Objective: To investigate the clinical characteristics and risk factors of congenital choledochal cysts (CCC). Methods: This retrospective study recruited 52 cases who were antenatally diagnosed with CCC and underwent surgical treatment after birth in Guangdong Women and Children Hospital from January 2013 to August 2018, with complete clinical data. According to the enlargement of cysts during pregnancy, they were divided into two groups: progressive group (≥15 mm, 22) and stable group (<15 mm, 30). Antenatal and postpartum ultrasound and MRI features of the two groups were analyzed. Clinical manifestations and biochemical examination results before and after operation were compared between the two groups. Other data, including amylase level in cyst fluid during operation, cholangiography findings, liver biopsy results, and post-operation follow-up, were also analyzed. Chi-square test, t (t') test, and Pearson correlations tests were performed for data analysis. Results: (1) The average age of the 52 patients at operation was 46(7-822) d. The cysts of all cases were first detected during 19-21 weeks of gestation. The maximum diameter of the cyst in the progressive group was larger than that in the stable group after 34 weeks of pregnancy [31-34 weeks: (31.1±8.4) vs (23.1±6.6) mm, t=3.911; >34 weeks: (36.1±6.8) vs (27.1±7.3) mm, t=4.557; pre-operation: (51.8±18.0) vs (34.0±15.6) mm, t=3.809; all P<0.01]. (2) In the progressive group, the cysts were irregular in shape and enlarged after birth. The common hepatic duct and intrahepatic bile duct were dilated and gradually distended after birth, while the distal end of the common bile duct was narrowed, thus to form a cone-like duct. Deposits could be seen inside the cysts after delivery. Irregular cysts were also presented in the stable group, and five of them had dilatation of common hepatic duct and intrahepatic bile duct after birth. However, no cone-like formation was seen, the distal end of the common bile duct was visible, and deposits in cysts were occasionally found. (3) Twenty-five patients underwent laparotomy, and seven of them showed increased amylase level in cyst fluid including four with 2-5 times above the upper limit of normal value (one in the progressive group and three in the stable group). The other three cases were all in the stable group and their amylase levels in cyst fluid were more than ten times of the upper limit. The level of direct bilirubin in the progressive group was higher than that in the stable group before the operation [18.40(2.50-113.30) vs 8.70(0.00-16.80) μmol/L, u=2.400, P<0.05]. (4) Among the 52 cases, patients with type Ⅰ, Ⅳ and Ⅴ cyst accounted for 71.1% (37/52), 26.9% (14/52) and 2.0% (1/52), respectively. All cases were followed up regularly six months to one year after the operation. Liver function and bilirubin became normal and the growth and development of the babies were similar to those of the same age. (5) Different degrees of liver fibrosis and inflammation were shown in 46(88.5%) cases and more severe in older babies among those who underwent surgery in the progressive group. The time at operation was not associated with the severity of liver fibrosis and inflammation in the stable group. Hepatic fibrosis and inflammation were more serious in the progressive group than in the stable group (fibrosis grading: χ²=14.260, P=0.006; inflammatory activity grading: χ²=9.904, P=0.019). Conclusions Larger diameter (≥30 mm) in the initial prenatal examination or a significant increase in cystic diameter (≥15 mm) during pregnancy are risk factors for early stenosis or occlusion in the distal end of common bile duct requiring close follow-up after birth. When jaundice or abnormal liver function occur and stool color becomes light, early surgical treatment (one to two months after birth, generally within three months) for CCC is recommended to rule out the anomalous union of the pancreaticobiliary duct and hepatic disorders, as well as the cystic biliary atresia.

