BACKGROUND:Obstructive sleep apnea (OSA) can affect the growth and development of children, and serious OSA can lead to significant complications if left untreated. Children with cerebral palsy (CP) also experience sleep problems. Therefore, the present study examined the prevalence and differences of OSA in children with CP compared to healthy children. In addition, it sought to classify the children with CP according to different severities and clinical types in order to investigate whether there are differences in the severity of OSA and in sleep and respiratory characteristics among groups of children with different severities of CP. METHODS:One hundred and fifty-six children with CP and one hundred and fifty healthy children completed the Pediatric Sleep Questionnaire (PSQ). Based on the PSQ results, a threshold of 0.33 was used to define high risk of OSA. Children identified as high risk underwent polysomnography (PSG) to analyze their sleep structure, breathing events, oxygen saturation, and heart rate. RESULTS:48.7% of children with CP and 26.67% of healthy children identified as high risk of OSA. The prevalence of OSA in children with CP (23.72%) was higher than that in healthy children (7.3%). Thus, children with CP have both a higher risk and a higher prevalence of OSA than healthy children, but the difference in the severity of OSA was not statistically significant.Also, there were no differences in OSA severity among groups of children with varying severities and types of CP. The proportion of rapid eyes movement (REM) sleep time, minimum transcutaneous oxygen saturation (SpO2), and average SpO2 during the sleep period was lower in children with CP than in healthy children. However, the N2 ratio, sleep latency (SL), OAI, OAHI and ODI were higher in children with CP as compared to healthy children. Additionally, the average and maximum heart rates during sleep were higher in children with CP than in healthy children. According to the severity of CP and clinical classification, children with severe CP exhibited a lower proportion of REM sleep time, a lower N3 ratio, reduced total sleep time (TST), decreased sleep efficiency (SE), and lower average SpO2 during the sleep period compared to children with mild and moderate CP. However, they had a higher N2 ratio, increased OAI, elevated ODI, and a higher maximum heart rate during the sleep period compared to children with mild and moderate CP. Children with dyskinetic CP had a higher ODI index and N2 ratio than children with spastic CP. CONCLUSION:Children with CP have a higher risk and prevalence of OSA than healthy children. Although there were no differences in OSA severity among groups of children with varying severities of CP, children with severe CP exhibited more severe sleep disturbances and breathing issues compared to children with mild and moderate CP.

目的 观察非典型肾球旁细胞瘤患者临床特征,探讨手术治疗的效果和安全性.方法 回顾性分析5例非典型肾球旁细胞瘤患者的临床资料.5例术前行全腹部CT平扫+增强扫描及胸部CT平扫检查,测定血钾水平,行立卧位醛固酮试验测定卧位及立位时血浆肾素活性、血管紧张素Ⅱ和醛固酮水平.3例腹部CT提示肾上腺增粗者测定促肾上腺皮质激素、血皮质醇节律、肾上腺素、去甲肾上腺素、多巴胺及尿香草苦杏仁酸水平,其中2例提示肾上腺髓质增生.5例于全身麻醉下行机器人辅助腹腔镜或传统腹腔镜辅助保留肾单位手术,2例肾上腺髓质增生者同期行肾上腺切除术.记录手术情况,术后漏尿、肾动静脉瘘、感染及延迟出血等并发症发生情况;手术切除肿瘤组织常规行组织病理及免疫组织化学检查.术后每6～12个月复查CT,测定血浆肾素活性、血管紧张素Ⅱ和醛固酮水平及血压;随访6～92个月,记录肿瘤复发、转移及血压、肾素活性、醛固酮、血钾等情况.结果 5例术前腹部CT平扫均表现为肾内类圆形低密度病灶,增强扫描示病灶呈实性软组织密度影,边界清,形态规则,延迟期、髓质期轻中度强化,3例CT检查提示肾上腺增粗;5例胸部CT检查均未见异常.5例术前血钾水平[(3.59～5.07)mmol/L]正常;卧位血浆肾素活性为9.64～24.71 ng/(mL·h)、血管紧张素Ⅱ为 93.90～126.00 ng/L、醛固酮为146.40～352.00 ng/L,立位血浆肾素活性为 14.50～25.30 ng/(mL·h)、血管紧张素 Ⅱ 为 103.00～155.30 ng/L、醛固酮为 187.20～609.00 ng/L,均升高;3 例腹部CT提示肾上腺增粗者促肾上腺皮质激素、血皮质醇节律、肾上腺素、去甲肾上腺素及多巴胺水平均正常,其中2例尿香草苦杏仁酸水平升高,分别为86、89 μmol/24 h.5例手术均顺利完成,手术时间90～126 min,术中出血量40～100 mL,术后均未发生漏尿、肾动静脉瘘、感染及延迟出血等并发症.5例术后组织病理均证实为肾脏球旁细胞瘤,镜下可见纤维包膜,与周围肾组织分界清晰;肿瘤间质血管丰富,肿瘤细胞呈中等大小,细胞核形态规则,位于胞质中央,未见病理性核分裂;免疫组织化学示CD34、Vimentin阳性,CK阴性,Ki-67阳性表达率5％～15％,4例SMA阳性,4例HBM-45阴性.随访至2022年4月,5例血压及血浆肾素活性、血管紧张素Ⅱ、醛固酮水平均正常,未发生肿瘤复发或转移.结论 非典型肾球旁细胞瘤患者临床可表现为高血压、高肾素活性、高醛固酮水平,血钾水平正常;行保留肾单位手术或联合肾上腺切除术治疗可降低患者高血压,安全性好.

