Objective To explore the effect of preoperative chemotherapy for children with malignant extragonadial germinoma. Methods Twenty patients with malignant extrogonadal germinoma had been treated with preoperative chemotherapy from Mar.2003 to Mar.2007.Protocol 1 of chemotherapy was to improve PEB:(cisplatin plus etoposide plus bleomycin A5);Protocol 2 was VAC(vincristine plus actinomycin D plus cyclophosphamide) the average time span of the chemotherapy was 16 weeks.Upon completion of chemotherapy,tumor resection was performed.The content of alpha fetoprotein(AFP) was determined before operation and compared with the content before chemotherapy.Re-gular follow-up procedure was taken after operation. Results All 20 patients received chemotherapy and underwent operation.The removal rate of resection operation was 100%,the process of operation was smooth.The volume of tumors in 14 patients decreased over 50% compared with those before chemotherapy.The response rate was 70%.The content of AFP decreased significantly in 15 patients(75%).Fifteen patients had been living without tumor for up to 2 years,for 5 cases the survival time went beyond 5 years. Conclusions Malignant extrogonadal ger-minoma in children grow infiltratively,bring detrimental effects to neighboring organs,and bring obstacles to resection operation.Chemotherapy for children with malignant extragonadal germinoma before operation can reduce volume of tumor and bleeding during operation,raise the resectability rate and lower the content of AFP.It will enhance the effectiveness of operation and improve prognosis.Therefore,it can be used as a conventional clinical method.

Adult ; China ; Female ; Humans ; Male ; Middle Aged ; Program Evaluation ; Smoking Cessation ; psychology ; statistics & numerical data ; Young Adult

BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery (ENOTES) in treating severe acute pancreatitis (SAP) complicated with abdominal compartment syndrome (ACS). METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared. RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II (APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day (P<0.05). The cure rate was 96.87％ in the ENOTES group, which was statistically different from 78.12％ in the operative group (P<0.05). There were significant differences in complications and mortality between the two groups (P<0.01). CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.

OBJECTIVETo analyze the variation of serum insulin levels in critically ill children and investigate the underlying mechanism and clinical significance to provide the basis for treatment.

METHODTotally 332 critically ill children admitted in pediatric intensive care unit (PICU) of Hunan Children's Hospital from Nov., 2011 to April, 2012 were studied. The high insulin group (n = 332) was defined as insulin levels within 24 h > 11.1 mU/L and was divided into 2 groups: mildly elevated group (n = 194): 11.10 - 33.30 mU/L, increased three times group (n = 138): > 33.3 mU/L. Insulin, C-peptide and blood glucose were measured within 24 hours after admission, on day 3 and 7. Other results of inflammatory markers, lactate, cardiac enzymes, amylase, pancreatic ultrasound, hepatic and renal function as well as indicators related to severity and prognosis were recorded after admission.

RESULTThe peak of insulin level was seen on day 1, then presented a downward trend and reached the normal level on day 7. The peaks of blood glucose and C-peptide level were seen on day 1 then declined, the levels on day 7 were still slightly higher than normal level. The insulin level on admission (41.47 ± 30.85) mU/L were positively correlated with lactic acid (2.29 ± 1.81) mmol/L and procalcitonin level (5.08 ± 6.70) ng/ml (r = 0.370, P = 0.000; r = 0.168, P = 0.002) (P < 0.01). The insulin level on admission in children with 1 organ failure (41.24 ± 22.60) mU/L or 2 or multiple organ failure (48.98 ± 22.17) mU/L was higher than that in children with non-organ failure (34.11 ± 29.84) mU/L (U = 1621.001, P = 0.000;U = 1300.000, P = 0.000) (P < 0.01). The insulin level on admission in death group (52.99 ± 32.34) mU/L was higher than that in survival group (32.85 ± 24.10) mU/L (U = 1585.000, P = 0.000) (P < 0.01). Ten cases in death group were complicated with pancreatic damage and the average insulin level on admission was (65.29 ± 50.53) mU/L.

CONCLUSIONThe high insulin level was correlated with the degree of inflammatory response, ischemia and hypoxia. The high insulin level in critically ill children was relevant to the pancreatic damage, the severity of the disease, organ dysfunction, and evaluation of prognosis.