OBJECTIVE: Providing a risk assessment method for the implementation of radiotherapy to identify possible risks in the implementation of the treatment process, and proposing measures to reduce or prevent these risks. METHODS: A multidisciplinary expert evaluation team was developed and the radiotherapy treatment process flow was drawn. Through the expert team, the failure mode analysis is carried out in each step of the flow chart. The results were summarized and the (risk priority ordinal) score was obtained, and the quantitative evaluation results of the whole process risk were obtained. RESULTS: One hundred and six failure modes were obtained, risk assessment of (20%) high risk failure model are 22 and severity (≥ 8) high risk failure model are 27. The reasons for the failures were man-made errors or hardware and software failures. CONCLUSIONS Failure mode and effect analysis can be used to evaluate the risk assessment of radiotherapy, and it provides a new solution for risk control in radiotherapy field.
Healthcare Failure Mode and Effect Analysis ; Risk Assessment

Objective To investigate the effect of comprehensive nursing intervention on pregnancy outcome in patients with artificial insemination by husband. Methods 80 patients with artificial insemination by husband in the Department of Reproductive Medicine of Yichun People's Hospital from July 2016 to July 2018 were collected and divided into two groups by random number table method. The control group was treated with routine care intervention. The observation group was treated with comprehensive nursing intervention. The serum FSH level, serum estradiol concentration, serum LH level, endometrial thickness on the day of transplantation, pregnancy outcome, and psychological status in patients were observed. Results The serum LH level in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference in serum FSH level, serum estradiol concentration, endometrial thickness on the day of transplantation between the observation group and the control group (P>0.05). There was no significant difference in the clinical pregnancy rate and spontaneous abortion rate between the two groups (P>0.05). The SAS and SDS scores were lower in the observation group after the intervention, and the difference was significant from those of the control group (P<0.05). Conclusion Comprehensive nursing intervention had no significant effect on the pregnancy outcome of patients with artificial insemination by husband. The clinical pregnancy rate and spontaneous abortion rate are similar. But comprehensive nursing intervention can improve the serum LH level and improve the psychological status of patients.

SUMMARY Thehumanembryonicstemcells(hESCs)serveasaself-renewable,genetically-healthy, pluripotent and single source of all body cells,tissues and organs.Therefore,it is considered as the good standard for all human stem cells by US,Europe and international authorities.In this study,the standard and healthy human mesenchymal progenitors,ligament tissues,cardiomyocytes,keratinocytes,primary neurons,fibroblasts,and salivary serous cells were differentiated from hESCs.The human cellular health-safety of NaF,retinoic acid,5-fluorouracil,dexamethasone,penicillin G,adriamycin,lead ace-tate PbAc,bisphenol A-biglycidyl methacrylate (Bis-GMA)were evaluated selectively on the standar-dized platforms of hESCs,hESCs-derived cardiomyocytes,keratinocytes,primary neurons,and fibro-blasts.The evaluations were compared with those on the currently most adopted cellular platforms.Parti-cularly,the sensitivity difference of PM2.5 toxicity on standardized and healthy hESCs derived fibroblasts, currently adopted immortalized human bronchial epithelial cells Beas-2B and human umbilical vein endo-thelial cells (HUVECs)were evaluated.The results showed that the standardized hESCs cellular plat-forms provided more sensitivity and accuracy for human cellular health-safety evaluation.

Objective To summarize the etiology and surgical treatment of obstructive infantile cholestasis.Methods Clinical data of 108 cases of obstructive infantile cholestasis was studied retrospectively from April 2009 to April 2014.Results Correct diagnosis was established in all 108 patients by laparoscopic biliary tract exploration and cholangiography.Among those,there were noncorrectable biliary atresia in 81 cases (75.0％),correctable biliary atresia in 5 cases (4.6％),inspissated bile syndrome in 8 cases (7.4％),infantile hepatitis syndrome in 6 cases (5.6％),choledochal cyst in 4 cases (3.7％),biliary hypoplasia in 2 cases (1.9％),1 case (0.9％) suffered from spontaneous bile duct perforation,1 case (0.9％) suffered from oppression of lymph nodes in hepatic portal.Patients of nocorrectable biliary atresia were treated with open Kasai portoenterostomy or laparoscopic Kasai portoenterostomy,correctable biliary atresia and choledochal cyst underwent laparoscopic cyst excision and Roux-Y hepaticojejunostomy,inspissated bile syndrome,infantile hepatitis syndrome and biliary hypoplasia were treated by laparoscopic cholecystostomy and biliary tract irrigation.The patient of spontaneous bile duct perforation was treated with laparoscopic common bile duct exploration and T-tube drainage,the lymph node was excised in patient with oppression of lymph nodes in hepatic portal.All infants were followed-up for 3 months to 48 months,the clearance of jaundice rate varied in patients with Kasai portoenterostomy,patients with non-Kasai portoenterostomy were all in good condition and there were no symptom recurrence.Conclusion Biliary atresia,inspissated bile syndrome,infantile hepatitis syndrome,choledochal cyst and biliary hypoplasia are the most common cause of surgery-related infantile cholestasis.Kasai portoenterostomy,hepaticojejunostomy and cholecystostomy and biliary tract irrigation are the main surgical method for surgery-related infantile cholestasis.

