Objective To investigate the efficacy and safety of the application of selective cerebral perfusion (SCP) technique in pediatric aortic arch reconstruction, so as to alleviate brain injury during operation. Methods From April 2007 to May 2008, 32 children aged from 8 days to 103 months (14.4±25.4 months) and weighed from 27 kg to 22.0 kg (6.7±4.4 kg) underwent aortic arch reconstruction with selective cerebral perfusion in Shanghai Children’s Medical Center. Twentytwo suffered from aortic coarctationwith intracardiac anomaly, and 10 suffered from interrupted aortic arch with intracardiac anomaly. The arterial cannulation was achieved by placing a flexible wire wound cannula in ascending aorta close to the root part of innominate artery. The rectal temperature was about 1820℃. Then the cannula was moved upward into innominate artery to perform SCP. Results The time of SCP was 17-121 mins（39.6±19.4 mins）, perfusion blood flow maintained in 15-40 ml/(kg·min)［29.7±6.1 ml/(kg·min）］. Four cases died of low cardiac output syndrome or arrhythmia, and no evidence of brain injury was observed. No obvious neurologic complication was observed in 28 survivls. No abnormal electroencephalogram was observed in 25 cases. The results of head Bsonography and brain magnetic resonance image (MRI) were normal in 5 neonates. Conclusion Selective cerebral perfusion is a simple, feasible, safe and effective technique in pediatric aortic arch reconstruction.
Objective To discuss the diagnostic value of multidetector CT(MDCT) on encapsulated fat necrosis after operation of abdominal cancer, and to investigate the key differences of CT features between encapsulated fat necrosis and postoperative recurrence or metastasis. Methods CT data of 36 patients with encapsulated fat necrosis after operation of abdominal cancer, who received CT in our hospital between Feb. 2012 to May. 2014 during followed-up were retrospectively analyzed, for the purpose of summarizing the CT characteristics. In addition, the clinical presentation, level of carcinoembryonic antigen (CEA) and CA-125 before and after operation were also taken into account, to explore the difference between encapsulated fat necrosis with tumor recurrence and metastasis. Results Among the 36 patients who had suffered from encapsulated fat necrosis after operation of abdominal cancer, 3 patients (8.3%) had 2 lesions and the rest of 33 patients (91.7%) had solitary lesion(a total of 39 lesions). All lesions showed non homogeneous masses consistent with the surgery path and surrounded by fat density ring and soft tissue density capsule. The size of most lesions (94.8%, 37/39) decreased over time. All lesions were found slightly enhancement in portal phase. Five patients with postoperative tumor metastasis, 31 patients had no recurrence or metastasis. Among the 5 patients who had postoperative tumor metastasis at the same time, postoperative CEA was positive in 3 patients, and postoperative CA-125 was positive in 2 patient. Among the other 31 patients who had no recurrence or metastasis, the levels of postoperative CEA and CA-125 of 1 patient were unknown, and the postoperative CEA and CA-125 of 27 patients in the rest patients(90.0%, 27/30) were both negative. Most of them had no special clinical symptoms, only a few (1 patient)patient had mild abdominal pain without other associated symptoms. Conclusion CT is a valuable tool to reveal and diagnose encapsulated fat necrosis in postoperative abdominal cancer. Combined CT findings(such as location, shape, and density) with CEA, CA-125, and clinical presentation, that is easy to differ it from postoperative recurrence and metastasis.
ObjectiveTo discuss the CT imaging differences between mass-forming intrahepatic cholangiocarcinoma (ICC) and poorly-differentiated hepatocellular carcinoma (HCC). MethodThe clinical and CT data of 28 patients with mass-forming ICC (mass-forming ICC group) and 27 patients with poorly-differentiated HCC (poorly-differentiated HCC group), who were confirmed by pathological diagnosis in the West China Hospital from February 2014 to August 2014, were collected and analyzed retrospectively. ResultsThe contour, margin, enhancement patterns in the arterial phase and portal vein phase of the tumor had significant differences between the mass-forming ICC group and poorlydifferentiated HCC group (P < 0.05), in other words, the lobulated shape (15/28, 53.6%), indistinct margin (17/28, 60.7%), peripheral enhancement in the arterial phase (21/28, 75.0%) and prolonged enhancement in the portal vein phase (14/28, 50.0%) were more often seen in the mass-forming ICC group, while the poorly-differentiated HCC group were mainly the round shape (17/27, 63.0%), partially well-defined margin (18/27, 66.7%), diffuse heterogeneous enhancement in arterial phase (20/27, 74.1%) and wash out in the portal vein phase (18/27, 66.7%). The presence of bile duct dilatation in the the mass-forming ICC group was significantly higher than that in the poorly-differentiated HCC group﹝57.1% (16/28) versus 14.8% (4/27), P=0.001﹞. The size and enhancement degree of lymph node in the mass-forming ICC group were significantly bigger or higher than those in the poorly-differentiated HCC group (average lymph node size: 1.7 cm versus 1.3 cm, P=0.009; average enhancement degree of lymph node: 62.6 HU versus 51.8 HU, P=0.031). ConclusionCT features, such as tumor contour, margin, enhancement characteristics, the presence of bile duct dilatation, and the size and enhancement degree of lymph node, might help for differentiating mass-forming ICC from poorly-differentiated HCC, so that more timely selection of appropriate treatment strategies would be made.
