This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients' mean age was 60.09 ± 36.42 months (13-182 months), and their mean body weight was 20.16 ± 10.04 kg (9-77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms.The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58 ± 5.31 mm (3-28 mm), and the mean size of the occlusion device was 16.07 ± 5.29 mm (6-36 mm). The mean procedural times were 13.33 ± 2.82 minutes (6-16 minutes). The mean hospitalization costs were 27,259.66 ± 2507.04 RMB (25,200.00-33,911.45 RMB). The mean postoperative hospital stay was 3.22 ± 0.53 days (3-5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation.Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.
In 31 patients with intracranial germinoma who received radiotherapy, 15 were operated on, and 13 were treated with CSF shunt (7) and external ventricular drainage (6). After radiotherapy, clinical symptoms were improved in 93.5% of the patients. Follow-up of 16 patients for 2 to 14 years showed better results. We consider that initial treatment with radiotherapy may be appropriate for germinomas because of its high radiosensitivity. If hydrocephalus developed, external ventricular drainage combined with radiotherapy was performed, but shunting operation might be avoided because of potential peritoneal seedings of germinomas. In addition to chemotherapy, re-irradiation is an effective method for recurrent germinoma.
Objective: To investigate the safety, feasibility, and preliminary clinical experience of ultrasonic guided percutaneous portal vein punctures combined bi-directional angiography in the treatment by transjugular intrahepatic portosystemic shunt(TIPS). Methods: From January 2016 to June 2018, 15 patients with TIPS from our hospital who were treated by ultrasonic guided percutaneous portal vein punctures combined with bi-directional angiography were enrolled,and were recruited as experimental group. During the same period, 30 patients who were treated by TIPS combined with traditional methods were enrolled, and were recruited as control group. There was no statistical difference in baseline characteristics between the two groups (P > 0.05). The portal pressure difference in preoperative and postoperative, the fluoroscopy time, the number of puncture needles and complications were recorded. After treatment, the patients were followed up through outpatient service or telephone method. Results: The technical success rate was 100% in experimental group, and 96.7% in control group. In the experimental group, number of percutaneous transhepatic portal vein puncture by needle was 1-3 (average, 2.13 ± 0.74), and the number of portal vein puncture needles in the control group were 1-11 (average, 4.16 ± 2.13). The number of puncture needles in the experimental group were significantly decreased than in the control group (P < 0.001). In the experimental group, the fluoroscopy time was 18 ~ 46 (average 29.64 ± 8.79) minutes. In the control group, the fluoroscopy time was 12 ~ 150 (average 44.57 ± 26.84) minutes.The fluoroscopy time was significantly reduced in the experimental group compared with the control group(P = 0.023). Conclusion: Ultrasound-guided portal vein combined with bidirectional angiog-raphy is safe, feasible, and reliable in the treatment by TIPS. Compare with traditional TIPS, it can reduce the fluoroscopy time, the number of puncture needles and the liver injury.目的： 探讨超声引导穿刺门静脉联合双向造影在经颈静脉肝内门体分流术（TIPS）术中的安全性、可行性和初步临床经验。 方法： 选取2016年01月至2018年6月TIPS术中应用超声引导穿刺门静脉联合双向造影患者15例，设为实验组；随机选取同期采用传统TIPS患者30例，设为对照组。两组患者基本情况差异无统计学意义。记录患者穿刺针数、射线暴露时间及并发症等情况。不服从正态分布的计量资料采用非参数检验，计数资料比较采用χ(2)检验。 结果： 实验组技术成功率为100%，对照组技术成功率为96.77%。实验组穿刺针数为1～3针，共32针（2.13±0.74）针，对照组穿刺针数为1～11针，共125针（4.16±2.13）针，实验组较对照组穿刺针数明显减少，差异有统计学意义（P < 0.001）。实验组射线暴露时间为18～46（29.64±8.79）min，对照组射线暴露时间为12～150（44.57±26.84）min，实验组较对照组射线暴露时间明显减少，差异有统计学意义（P = 0.023）。 结论： 超声引导穿刺门静脉联合双向造影在TIPS术中安全、可行，该方法与传统TIPS相比，可明显缩短术中射线暴露时间、减少术中穿刺针数，减少对肝脏的损伤。.
