Objective To study the clinical characteristics,treatment and prognosis of neonatal VACTERL association.Method The clinical data of newborns diagnosed with VACTERL association from January 2010 to December 2015 were collected and retrospectively analyzed.Result A total of 33 patients diagnosed with VACTERL association were included,including 23 males and 10 females.Among them,17 cases were term infants,15 cases premature infants and 1 case of overdue birth,with an admission age of 1 to 24 days.The most common deformities were cardiac anomalies (C) in 27 cases (81.8％),followed by anal atresia/anorectal malformation (A) in 25 cases (75.8％),renal deformity (R) in 24 cases (72.7％),limb abnormalities (L) in 20 cases (60.6％),Tracheoesophageal fistula (TEF) in 8 cases (24.2％) and vertebral abnormalities (V) in 3 cases (9.1％).11 cases (33.3％) had other deformities.Among these 33 patients,24 cases had 3 types of malformations and 9 cases had 4 types of malformations.The most common combination was ACR (n =8).20 patients had no abnormalites on chromosome karyotype test including 2 patients had normal gene microarray results.16 patients received surgical treatment during neonatal period and 13 of them recovered and discharged.Among the other 17 cases received no surgery,only 1 patient improved and discharged.A telephone follow-up was proceeded in 14 discharged cases at 1 year old.Among them,13 cases had good prognosis,however,the remaining one was dead.Conclusion VACTERL association is a rare non-random combination of multiple malformations.The early discovery and appropriately treatment after diagnosis will improve the prognosis and prevent death.Doctors should reinforce the ability to detect various types of deformities and examine the chromosome and gene properly.

Health Promotion ; methods ; Japan

Objective To investigate the clinical effects of a modified splenocaval shunt combined with pericardial devascularization ( PCDV ) in the treatment of gastroesophageal variceal bleeding. Methods From 1997 to 2007, 168 patients with gastroesophageal variceal bleeding caused by portal hypertension were treated at the People's Hospital of Shaanxi Province. Among all the patients, 90 received a splenocaval shunt + PCDV(combined group) and the remaining 78 received PCDV (PCDV group). Changes in intra- and postoperative hemodynamics of the portal venous system were detected by Doppler color flow imaging, and free portal pressure was measured intraoperatively. All data were analysed using analysis of variance, the paired t test and chi-square test.Results The mortality was 3% (3/90) in the combined group and 5% (4/78) in the PCDV group, with no significant difference between the two groups (x2 = 0.038, P ＞0.05 ). The postoperative rebleeding rate was 6%(5/79) in the combined group, which was significantly lower than 13% (8/60) in the PCDV group (x2 =4.824,P ＜ 0.05 ). The incidence of hepatic encephalopathy was 6% (5/79) in the combined group and 7% (4/60) in the PCDV group, with no significant difference between the two groups ( x2 = 0.072, P ＞ 0.05 ). The 1-, 3-, 5-,and 10-year survival rates were 97% (77/79), 92% (55/60), 80% (16/20) and 60% (3/5) in the combined group, and 97% (58/60), 83% (40/48), 73% (22/30) and 53% (8/15) in the PCDV group, respecitvely,with no significant difference between the two groups ( x2 = 0.731, P ＞ 0.05 ). The intra- and postoperative portal pressures in the combined group were (38.8±4.2) cm H20 ( 1 cm H2O =0. 098 kPa) and (33.1 ± 1.5) cm H2O,with a significant difference ( t = 8. 574, P ＜ 0.05 ). The intra-and postoperative portal pressures in the PCDV group were (38.9±2.5) cm H2O and (34.6±2.6) cm H2O, with a significant difference (t =6. 530, P ＜0.05 ). There was also a significant difference in postoperative portal pressure between the two groups ( t = 2. 859,P ＜ 0.05 ). The intra-and postoperative diameters of the portal vein in the combined group were (1.40 ± 0.41 )cm and ( 1.22 ± 0. 15) cm, respectively, with a significant difference ( t = 2. 608, P ＜ 0.05 ). The intra-and postoperative portal venous flows in the combined group were (1280 ±350) ml/min and (830±360) ml/min, with a significant difference ( t = 5. 668, P ＜ 0. 05 ). The intra-and postoperative diameters of the portal vein in the PCDV group were ( 1.41 ±0.32) cm and ( 1.27 ±0.32) cm, respectively, with no significant difference between the two groups (t = 1. 637, P ＞ 0.05 ). The intra-and postoperative portal venous flows in the combined group were ( 1350 ± 380) ml/min and (980 ± 290) ml/min, with a significant difference ( t = 4. 096, P ＜ 0.05 ). There was no significant difference in postoperative portal venous flow between the two groups ( t = 1.871, P ＞ 0.05 ).Conclusions The modified splenocaval shunt combined with PCDV is safe and effective with a low rate of recurrent rebleeding. The clinical outcome and rational hemodynamic changes show that the combined procedure of splenocaval shunt and PCDV is a good choice for treatment of gastroesophageal variceal bleeding.

