Objective To summarize the clinical manifestations,pathological character,diagnosis and treatment of aggressive angiomyxoma (AAM).Methods A computer-based online search of PubMed database and CHKD database was undertaken for literature about AAM published from all the relevant documents with the key words of aggressive angiomyxon.According to the condition 210 articles were analyzed.All the articles were analyzed about natural history,clinical manifestation,diagnosis,pathological character,treatment and prognosis of AAM.Results A total of 282 cases in well-documented articles had been reported,among which 64 were male and 218 were female,with male to female ratio of 1:3.4.The age of the patients from 1 to 83 years(mean 40.38 years).The most common sites were the perineum,genital tract and soft tissue in pelvic cavity in females and the scrotum,spermatic cord and groin in males.None of the cases could be accurately diagnosed as AAM preoperatively.The minimum diameter of the tumors was 1 cm,and the maximum was 60 cm.All the specimens showed typical pathological features of AAM as reported previously.Immunohistochemistry indicated that AAM tended to be strongly positive for vimentin,CD34,Desmin,estrogen receptor,progesterone receptor but mostly negative for S-100 and Ki-67 and Actin.The medical history was from 1 month to 20 years.The recurrence of the postoperative follow-up was 2 months to 20 years.The diagnosis depended on pathological examination.Conclusions AAM is a sort of unusual soft connective tissue tumor.It is a kind of unknown cause,slow progression,locally invasive,easy to recur after tumor resection.Long-term follow-up is quite necessary because of the high rate of local recurrence.

Medical mode , as the concept of combination of medicine and philosophy , is an abstract summary of the nature of medicine in the process of exploring health , disease prevention and control , and is developing with the change of human conception and the deepening of cognition to health and disease .The Bio-Psycho-Social Medi-cal Mode is gradually changing people ' s cognition to the nature of medicine , and prompting people to examine the disease and health from the physiological , psychological , social and multi -angle.But this mode also needs to be further enriched and perfected , does not fully reflect the moral factors of health and the nature of medical ethics . It' s mainly manifested as that the biological basis of life science abandoned the moral health , the psychological mechanism of physical and mental trauma shielded the moral injury , and the social attributes of medicine replaced the moral essence .

Objective To compare the clinical results of the ureteral reimplantation with the traditional open approach and laparcocopic pneumovesical approach. Methods A retrospective review of 108 patients who underwent ureteral reimplantation from December 2004 to October 2010 was conducted.The patients were divided into open and pneumovesical groups according to the surgical approach.Perioperative results were compared between the two groups in terms of operative time,postoperative intravenous antibiotics duration,catheterization duration,postoperative stay,average total cost and surgical cost,respectively.And the pneumovesical group was divided into two stages by time,compared the operative time of the two stages and between the later stage and the open group. Results The postoperative hospital stay of pneumovesical group was shorter than the open group (6.8 ± 1.9 d and 8.9 ± 2.9 d,P =0.002 ).For catheterization duration,the pneumovesical group was shorter than the open group as well (5.2 ± 1.2 d and 6.2 ±2.2 d,P=0.057).For the postoperative intravenous antibiotics duration,the pneumovesical group was 5.0 ± 1.3 h,the open group was 5.4 ±1.6 h (P =0.159).For the total cost,the pneumovesical group was 16 067.9 ±4 295.8 RMB,the open group was 15 617.7 ± 5 486.5 R MB (P =0.168).For the surgical cost,the pneumovesical group was 9369.4 ± 1366.6 RMB,the open group was 7397.9 ± 1797.3 RMB ( P =0.083 ).Operative duration of the pneumovesical group and open group were 3.2 ± 1.1 h and 2.3 ± 1.1 h ( P =0.003).For pneumovesical group,the mean operative durations of the two stages were 3.6 h and 2.8 h (P =0.286).And the later stage of pneumovesical group was a little longer than the open group,but no significant difference ( P =0.234 ).No major complication was found in the 2 groups during the operative time and the postoperative hospital stay.Twenty-four patients (38 ureters) of the pneumovesical group were followed up with micturating cystourethrography ( MCU),ureterovesical reflux recurred in 3 patients.Two patients changed from grade Ⅲ to grade Ⅰ and 1 patient changed from grade Ⅴ to grade Ⅲ after the surgery.Five patients (9 ureters) of the open group were followed up,1 patient found bladder diverticulum; 1 patient found ureteral stricture 6 months after the surgery and got improved after secondary ureteral relimplantation surgery. Conclusions The pneumovesical approach is shorter than the open group in postoperative hospital stay and catheterization reserved duration.The pneumovesical approach is a safe and effective option for ureteral reimplantation.

