Objective To analyze the efficacy of umbilical one trocar laparoscopic appendectomy (UOTLA) in treatment of complicated appendicitis in children. Methods Clinical data of 78 cases of children patients with complicated appendicitis from January 2012 to October 2015 was summarized, including 44 cases as UOTLA group received umbilical one trocar laparoscopic appendectomy, 34 cases as OA group received open appendectomy. Then statistically analyzed all the patients' operation time, postoperative hospital stay, postoperative abdominal abscess, incision infection, early inflammatory intestinal obstruction and pain level. Results The laboratory test results of C reaction protein (CRP) had no significant difference between the two groups, while peripheral white blood cell count decreased more significantly in UOTLA group than that in OA group; the operation time of UOTLA group was shorter than that in OA group with no statistical difference [(66.59 ± 33.24) vs (72.86 ± 30.36) min, P > 0.05], but postoperative hospital stay was shorter [(8.21 ± 1.67) vs (9.21 ± 2.01) d, P < 0.05]. Abdominal abscess after operation: 3 cases in UOTLA group, while 1 case in OA group (P > 0.05); incision infection: 6 cases in UOTLA group, 9 cases in OA group (P > 0.05); early inflammatory intestinal obstruction: 1 cases in UOTLA group, 5 cases in OA group (P > 0.05); the pain level, postoperative recovery time was significantly shorter in UOTLA group compared with OA group (P < 0.05). The average expenses comparison of the two groups has no statistical difference [(10639.37 ± 2970.92) vs (10765.04 ± 2902.64) yuan, P > 0.05]. Conclusion UOTLA is safe and effective for complicated appendicitis in children due to minimally invasive, less pain and faster recovery without significant increase in the cost and postoperative complications. It can be applied in children with purulent, perforated appendicitis and gangrene, perforated appendicitis and other complicated appendicitis.

Objective To investigate the effect of Rho GDP dissociation inhibitor 2 (RhoGDI2) and Bcl-2 in pathogenesis of hypoxic-ischemic brain damage (HIBD).Methods Neonatal 7-day-old Sprague Dawley rats were randomly divided into sham-operation control group,HIBD 6 h group and HIBD 48 h group (n =10 per group).The apoptosis rate of brain cell was measured by flow cytometer and the expression of RhoGDI2 mRNA and Bcl-2 mRNA were detected by Real-time RT-PCR.Results ( 1 ) The ligated cerebral hemisphere of neonatal rats showed obvious edema at 48 h after hypoxia-ischemia.( 2 ) Apoptotic cell appeared at 6 h in HIBD group,the apoptosis rate was ( 1.40 ± 0.12 ) ％.The apoptosis rate obviously increased to (15.86 ±0.98)％ at 48 h after HIBD,which showed a significant increase compared to sham-operation control group ( P ＜ 0.01 ).( 3 ) The expressions of both RhoGDI2 mRNA and Bcl-2 mRNA were 4.12 ±0.74 and 2.55 ± 0.65 respectively in sham-operation control group.In HIBD group,the expressions of both RhoGDI2 mRNA and Bcl-2 mRNA began to decrease at 6 h after HIBD ( 3.19 ± 0.77,1.96 ± 0.36) and decreased furthermore at 48 h after HIBD ( 1.04 ±0.18,1.06 ±0.17 ).The differences of expression levels among three groups were statistically significant (P ＜0.01 ).(4) The expression of RhoGDI2 mRNA positively correlated with the expression of Bcl-2 mRNA ( r =0.831,P ＜ 0.05 ).Conclusion With the emerging of apoptosis after HIBD,the expressions of both RhoGDI2 mRNA and Bcl-2 mRNA are decreased.The imbalance of expression of RhoGDI2 is involved in pathogenesis of HIBD by regulating Bcl-2 expression.