Objective To explore the clinical characteristics of portal vein thrombosis(PVT) after splenocaval shunt plus devascularization in treatment of portal hypertension and find Out ways for its prevention.Methods The formation,diagnosis,treatment of PVT and variceal rehemorrhage in 110 patients with portal hypertension who received splenocaval shunt plus devascularization procedures (Combined Group)and 92 patients subjected to pericardial devascularization operation(PCDV Group) were retrospectively analyzed.Meanwhile,the effect of two procedures on PVT was compared.Results The incidence of PVT was 10.0%in combined group and 22.8%in PCDV group (P<0.05).The rebleeding rate from esophagogastric varices because of PVT in combined group was 3.6%,which was significantly lower than that of 10.8%in PCDV group(P<0.05).Conclusion Splenoeaval shunt plus devascularization is a better choice to decrease the incidence of PVT.The postoperative anti-coagulation therapy in the early stage is important for the prevention of PVT.

Objective To evaluate the effects,hemodynamies and hepatic functional reserve of a combined procedure of modified pmximal splenocaval shunt and pericardial devascularlzation (PCDV) in the treatment of portal hypertension.Methods From 1997 to 2007,a total of 255 patients with cirrhotic portal hypertension received combined (135 cases) or PCDV procedure (120 cases,) in our hospital.The clinical results were retrospectively analyzed.Changes of hemodynamics of the portal venous system were studied by Doppler color flow imaging and intraoperative free portal pressure (FPP) measurement.The hepatic functional reserve was evaluated by indocyanine green (ICG) retention ratio and functional hepatic flow(FHF).Results Postoperative mortality was 2.2% in combined group and 4.3% in PCDV group.The long term rebleeding rate was 5.5%as revealed by follow-up in combined group,which was significantly lower than that in PCDV group of 14.1%(P<0.05).The incidence of encephalopathy was 6.4%and 5.4%in combined group and PCDV group respectively(P>0.05).The 1-,3-,5-and 10 year-survival rates were 96.4%,90.0%,81.3%and 62.5% in combined group and 95.7%,86.7%,75.0%,57.1%in PCDV group.In combined group,the FPP、PVF and FHFwere(32.0±1.5)cm H_2O、(880±260)ml/min and(430±1 80)ml/min respectively,a significant decrease when compared with preoperative parameters (P<0.05),while R_(15) (30%±4%)increased (P<0.01).The similar results were observed in PCDV group postoperatively (P<0.05).Compared to PCDV group,the decrease of FPP in combined group was more significant(P<0.05),but the PVF,FHF and R_(15) were not significantly different (P>0.05).Conclusions The combined procedure is safe and effective in treatment of portal hypertension with better clinical outcome,moderate homodynamic changes and good maintenance of hepatic functional reserve.

BACKGROUND:Legacy posterior stabilized prosthesis has advantages in theoretic design,in vitro kinematics and abrasion, but it remains unclear whether its clinical outcomes for vaglus knee deformity are better than Legacy constrained condylar knee prosthesis. OBJECTIVE:To explore the midterm folow-up effect of Legacy posterior stabilized prosthesis in total knee arthroplasty in patients with valgus knee deformity. METHODS: From February 2006 to November 2013 in Department of Bone and Joint Surgery, Affiliated Hospital of Luzhou Medical Colege, total knee arthroplasty was used to treat valgus knee deformity in 33 cases (35 knees). Parapatelar medial approach was used. Precise osteotomy was utilized to correct limb alignment. Lateral soft tissue received selective release. Finaly, an equal type of Legacy posterior stabilized prosthesis (Zimmer, USA) was implanted and fixed with antibiotic bone cement. The differences in hospital for special surgery knee score, range of motion of knee, femoral tibial angle, and maximum flexion and extension angle, as wel as X-ray film results were compared and analyzed before and after replacement. The complications including deep vein thrombosis, peri-prosthetic infection, patelar clicking, unstable knee, and common peroneal nerve injury were recorded after surgery. RESULTS AND CONCLUSION: Al patients were folowed up for 24-50 months. The incision was healed in one-stage. No complications such as peri-prosthetic infection appeared. Three patients suffered from common peroneal nerve palsy, which was cured at half a year after surgery by expectant treatment such as trophic nerve. Two cases suffered from knee instability after replacement, which was improved at 1 month after external fixation with a brace. One case experienced deep vein thrombosis in the lower extremity, which was improved after treatment with low molecular weight heparin anticoagulation. During final folow-up, hospital for special surgery knee score increased from (51.85±4.15) preoperatively to (85.77±2.50) postoperatively (P < 0.01). There were excelent in 20 knees, good in 11 knees, with an excelent and good rate of 89%. X-ray films showed that hindlimb alignment was apparently corrected, prosthetic position was good, no loosening occurred. These data indicate that total knee arthroplasty, using parapatelar medial approach, obtained good correction outcomes through the accurate amputation to correct hindlimb alignment and selective release of the soft tissue with Legacy posterior stabilized prosthesis in the treatment of valgus knee deformity.

