Objective To evaluate the feasibility of trans-umbilicus two-port laparoscopic procedures in pediatric surgery.Methods Sixty children (age, 3 months～14 years; mean, 3.5 years) with indirect inguinal hernia and 40 children (age, 2.5～14 years; mean, 6.3 years) with appendicitis underwent supra-high ligation and appendectomy, respectively, by using mini laparoscope from January 2003 to December 2003. During the supra-high ligation, the camera and forceps were respectively introduced via the left and right side of umbilical ring, and a hernial-ring needle with suture was brought in at the site of body surface projection of internal ring to apply external knotting. During the appendectomy, laparoscopic instruments were put through the site of right McBurney’s point, and explorations for contralateral hernia or other digestive tract malformations were applied simultaneously. Results All the operations were completed smoothly. The mean operating time was 8.5 min and 55.7 min in hernia repair (per side) and appendectomy, respectively. The mean postoperative hospital stay was 1～2 days in children with indirect inguinal hernia and 5～7 days in children with appendicitis. Follow-up for 3～12 months showed no recurrence of hernia except for 1 case of intraoperatively misdiagnosed latent hernia, which relapsed 2 months after the surgery. Postoperative abdominal cavity infection took place in 2 cases of perforated appendicitis. Conclusions Trans-umbilicus two-port laparoscopic technique is simple to perform, safe and minimally invasive. The technique has fewer complications and gives satisfactory cosmetic results, being highly recommended.

Recent years,progress has been made on the basic researches and clinical applications of ocular surface reconstruction with autologous or allogeneic limbal stem cells,oral mucosa epithelium and ex vivo cultured limbal stem cells.However,there are several issues,including the successful treatment for severe ocular damage,longterm follow-up and evaluation of clinical outcome,and the in vivo tracking of donor stem cells,remained to have definitive conclusions.Future studies should address the questions and challenges based on the basic research of limbal stem cell deficiency and standardized evaluation of clinical outcome.

Objective To summarize clinical data of 33 patients with off-pumb coronary artery bypass grafting(OPCABG) procedure and analyze the benefit and curative effects of OPCABG procedure. Methods From February 2002 to June 2005,33 patients with cardiac function in class Ⅱ-Ⅲ (NYHA) and left ventricular ejection fraction(LVEF) was 34%-68%,and all of them underwent coronary artery bypass grafting(CABG) surgery without cardiopulmonary bypass. Results After operation,There was no death, the cardiac function improved in various degree. Preoperative angina disappeared. Conclusion OPCABG procedure is a safe, available, effective method for coronary artery disease.

Bile Duct Neoplasms ; diagnosis ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; diagnosis ; surgery ; Hepatectomy ; Humans ; Liver Transplantation ; Prognosis

Objective To assess the efficacy and clinical resuhs of thoracic endovascular aortic repair (TEVAR) in Stanford type B aortic dissection,and to explore the therapentic strategy and prevention of complication.Methods Fifty-eight patients with Stanford type B aortic dissection underwent TEVAR were enrolled,and were followed up regularly.Results The technical feasibility and success with deployment proximal to the entry tear was 100.0％(58/58),requiring partial coverage of the left subclavian artery in 20 patients and total coverage in 4 patients,and 2 patients used chimney stents.Hospital mortality was 5.2％ (3/58).Type Ⅰ endoleak was found in 11 patients (19.0％,11/58).In 55 survival patients,48 patients occurred thrombosis in pseudocoele and 2 patients' endoleak disappeared.Seven patients' endoleak appeared blood flow.Forty-eight patients(87.3 ％,48/55) were followed up for 3-68 months.Two patients died,and 2 patients' endoleak disappeared,with total suberization in pseudocoele.Other 5 patients' endoleak relieved,with partial suberization in pseudocoele.One patient had new intimal tear at the distal end of the stent-graft and required a second stent implantation.Conclusion TEVAR is safe and effective for the treatment of Stanford type B aortic dissection.

