BACKGROUND:Cholangitis is common in patients with biliary atresia following Kasai portoenterostomy (KPE). The prompt use of empiric antibiotics is essential due to the lack of identified microorganisms. The authors aimed to validate a severity grading system to guide empiric antibiotic therapy in the management of post-KPE cholangitis.MATERIALS AND METHODS:This multicenter, prospective, randomized, open-label study recruited patients with post-KPE cholangitis and was conducted from January 2018 to December 2019. On admission, patients were categorized into mild, moderate, and severe cholangitis according to the severity grading system. Patients in the mild cholangitis group were randomized to receive cefoperazone sodium tazobactam sodium (CSTS) or meropenem (MEPM). Patients with severe cholangitis were randomized to treatment with MEPM or a combination of MEPM plus immunoglobulin (MEPM+IVIG). Patients with moderate cholangitis received MEPM.RESULTS:The primary endpoint was duration of fever (DOF). Secondary outcomes included blood culture, length of hospital stay, incidence of recurrent cholangitis, jaundice clearance rate, and native liver survival (NLS). For mild cholangitis, DOF, and length of hospital stay were similar between those treated with CSTS or MEPM (all P >0.05). In addition, no significant difference in recurrence rate, jaundice clearance rate, and NLS was observed between patients treated with CSTS and MEPM at 1-month, 3-month, and 6-month follow-up. In patients with moderate cholangitis, the DOF was 36.00 (interquartile range: 24.00-48.00) h. In severe cholangitis, compared with MEPM, MEPM+IVIG decreased DOF and improved liver function by reducing alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and direct bilirubin at 1-month follow-up. However, recurrence rate, jaundice clearance rate, and NLS did not differ significantly between MEPM+IVIG and MEPM at 1-month, 3-month, and 6-month follow-up.CONCLUSIONS:In patients with post-KPE cholangitis, MEPM is not superior to CSTS for the treatment of mild cholangitis. However, MEPM+IVIG treatment was associated with better short-term clinical outcomes in patients with severe cholangitis.

Background and AimWe evaluated the clinical features of neonatal Hirschsprung's disease (HD)-associated bowel perforation (perforated HD) and investigated risk factors related to it.MethodsWe retrospectively collected clinical data of neonates (<1 month of age) with perforated HD from multicenters in China from January 2006 to December 2019. A total of 142 patients (6.7%) with perforated HD were enrolled in the study. A 1:2 matching method was used to compare the clinical information of HD patients with and without bowel perforation during the neonatal period. The risk factors for bowel perforation were identified using univariate and multivariate logistic risk regression analyses.ResultsPerforation site was present in the proximal ganglionic bowel in 101 (71.1%) cases and the distal aganglionosis segment in 41 (28.9%) cases. Adjacent marginal tissue from the perforated intestine revealed varying degrees of inflammatory cell infiltration, and the severity of enterocolitis was higher in the proximal ganglionic bowel than in the distal aganglionosis segment (p < 0.05). In the univariable and multivariable logistic analyses, clinical symptoms, such as vomiting (adjusted OR = 2.06, 95% CI: 2.01–2.88, p < 0.05), and inflammation index in hematologic tests, such as neutrophil proportion (adjusted OR = 1.09, 95% CI: 1.05–1.33, p < 0.05) and CRP (adjusted OR = 2.13, 95% CI: 1.01–3.27, p < 0.05) were associated with increased risk for perforated HD.ConclusionClinical Hirschsprung disease-associated enterocolitis (HAEC) highly correlated with perforated HD. Timely treatment of HAEC should be appropriate therapeutic approaches to prevent perforated HD.

回顾性分析2016年1月至2020年1月郑州大学第一附属医院灌肠复位治疗的436例原发性肠套叠患儿的临床资料，其中彩超引导水压灌肠组180例，X线下空气灌肠组256例。结果显示水压灌肠组的复位成功率为95%，高于空气灌肠组的84%，差异有统计学意义( P<0.05)；水压灌肠组肠套叠时间>48 h的复位率为92%，高于空气灌肠组的89%，差异有统计学意义( P<0.05)。两组均无肠穿孔发生。水压灌肠对原发性肠套叠患儿的复位率高、安全性强，并且可以避免X线辐射。

