Objective
To evaluate the outcomes of urogenital sinus mobilization (UGSM) for congenital adrenal hyperplasia (CAH).
Methods
From September 2008 to July 2014, 13 cases of CAH underwent cliteroplasty and UGSM in one stage.They were divided into two groups of partial urogenital mobilization (PUM) and total urogenital mobilization (TUM). Their perioperative conditions were assessed.And postoperative postoperative lower urinary tract symptoms (LUTS) were evaluated by DAN-PSS scale and postoperative perineal appearance was graded by improved rating scale.
Results
The procedures of PUM (n=8) and TUM (n=5) were performed.The median operative age was 3.2 years for PUM versus 5.9 years for TUM, median length of common channel 1.1 cm for PUM versus 3.0 cm for TUM, median operative duration 180 min for PUM versus 200 min for TUM, median follow-up time 42 months for PUM versus 50 months for TUM.In PUM group, 2 cases presented obvious LUTS.One had frequent enuresis and another urinary incontinence.In TUM group, 3 cases presented obvious LUTS, there were moderate incomplete emptying (n=1), enuresis (n=1) and urinary incontinence (n=1). LUTS and perineal appearance had no inter-group difference.All cases had excellent postoperative urinary continence.The cosmetic outcomes were satisfactory (n=4), average (n=6) and unsatisfactory (n=3). Six cases of poor vaginal exposure were recommended for re-operation.
Conclusions
As an ideal treatment for female CAH, UGSM may be completed in one stage with cliteroplasty.Overall preoperative assessment of urogenital sinus status yields excellent cosmetics and functional outcomes.
Key words:
Congenital adrenal cortical hyperplasia; Urogenital sinus; Perineum
Exogenous stem cell therapy (SCT) has been recognized recently as a promising neuroregenerative strategy to augment recovery in stroke survivors. Mesenchymal stem cells (MSCs) are the primary source of stem cells used in the majority of both pre-clinical and clinical studies in stroke. In the absence of evidence-based guidelines on the use of SCT in stroke patients, understanding the progress of MSC research across published studies will assist researchers and clinicians in better achieving success in translating research. We conducted a systematic review on published literature using MSCs in both pre-clinical studies and clinical trials between 2008 and 2017 using the public databases PubMed and Ovid Medline, and the clinical trial registry ( www.clinicaltrials.gov ). A total of 78 pre-clinical studies and eight clinical studies were identified. While majority of the pre-clinical and clinical studies demonstrated statistically significant effects, the clinical significance of these findings was still unclear. Effect sizes could not be measured mainly due to reporting issues in pre-clinical studies, thus limiting our ability to compare results across studies quantitatively. The overall quality of both pre-clinical and clinical studies was sub-optimal. By conducting a systematic review of both pre-clinical and clinical studies on MSCs therapy in stroke, we assessed the quality of current evidence and identified several issues and gaps in translating animal studies to human trials. Addressing these issues and incorporating changes into future animal studies and human trials may lead to better success of stem cells-based therapeutics in the near future.
Objective To explore the effects of continuous veno-venous hemofiltration (CVVH) on respiratory function of critical patients with influenza A/H1N1. Methods Ten cases of influenza A/H1N1 eceived CVVH on the basis of conventional therapy. Before and at 24th, 48th, 72nd, 120th hour after intervention, serum inflammatory mediators [tumor necrosis factor-α (TNF-α) ,interleukin-6 (IL-6), IL-8,IL-10], respiratory mechanics indexes (airway pressure, static compliance, oxygenation index),extravascular lung water, blood gas analysis indexes (PaO2, PaCO2, pH) and APACHE Ⅱ score were determined. Results Compared with before CVVH intervention, TNF-α, IL-6, IL-8 in blood at 72th,120th hour after intervention were significantly decreased ( P ＜0.05). There was statistical significance on airway pressure, static compliance, oxygenation index between before CVVH intervention and at 72th hour after intervention ( P ＜0.05). Extravascular lung water gradually declined from 48th hour after intervention ( P ＜0.05). Compared with before treatment, PaO2, PCO2 improved at 72th hour after intervention ( P ＜0.05). Oxygenation index improved at 48th hour after intervention ( P ＜0.05), and had been stable at normal level at 72th hour after intervention. Meanwhile, APACHE Ⅱ score decreased at 72th hour after intervention ( P ＜0. 05). Conclusions For critical patients with influenza A/H1N1,CVVH can remove some inflammatory mediators and extravascular lung water, improve respiratory function, and increase the success rate of rescue.