Adolescent ; Blood Glucose ; metabolism ; C-Peptide ; blood ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Child ; Child, Preschool ; Critical Illness ; Female ; Humans ; Infant ; Infant, Newborn ; Insulin ; blood ; Intensive Care Units, Pediatric ; Male ; Multiple Organ Failure ; blood ; mortality ; Pancreas ; metabolism ; pathology ; Prognosis ; Protein Precursors ; blood ; Survival

Adolescent ; Child ; Collagen Type I ; metabolism ; Extracellular Matrix ; metabolism ; Female ; Fibrillin-1 ; Fibrillins ; Heart Defects, Congenital ; metabolism ; pathology ; Humans ; Male ; Microfilament Proteins ; metabolism

OBJECTIVETo evaluate the effects of catheter depth and infused semen volume on the pregnancy rate of intrauterine insemination(IUI) with the husband's semen.

METHODSAccording to different catheterizing distances from the fundus and infused semen volumes, 330 patients undergoing intrauterine insemination were randomly divided into 6 groups: A, 1 cm/0.5 ml; B, 1 cm/0.3 ml; C, 2 cm/0.5 ml; D, 2 cm/0.3 ml; E, 3 cm/0.5 ml and F, 3 cm/0.3 ml. The pregnancy rate was investigated in each group.

RESULTSThe pregnancy rates from group A to group E were 9.09% (5/55), 12.73% (7/55), 10.91% (6/55), 29.09% (16/55), 9.09% (5/55) and 12.73% (7/55), respectively. It was significantly higher in group D than in groups A, B, C, E and F(P < 0.05).

CONCLUSIONSCatheterizing distance of 2 cm from the fundus with infused semen volume of 0.3 ml can significantly improve pregnancy rate in patients undergoing IUI with the husband's semen.

Adult ; Catheterization ; methods ; Female ; Humans ; Infertility ; therapy ; Insemination, Artificial, Homologous ; methods ; Male ; Pregnancy ; Pregnancy Rate ; Semen

OBJECTIVETo study the clinical validity in improving quality of life (QOL) of patients and alleviating adverse reaction of chemotherapy in treating children with solid tumors by Chinese herbal medicine for supporting healthy energy and strengthening Pi.

METHODSA prospective cohort study was conducted in 60 children with solid tumor in stage II-IV, who were assigned to two groups, 30 in each group. All children received chemotherapy and those in the observed group were given Chinese herbs according to syndrome differentiation additionally. The conditions of the two groups were compared after 6-month treatment.

RESULTSCompared with before treatment, the white blood cells (WBC), hemoglobin (Hb), and platelet (PLT) all increased in the observed group after treatment (P < 0.01, P < 0.01, P < 0.05), while in the control group, the WBC and Hb have no significant difference (P > 0.05) and PLT decreased (P < 0.05) after treatment. Comparison between the two groups, the clinical symptom score in the observed group has significant difference after treatment (P < 0.05).

CONCLUSIONChinese herbal medicine for supporting healthy energy, strengthening Pi and supplementing qi-blood is good for alleviating the adverse reaction and improving patients' peripheral blood picture in children with solid tumor undergoing chemotherapy.

Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Child ; Child, Preschool ; Cohort Studies ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Kidney Neoplasms ; drug therapy ; Male ; Neuroblastoma ; drug therapy ; Phytotherapy ; Prospective Studies ; Quality of Life ; Treatment Outcome ; Wilms Tumor ; drug therapy

Objective To evaluate the precision of GFR using Gates method and compared with the results from renal pathological changes. Methods Twenty-seven patients whose 99Tcm-DTPA renograms had no obvious uptake phase were enrolled in Group A, and 27 patients whose 99Tcm-DTPA renograms had obvious uptake phase were enrolled in Group B. The measurement of GFR by Gates method was compared to the creatinine clearance measured and predicted by Cockroft-Gault (C-G), modification of diet in renal disease (MDRD) and SCr level. Renal pathological changes in two groups were compared using Pearson correlation and t test analysis. Results In Group A, GFR determined by Gates method did not show correlation with that estimated by C-G or 1/SCr (r = 0. 357,0. 376, both P ＞0.05), but was significantly correlated with GFR estimated by MDRD(r = 0. 440, P ＜ 0.05). In Group B, GFR determined by Gates method showed significantly correlation among GFR estimated by MDRD, C-G, and 1/SCr (r =0. 471, 0. 527,0. 452, all P ＜ 0.05). Renal tubulointerstitial damage score in Group A was higher than that in Group B (7.15±2.32, 3.70±3.06, t=4.66, P ＜0.001). Conclusions GFR determined by Gates method is less precise when 99Tcm-DTPA renogram has no obvious uptake phase than that when 99Tcm-DTPA renogram has obvious uptake phase. Renal tubulointerstitial damage is a strong indicator of no obvious uptake phase in 99Tcm-DTPA renogram.

Echinococcosis is a zoonotic parasitic disease caused by the larvae of Echinococcus granulosus and E.multiltilocu-laris,which mainly violate the liver.And the surgical treatment is an important method to cure the disease at present.However, there are many surgical methods for the treatment of hepatic echinococcosis,and different surgeries with different indications and risks.With the standard of precision surgery and no tumor surgery,the surgical operation is more precise.The innovation of surgical methods makes the operation of curing complex hepatic echinococcosis become true. This paper reviews the surgical methods and indications in clinical practice so as to provide some help for better choice.

OBJECTIVETo explore the clinical significance of ATP based bioluminescence in vitro tumor chemosensitivity assay (ATP-TCA) in the chemotherapy of pediatric solid tumor.

METHODSThe cell culture technique and ATP-TCA were used to study chemosensitivity assay in specimens from 50 cases who underwent resection surgery for solid tumor (15 malignant neurogenic tumor, 8 malignant germ cell tumors, 10 Wilms' tumors, 10 hepatoblastomas, 6 rhabdomyosarcomas, 1 adrenocortical carcinoma), 8 chemotherapeutic drugs and 8 drug combination schedules were applied in every specimen.

RESULTS(1) Specimens of 46 of 50 pediatric patients with solid tumors were suitable for evaluation and were evaluated, the overall evaluation rate was 92% (46/50). (2) There was the heterogeneity in the chemosensitivity of the solid tumors in vitro. (3) The drug combination schedules of high sensitivity rate of every kind of pediatric solid tumor are as follows: the malignant neurogenic tumor: CBP + EPI + IFO (12/15, 80.0%), VCR + CTX + DDP + DTIC (11/15, 73.3%); malignant germ cell tumor: DDP + VCR + BLM(8/8, 100%), TPTN + ACTD + IFO(8/8, 100%), As2O3 (7/8, 87.5%); Wilms' tumor: VCR + ACTD(6/7, 85.7%), CBP + VP16 (6/8, 75.0%); hepatoblastoma: VCR + CTX + DDP + VP16 (8/9, 88.9%), CBP +IFO + VM26 (7/9, 77.8%), DDP + VP16 + TPTN(7/9, 77.8%); rhabdomyosarcoma: VCR + CTX + DDP + VP16 (5/5, 100%); adrenocortical carcinoma: VCR + CTX + ADM. (4) As2O3 reached a high in vitro sensitive rate of 87.5% (7/8) and 46.7% (7/15) in malignant germ cell tumor and the malignant neurogenic tumor respectively, PTX was sensitive to the malignant neurogenic tumor and rhabdomyosarcoma (40.0% (6/15), 60.0% (3/5)), GEM was sensitive to pediatric malignant germ cell tumor and rhabdomyosarcoma (50.0% (4/8), 60.0% (3/5)).

CONCLUSIONSATP-TCA is a sensitive method for the chemotherapeutic agents screening of pediatric malignant solid tumor, and ATP-TCA assay results correlated well with clinical response. It appears to be useful in screening new drugs for pediatric solid tumor, exploring the possible combination plots and principles, evaluating the efficacy of existing chemotherapy, and optimize chemotherapy on an individual basis.

Adolescent ; Antineoplastic Agents ; Child ; Child, Preschool ; Drug Screening Assays, Antitumor ; methods ; Female ; Humans ; In Vitro Techniques ; Infant ; Male