Objective This study aims to explore the effectiveness and safety of the new-type ultrasound-guided hydrostatic reduction for children with acute intussusception. Methods The clinical data of 364 children with primary acute intussusception who underwent nonsurgical reduction in our hospital between January 2016 and May 2019 were retrospectively analyzed. Among the 364 children, 119 formed the hydrostatic reduction group. There were 89 males and 30 females, and the average age of admission was 25.13 ± 1.43 months. Among the pneumatic reduction group of 245 patients, there were 163 males and 82 females. The average age of admission was 22.47 ± 1.52 months. The reduction rate, length of stay, and perforation rate were compared between the two groups. Results Univariate analysis showed that the reduction rate in the hydrostatic group (94.96%) was higher than in the pneumatic group (85.31%) ( p = 0.007), and the hospital stay (2.76 ± 0.15 days) of the hydrostatic reduction group was shorter than that of the pneumatic reduction group (3.56 ± 0.35 days) ( p = 0.038). In children with intussusception time >48 h, the reduction rate was 95.45% in the hydrostatic reduction group and 86.20% in the pneumatic reduction group. Conclusion The new-type ultrasound-guided hydrostatic reduction has a higher reduction rate in the treatment of acute intussusception in children results in a shortened hospital stay, It is effective, safe, and avoids radiation exposure.

Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it. Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP). Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant ( P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions ( P < 0.05). Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.

Objective:To enhance the awareness of biliary hypoplasia (BH) through exploring its diagnosis, treatment and prognosis.Methods:For this retrospective study, the clinical data of BH were collected at five domestic hospitals from January 2009 to January 2017. There were 18 boys and 12 girls with an operative age of (83±36) days, a birth weight of (2.75±1.0) kg and a postnatal time of jaundice at (30±6) days. Their birth was term ( n=21) and premature ( n=9). And the stool was pale yellow stool ( n=28) and white ( n=2); dark urine ( n=19); hepatomegaly & splenomegaly ( n=18); mild ascites ( n=12). Results:All of them were operated. The procedures included cholecystostomy ( n=20), cholangiography & biliary flushing ( n=8) and non-treatment after cholangiography ( n=2). And postoperative medications included antibiotics ( n=15), hormone ( n=22), hepatic protector & cholagogue ( n=30) and gamma globulin ( n=9). The follow-up period was 40 to 288 weeks. Jaundice subsided ( n=21) and persisted ( n=9) within 6 months. And 4/9 had the complications of itchiness ( n=3) (1/3 with growth retardation) and anemia ( n=1). They were divided into two groups of good prognosis ( n=21) and poor prognosis ( n=9) according to whether or not jaundice clearing at 6 months post-operation (icteric regression, total bilirubin ≤20 μmol/L), the growth up to standard and presence/absence of complications. Hepatocyte degeneration ( n=6 vs. 8) and spot-like necrosis ( n=3 vs. 7) were found in good and poor prognosis group. And the difference was statistically significant ( P=0.004 & 0.002). Conclusions:As a rare disease, BH may be diagnosed by cholangiography and liver biopsy and treated by surgery and postoperative medications. Surgical options include cholecystostomy and flushing. The overall prognosis is excellent. A poor prognosis may be associated with hepatic injury.

目的 总结儿童及青少年炎性肌纤维母细胞瘤(IMT)的诊断及治疗经验.方法 回顾性分析2013年11月至2018年6月郑州大学第一附属医院15例病理确诊为IMT的患儿(≤18岁)临床资料.结果 15例患儿中,男8例,女7例;入院年龄11个月～18岁;随访时间1个月～4.7年.6例腹腔IMT表现为腹胀、腹痛、腹部包块、血便、皮肤黏膜黄染等症状,2例膀胱IMT表现为血尿,4例肺部IMT表现为咳嗽、咳痰、呼吸困难、胸部疼痛,3例颌面颈部IMT表现为肿胀、触及包块.15例患儿入院查血常规:6例(40.0％)患儿白细胞计数升高,10例(66.7％)患儿贫血.3例患儿行红细胞沉降率检测均升高.9例患儿行C反应蛋白检测,4例(44.4％)升高.11例患儿肿瘤标志物检测未见特异性.15例患儿均行抗炎治疗.11例患儿CT显示瘤体边界清楚,手术完整切除;3例患儿CT显示瘤体边界不清,侵袭周围组织器官,姑息切除;1例穿刺活检后家属放弃治疗.免疫组织化学间变性淋巴瘤激酶(ALK)阳性患儿8例(67％),2例应用荧光原位杂交技术行基因检测显示ALK基因激活,服用克唑替尼.11例手术完整切除患儿中1例术后规律化疗:9例患儿术后无复发,1例术后因胸腔重度感染死亡,1例失访.3例瘤体姑息切除患儿:1例术后规律化疗,未见复发;1例术后7个月复发再次手术并规律化疗,现无复发;1例术后1年内2次复发均手术姑息切除,现带瘤生存.结论 IMT较为罕见,临床表现及辅助检查缺乏特异性.完全切除是治疗的关键,必要时行抗炎、放化疗、靶向治疗等综合治疗.完整切除预后良好,术后应定期复查.