Objective To analyze relevant factors of cervical intraepithelial neoplasia residual or recurrence after loop electri‐cal excision procedure(LEEP) .Methods We observed the patients who were histopathologically confirmed CIN and treated with LEEP in our hospital from January 2006 to September 2012 ,and investigated the postoperative residual and recurrence .Then we an‐alysed relevant factors of residual or recurrence .Results (1)After at least 2 years of follow‐up ,26 cases showed residual or recur‐rence(the residual rate was 0 .97% and the recurrence rate was 4 .08% ) .(2)Overall severity of residual or recurrence had been re‐duced ,but the severity and recurrence of preoperative severity was positively correlated(r=0 .354 0 ,P<0 .05) .(3)Age ,smoking , preoperative high‐risk HPV load ,post‐operative the same type of HPV continuous infection ,endocervical involvement ,lesions in‐vo1ving quadrants ,and post‐operative TCT results between the recurrence group and non‐recurrence group were statistically signifi‐cant different(P<0 .05) .Conclusion CIN residual or recurrence after LEEP might be affected by many factors ,and the treatment should be individualized .

Objective To explore the relationship of the expression level of monocyte Chemotactic protein-1 and nuclear factor κB(NF κB)with atrial fibrosis of atrial fibrillation patients with rheumatic heart disease.Methods About 200 mg right atrial tissue were taken from 26 patients with rheumatic heart disease undergoing valve replacement surgery and divided into sinus rhythm (SR) group (n=12) and atrial fibrillation (AF) group (n=14).Masson staining and atrial myocardial fibrosis markers were used to determine the level of fibrosis.The mRNA levels of cytokines in atrial tissue were measured by reverse transcription polymerase chain reaction (RT-PCR)The protein level of MCP-1 and phosphorylation of NFκB in atrial tissue were detected by Western blotting.Results Compared with SR group,the AF group showed that collagen volume fraction (AF:0.42 ± 0.03;SR:0.13 ± 0.02),the mRNA levels of myocardial fibrosis markers such as transforming growth factor (TGF)-β1,type Ⅰ collagen and type Ⅲ collagen,and cytokines such as IL-1β and TNF-α,and the protein level of MCP-1 (AF:0.170±0.003;SR:0.040±0.005) and level of phosphorylation of NF-κB (AF:0.35 ± 0.02;SR:0.12 ± 0.03) were significantly increased (all P＜0.05).In addition,the expression levels of cytokines,the protein expression level of MCP1 and the phosphorylation level of NF-κB were positively correlated with collagen volume fraction of the right atrial myocardial tissue (all P＜0.05).Conclusions Activation of NF-κB may induce the expression of MCP-1 in the myocardial tissue of patients with rheumatic heart disease,and sequentially stimulate the secretion of cytokines and extracellular matrix deposition,and finally participate in the occurrence and persistence of atrial fibrillation.

Objective To detect adenovirus from children with acute upper/lower respiratory tract infections and to investigate the genetic evolution of virus .Methods A total of 1 178 clinical specimens were collected from the Children ’ s Hospital , Zhejiang University School of Medicine during March 2011 and February 2013, including 513 throat swabs from children with acute upper respiratory tract infection and 665 nasopharyngeal aspirates from children with acute lower respiratory tract infections .Besides, 9 specimens in an outbreak of adenovirus infection during 2011 and 2014 were also collected .Adenovirus was identified by real-time fluorescent polymerase chain reaction (RT-qPCR).The hypervariable region (HVR)-7 region of hexon gene in positive samples was amplified and sequenced for typing and phylogenetic analysis .Other respiratory viruses were also detected with RT-qPCR in adenovirus positive samples .Clinical characteristics of adenovirus infection were analyzed in children with lower respiratory tract infections .Chi-square test and Fisher exact probability were used for data analysis .Results Among 1 178 samples from sporadic cases , 104 samples (8.83%) were adenovirus positive .The rates of adenovirus infection in upper respiratory tract infection group and lower respiratory tract infection group were 13.65%(70/513) and 5.11%(34/665), respectively (χ2 =26.193, P<0.05).Compared with that in lower respiratory tract infections , positive rates of adenovirus were higher in upper respiratory tract infections in children aged 0-1 year and >3 years (χ2 =6.575 and 7.334, P<0.05 or <0.01).Adenovirus infection might occur throughout the year and peaked in spring and summer .Among 54 adenovirus-positive samples from 104 sporadic cases , adenovirus types 1, 2, 3, 4, 7 and 31 were identified in 4, 6, 26, 2, 15 cases and 1 case, respectively.While among 9 adenovirus-positive samples from outbreak cases , type 4 and type 3 were identified in 1 and 8 cases, respectively .The HVR-7 region of hexon gene was highly homologous in the same type , and the sequence alignment indicated that the sequence of HVR-7 might have regional differences .Nine out of 70 children (12.86%) were co-infected with other virus in upper respiratory tract infection group , while the rate of co-infection in lower respiratory tract infection group was much higher [58.82%(20/34), χ2 =24.045, P<0.05 ].There was no significant difference in clinical manifestations between children infected with adenovirus only and those with co-infection in lower respiratory tract infection group (P>0.05), but two children with co-infection died.Conclusions Adenovirus infection is more common in upper respiratory tract infection .Adenovirus type 3 and type 7 are the most prevalent serotypes in sporadic cases , while type 3 is the most prevalent serotype in outbreak cases .