Objective To investigate the clinical features of pedistric Littre hernia.Methods Clinical data of 11 cases of Littre hermia admitted from January 2002 to December 2010 was studied retrospectively.Results The diagnosis of Littre hernia was all established by laparotomy.All of the 11 cases were boys,the median age was 1.2 years (22 days to 3 years and 7 months).The main clinical features were:painful,irregular and nonresetable mass in the groin area (11/11),vomiting in 6 cases (6/11 ),fever (＞38.5 ℃ ) in 4 cases (4/11 );X-ray showed intestinal obstruction in 9 cases (9/11 ),Ultrasound found mixed mass in the groin area in 11 cases ( 11/11 ),pouch-like structure were found in 6 cases (6/11).Eight cases (8/11) presented with elevated WBC ( ＞ 10000).Palpable lobulated structure were fell in 5 cases (5/11).All cases of Littre hernia were successfully operated on,Meckel diverticulum perforation was found in 2 cases ( 2/11 ),Meckel diverticulum adhered to the hernia sac in 8 eases (8/11).All patients were cured by surgery,and postoperative follow-up (10ms-8y) found no recurrence.Conclusions Pediatric Littre hernia is rare,preoperative diagnosis is difficult.Avoiding preoperative violent reduction and intraoperative injuring Meekel's diverticulum or the small bowel helps improve the cure rate of Littre hernia in children.

OBJECTIVE: To construct short hairpin RNA interfering expression vector of TDRG1,and detect the specific interfering effect of TDRG1-shRNA expression vector on NTERA-2 cells. METHODS: Oligos for short hairpin RNA targefing for TDRG1 were designed and connected to the expression vector pGPU6/GFP/Neo to construct the TDRG1 shRNA expression vector. The recombinant plasmid TDRG1-shRNA486, TDRG1-shRNA738, TDRG1-shRNA921 and lipofectamine ™2000 were used to generate and transfect shRNA into NTERA-2 cells. Expression of TDRG1 mRNA was assayed by RT-PCR. RESULTS: TDRG1-shRNA expression vector was successfully constructed. TDRG1-shRNA486 was more effective in the suppression of TDRG1 with significant reduction of TDRG1 mRNA. CONCLUSION TDRG1-shRNA can interfere the expression of TDRG1 in NTERA-2 cells.
Cell Line, Tumor ; Genetic Vectors ; Humans ; RNA Interference ; RNA, Messenger ; RNA, Small Interfering ; Transfection