OBJECTIVE:This study aims to elucidate the regulatory effect of circular RNA UBAP2 (circUBAP2) on the progression of ovarian cancer (OC).PATIENTS AND METHODS:Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the expressions of circUBAP2, microRNA-144 and CHD2 in OC tissues and adjacent normal tissues. The correlation between the expression levels of circUBAP2 and microRNA-144 with pathological parameters of OC patients was analyzed. Subcellular distribution of circUBAP2 was detected by chromatin fractionation assay. After overexpression of circUBAP2 in OC cells, changes in proliferative and migratory abilities were evaluated by Cell Counting Kit-8 (CCK-8) and transwell assay, respectively. In addition, the Dual-Luciferase reporter gene assay was used to verify the binding of circUBAP2 and microRNA-144, and the binding of CHD2 to microRNA-144.RESULTS:QRT-PCR results showed that circUBAP2 was highly expressed in OC tissues, and its expression was negatively correlated with TMN stage and five-year survival of OC patients. CircUBAP2 was mainly distributed in the cytoplasm. Overexpression of circUBAP2 significantly promoted the proliferative and migratory abilities of OC cells. The Dual-Luciferase reporter gene assay demonstrated that circUBAP2 could bind to microRNA-144. Meanwhile, circUBAP2 negatively regulated microRNA-144 expression in OC cells. Besides, the promotive effects of circUBAP2 on the proliferation and migration of OC cells were reversed by microRNA-144 overexpression. MicroRNA-144 was lowly expressed in OC tissues, which was negatively correlated with TNM stage of OC patients. The Dual-Luciferase reporter gene assay confirmed the binding condition between CHD2 and microRNA-144. CHD2 expression was negatively regulated by microRNA-144 in OC cells. Moreover, CHD2 could bind to microRNA-144 and partially inhibited its activity, thereby promoting the proliferative and migratory abilities of OC cells.CONCLUSIONS:CircUBAP2 promotes the progression of ovarian cancer by adsorbing microRNA-144.

Kasabach-Merritt现象(卡-梅现象)是主要由卡波西样血管内皮细胞瘤或丛状血管瘤所引起的严重血小板减少和消耗性凝血功能障碍为特征的一类疾病.该类疾病好发于婴幼儿,往往起病较急,病情进展迅速,若得不到及时诊治,可引起严重并发症,甚至危及生命.鉴于当前在卡-梅现象的诊断和治疗方面还存在一定分歧,为了提高国内对卡-梅现象的认识和诊治水平,规范临床治疗,我们组织国内相关专家讨论并制定了本专家共识.该共识对卡-梅现象的发病机制、临床表现、诊断方法及治疗流程等给出了规范化建议.可供临床实践参考.

Objective To explore the effect of nursing intervention on the biofeedback effect of functional constipation in children. Methods A total of 112 children (4-16 years old) who were diagnosed with functional constipation in the Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University were randomly divided into the experimental group (54 cases) and the control group (53 cases). Children in the experimental group were treated with biofeedback training and personalized nursing intervention for functional constipation in children. The control group used biofeedback combined with traditional nursing intervention to treat functional constipation in children. The WHO-5 (World Health Organization′s five physical and mental health) scales were used to compare the effects of the two groups and were followed up for 3-6 months. Results A total of 107 children completed the study, 54 in the experimental group and 53 in the control group. There were no significant differences in the scores of the WHO-5 scale and clinical symptoms between the two groups before the intervention (P>0.05). After intervention, the total score of WHO-5 in the experimental group was (21.69± 2.28), the total score of clinical symptoms was (6.56±1.16), the total score of WHO-5 in the control group was (17.85 ± 3.189), and the total score of clinical symptoms was (9.04 ± 2.121). The difference was significant (t=-7.146, t=7.491, P<0.01). Conclusion Personalized nursing intervention can enhance the effect of biofeedback training on children and adolescents with functional constipation and improve their quality of life.

This study aimed to demonstrate whether exposure to bifidobacteria during early life influences immunity and alleviates the risk of immunoglobulin E (IgE)-mediated allergies in adulthood. BALB/c neonatal mice (n=54) were administered with a lyophilised cell preparation of Bifidobacterium bifidum TMC3115 (TMC3115) for 3 weeks. Following the intervention, the mice were immunised with intraperitoneal ovalbumin (OVA). The morphology and function of the intestinal epithelium were determined using histopathological examinations. Intestinal microbiota was detected using quantitative PCR and characterised using next-generation sequencing of 16S rRNA genes from faecal DNA. Caecal short-chain fatty acids (SCFAs) were measured using gas chromatography-mass spectrometry. Serum levels of tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and immunoglobulin E (IgE) and the percentage of splenic CD4+ T cells were examined using enzyme-linked immunosorbent assay and flow cytometry, respectively. TMC3115 did not significantly affect body weight, and cause any severe systemic inflammation or other clinical symptoms among the neonatal or adult mice, although the crypt depths and Muc2-positive cells in some intestinal segments of neonatal mice were significantly lower than control. Oral TMC3115 administration significantly increased faecal microbial diversity, relative abundance of Bacteroidetes and caecal SCFAs production in neonatal mice. Following the intervention, neonatal mice treated with TMC3115 exhibited less increase in serum IgE levels induced by OVA in adults and significantly higher TNF-α and IL-10 levels than in control. Our findings indicate that the oral administration of bifidobacteria, particularly certain strains, such as TMC3115, during early life could alleviate the risk of IgE-mediated allergies in adult host animals. Modifications of intestinal microbiota, SCFAs metabolism and anti-inflammatory cytokine IL-10 production by bifidobacteria may at least in part be a key mechanism underlying the effect of bifidobacteria on the IgE-mediated immune sensitivity of hosts to attacks by allergens at both neonatal and adult stages.

ABSTRACT Necrotizing enterocolitis (NEC) is a potentially fatal illness in premature neonates. Tumor necrosis factor-α (TNF-α) and autophagy are associated with the pathogenesis of NEC. This study aimed to explore whether TNF-α might regulate apoptosis in neonatal NEC model cells IEC-6 via regulation of autophagy. NEC rat model was induced by hand feeding and exposure to asphyxia/cold-stress for histologic examination. The NEC in vitro model (IEC-6/NEC cells) was established by stimulating the intestinal epithelial cell line IEC-6 with lipopolysaccharide (LPS, 100 μg/mL) for 3 h to investigate the effects of TNF-α on IEC-6 proliferation and apoptosis. In this study, NEC rats showed decreased proliferating cell nuclear antigen (PCNA) expression, increased TUNEL-positive cells, higher expression of TNF-α, p-ERK1/2, and autophagy-related proteins in rat small intestine compared with their controls. Additionally, the LPS-stimulated IEC-6/NEC cells showed a significantly decreased proliferation and increased apoptosis compared with the control cells. Furthermore, the LPS-stimulated IEC-6/NEC cells exhibited enhanced autophagy level, as evidenced by a dose-dependent increase in Beclin-1 protein expression, LC3II/LC3I ratio and accumulation of MDC-positive autophagic vacuoles. Moreover, inhibition of autophagy by wortmannin or LY294002 significantly abolished the LPS-mediated decreased proliferation and increased apoptosis of IEC-6/NEC cells. Results also showed that inhibition of ERK1/2 pathway using U0126 significantly inhibited TNF-α-induced autophagy. Furthermore, the TNF-α-mediated inhibition of IEC-6 proliferation and promotion of IEC-6 apoptosis was abolished by U0126. Our findings demonstrated that TNF-α might induce autophagy through ERK1/2 pathway to regulate apoptosis in neonatal NEC cells IEC-6. Our study enhances our understanding of neonatal NEC pathogenesis.

OBJECTIVE:Growing evidence has identified that excessive accumulation of pericardial adipose tissues (PAT) and epicardial adipose tissues (EAT) is associated with atrial fibrillation (AF) development. Moreover, beige adipocytes, present in PAT and EAT, have been proved beneficial in consumption of fatty acid and promotion of weight lose by nonshivering thermogenesis. The objective of this prospective, observational study was to reveal the potential association between beige adipocytes and AF development.PATIENTS AND METHODS:Fat tissues from subcutaneous adipose tissue (SAT), PAT and EAT were obtained from 70 AF and 30 sinus rhythm patients. Hematoxylin and eosin (H&E) staining were performed to analyze morphological changes in fat tissues. Real-time PCR was performed to identify mRNA expression of unique uncoupling protein-1 (UCP-1). Western blotting and immunohistochemistry (IHC) were performed to determine protein expression of UCP-1.RESULTS:Our results indicated that pericardial and epicardial adipocytes in AF patients demonstrated white-like change tendency and had lower expression of UCP-1 when compared to sinus rhythm patients. Additionally, the decrease of UCP-1 mRNA expression in PAT and EAT, together with LA enlargement, were independent risk factors of AF. Further, UCP-1 mRNA expression in EAT, but not in PAT, have a significant correlation with LA diameter. The function of nonshivering thermogenesis in PAT and EAT was impaired in AF patients, and this dysfunction in EAT had a great correlation with LA dilation.CONCLUSIONS:Our data provide a new therapeutic target for LA remodeling and AF treatment.

Objective To construct a recombinant retrovirus vector expressing small interfering RNA (siRNA) targeting human telomerase reverse transcriptase (hTERT),and assess its effect on proliferation and apoptosis of human hepatoblastoma cells.Methods The sequences of the siRNA targeting hTERT,U6 promoter and enhanced green fluorescent protein (EGFP) gene were amplified by polymerase chain reaction (PCR) and inserted into the mammalian retroviral expression vector pLXSN.The PCR method was used to amplify hTERT-siRNA,EGFP,DNA fragment of U6 + 27.The retroviral expression vector pLXSN-EGFP-U6-siTERT was constructed and subjected to enzyme digestion identification.The recombinant retroviral vector pLXSN-EGFP-U6-siTERT was constructed.The vector was then used to infect human hepatoblastoma cell HepG2.The telomerase activity of the infected cells was detected by telomerase repeat amplification protocol-silver staining,and the cell apoptosis was examined using flow cytometry.The inhibition rate of HepG2 cell proliferation was analyzed by methyl thiazol tetrazolium (MTF) assay.Results hTERT-siRNA retroviral expression vectors were successfully prepared.In the control group,the telomerase activity was 2 143.06 ± 198.69.At 24,48 and 72 h after colony forming units (CFU) recombinant virus infection the telomerase activity was 1 632.02 ± 116.28,899.38 ± 126.11 and 321.25 ± 25.25 respectively.As compared with before infection,the telomerase activity was respectively decreased by 23.84％,58.03％ and 85.01％.There was significant difference among different time groups (P =0.046,0.024 and 0.008).The results of flow cytometry showed that there was significant difference in the cell apoptosis rate between the experimental group and the control group with different titer of recombinant virus infection,and there was a concentration-dependent relationship.At 24 h after 1 × 105 CFU recombinant virus infection,the apoptosis rate was 29.05％.MTT results showed that apoptosis rate was 29.05 ％ at 24 h after recombinant virus infection,the tumor cell death was significant,and with the increase in virus titer and prolongation of time,cell death also gradually increased.At 24,48 and 72 h after virus infection of 6.0 × 105 CFU,the results of MTT assay were 0.29 ± 0.14,0.20 ± 0.13 and 0.18 ±0.I1 respectively.At 24,48 and 72 h after virus infection of 3.0 × 105 CFU,MTT results were 0.32 ±0.11,0.26 ±0.12 and 0.25 ±0.10.At 24,48 and 72 h after virus infection of 1.0 × 105 CFU,results of MTT assay were 0.33 ±0.12,0.26 ±0.13 and 0.26 ±0.12.At 24,48 and 72 h after virus infection of 1.0 × 104 CFU,the results of MTT assay were 0.43 ±0.14,0.35 ±0.10 and 0.33 ±0.15.At 24,48 and 72 h after virus infection of 1.0 × 103 CFU,the results of MTT assay were 0.52 ± 0.11,0.44 ±0.13 and 0.44 ±0.10.At 24,48 and 72 h after virus infection of 1.0 × 102 CFU,the results of MTT assay were 0.65 ±0.13,0.61 ±0.15 and 0.60 ±0.16.In the negative control group,the results of MTT assay were 0.69 ±0.11,1.01 ±0.14 and 2.98 ±0.16 respectively at 24,48 and 72 h.There existed the concentration-effect and time-effect relationship (P =0.037,0.034 and 0.028).Conclusion hTERT-siRNA can effectively silence hTERT gene and suppress the telomerase activity and proliferation of HepG2 cells.