Objective To investigate the effect and mechanism of phosphorylated protein kinase R-like ER kinase(p-PERK) and C/EBP homologous protein(CHOP) after hypoxic-ischemic brain damage ( HIBD) . Methods Neonatal 7-day-old Sprague Dawley rats were divided into sham-operation control group and HIBD group( n=30 per group) . Each group was divided into 0 h,6 h and 24 h subgroup after operation ( n=10 per group) . The ratio of apoptosis of brain cell was measured by flow cytometer and the expression of p-PERK and CHOP were detected by Western blot. Results (1)Apoptosis cell appeared at 6 h in HIBD group,the ratio of cell apoptosis was(2. 17 ± 0. 19)%. The apoptosis cell obvious increased at 24 h,the ratio of cell apoptosis was(13. 42 ± 0. 83)%. There was a significant increase in the ratio of apoptosis after HIBD 6 h and 24 h, as compared with sham-operation control group [ ( 0. 57 ± 0. 06 )%( P <0. 01 ) ] . ( 2 ) The expression of both p-PERK and CHOP was very low in sham-operation control group. In the HIBD group,the expression of both p-PERK and CHOP began to increase at 6 h and increased furthermore at HIBD 24 h. The differences in the expression levels of p-PERK and CHOP in HIBD group among different time points were significant( P<0. 01 ) . ( 3 ) The expression of p-PERK positively correlated with the expression of CHOP (r=0. 997,P< 0. 05). Conclusion With the emerging of apoptosis after HIBD,the expression of both p-PERK and CHOP increases. The imbalance in the expression of PERK induces the apoptosis of brain cells in the HIBD of neonatal rats by regulation of CHOP expression.

BACKGROUND: Encopresis after operation for congenital.ectopic anus can cause psychological, physiological and social ability disorders.OBJECTIVE: To treat the children with encopresis with biofeedback training so as to improve the function of post-operative defecation.DESIGN: A self-controlled trial.SETTING: Department of Pediatric Surgery, Second Clinical College of China Medical University.PARTICIPANTS: Totally 20 cases of encopresis after treatment with operation for ectopic anus,were recruited from the Department of Pediatric Surgery, Second Clinical College of China Medical University, between January 1998 and October 2004. Among them, there were 4 cases of complete encopresis, 7 cases of loose encopresis and 9 cases of blotch. All the cases were followed up. There were 9 cases of ectopic anus in the middle and lower parts, and 11 cases of ectopic anus at the high part.METHODS: The objective measuring methods of biofeedback training such as anorectal pressure and anus sphincter electromyography were used to train the patients with postoperative encopresis. After one-month self-directed training in anus contraction and defecation habit, the children received proper biofeedback training. ① Biofeedback training to strengthen the muscles around the anus twice per day. The portable biofeedback-training machine was taken home after the children patients could automically contract the muscles around the anus 3 weeks later. ② Biofeedback training to improve rectal sensitivity and coordination of anus sphincter, and repeated training in expanding saccus. A normal defecation reflex was established. Anus sphincter presented reflex contraction to prevent encopresis once the rectum expanded. ③ Defecation training was performed for 30 minutes after meals every day. ④ Electrostimulation combined with biofeedback training was performed for 10 minutes twice a day for 3 or 4 consecutive weeks.MAIN OUTCOME MEASURES: ① The maximum contraction anal pressure, vector volume, and electromyographic amplitude of external sphincter of anus; ② positive rate of anorectal contraction reflex of the children patients before and after training.RESULTS: According to actual treatment analysis, all the 20 children patients entered the result analysis. ① In middle and lower parts groups, the maximum contraction anal pressure increased from (11.87±5.61) kPa before training to (24.88±16.58) kPa after training; in high part group, they increased from (5.76±3.84)kPa to (18.18±13.71) kPa (P＜ 0.05). ② In middle and lower parts groups, the vector volume increased from (139.17±130.02) cm (cm Hg)2 to 608.10±131.06 cm·(cmHg)2, whereas in high group it increased from (117.01±74.35) cm(cm Hg)2 to (452.17±69.43) cm(cm Hg)2 (P＜ 0.05). ③ In middle and lower parts groups, the electromyographic amplitude of external sphincter of anus increased from (152.20±37.42) μV to (324.12±67.78) μV; in high part group, it rose from (114.08±51.41)μV to (266.18±49.38)μV (P ＜ 0.05). ④ The positive rate of anorectal contraction reflex improved from pretraining 55％ (11/20) to post-training 90％ (18/20).CONCLUSION: After biofeedback training, the maximum contraction anal pressure, anorectal sensitivity and the coordination of anus external sphincter, defecation habit, and contractibility of external sphincter of anus were all improved obviously, especially in those with ectopic anus in the middle or lower parts. Anus external sphincter function can be improved to the uttermost so as to cure encopresis.

