Airway problems in foetus that may cause airway obstruction can be safely managed by using an ex utero intrapartum technique(EXIT).The EXIT procedure maintains a period of uteroplacental circulation for fetal oxygenation during delivery to provide time to explore and secure the airway of the fetus or to perform fetal operations before the umbilical cord is clamped.The common indication for the EXIT procedure is the presence of foetal airway obstruction,which is usually caused by neck mass,congenital diaphragmatic hernia,congenital high way obstruction syndrome,thoracic abnormality,congenital heart and lung dysfunction,conjoined twins,and so on.It avoids the acute airway obstruction in a neonate that has disastrous consequences.

Objective To evaluate the prevention of glucocorticoid -induced avascular necrosis of the femoral head(ANFH)with Tongluo Shenggu Capsule(TSC).Methods One hundred and twenty adult SD rats were randomized into six groups:normal control group,model group,clofibratum group and three -dose TSC groups(high -,moderate -and low -dose respectively).ANFH rat models were established by injection of glucocorticoid once per week and the med-ication groups were given drugs by ga stric infusion one time a day.The rats were killed in the fourth,eighth and twelfth week respectively.Then the macrosc opic and microscopic feature of the f emoral head were observed,and ink -p erfused specimens of the femoral head were detected and analyzed by auto -photograph software of Metamoph to evaluate the pre-ventive effect of TSC.Results In TSC groups,bone trabecula grew we ll,similar to the normal group;lacu nar bone per-centage was lower than that in the mod el group;fatty degeneration in marrow cavity of the femoral head was redu ced,andthe number of subcartilaginous bloo d vessels and their diameter were increased as compared with those in the model group(P

BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insufficiency (CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit (ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group (n=32) and a control group (n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone (150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers of inflammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically significant. RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4％. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI (23.8％ vs. 8.7％, P<0.01). Kaplan-Meier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group (P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group (18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers of infection and inflammation (P<0.01), such as C-reactive protein (13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α (26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin (3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group (P<0.01). CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers of infection and inflammation.

Objective To study the distribution of apolipoprotein E(apoE) genotypes and alleles in children with primary nephrotic syndrome(PNS),and to investigate the relationship between apoE gene polymorphism and disturbance of serum lipid metabolism.Methods Forty-six children with PNS were compared with 39 age-sex-matched healthy children.Serum levels of total cholesterol(TC),triglyeride(TG),high density lipoprotein-cholesterol(HDL-C),low density lipoprotein-cholesterol(LDL-C),apoA_1,apoB and apoA_1/B were detected,and polychain reaction single-strand conformation polymorphism(PCR-SSCP) combined with gene sequence determination was used to confirm the apoE genotypes in two groups.Results 1.Serum TC,TG,HDL-C,LDL-C,apoB and apoA_1/B in PNS group were higher than those of control group,respectively(P

Objective To investigate the features of chronic prostatitis during puberty(CPP)and the effects of pelvic floor biofeedback therapy.Methods Totally,25 CPP children (mean age,16 years) and 15 children (mean age,16 years) with normal lower urinary tract as controls were included.In CPP group,NIH-CPSI scores were evaluated,expressed prostatic secretions (EPS) were examined,and bacterial culture was done;and CPP patients were categorized based on the definitions of NIH types.In both groups, urodynamic examination was performed,including evaluation of uroflow curve,maximum flow rate (Q_(max)), post-voiding residual urine (PVR),detrusor-sphincter dyssynergia (DSD),maximum detrusor pressure (P_(det,max))and maximum urethral closure pressure (MUCP).CPP patients underwent biofeedback therapy, and 10 weeks later the effects were assessed.Results In CPP group,NIH typing showedⅡ,ⅢA andⅢB in 1,3 and 21 cases,respectively.Before treatment in CPP and control groups,the incidence of staccato voiding (20 cases vs 1 case),DSD (22 cases vs 1 case),Q_(max)(10.7?3.7 vs 15.0?4.3ml/s),PVR (7.7?4.1vs 3.2?2.6ml),P_(det,max)(115.1?33.6vs 76.8?16.6cm H_2O)and MUCP(176.5?45.7 vs 86.2?28.5cm H_2O)all showed significant differences between the 2 groups(P＜0.05).In CPP group,the differences in pain(4.6?2.2 vs 2.1?1.6),urination (7.9?2.0vs 2.2?1.7),life impact (9.4?2.2vs 2.6?2.1)and total scores(22.0?5.2vs 7.0?4.2) of NIH-CPSI and Q_(max)(10.7?3.7 vs 14.9?5.6) between pre-and post-biofeedback were significant (P＜0.05).Conclusions The main type of CPP is categoryⅢB.The primary symptom is voiding disorder,which leads to greater psychological stress in patients.Children with CPP have pelvic floor dysfunctions and multiple abnormal urodynamic param- eters.The short-term effect of biofeedback strategies for CPP is satisfactory.

Adolescent ; Adult ; Dacryocystorhinostomy ; methods ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; surgery ; Young Adult

OBJECTIVETo evaluate the clinical studies of acupuncture for treatment of depressive neurosis, collect the high quality evidence relative to clinical acupuncture practice for clinical decision-making reference.

METHODSAround crucial common questions of acupuncture clinical practice, the documents of clinical study were comprehensively retrieved. According to 5-grade criterion of evidence-based medicine, the evidence from high to low level were selected to answer corresponding clincal questions and RevMan 5.0.20 was used to analyze the final indicator.

RESULTSNineteen documents of clinical study accord with the inclusive criterion were retrieved. Level-A evidence showed effectiveness of acupuncture. Acupuncture might be superior or equal to fluoxetine, with little adverse effect and high safety. Level-C evidence showed acupuncture might be superior or equal to Amitriptyline, with little adverse effect and high safety. And no relative clinicial evidence compared effect of acupuncture with that of psychotherapy or behavior therapy. Only one level-C evidence showed there was no effect difference between acupuncture combined with bloodletting therapy and bloodletting alone. Two level-C evidence showed the effect of acupuncture combined with western medicine was superior to that of medicine alone, eg. catgut embedding therapy combined with Fluoxetine, electroacupuncture combined with Seroxat.

CONCLUSIONAcupuncture for depressive nerosis has a positive effect. Acupuncture has an equal effect compared with western medicine, while strictly designed equivalent and non-inferior studies are demanded. The effect of acupuncture combined with medicine has some advantage, but need high quality studies to verify.

Acupuncture Therapy ; Depressive Disorder ; therapy ; Humans ; Randomized Controlled Trials as Topic

Objective To investigate the operative methods and clinical significance of the treatment for large acoustic ncuroma with microsurgery by retrosigmoid approach.Methods 15 cases of large acoustic neuroma treated with microsurgery by retrosigmoid approach were systematic analyzed,including the operative approach,microsurgical technique,disposal after operation,prevention and cure of complications.Results Tumors were totally removed in 12 cases and were subtotally removed in 3 cases.Facial nerve was kept ana- tomic intact in 13 cases(86.7%) and acoustic nerve was kept anatomic intact in 6 cases(40.0%).The short period complications happened in 3 cases and no patient died in this series.Conclusion Treatment for large acoustic neuroma with microsurgery by retrosigmoid approach is a safe method,which give small hurt brain tissue and benefit to increase the total removal rate and protect effectively the function of facial nerve and acoustic nerve.

OBJECTIVETo elucidate the regulatory mechanism underlying proliferation and anti-apoptosis in NSCLC by overexpression of miR-21.

METHODSReal-time PCR was used to measure miR-21 abundance in non-small cell lung cancer (NSCLC) tumor samples and adjacent normal tissues, as well as NSCLC cell lines. Tumor suppressor genes as potential targets of miR-21 were predicted by sequence analysis. Luciferase assay and Western blot were used to assess the regulatory effect. The effect on A549 cell viability and apoptosis by miR-21-induced gene repression was tested by trypan-blue exclusion and flow cytometry.

RESULTSmiR-21 expression was 2.24-fold higher in the NSCLC tumor samples and 3.06-fold higher in the A549 cells than that in the adjacent normal tissues. Sequence prediction and gene expression regulation assays showed that miR-21 could reversely regulate the expression of PDCD4 (P < 0.01). Suppression of miR-21 expression is associated with an elevation of Pdcd4, resulting in a significant reduction of proliferation and the apoptosis rate (2.6%) was increased to 10.9%. Moreover, the anti-proliferation and pro-apoptotic effect by miR-21 suppression could be reversed by PDCD4 knock down.

CONCLUSIONSuppression of the tumor suppressor PDCD4 expression may be one of the important regulatory pathways of the miR-21-mediated cell proliferation and decrease of apoptosis in non-small cell lung cancer.

Aged ; Apoptosis ; Apoptosis Regulatory Proteins ; genetics ; metabolism ; Carcinoma, Non-Small-Cell Lung ; metabolism ; pathology ; Cell Line, Tumor ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; Humans ; Lung Neoplasms ; metabolism ; pathology ; Male ; MicroRNAs ; genetics ; metabolism ; Middle Aged ; Oligonucleotides, Antisense ; genetics ; RNA Interference ; RNA-Binding Proteins ; genetics ; metabolism ; Transfection

Objective To observe the regulative effect of high dose of glucocorticoid (GC) on protein synthesis and mRNA transcription of corticotropin-releasing hormone (CRH) in paraventricular hypothalamic nucleus (PVN) so to ascertain whether there exists difference upon effect of GC either at high dose or at normal dose. Methods A total of 60 Wistar rats were divided into five groups, ie, blank control group, 10 -6 mol/L dexamethasone (DEX) group, 10 -9 mol/L DEX group, 9 g/L saline group and group that was treated with 10 -4 mol/L RU486 first and then with 10 -6 mol/L DEX. The drugs were given through femoral vein. CRH protein expression was measured by means of immunohistochemistry and laser confocal scanning microscophy (LCSM); CRH mRNA transcription level was investigated by in situ hybridization. Results There appeared positive CRH mRNA granules in cytoplasm of PVN after administration with 10 -6 mol/L DEX for 20 minutes but could be seen positive fluorescent granules of CRH protein 30 minutes later, which was reversed at an in advance blockage of GR, as was free in 10 -9 mol/L DEX group, 9 g/L saline group and blank control group. Conclusions High dose of GC can up regulate CRH gene expression in PVN and differs much from the traditional effect of GC at normal dose, as may be due to that high dose of GC exerts effects depending on membrane glucocorticoid receptor but normal dose of GC dose via iGR.