Objective To observe the clinical outcome of modified posterolateral approaches for the treatment of posterolateral tibial plateau fractures. Methods From January 2012 to January 2015,13 patients with posterolateral tibial plateau fractures were identified in the Second Hospital of Changzhou Affiliated to Nan?jing Medical University. All the posterolateral fractures were fixated with a plate. The knee function was evaluated at the last follow?up by the Hospital for Special Surgery( HSS) Score,and the occurrence of postoperative compli?cations were observed. Results Thirteen patients were followed up for an average of 14. 4 months,all patients obtained bony union. There were no significant differences regarding the mean HSS score among 3 months, 6 months and 1 year post?operation((71. 6±1. 5) points, (76. 4±1. 6) points, (83. 2±1. 1) points;P=0. 154) . There were no significant differences regarding the tibial plateau angle and posterior slope angle on radiograph?ies of inside and outsideamong immediate,6 and 12 months postoperation((83. 7±1. 7)°,(84. 3±1. 5)°,(85. 1 ±1. 4)°,(85. 4±1. 5)°;(7. 7±1. 5)°,(7. 7±1. 4)°,(7. 7±1. 3)°,(7. 6±1. 8)°;P=0. 223,0. 191). No com?plications associated with the approach were observed and there was no infection,no malunion or fixation failure either. Conclusion In the treatment of posterolateral tibial plateau fractures,the modified posterolateral approa?ches can result in excellent fracture reduction under direct visualization and allow for posterior buttress plating.

Objective To investigate the effect of di-(2-ethylhexyl) phthalate (DEHP) on the postnatal lung development in newborn rats.Methods A total of 60 newborn Sprague-Dawley rats (weighing 5.0-8.0 g) in five age groups were studied in the first experiment.The rats were divided based on the different postnatal ages:postnatal day (PND)I,PND4,PND7 and PND14.A total of 45 newborn Sprague-Dawley rats (weighing 5.0-8.0 g) were randomly divided into three groups according to the dosage of DEHP administered in the second experiment.The newborn rats were administered DEHP through intraperitoneal injection at 10 (low-dose subgroup),100 (medium-dose subgroup) or 750 (high-dose subgroup) mg/kg daily from PND1 to PND13.The rats were sacrificed on PND14.Pups were sacrificed with lethal dose injection of pentobarbital sodium.The lung was removed.The right middle lobes were used for analysis.The tissue was processed for histology and lung sections were stained with HE for light microscopic (LM) morphometric measurement.The analysis was performed by means of a digital image analysis system,including pulmonary interstitial area ratio (IAR) and total length density of all segments.One-way ANOVA,LSD and Dunnet T3 methods were used for statistical analysis.Results In the normal controls,IAR decreased significantly by (31.97±5.03) ％,(30.05±3.57)％,(25.33± 1.83)％ and(22.01 ±2.19)％,respectively,from PND1 to PND14 (P＜0.05 or P＜0.01).IAR in medium-and high-dose subgroups increased significantly by (24.11 ±2.78)％ and (26.53± 3.42)％,respectively on PND 14.The total length density of all segments in unit area lung volume increased significantly by 0.047 8±0.003 7,0.050 0±0.002 9,0.071 2±0.003 0 and 0.084 4±0.004 3,respectively from PND1 to PND14 (P＜0.01).In the DEHP treated animals,when compared with the control group,IAR was significantly higher on PND14 (P＜0.05 or P＜0.01),while the total length density of all segments in unit area lung volume was significantly decreased (P＜0.05 or P＜0.01).Length density in medium-and high-dose subgroups were higher than that of low-dose subgroup by 0.082 9±0.001 8,0.077 2±0.002 0 and 0.071 3±0.003 7,respectively on PND14 (P＜0.05 or P＜0.01).Conclusions Medium-and high-dose DEHP affect the postnatal lung development in rats in a dose-dependent mode.

Objective To investigate the effects of the interaction between human hepatoma cells and hepatic stellate cells on their growth state,and study its role of interaction on the progression of hepatocellular carcinoma.Methods Human hepatoma cell line HepG2 and hepatic stellate cell line hepatic stallate cells (HSC)-T6 were used and the methods including methyl thiazolyl tetrazolium (MTT) assay,flow cytometry (FCM) analysis,immunohistochemistry,and electron microscopy were employed in this experiment.The effects of conditioned medium (CM) of HepG2 on the activation and proliferation of HSC were explored.The effects of activated HSC CM on HepG2 proliferation were investigated.The uhrastructural changes of the two co-cultured cells were observed.Results MTT assay result showed that HepG2/HSC CM could promote HSC/HepG2 proliferation.FCM result demonstrated that HepG2/HSC CM could influence the cell cycle distribution in HSC/HepG2.Immunohistochemistry exhibited that after the treatment of HepG2/HSC CM,the expression ofα-smooth muscle actin (α-SMA) in HSC and proliferating cell nuclear antigen (PCNA) in HepG2 were increased.When HepG2 and HSC were co-cultured,the ultrastructure of HSC displayed an activated feature.Conclusions HepG2 cells can induce the activation and proliferation of HSC,and the activated HSC can also stimulate the proliferation of HepG2.Interaction between hepatoma cells and hepatic stellate cells may play an important role in the progression of hepatocellular carcinoma.