Key words:
Continuous veno-venous hemofiltration; Influenza A/H1N1 ; Respiratory function
Background: The aim of this study is to explore the application value of layered suture technique in two-port laparoscopic choledocholithotomy with primary suture. Materials and Methods: A prospective study of 267 patients received laparoscopic common bile duct choledocholithotomy with primary suture in our hospital from January 2014 to July 2017. Of these cases, layered suture technique was utilised in 110 patients, and single-suture technique was used in 157 patients. The operation time, post-operative hospital stay and post-operative complications were compared between the two groups. Results: Two groups of patients were operated smoothly, with no conversations to laparotomy. Post-operative recovery was symptom free. The operative time was not significantly different between the two groups of patients (t = −0.587, P = 0.086). The post-operative hospital stay and incidence of post-operative bile leakage were significantly lower in layered suture group than those in single-layer suture group ([7.6 ± 1.8] days vs. [5.8 ± 1.7] days, t = 2.776, P = 0.000; 4.5% [5/110] vs. 20.4% [32/157], χ2 = 9.885, P = 0.002). In the single-layer suture group, the incidence of post-operative bile leakage was significantly higher in patients complicated with acute cholangitis (44.4% [12/27] vs. 15.4% [20/130], χ2 = 11.634, P = 0.001), whereas in the layered suture group, the incidence of post-operative bile leakage was insignificantly different among patients with and without acute cholangitis (11.8% [2/17] vs. 3.2% [3/93], χ2 = 0.848, P = 0.357). Conclusion: Application of layered suture technique in laparoscopic choledocholithotomy with primary suture is feasible and safe, with advantages of less bile leakage and shorter hospital stay.
In this multicenter study, we collected a total of 52 babies of 18-trisomy syndrome (34 cases were prenatally diagnosed and 18 failed to be diagnosed), and analyzed their characteristics. In the past 13 years, according to the data from the prenatal diagnosis center in Jiangsu, the estimated detection rate was 65.4% for trisomies 18 in the second trimester. After analyzed the distribution of the groups according to T18-risk, there were two important cut-off value to be noted: 1/455 and 1/5050. It was worthwhile noting that the risk of 65.4% trisomy 18 cases were higher than 1/455, 90.4% higher than 1/5050. However, 96.1% cases in normal control group were lower than 1/5050. No case from normal control group would be higher than the value of risk in 1/450. Meanwhile, the T18-risk of 50% T18 failed to be diagnosed cases were 1/1001~1/5050. If we chosen NIPT follow the standard of 1/5050, we could found 90.4 % T18 cases. It could increased 19.2% T18 babies be detected, but 3.2% normal mother would accepted the NIPT examination which maybe unnecessary. The prediction mode of HCG MoM and AFP MoM might be able to help us reduce the failed to be diagnosedis. It is also necessary to adjust more reasonable range of NIPT with further clinical researches.
AIM: To compare the expression of IL-1α and TNF-α mRNA in periapical disease between rats with immuno-suppression and rats without treatment to investigate the effect of immuno-suppression on periapical disease. METHODS: Cyclophosphamide, an immuno-suppressant, was injected into the abdominal cavity of rats and the expression of IL-1α and TNF-α mRNA was examined with RT-PCR. RESULT:The expression of IL-1α and TNF-α mRNA was detected in periapical tissues at 7 th day and formed a peak at 14 th day and slightly decreased at 28 th day after the injection of the cyclophosphamide. There was no significant difference between the test and control groups. CONCLUSION: Decrease of the peripheral leucocytes has no effect on periapical disease. [
In this randomized, placebo-controlled trial in subjects with obesity, we implemented multi-parametric MRI including fat fraction (FF), R2*, and T1 values on PET-MRI in both thermoneutral and cold-activated non-shivering thermogenesis conditions to investigate whether brown adipose tissue property changes measured by MRI can reflect its activation secondary to cold-activated stimulation and chronic capsinoids ingestion before and after weight loss. In subjects taking capsinoids, FF decreased and R2* increased significantly after weight loss as compared with baseline, and these changes were significantly larger than the changes seen after weight loss in the group taking placebo.
Objective To estimate the meaning of monitoring blood gas in mutual switch between invasive ventilation and noninvasive positive pressure ventilation in the treatment of patients with critical chronic obstructive pulmonary disease.Methods Patients with critical COPD admitted to ICU were treated with noninvasive positive pressure ventilation at first, and then were divided into two groups according to the results of blood gas analysis and relative conditions. Group A were treated with immediate switch to NIPPV. Group B were treated with no switch. Mortality, the incidence of ventilation associated pneumonia, the duration of mechanical ventilation and ICU stay were compared between the two groups.Results The mortality (13.3%) in patients of group A was significantly lower than that (100%) in patients of group B (P0.05). Incidence of VAP in patients of group A was significantly lower than that of group B (P0.05). The duration of mechanical ventilation and ICU stay in patients of group A were obviously shorter than those of group B (P0.05). Conclusion During mechanical ventilation of critical COPD patients, it is very important to determine the optimum time to switch mechanical ventilation from NIPPV to invasive ventilation or from invasive ventilation to NIPPV according to the results of blood gas analysis and relative conditions. A prompt change of mechanical ventilation mode can improve outcome of the patients and decrease the incidence of VAP and mortality.[
'/%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)
