difference in interaction(P＜0.05 ) in the AH6809+TGF-β2 antibody group.Compared with the control group,the expression of CD80 and CD86,and the stimulate index was still lower(P＜0.05 ).Conclusions TGF-β2 and PGE2 contribute to the inhibitory effects on DCs maturation mediated by murine CSCs in vitro and further have additive effect on the immunosuppression of DCs.

Rheumatoid arthritis (RA) is a chronic inflammatory disease. Joint deformity and dysfunction can occur in the late stage of the disease,which is seriously harmful to human health. Anti-inflammatory factors (AIC), as a protective factor, together with pro-inflammatory factors (PIC) play important roles in the pathogenesis and progression of RA. It is widely accepted by the majority of scholars that the decrease of AIC and the increase of PIC in RA can aggravate the systemic and local inflammatory reactions and accelerate the articular cartilage and subchondral bone destruction, resulting in further progress of RA. A new generation of biological therapy for RA targeting at AIC is in the ascendant. Therefore ,it is important to understand the role of AIC in the pathogenesis of RA. From the perspective of the relationship between AIC and RA and the mechanism, this article reviews the research progress in this field, which provides new concepts for the diagnosis and treatment of RA.

OBJECTIVETo compare the clinical safety and efficacy of laparoscopic versus open colorectal resection in octogenarians. Methods Studies comparing laparoscopic colorectal resection with open colorectal resection in octogenarians were identified from the Medline, Embase, Ovid, and Cochrane databases from 1990 to 2012. The methodological quality of the selected studies was assessed to determine studies suitable for inclusion. Meta-analysis was performed by fixed or random effects model.

RESULTSFive observational studies with a total of 685 patients (330 laparoscopic colorectal resections and 355 open colorectal resections) were identified. Laparoscopic colorectal resection was associated with a prolonged operative time (WMD=27.89, P<0.01) and a lower rate of overall complications (OR=0.58, P<0.01), wound infection (OR=0.50, P<0.05), cardiovascular complication(OR=0.53, P<0.05), quicker bowel function return (WMD=-0.83, P<0.01), and shorter length of hospital stay (WMD=-3.60, P<0.05). No differences were found with regard to anastomotic leak (OR=1.13, P>0.05), prolonged ileus (OR=0.71, P>0.05), respiratory complication (OR=0.59, P>0.05),mortality (OR=0.67, P>0.05), and reoperation (OR=0.85, P>0.05).

CONCLUSIONLaparoscopic colorectal resection is as safe as open colorectal resection, and is more favorable in terms of length of hospital stay and bowel function return in octogenarians.

Aged, 80 and over ; Anastomotic Leak ; Colectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Treatment Outcome

Biliary Atresia ; diagnosis ; etiology ; therapy ; Bilirubin ; blood ; Biomarkers ; blood ; Calcium-Binding Proteins ; deficiency ; Cholangiopancreatography, Magnetic Resonance ; Cholestasis, Intrahepatic ; diagnosis ; etiology ; therapy ; Citrullinemia ; diagnosis ; etiology ; therapy ; DNA Mutational Analysis ; Humans ; Infant ; Jaundice ; diagnosis ; etiology ; therapy ; Liver Function Tests ; Male ; Mitochondrial Membrane Transport Proteins ; genetics ; Mutation ; Organic Anion Transporters ; deficiency

Objective To investigate the effects of chronic hyperglycemia on the proliferation,secretion function and expression of endoplasmic reticulum stress(ERS) related molecules in pancreatic ? cell line MIN6. Methods MIN6 cells were treated with different concentrations of glucose(5.6,25 and 33.3mmol/L) and were harvested at indicated time(24h and 96h) for examinations.Cell proliferation was tested using CCK-8 solution,insulin and proinsulin secretion function was determined by ELISA,and mRNA expression of ERS related molecules(Total XBP-1,Spliced XBP-1) and protein expression of phosphorylated IRE1? were detected by Real-time PCR and Western blotting,respectively. Results After treatment with hyperglycemia for 96h, cell proliferation was significantly lower than that treated for 24h(P

Caliciviridae Infections ; epidemiology ; China ; epidemiology ; Disease Outbreaks ; Female ; Humans ; Male ; Norovirus ; Schools