Objective:To explore the characteristics of diagnosis, treatment and prognosis of intermittent testicular torsion (ITT) in children.Methods:Retrospective review was conducted for the clinical data of 9 ITT cases from April 2014 to December 2019. The average age of all patients was 11.9 years (range 4.7-13.9 years). The involved side was left ( n=4), right ( n=4) and bilateral ( n=1). The main symptoms included severe pain of rapid onset and rapid resolution associated with nausea and lower abdominal pain ( n=1). The average number of painful episode was 2.4(1-5). There was a number of 1 painful episode in 4 emergency operative cases and more than 1 in 4 elective operative cases and 1 emergency operative cases. One patient of recurrent scrotal pain was relieved by manual detorsion. Among the five emergency operative cases, scrotal swelling and tenderness were found on the affected side, and the cremasteric reflex disappeared. Ultrasonic examination showed that two had absent testicular flow, one had decreased testicular flow, one had normal testicular flow with swelling epididymis and one with torsion of spermatic cord above testis. While among the 4 elective operative cases, the lie of the affected testis with cremasteric reflex was low on physical examination in all patients, compared with the contralateral testis. Atrophy of the affected testis were found in one case and horizontal lie in another one. The duration of prehospital symptoms ranged 4-24 hours during acute presentation in the 5 emergency patients, and 5-24 months in the 4 elective patients. All patients underwent testicular surgical exploration and bilateral orchidopexy. Results:Surgical exploration revealed no testicular ischemic infarction, and the rate of testicular salvage was 100%. A bell-clapper deformity (BCD) was found on all the affected testis and 2 contralateral testis as well. The median time of follow-up time was 10 months (range 1-69 months). No recurrence of testicular pain and other complications was found. Except for one case of testicular atrophy in the affected side before operation, the testicles of all patients recovered well without testicular atrophy.Conclusions:Intermittent testicular torsion is mainly manifested as repeated episodes of sudden onset unilateral scrotal pain that could be spontaneously resolved. The positive clinical findings include a horizontal position of the testes while standing and discrepancy in size of the testes. The ultrasonic examination is diversified because testicular torsion can be spontaneously relieved. Although the rate of testicular salvage is high in ITT, surgical exploration and bilateral scrotal orchiopexy should be carried out as early as possible to prevent recurrent painful episodes and testicular ischemic damage.

Objective:To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock.Methods:This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment.Results:A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value ( AUC=0.54, 95% CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion:EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.

OBJECTIVETo study and summarize the etiology of children patients with chronic kidney disease (CKD) stage 2 to 5 seen in Children's Hospital of Fudan University from Jan. 2004 to Dec. 2013.

METHODBy complying with the NKF-K/DOQI guidelines, we collected data of 264 cases of children patients with CKD stage 2-5 from Jan. 2004 to Dec. 2013 in the medical record system of Children's Hospital of Fudan University. And we retrospectively analyzed their age and CKD stage at first diagnosis, primary diseases, complications, etc.

RESULTIn the collected 264 cases, 52 cases (19.7%) were diagnosed at stage 2, 67 (25.4%) at stage 3, 52 (19.7%) at stage 4 and 93 (35.2%) at stage 5. For disease causes, 116 cases (43.9%) had congenital anomalies of the kidney and urinary tract (CAKUT), 61 cases (23.1%) had glomerular disease, 15 (5.7%) had hereditary kidney disease, 14 (5.3%) had other diseases and in 58 cases (22.0%) the causes of disease were unknown. In the group with age between 0 and 3.0 and 3.1 and 6.0 years, 57.1% (24 cases) and 60.0% (30 cases) had primary disease with CAKUT. In the group with age older than 10 years, 49.2% (30 cases) had primary disease with glomerular disease and 32.0% (32 cases) with unknown causes.

CONCLUSIONThe major cause of CKD stage 2-5 in children in our hospital during the last ten years was CAKUT (43.9%), followed by glomerular disease (23.1%). The primary diseases of CKD were significantly different between the 2 age groups. CAKUT was more common in infants and preschool children while for adolescents, glomerular disease was the major cause.

Child ; Child, Preschool ; China ; Humans ; Infant ; Infant, Newborn ; Kidney ; physiopathology ; Renal Insufficiency, Chronic ; etiology ; Retrospective Studies

Objective:To investigate the distribution and antimicrobial resistance patterns of common pathogens in children with urinary tract infections in a single center in Shanghai, and to provide basis for the selection of empirical antibiotics in the clinical practice.Methods:The clinical data, urine culture and drug sensitivity tests results of children with urinary tract infections between 0 to 14 years admitted to the Children′s Hospital of Fudan University from January 2016 to December 2019 were retrospectively analyzed. According to the time of onset and the complicated factors, the patients were divided into different groups. The distributions and antimicrobial resistance patterns of common pathogens were compared among the groups. The chi-square test was used for statistical analysis.Results:Among the 1 832 children, 1 042 cases had positive urine culture, with the culture positive rate of 56.9%. The top five pathogens detected were Escherichia coli (375 strains, 36.0%), Enterococcus faecium (164 strains, 15.7%), Klebsiella pneumoniae (133 strains, 12.8%), Enterococcus faecalis (95 strains, 9.1%) and Pseudomonas aeruginosa (44 strains, 4.2%). The annual detection rates of gram-negative bacteria (65.3% to 72.9%) were always higher than those of gram-positive bacteria (22.6% to 30.1%). The distributions of pathogens among the years were not significantly different ( χ2 =27.79, P=0.146). In patients with complicated urinary tract infections, the detection rates of Pseudomonas aeruginosa (5.8%(40/688) vs 1.1%(4/354)) and fungi (6.5%(45/688) vs 1.7%(6/354)) were significantly higher than those in patients with simple urinary tract infections ( χ2=12.68 and 11.79, respectively, both P<0.050). Both of Escherichia coli and Klebsiella pneumoniae had the highest resistance rates to ampicillin, which were 87.2%(301/345) and 87.1%(115/132), respectively. The resistance rates of Escherichia coli to amikacin, nitrofurantoin, fosfomycin, cefmetazole, piperacillin/tazobactam, ertapenem, imipenem and meropenem were 1.4%(5/345), 6.1%(21/345), 6.1%(21/345), 8.3%(11/132), 11.6%(40/345), 6.4%(22/345), 4.6%(16/345) and 4.6%(16/345), respectively. The resistance rates of Klebsiella pneumoniae to these drugs were 6.1%(8/132), 37.9%(50/132), 15.2%(20/132), 23.2%(13/56), 26.5%(35/132), 23.5%(31/132), 17.4%(23/132) and 16.7%(22/132), respectively, which were all higher than those of Escherichia coli, and the differences were all statistically significant ( χ2=6.02, 76.17, 9.99, 7.94, 16.04, 28.29, 20.79 and 18.84, respectively, all P<0.050). The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam, piperacillin/tazobactam and ceftazidime were 6.8%(3/44), 4.5%(2/44) and 2.3%(1/44), respectively, while those to carbapenems, amikacin and ciprofloxacin were all 0(0/44). The resistance rate of Enterococcus faecium to ampicillin was 96.8%(153/158), while that of Enterococcus faecalis was 9.1%(8/88). There was no Enterococcus strain resistant to vancomycin, teicoplanin or linezolid. When dynamically comparing the trends of the antimicrobial resistance from 2016 to 2019, the resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams (including carbapenems) antimicrobial agents had shown a downward trend. Conclusions:Gram-negative bacteria are still the main pathogens of urinary tract infections in children, with a downward trend of drug resistance rates to β-lactams (including carbapenems) antimicrobial agents.

Objective:To investigate sleep quality in pregnant women during their first and second trimester and to identify risk factors.Methods:Data was from the Chinese Pregnant Women Cohort Study. A total of 3 618 pregnant women were included, with the exclusion 346 women who had missing information. Sociodemographic, health-related behavior, depression and sleep quality information were collected and analyzed. Logistic regression analysis were used to explore the influencing factors of sleep quality in pregnant women.Results:Among the 3 618 pregnant woman 28.2% had poor sleep quality in their first trimester and 28.7% in the second trimester. 15.2% pregnant women had progressively worse sleep and 13.0% had persistently poor sleep had pregnant women were generally suffered from poor sleep quality, difficulty falling asleep, sleep disorders and daily fatigue. Regular diet ( OR=0.75, 95% CI: 0.62-0.92) and work ( OR=0.84,95% CI: 0.71-0.99) in the first trimester were protective factors of sleep quality in pregnant women. Age ≥30 year old ( OR=1.19, 95% CI: 1.03-1.37), passive smoking ( OR=1.18, 95% CI: 1.02-1.36) and depression ( OR=2.25, 95% CI: 1.95-2.61) in the first trimester were risk factors. Conclusions:The rate of poor sleep quality are high among Chinese pregnant woman during their first and second trimester. The risk factors of sleep quality are multiple. Regular diet and work, reduction of tobacco exposure, alleviation of depression symptom may help improve sleep quality among pregnant women.

BACKGROUNDClinical meaning of recovery phase limited ST segment depression of a treadmill exercise test is controversial. The aim of this study was to re-assess the diagnostic and prognostic value of ST segment depression during the recovery phase with the active phase of a treadmill exercise test in suspected coronary artery disease patients.

METHODSClinical, exercise and angiographic data were retrospectively collected from 602 patients in the study. Five hundred and seventy-six patients developed ST segment depression during the active phase of the treadmill exercise test (group 1) and 26 patients developed ST segment depression only during the recovery phase (group 2).

RESULTSWith similar major clinical features, the prevalence of significant coronary artery stenosis and average Gensini scores were lower in the recovery phase-limited depression patients (group 2 vs. group 1, 50.0% vs. 66.9%, P = 0.031 and group 2 vs. group 1, 1.5 vs. 8.5, P = 0.04). At a median follow up of 50.9 months for 22 group 2 and 34.8 months for 438 group 1 patients, the prevalence of total cardiac events was higher in group 1 than in group 2 patients (RR 1.60, 95% CI 1.00-2.54, P = 0.049).

CONCLUSIONThe present study provides preliminary evidence that the diagnostic and prognostic value of recovery phaselimited ST segment depression of treadmill exercise test is limited.

Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Electrocardiography ; Exercise Test ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

Abstract OBJECTIVE To determine the index weight, optimize the extraction process of gastropathy oral thick paste 1. METHODS Taking the amount of water added, extraction time and extraction times as factors, depend on the single factor experiment, L9(34) orthogonal table was selected to design the experiment. The content of chlorogenic acid was determined by HPLC and the content of total flavonoids content was determined by ultraviolet spectrophotometry. With the above two contents plus the yield of dry extractum as the evaluation index, the weights were assigned based on the analytic hierarchy process, entropy weight method and independence weight method, and the extraction process was optimized by orthogonal experimental design. RESULTS Multi-index scoring was more scientific and reasonable, and the final optimal extraction conditions for gastropathy oral thick paste 1 were as follows: add 8 times the amount of water, extract twice and 0.5 h for each time. CONCLUSION The optimized extraction process using analytic hierarchy process, entropy weight method and independence weight method is reasonable, feasible, stable, and reproducible, which is suitable for the preparation of gastropathy oral thick paste 1, providing reference for subsequent research and development.