Objective To explore the role of activated macrophage in the repair of traumatic optic nerve injury in an animal model of incomplete traumatic optic nerve injury with lens damage.Methods One hundred and twelve healthy New Zealand big ear white rabbits were divided into two groups (experimental and control groups) randomly. According to the different time points (one, four, seven, ten, 14, 21 and 28 days), each group was further divided into seven subgroups, each subgroup had eight rabbits. Traumatic optic neuropathy and lens damage were induced in one eye of each rabbit by fluid percussion brain injury device (FPI); those eyes were the experimental group. The eyes of control group only had traumatic optic neuropathy. The functional and morphological changes of retina and optic nerve were evaluated by histopathology and flashvisual evoked potential (FVEP).Results FVEP P100 latency was (42.74plusmn; 5.83) ms, P100 amplitude was (7.98 plusmn; 2.15) mu;V before optic nerve injury was induced. One day after the injury, the P100latency increased and the P100amplitude reduced significantly. The P100 latency reached the longest at ten days after injury, and then recovered gradually. The P100 amplitude reached the lowest at seven days after injury, and then recovered gradually. The histopathological examination showed activated macrophages were not detected in the retina and optic nerve at day one after the injury, then they increased gradually and reached their peak (91.25plusmn;6.91) at day ten, and decreased after that, the difference was statistically significant (F=21.277, P=0.000); retinal ganglion cell axon regeneration began at day seven after the injury with an average of (6.38plusmn;1.85). The axons increased gradually and reached their peak (49.63plusmn;2.50) at day 28, and the changes were significant (F=7.711, P=0.000). Conclusions Incomplete optic nerve injury can recover gradually if there is lens damage at the same time. Activated macrophage may play an important role in this recovery process.
Comparison among multiple interventions has been realized due to the development of network meta-analysis and so far many studies have reported its implementation process. However, its results are rarely interpreted in domestic studies at present. This article interprets the results of trace plots, density plots, Brooks-Gelman-Rubin diagnosis plots, rankogram, surface under the cumulative ranking, and network plots, to provide references and assistance for further research regarding network meta-analysis.
ObjectiveTo summarize and explore the individualized surgical treatment strategy and prognosis of anomalous aortic origin of coronary artery (AAOCA). MethodsThe clinical data of children with AAOCA admitted to Shanghai Children's Medical Center from March 2018 to August 2021 were retrospectively analyzed. ResultsA total of 17 children were enrolled, including 13 males and 4 females, with a median age of 88 (44, 138) months and a median weight of 25 (18, 29) kg. All patients received operations. The methods of coronary artery management included coronary artery decapitation in 9 patients, coronary artery transplantation in 5 patients and coronary artery perforation in 3 patients. One patient with severe cardiac insufficiency (left ventricular ejection fraction 15%) received mechanical circulatory assistance after the operation for 12 days. No death occurred in the early postoperative period, the average ICU stay time was 4.3±3.0 d, and the total hospital stay was 14.4±6.1 d. All the children received regular anticoagulation therapy for 3 months after discharge. The median follow-up time was 15 (13, 24) months. All patients received regular anticoagulation therapy for 3 months after discharge. No clinical symptoms such as chest pain and syncope occurred again. The cardiac function grade was significantly improved compared with that before operation. Imaging examination showed that the coronary artery blood flow on the operation side was unobstructed, and no restenosis occurred. ConclusionAAOCA is easy to induce myocardial ischemia and even sudden cardiac death. Once diagnosed, operation should be carried out as soon as possible. According to the anatomic characteristics of coronary artery, the early effect of individualized surgery is satisfactory, and the symptoms of the children are significantly improved and the cardiac function recovers well in the mid-term follow-up.