Background Global developmental delay (GDD) is a common neurodevelopmental disorder in childhood whose clinical manifestations are diverse. Currently, there are few large sample analyses of the gender differences of clinical manifestations in GDD children in China. Objective To investigate the gender differences of clinical data in GDD children. Methods Seven hundred and ninety-nine GDD children who received initial inpatient treatment from Department of Child Rehabilitation, Third Affiliated Hospital of Zhengzhou University from January 2020 to February 2022 were recruited. Clinical data including maternal data in pregnancy and the perinatal period, and general data, measurement results of EEG, brain MRI, the Chinese version of Gesell Developmental Scales-Revised of the children and comorbidity rate were retrospectively collected. Gender differences of clinical data of GDD children were analyzed. Results The ratio of male children (n=568) to female children (n=231) was 2.46∶1. The age of first visit in male children〔19.0 (8.8, 33.0) 〕 was older than that of female children〔12.7 (6.8, 27.0) 〕 (P<0.05). The chief complaint was motor retardation (51.1%, 118/231) in female children, and language retardation (41.4%, 235/568) in male children. There were significant differences in chief complaint, birth season, gestational age at birth, gestational age at birth in relation to birth weight, birth weight classification and fine motor classification between male and female children (P<0.05). Male children had lower rates of fetal intrauterine distress, EEG abnormalities and microcephaly and higher rate of autism spectrum disorder than female children (P<0.05) . Conclusion There are gender differences in some clinical data of children with GDD. Male children have higher prevalence of GDD, and females have more clinical symptoms.

目的 比较机器人辅助腹腔镜膀胱阴道瘘修补术(RALVR)与腹腔镜膀胱阴道瘘修补术(LVR)治疗高位膀胱阴道瘘(VVF)的效果.方法 回顾性分析 2018-01-2022-06 郑州大学第一附属医院泌尿外科收治的高位VVF患者的临床资料,分为RALVR组(23 例)和LVR组(35 例).比较2 组患者的基线资料、术中情况、术后临床指标,以及并发症发生率.结果 2 组术中出血量、手术成功率,以及术后并发症发生率的差异均无统计学意义(P＞0.05).RALVR组的手术时间、术后引流管拔除时间和住院时间均短于LVR组,差异有统计学意义(P＜0.05).结论 对于高位VVF患者,RALVR与LVR有相同的安全性和良好效果.但RALVR具有更加灵活、高效,以及手术时间和住院时间短的优势,更利于患者术后恢复.