Background and purpose: The ataxia-telangiectasia mutated (ATM) gene results in ataxia-telangiectasia (A-T) and it is closely associated with tumors. ATM is an important signal transducer that is involved in the repair of DNA double-strand break damage by phosphorylating numerous target proteins . This study was aimed to investigate the correlation between a single nucleotide polymorphism (SNP) in ATM gene (IVS62+60G>A) and the risk of non-small cell lung cancer(NSCLC) in a case-control study. Methods: From June 2004 to December 2005, a total of 264 patients with NSCLC were recruited, 264 healthy people as control. All of specimens were collected from Zhejiang Tumor Hospital. DNA was extracted from peripheral blood and then was used to determine. ATM genotype by Taqman SNP genotyping assays. Logistic regression model was employed to analyze the relationship between SNP and NSCLC risk. Results: The percentage of NSCLC patients in 86 patients with A/A genotype, 139 patients with A/G and 39 patients with G/G were 32.6% (86/264), 52.6% (139/264), 14.8% (39/264), respectively. The percentage in 68 healthy people with A/A genotype, 139 healthy people with NG and 55 healthy people with G/G were 26.0% (68/262), 53.0% (139/262) and 21.0% (55/262), respectively. The proportion of G/G genotype in 264 patients was obviously lower than that in the 264 healthy control (14.8% vs 21.2%, P<0.05). The people with G/G genotype had lower risk to NSCLC than there with A/A genotype (OR=0.561, 95% CI=0.334-0.942, P=0.029). Conclusion: The ATM SNP(IVS62+60G>A)was associated with the NSCLC risk, and homozygous G alleles may be a protective factor to NSCLC.

OBJECTIVETo investigate the effects in vitro of 17 beta-estradiol (E2) on the proliferation and metabolism of rabbit mandibular condylar cartilage cells.

METHODSChondrocytes were derived from neonatal rabbit mandibular condylar cartilage using a modified enzyme method. 17 beta-estradiol was added to the culture medium in a variety of concentrations. Cell growth and DNA, collagen, and proteoglycan synthesis were used as indicators of proliferation and differentiation of condylar chondrocytes. These were measured by cell number, 3H-proline and 35S-incorporation, respectively.

RESULTSE2 increased cell number and 3H-thymidine incorporation at 10(-8) to 10(-10) mol/L, and 10(-8) to 10(-11) mol/L in a dose-dependent manner, peaking at 10(-8) mol/L and 10(-9) mol/L, respectively. However, further increase in the concentration of estradiol caused inhibition of both cell number and 3H-thymidine incorporation, and this was significant at 10(-6) mol/L. The effect of E2 on proteoglycan synthesis was similar; the maximum stimulating effect was at 10(-8) mol/L, and inhibition was significant at 10(-6) mol/L. There was no obvious stimulatory effect of E2 on 3H-thymidine incorporation observed.

CONCLUSIONSEstradiol affects condylar chondrocyte cell growth, DNA, and proteoglycan synthesis in a biphasic manner depending on its concentration. This indicates that estrogen may be important in the proliferation and differentiation of mandibular condylar chondrocytes, and could be relevant to some aspects of certain temporomandibular joint diseases by modulating the function of the chondrocytes.

Animals ; Cartilage, Articular ; cytology ; metabolism ; Cell Differentiation ; Cell Division ; drug effects ; Cells, Cultured ; Estradiol ; pharmacology ; Mandibular Condyle ; cytology ; metabolism ; Rabbits

OBJECTIVETo test the antimetastatic effects of Arg-Asp (RD) on salivary adenoid cystic carcinoma (SACC-LM) in vivo.

METHODSRD was administered orally to experimental metastasized nude mice. The pulmonary metastatic foci number and survival were determined to assay the antimetastatic effects of RD.

RESULTS30 mg/kg, 120 mg/kg of RD demonstrated an inhibitory effect on the pulmonary metastatic foci formation. All of the tested dosages (7.5 mg/kg, 30 mg/kg, 120 mg/kg) of RD prolonged the survival.

CONCLUSIONSOral administration of RD has a antimetastatic effect on SACC-LM. RD is low toxicity.

Animals ; Antineoplastic Agents ; therapeutic use ; Arginine ; therapeutic use ; Aspartic Acid ; therapeutic use ; Carcinoma, Adenoid Cystic ; drug therapy ; prevention & control ; secondary ; Dose-Response Relationship, Drug ; Female ; Humans ; Lung Neoplasms ; prevention & control ; secondary ; Mice ; Mice, Inbred BALB C ; Neoplasm Metastasis ; prevention & control ; Salivary Gland Neoplasms ; drug therapy ; pathology