Objective To investigate the genetic variation and molecular evolution of human bo-cavirus 1 (HBoV1) strains isolated during 2009 to 2014 in Hangzhou, China.Methods Throat swab sam-ples were collected from children with acute respiratory tract infections in the Children′s Hospital Affiliated to the Zhejiang University School of Medicine from 2009 to 2014.Real-time PCR was performed for the detec-tion of HBoV1 strains.Fifteen HBoV1 strains with high virus load were screened out for the amplification and sequencing of complete genomes.The complete genomes were submitted to GenBank for further analysis with bioinformatics software.Results A total of 48 nucleotide mutations were detected in the complete genomes of 15 HBoV1 strains, resulting in 11 amino acid mutations with 5 of them located in the active region of phospholipase A2 ( PLA2) .The 15 HBoV1 isolates along with 16 HBoV1 strains in GenBank were classified into three clusters as indicated by the phylogenetic analysis based on their complete coding sequences.All of the 15 strains were belonged to clusterⅠ, the representative strain of which was the Sweden prototype strain ST2.The phylogenetic trees constructed using genes encoding the capsid proteins VP1 and VP2 were highly similar to those based on the complete coding sequences.The estimated mean evolutionary rate of HBoV1 with regard to the complete coding sequence was 3.03×10-4(95%HPD, 2.14×10-4-3.92×10-4 ) substitu-tions per site per year.With regard to each gene, the NS1 gene was considered to the most conserved gene while the NP1 gene showed the highest substitution rate.The dN/dS ratios (ω) of the four genes were all less than 1, indicating that all of them were under negative selection.Moreover, the VP2 gene was under the strongest negative selection, while the NP1 gene was under the weakest negative selection.Conclusion All of the HBoV1 isolates circulating in Hangzhou province during 2009 to 2014 were belonged to ST2 genotype with a relatively high mutation in the area of PLA2.Despite the complete genome was conservative, its evo-lutionary rate was high.Among the four genes, the NP1 gene showed the highest substitution rate.All of the four genes were under negative selection, of which the VP2 gene was under the strongest negative selection.

Objective To explore the value of free anterolateral thigh flaps in the reconstruction of maxillofacial defects after resection.Methods Patients were recruited from January,2008 to March,2016 in the Department of Oral and Maxillofacial Surgery of Nanjing University.All patients sunder when reconstructive surgery employing anterolateral thigh myocutaneous flaps follow-up of 3 months to 84 months after operation.Results Among 422 cases,survived completely with satisfied configuration,the survival rate was 98.6％.Postoerative vessel thrombosis occurred in flaps,21 patients required operative exploration in the perioperative period including 10 flaps with thrombotic events and 11 flaps with venous thrombosis were complete survival after the salvages,and 6 flaps were failure.The mean follow-up was 36.5 months (range:3 to 84 months).Conclusion The free anterolateral thigh flap is an ideal choice for reconstruction of maxillofacial defects,as it has many advantages such as abundance volume,easily molding and adjusting the thickness,possessing,long vascular pedicle,composition need to be adjusted according to defects,easily concealed donor site,and little donor site complications and malformation.