Objective To investigate the potential clinical factors associated with the prognosis and relapse of adult onset Still's disease(AOSD).Methods The factors possibly influencing the prognosis and relapse of AOSD were analyzed by logistic regression and COX regression in the cohort study.Ninety-six con- secutive inpatients of AOSD diagnosed based on Yamaguchi criteria in the hospital from March 1996 to September 2004 were included in the study.Results Nine cases(9.4%)were lost during the follow-up. Eleven patients(12.6%)were diagnosed as other diseases(5 with other rheumatic diseases,4 with tumor and 2 with infections)in the 87 follow-up cases.In 76 cases,3 patients(3.9%)died and 33 patients(43.4%) got remission over one year after treatment.Splenomegaly(OR=3.14,95%CI=1.01～9.74)and treated with methotrexate(OR=0.22,95%CI=0.07～0.67)were associated with the prognosis from the logistic regression analysis of the 76 cases.The serum ferritin(RR=I.05,95%CI=1.01～1.08)and treated with methotrexate (RR=0.13,95%CI=0.02～0.76)were associated with relapse from the COX regression analysis of the 61 remis- sion cases.Conclusion We need to be very cautious in the follow-up of AOSD patients because some of them may change to other diseases.Methotrexate may be an importent therapy of AOSD not only in improve- ment the prognosis but also in reduction of relapse.

OBJECTIVETo discuss the clinicopathological characteristics and access the immediate- and long-term outcome of radical surgery in patients with colon cancer invading duodenum.

METHODSA retrospective review of 19 patients with colon cancer invading duodenum underwent radical surgery between 1995 and 2010 was performed. There were 7 male and 12 female, age ranged from 36 to 73 years with an average of 56 years. The main manifestations were abdominal pain, loss of weight, change of stool frequency and so on. The tumors located at the hepatic flexure in 15 patients. All of the patients underwent radical surgery, and none of the patients had positive resection margins. One patient underwent pancreaticoduodenectomy combined with right hemicolectomy (RH). Two patients underwent pylorus preserving pancreaticoduodenectomy combined with RH. One patient underwent duodenectomy combined with RH. Four patients underwent RH. And the other 11 patients underwent lateral duodenectomy combined with RH.

RESULTSThere was no postoperative morbidity and mortality, and the 30-day mortality rate was 0. The median overall survival was 5.3 years. Overall 1 and 5 years survival rate were 94.4% and 70.4%, respectively. And 3 patients developed recurrence in 3 years.

CONCLUSIONSThe patients with colon cancer invading duodenum are lack of specific clinical manifestations. And the radical surgical procedure is safe, which could prolong the survival and improves the prognosis in these patients.

Adult ; Aged ; Colectomy ; Colonic Neoplasms ; pathology ; surgery ; Duodenal Neoplasms ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Retrospective Studies ; Treatment Outcome

BACKGROUNDTotal mesorectal excision (TME) has increased the rate of sphincter-preservation (SP) for more patients with low-lying rectal cancer. Here, we analyze the change of sphincter preserving rates in lower rectal cancer and their related factors.

METHODSWe reviewed retrospectively the medical records of 316 patients with lower rectal cancers, 1 to 5 cm from the anorectal line, who had surgical resections from August 1994 to November 2005. The 12-year span was divided into 2 periods: period I (August 1994-December 1998) and period II (January 1999-November 2005), based on the date (January 1999) when standard total mesorectal excision (TME) was introduced. The patients were divided into two groups based on the operation: abdominoperineal resection (APR) or SP surgery. SP rates, leakage and other clinico-pathological characteristics were compared between the two time periods and between the two different groups.

RESULTSThe SP rate increased significantly over the 12 years, from 44.9% in period I to 76.2% in period II (P = 0.000). The factors significantly influencing SP included the distance of the tumor from the anorectal line, gender, time period, circumference of intramural spread and histological differentiation (P < 0.05). Significant differences were detected between the two time periods in gender, blood transfusion volume and Dukes' stage (P < 0.05). The leakage rate was 2.7% in period I and 1.3% in period II (P > 0.05).

CONCLUSIONSOver the 12-year period of the study the SP rate in rectal cancers 1 - 5 cm from the anorectal line has increased significantly while the blood transfusion volume has decreased due to the introduction of TME. However, TME had no effect on operating time and leakage rates.

Adult ; Aged ; Anal Canal ; surgery ; Anastomosis, Surgical ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery