Objective To develop a new methodology of prenatal sonography scoring to assess and dignose clubfoot.Methods Thirty-one fetuses suspected clubfoot(50 foots) and 62 normal fetuses(124 foots) were scanned with both 2D and 3D sonography,and were divided into normal feet group and clubfeet group.Our scoring system was made according to the Pirani-scoring for children,while considering the morphology of mid-foot and hind-foot of infants.The doctors would give final diagnosis for all fetuses after delivery or induced labor,and analyse the correlations among the abnormal signs,sonographic score and the clinical outcomes.Results The curve lat border,the medial crease,the empty heel and the post crease can be observed in the 3D reconstruction images.These four abnormal signs had close correlations with the clinical results.Conclusions The new prenatal clubfeet scoring system by 3D sonography is a promising methodology with clinical values.

Abnormalities, Multiple ; diagnosis ; genetics ; Child ; Chromosome Deletion ; Chromosomes, Human, Pair 22 ; genetics ; Female ; Genetic Testing ; Humans ; Karyotyping ; Mutation ; Ring Chromosomes

Objective To analyze the long-term efficacy,prognostic factors and radiation sequela of nasopharyngeal carcinoma(NPC)treated with radiotherapy at the end of last century.Methods From January 1995 to December 1998,1706 newly diagnosed NPC patients treated with radiotherapy were included in the retrospective clinical analysis.There were 1081 patients treated with radiotherapy alone,625 with two to three circles of chemotherapy(5-Fu and DDP)before radiotherapy,23 with thermotherapy during radiotherapy and 162 with braehytherapy by 192Ir after external beam radiation.Results The 5-year overall survival. local control survival and disease-free survival rates were 67.60%.84.20%and 64.22%.respectively.The 5-year survival of patients with stage Ⅰ,Ⅱ,Ⅲand Ⅳ(the Fuzhou Staging,1992)were 100%,75.93%,66.47%and 49.34%.respectively.Cox regression analysis showed that the TNM classification,radiotherapy discontinuance,chemotherapy,sex,age and anemia before radiotherapy were the significant factors of survival.Conclusions Our experience shows that the main factors for the long term survival of NPC patients after radiotherapy are early TNM stage,young age,female,non-anemia before radiotherapy, radiotherapy continuance and chemotherapy.

Objective To analyze the clinical characters,treatment and prognosis of primary malignant tumor in vagina.Methods A retrospective analysis of 42 patients diagnosed with primary malignant tumor in vagina in Peking Union Medical College Hospital(PUMCH)between Jan 1984 and Aug 2006 was performed.Results Primary malignant tumor accounted for 0.98%(42/4286)in the total gynecological malignant tumors during that period in PUMCH.According to the International Federation of Gynecology and Obstetrics(FIGO)staging system,19 cases were at stage Ⅰ,12 cases at stage Ⅱ,5 cases at stageⅢ,and 6 cases at stage Ⅵ.Thairteen cases were squamous carcinoma,13 cases were malignant melanoma,8 cases were adenocarcinoma.3 case8 were yolk sac tumor and 5 cases were other types.The majority of patients were treated with surgery combined with radiotherapy and chemotherapy.Up to August 2007,19 cases survived.18 cases were dead and 5 casefl were lost.The longest follow up was 10 years,with the median time of 2 years.The overall 2-year SUrvival rate was 60.6%.For stage Ⅰ,stage Ⅱ, and stage Ⅲ-Ⅵ,the 2-year survival rates were 71.3%.58.3%and 29.6%respectively.The 2-year survival rate of patients with squamous carcinoma Was 46.8%,malignant melanoma 72.9%,adenocarcinoma 20.0%and patients with yolk sac tumor were all alive tumor-free after 6-10 years'follow up.Conclusions The prognosis of primary malignant tumor in vagina is affected by clinical stage and histological type.A8 to malignant melanoma,radical surgery combined with chemotherapy and immunotherapy produce good effects.Patients with yolk sac tumor can be cured only with chemotherapy.As to other types,more treatment experiences are needed.

A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine (D) or midazolam plus sufentanil (MF) group.Group D:topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF:intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil.Fiberoptic bronchoscopic (FOB)-assisted awake nasotracheal intubation was performed.Mean arterial pressure (MAP),heart rate (HR),Pulse oxygen saturation (SpO2),Ramsay score and success rate of intubation were recorded and compared between two groups.The intubation conditions and level of comfort were also evaluated.MAP and HR of group D at FOB through postnaris (T1),peep the epiglottis(T2),intubation success immediately(T3)and 1 min after intubation(T4) were significantly lower (P ＜ 0.05 or P ＜ 0.01) than those of group MF while Ramsay sedation scores were obviously higher (P ＜ 0.05) than those of group MF.Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF.Immediately after intubation,level 3 scores in grade 1 of group D (n =21) were significantly higher than group MF (n =12) ; initial success rate of intubation in group D was obviously higher than that in group MF (70％,n =21 vs.47％,n =14).And the incidence of unpleasant intubation memory in group D was lower than that in group MF (37％,n =11 vs.67％,n =20).Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness.