Objective The discovery of microRNA (miRNA) in maternal serum has opened up new possibilities for non-invasive prenatal diagnosis.However,our understanding of these pregnancy-related miRNA in the serum of pregnant women with fetuses with neural tube defects (NTDs) is still limited.This article is to study the dysregulated expression of microRNA-423 (miR-423) in the serum of pregnant women with neural tube defect(NTD) fetuses and its potential role as a biomarker for non-invasive prenatal diagnosis of fetal NTD.Methods Thirty-three pregnant women whose fetuses were diagnosed as neural tube defects by ultrasound (22 cases of spina bifida and 11 cases of anencephaly)and 33 normal pregnant women were selected.Peripheral venous blood of each pregnant woman was obtained early in the morning,the serum was purified from blood by centrifugation,then total RNA was isolated from serum and the miR-423 levels were detected by real-time RT-PCR.The ROC curve was used for assessing the diagnostic accuracy of miR-423 for fetal NTD.Results We revealed miR-423 with signifcant down-regulation in expression in serum of pregnant women with NTD fetuses (0.96 ±0.14) compared as women with normal pregnancies(2.28 ±0.43) (P ＜0.05).We performed ROC analysis of data from the 33 case-control pairs.The expression of miR-423 could distinguish NTD cases from normal controls,with an AUC of 0.711 (95 ％ CI:0.566 ～ 0.856) (P ＜ 0.05).Moreover,the expression of miR423 decreased only in serum of pregnant women with anencephaly fetuses(0.58 ±0.08)by the analysis in different forms of NTD.Conclusion miR-423 is deregulated in the serum of pregnant women with NTD fetuses and highlight the clinical potential of miR-423 as biomarker for diagnosis and prognostication of fetal NTD.

Objective To screen for serum protein differentially expressed between women whose fetuses had congenital heart defects(CHD) and women who had normal fetuses. Methods Serum samples were collected from pregnant women whose fetuses had CHD and those whose fe?tuses had no CHD,including a CHD group of 40 women and a control group of 10 women. The CHD group included 4 subgroups as follows:tetralo?gy of Fallot,ventricular septal defects,persistent truncus arteriosus,and a mixture of relatively rare types of CHD(n=10 each). Samples in the same group were pooled to obtain equal amounts of proteins ,and the iTRAQ proteomic approach was used to identify and quantify the proteins dif?ferentially expressed among these groups. Results We successfully identified 606 proteins,among which 47 showed at least a 1.5?fold difference between the CHD and control groups. Among the 47 proteins,23 and 24 were upregulated and downregulated,respectively. Conclusion Several proteins associated with CHD could be identified by using the iTRAQ proteomic approach ,and various proteins were involved in the pathogenesis of CHD in this study.

Objective To explore the colonic motor function of children with chronic constipation. Methods Twenty-five constipation children were enrolled in this study receiving determination of the colonic transit time and the anorectal vector manometry. Patients were then divided into subgroups with prolonged transit time and that with normal transit time. The value of anorectal manometry was assessed in these two subgroups. Results The total gastrointestinal transit time (TGITT), Left colonic transit time (LCTT)and rectosigmoid colonic transit time (RSTT) in constipation children were significantly longer than those measured in 33 healthy controls: (92?56) h vs. (29?8) h,P