Objective To explore the etiology,classification,treatment and prognosis of congenital absence of skin so as to improve its management.Methods Retrospective analyses were performed for the clinical characteristics and treatment in 3 cases of congenital absence of skin at our hospital.And 305 cases of congenital absence of skin were collected from the literature.Results Three cases of skin defect healed by parchment-like scar tissue.And there was neither contracture nor dysfunction.Among 305 cases,there were 8 deaths and 234 cases received conservative treatments.And 5/63 surgical eases were affected by scar contracture.The mortality and disability rates were low.Conclusions The etiology of congenital skin defect has remained elusive.Superficial wound may be managed conservatively.Cases of bone exposure,vital organ exposure and deep defect should be operated.If treated properly,the prognosis is excellent without any significant impact of daily life.

MicroRNAs (miRNAs) are dynamically regulated during neurodevelopment, yet few reports have examined their role in spina bifida. In this study, we used an established fetal rat model of spina bifida induced by intragastrically administering olive oil-containing all-trans retinoic acid to dams on day 10 of pregnancy. Dams that received intragastric administration of all-trans retinoic acid-free olive oil served as controls. The miRNA expression profile in the amniotic fluid of rats at 20 days of pregnancy was analyzed using an miRNA microarray assay. Compared with that in control fetuses, the expression of miRNA-9, miRNA-124a, and miRNA-138 was significantly decreased (> 2-fold), whereas the expression of miRNA-134 was significantly increased (> 4-fold) in the amniotic fluid of rats with fetuses modeling spina bifida. These results were validated using real-time quantitative reverse-transcription polymerase chain reaction. Hierarchical clustering analysis of the microarray data showed that these differentially expressed miRNAs could distinguish fetuses modeling spina bifida from control fetuses. Our bioinformatics analysis suggested that these differentially expressed miRNAs were associated with many cytological pathways, including a nervous system development signaling pathway. These findings indicate that further studies are warranted examining the role of miRNAs through their regulation of a variety of cell functional pathways in the pathogenesis of spina bifida. Such studies may provide novel targets for the early diagnosis and treatment of spina bifida.

Objective To explore the clinical application and efficacy in the treatment of children with bilateral Wilms tumor(BWT) by retroperitoneal nephrectomy or transabdominal nephrectomy.Methods Clinical data of 27 children with BWT in which 9 cases underwent retroperitoneal nephrectomy (study group) while 18 cases underwent transabdominal nephrectomy (control group) at Department of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University from April 1997 to July 2014 were retrospectively analyzed.The perioperative clinical parameters and survival data were compared between the study group and the control group.Results The operation duration [(129.5 ± 13.9) min],the length of intensive care unit (ICU) postoperatively [(6.3 ± 3.1) d],hospital stay [(13.9 ± 3.9) d] and the time to resuming an oral diet [(6.8 ± 3.4) d] of the study group were markedly lower than those of the control group [(149.5 ± 26.7) min,(9.7 ± 3.8) d,(20.5 ± 3.0) d,(11.5 ± 3.1) d],and the differences were statistically significant (t =2.129,P =0.051;t =2.551,P =0.017;t =4.489,P ＜ 0.001;t =3.488,P =0.002).The estimated blood loss [(95.5 ± 14.6) mL],postoperative renal recovery time [(22.3 ± 3.1) d] and mean serum creatinine levels by follow-up [(67.0 ± 21.3) μmol/L] of study group were lower than those of the control group [(105.9 ± 23.1) mL,(24.7 ± 4.5) d,(76.8 ± 13.3) μmol/L],but the differences were not significant (t =1.231,1.485,1.474,P =0.243,0.163,0.154).There was a similar tendency that i ntraoperative adverse event rates [0 (0/9 cases)] and postoperative urine leakage rates [11.1％ (1/9 cases)] of the study group were lower than those of the control group [11.1％ (2/18 cases),16.7％ (3/18 cases)],but the differences were not significant (P =0.103,0.093).Study group revealed longer median survival time than that of the control group and cumulative survival hazard of study group was lower than that of the control group (28.5 months,95 ％ CI:23.2-33.7 months vs 22.4 months,95 ％ CI:12.6-32.1 months;x2 =0.469,P =0.494).Conclusions Retroperitoneal nephrectomy provides valuable benefits clinically,including shorter operative time,postoperative length of ICU and hospital stays,avoidance of bowel injuries,and less adhesions and shorter time to resuming an oral diet over the transabdominal counterpart,which can be considered a viable surgical option for treatment of BWT.