To investigate the risk factors for re-dislocation after the closed reduction in children with developmental dysplasia of the hip (DDH).The clinical data of 88 children aged ≤ 18 months with DDH (103 hips) who were treated with adductor muscle relaxation + closed reduction + plaster fixation at the Children's Hospital, Zhejiang University School of Medicine from January 2015 to December 2017, were retrospectively analyzed. According to the diagnostic criteria of hip dislocation, patients were divided into two groups: reduction group and re-dislocation group. The univariate and multivariate logistic regression analysis were applied to identify the risk factors for the re-dislocation of children.Eighty-six patients (99 hips) successively underwent the treatment. 69 hips were fixed at the first intention, 9 hips at the second intention, and a total of 78 hips with no re-dislocation occurred till the last follow-up with a rate of 78.8%. The univariate analysis showed that preoperative acetabular index (AI), International Hip Dysplasia Institute (IHDI) grade, intraoperative hip flexion angle, and intraoperative head-socket spacing were significantly related to the occurrence of re-dislocation after closed-reduction. The multivariate logistic regression analysis showed that preoperative AI > 40.5° ( OR=5.57, P<0.01), flexion angle < 80.5° ( OR=4.93, P<0.01) and head-socket distance > 6.95 mm ( OR=8.42, P<0.01) were risk factors for the re-dislocation. The area under the receiver operator characteristic curve was 0.91 when preoperative AI > 40.5°, flexion angle < 80.5°, head-socket distance > 6.95 mm, and IHDI grade were used to predict the occurrence of re-dislocation, and the sensitivity and specificity were 0.72 and 0.87, respectively.Preoperative AI > 40.5°, intraoperative hip flexion angle < 80.5°, and head-socket distance > 6.95 mm are risk factors for postoperative re-dislocation in children with DDH. These risk factors combining with the IHDI grade would be better to predict the occurrence of re-dislocation.
Multiple DNA modifications have been identified in the mammalian genome. Of that, 5-methylcytosine and 5-hydroxymethylcytosine-mediated epigenetic mechanisms have been intensively studied. 5-hydroxymethylcytosine displays dynamic features during embryonic and postnatal development of the brain, plays a regulatory function in gene expression, and is involved in multiple neurological disorders. Here, we describe the detailed methods including immunofluorescence staining and DNA dot-blot to detect 5-hydroxymethylcytosine in cultured cells and brain tissues of mouse.
To compare the efficacy of percutaneous atrial septal defect (ASD) closure guided by transesophageal echocardiography (TEE) or guided by fluoroscopy in pediatric patients.Medical records of patients who underwent percutaneous ASD closure in the Children's Hospital, Zhejiang University School of Medicine from January 2017 to March 2018 were reviewed. There were 120 patients whose procedures were guided by TEE (TEE group), and 125 patients who had their procedures guided by fluoroscopy (fluoroscopy group). The performance of surgery, efficacy and postoperative complications were compared between two groups.Percutaneous ASD closure was successful in all patients. The operation time was shorter in the TEE group than that in fluoroscopy group[(20±14) min vs. (29±11) min, t=-7.939, P<0.05]. The size of the defect was larger in the TEE group than that of fluoroscopy group[(11±4) mm vs. (9±4) mm, t=2.512, P<0.05], but there was no significant difference in the sizes of occluder and occluder sheath between two groups (all P>0.05). No residual shunt, occluder shedding or displacement, severe arrhythmia or pericardial effusion were observed in either group. The incidence rates of fever, cough and diarrhea were not statistically different between two groups (all P>0.05).There was no significant difference in the outcome of percutaneous ASD closure guided by TEE or by fluoroscopy, but the procedure guided by TEE may reduce the operation time and can evaluate the size of ASD more accurately without involving radiation exposure, contrast agents use and large digital subtraction equipment.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)