Objective To determine the effects of intrauterine growth retardation(IUGR) caused by malnutrition during pregnancy on the lung structure and expression of Clara cell protein (CCSP) and interferon (IFN)-γ in the fetal lungs,and to explore their relation ship with pulmonary disease.Methods Fetal rats from maternal protein-malnutrition dams were studied on day 20(term 21.5 day).The lung pathology was examined by means of Hematoxylin and eosin(HE) stain.Plasma was collected to determine the CCSP and IFN-γ concentration.Lungs were harvested to measure the expression of CCSP and IFN-γ mRNA by using fluorescent quantization reverse transcription (RT)-PCR and the levels of CCSP and IFN-γ protein were assessed by using enzyme-linked immunosorbent assay.Results Malnutrition fetus body weight significantly less compared to control group,so did the lung weight.However,lung weight,expressed as a percentage of body weight between the 2 groups was not different.The IUGR group had significantly decreased alveolar number manifested by lower radial alveolar count,and significantly increased mean linear intercept of alveoli.Both the CCSP mRNA expression and protein level in lung of IUGR rats were decreased compared with control rats (all P ＜ 0.05).A decline in plasma CCSP protein concentration was also noted compared with control group (P ＜0.05).Furthermore,IUGR group fetus showed lower IFN-γ levels both in circulation and in the lung tissue (all P ＜ 0.05).Conclusions Intrauterine malnutrition significantly alters lung structure and cytokine IFN-γ level,and the latter may further inhibit the transcription of CCSP gene.These alterations may contribute to both early and late postnatal respiratory morbidity.

Objective To observe the effects of bone marrow mesenchymal stem cells (BMSC) transplantation on the expression of nerve growth factor(NGF) and brain derived neurotrophic factor(BDNF) in the rat spinal cord with spina bifida,and to investigate the change in cell apoptosis after BMSC transplantation.Methods Spina bifida aperta was induced with a single intragastric injection of all-trans retinoic acid,then the BMSC was microinjected into spina cord of rat embryos on embryo 16 d(E16),BDNF and NGF were tested by immunofluorescence staining,and TUNEL assay were used for investigating cell apoptosis.Results Transplantation of BMSC enhanced the expression of NGF and BDNF,and reduced cell apoptosis in the defective site of spinal cord.Conclusion The transplantation of BMSC may improve the microenvironment of spinal cord and repair the neurological defects by enhancing the expression of neurotrophic factor and reducing the cell apoptosis.

BACKGROUND:Laminoplasty and laminectomy are the most commonly used treatment methods for multilevel cervical spondylotic myelopathy, which is more common in elderly patients. C5 nerve root palsy is the common postoprative complication after posterior cervical repair. OBJECTIVE:To compare the incidence of C5 nerve root palsy after laminoplasty with mini-titanium plate fixation and laminectomy with internal fixation in repair of multilevel cervical spondylotic myelopathy. METHODS:Total y 134 patients with multilevel cervical spondylotic myelopathy from August 2010 to December 2014 were enrol ed, and then divided into laminoplasty group (n=45) and laminectomy group (n=89) owing to different ways of repair. Patients in the laminoplasty group were treated with laminoplasty with mini-titanium plate fixation, and patients in the laminectomy group were treated with laminectomy with internal fixation. C5 nerve root palsy condition after repair was recorded and evaluated. The cervical lordosis angle (Cobb angle) and cervical curvature index were compared. The Japanese Orthopaedic Association score was used for neurological assessment. RESULTS AND CONCLUSION:Al patients in both groups were fol owed up for more than 6 months. There were no significant differences in cervical lordotic angle and cervical curvature index at the first week before and after the treatment between these two groups (P>0.05). The Japanese Orthopaedic Association scores of patients after 6 months of treatment were significantly improved compared with that before treatment in these two groups (P<0.05). There were 2 cases of C5 nerve root palsy after the treatment of laminoplasty, the occurrence rate was 4%(2/45);there were 10 cases of C5 nerve root palsy after the treatment of laminectomy, the occurrence rate was 11%(10/89);there was significant difference between these two groups (P<0.05). These results suggest that compared with laminectomy fixation, the incidence of C5 nerve root palsy was lower after the laminoplasty with mini-trianium plate fixation, which can be widely used in decompression repair treatment of multilevel cervical spondylotic myelopathy.