Objective To explore and evaluate an extracorporal method for inducing magnetic capsule endoscopy into small intestine. Methods 40 patients receiving magnetic capsule endoscopy were randomly divided in two groups: the control group: doctors stopped manipulating capsule after the examination of stomach, and the capsule entered small intestine by the natural gastrointestinal motility; and the study group: after the examination of stomach, the patient lay on the right side, doctors moved the capsule to the pylorus, and then moved magnetic ball to induce capsule into small intestine. Gastric inspection time, gastric residence time, small intestine transit time and the completion rate were compared between the two groups. Results The average time for checking stomach was (32.50 ± 11.71) min in control group and (31.75 ± 9.12) min in study group respectively, and the difference was not significant (P > 0.05). After the observation of stomach, the gastric residence time in the control group was (40.60 ± 21.43) min, and the completion rate was 40%, while the average gastric residence time in the study group was (13.55 ± 9.62) min, and the completion rate was 75%. The difference between the two groups was statistically significant (P < 0.05). Small intestine transit time was (329.25 ± 90.00) min in the control group and (342.00 ± 89.80) min in the study group, and the difference was not significant (P > 0.05). Conclusion By doctors moving magnetic ball and the patient lying on the right side after the observation of stomach, gastric residence time could be reduced and the completion rate could be elevated obviously.

Objective To evaluate a thrombolytic system of portal vein port-catheter kit (PC) in the treatment of portal vein thrombosis (PVT). Methods In this study, 42 PVT patients with liver cirrhosis and portal hypertension after splenectomy from 2005 to 2007 were divided into two groups. In group A (20 eases) thrombolysis was administered through the PC device. Urokinase at the dosage of 1000 U?kg-1?h-1 was given for a consecutive 3 -6 days through the PC, and then the therapy was converted to 100 AxaIU/kg of low molecular heparin twice a day for 7 days subcutaneously. In group B, the thrombolysis was performed on 22 patients through peripheral veins. The therapy was same as in group A except for that the urokinase dosage was doubled. The complete thrombolysis rate, the effective thrombolysis rate, the time of thrombolysis, the long-term recurrence rate and the incidence of complication were compared between the two groups. Results The complete thrombolysis rate and the effective thrombolysis rate in group A were 75%, 90% respectively, compared with that of 41%, 59% respectively in group B. The significant differences in the complete thrombolysis rate, the effective thrombolysis rate, the time of thrombolysis and the incidence of complication were found between the two groups, while the thrombolysis recurrence rate had no significant difference between the two groups. Conclusion PC regime is an effective and safe method for the treatment of portal vein thrombosis.

ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and dyslipidemia in patients with type 2 diabetes mellitus,and to analyze the risk factors.Methods A total of 200 patients with type 2 diabetes mellitus including 99 with NAFLD and 101 without NAFLD were recruited.Height,weight,waist circumference,hip circumference,liver enzymes,blood lipids,fasting and postprandial blood glucose,insulin,C-peptide,and HbA1C levels were detected.Body mass index ( BMI),waist-hip ratio( WHR),and improved insulin and C-peptide index(HOMA-C-peptide) were calculated and compared between two groups.ResultsCompared with non-NAFLD group,weight,BMI,waist circumference,hip circumference,alanine aminotransferase ( ALT),aspartate aminotransferase,triglyceride ( TG ),total cholesterol ( TC ),low density lipoprotein-cholesterol(LDL-C) were significantly higher in NAFLD group( all P＜0.01 ),while age,duration,and high density lipoprotein-cholesterol were lower( all P＜0.05 ).The incidence of combined hyperlipidemia,especially hypertriglyceridemia,was significantly higher in NAFLD group( P＜0.01 ).Fasting and postprandial 1 h blood glucose [ ( 2.07 ±0.36 vs 1.83 ±0.43 ) mmol/L,( 14.04 ± 3.96 vs 12.59 ± 3.90 ) mmol/L ],fasting and postprandial 1 h Cpeptide [ (2.79± 1.15 vs 2.08±1.29 ) ng/ml,( 1.33 ±0.45 vs 1.12±0.54) ng/ml ],HbA1C [ (2.09±0.33 vs 1.96±0.28) ％ ],and HOMA-C-peptide index were significantly increased in NAFLD group ( P ＜ 0.05 or P ＜ 0.01 ).Logistic analysis showed that TG,BMI,and ALT were the major risk factors of NAFLD in type 2 diabetes mellitus( P＜0.05 or P＜0.01 ).ConclusionTriglyceridemia,obesity,and raised ALT level were significantly associated with an increased risk of NAFLD in patients with type 2 diabetes mellitus.

Adult ; Female ; Foreign Bodies ; diagnosis ; Humans ; Pharynx

Objective To investigate the effects of acetylated HMGB1 on cognitive function in rats with sepsis associated encephalopathy (SAE) and the effect of HMGB1 inhibitor.Methods Forty-eight males mice were randomly assigned to three groups (n=16): sham group (group S),cecal ligation puncture group (group C),cecal ligation puncture+sodium butyrate group (group B).Cecal ligation puncture was applied to establish the SAE model,and group S received sham operation.Rats in groups S and C were injected with normal saline 5 ml/kg 30 min and 4 h after CLP,respectively.The rats in group B were intraperitoneally injected with sodium butyrate 500 mg/kg 0.5 h and 4 h after CLP,respectively.All animals were performed Morris water maze test on 4th day after operation,and the exploring time of space exploration experiments were assessed on 7th day after CLP surgery.IL-6,BDNF,HMGB1 and acetylated HMGB1 expression in hippocampus of all rats were determined by Western Blot.Results Compared with group S,the latency of rats in group C was longer and the exploring time was shorter (P<0.05).Compared with group C,the latency of rats in group B was shorter and the exploring time was longer (P<0.05).Compared with group S,the expression of IL-6,HMGB1 and acetylated HMGB1 in group C increased (P<0.05) and the level of BDNF decreased (P<0.05).Compared with group C,the expression of IL-6,HMGB1 and acetylated HMGB1 in group B decreased (P<0.05) and the level of BDNF increased (P<0.05).Conclusion HMGB1 inhibitor sodium butyrate can inhibit the expression of acetylated HMGB1 in the hippocampus of SAE rats,and reduce the cognitive impairment induced by sepsis.