Objective:To observe the effect of mirror visual feedback training on upper limb function and muscle tension in children with spastic hemiplegia resulting from cerebral palsy (SHCP).Methods:Seventy-six children aged 2-5 with SHCP were randomly divided into a control group of 33 and a treatment group 34. All were given routine occupational therapy, physical therapy, massage and physical agents. Each therapy session lasted 30 minutes daily, 5 times a week over 3 weeks as a course of treatment. There was a one week interval after each of 6 courses, so the total treatment lasted 6 months. The treatment group was additionally trained with mirror visual feedback with the same schedule. Before, as well as after 3 and 6 months of treatment, each patient′s upper limb motor function, fine motor function and muscle tone were evaluated using the Fugl-Meyer motor function assessment scale (FMA), the Peabody fine motor development scales (PDMS-FM), the modified Ashworth scale (MAS) and integrated electromyograms (iEMGs).Results:There were no significant differences between the two groups before treatment. After both 3 and 6 months significant improvement was observed in both groups′ average FMA score, PDMS-FM total score, grip, and visual motor integration. At both points the treatment group′s averages were significantly better than those of the control group. The average MAS and iEMG results, however, were not significantly different at either time point.Conclusions:For children with spastic hemiplegia caused by cerebral palsy, mirror visual feedback training can effectively improve upper limb functioning, but it cannot reduce their muscle tone.

Objective:To analyze the clinical characteristics and genetic basis of two children patients with CHARGE syndrome.Methods:The clinical features of the two patients were analyzed, and potential variants were detected by Trio whole exome sequencing (trio-WES) of the probands and their parents.Results:Child 1 has manifested cerebellar vermis dysplasia, enlargement of cerebral ventricles, whereas child 2 manifested with infantile spasm and congenital hip dysplasia. Both children were found to harbor de novo heterozygous variants of the CHD7 gene, namely c. 4015C>T (exon 17) and c. 5050G>A (exon 22). Based on the guidelines of the American College of Medical Genetics and Genomics, the two variants were rated as pathogenic variants, and the related disease was CHARGE syndrome. Furthermore, child 2 was also found to harbor a novel heterozygous c. 6161A>C (p.Gln2054Pro) missense variant of COL12A1 gene, which was rated as possibly pathogenic, and the associated disease was Bethlem myopathy type 2, which is partially matched with the patient’s clinical phenotype. Conclusion:The special clinical phenotypes shown by the two children harboring novel CHD7 variants have further expanded the phenotypic spectrum of CHARGE syndrome.

目的:运用生物信息学技术探索转移性前列腺癌的关键基因及作用于关键基因的化学药物,并通过实验验证化学药物的治疗效果.方法:使用生物信息学技术及相关工具对GEO数据集GSE27616、GSE38241、GSE168718中转移性前列腺癌和非转移性前列腺癌的基因表达数据进行差异表达分析,使用STRING数据库、Cytoscape软件和人类蛋白表达图集(HPA)获取较差预后相关的关键基因,使用比较毒理学数据库(CTD)对关键基因的互作化学药物进行集合重叠分析.使用CCK-8法、平板克隆形成实验验证关键化学药物的效果.结果:差异表达分析获得差异表达基因共105个,其中下调基因79个,上调基因26个.STRING数据库、Cytoscape软件、人类蛋白表达图集(HPA)生存分析结果显示6个基因在前列腺癌组织中高表达且与较差预后有关(P＜0.05).使用CTD数据库分析较差预后相关基因,得出8个关键化学药物,通过CCK-8法、平板克隆形成实验最终证实1,2,4-苯三酸酐、环氧化苯并芘、达沙替尼、曲格列酮和舒尼替尼5种药物具有抑制转移性前列腺癌细胞系增殖的作用.结论:1,2,4-苯三酸酐、环氧化苯并芘、达沙替尼、曲格列酮和舒尼替尼5种化学药物能够抑制转移性前列腺癌细胞的增殖,为临床治疗转移性前列腺癌提供候选药物.

目的 探究下肢康复机器人训练联合家庭姿势管理对脑瘫患儿运动功能的疗效,为脑瘫患儿的康复治疗提供理论依据.方法 选取2020年3月—2021年3月在郑州大学第三附属医院儿童康复科门诊及住院治疗的痉挛型脑瘫患儿120例,随机分为4组,分别为对照组、观察组A、观察组B和观察组C,每组各30例.对照组只进行常规康复训练,观察组A在常规康复训练的基础上给予Lokomat Pro下肢康复机器人训练联合家庭姿势管理,观察组B在常规康复训练的基础上给予下肢康复机器人训练,观察组C在常规康复训练的基础上给予家庭姿势管理,4组患儿均治疗3个月.分别于治疗前及治疗3个月后采用粗大运动功能评定量表-88(GMFM-88)D和E能区总分、Berg平衡量表(BBS)和改良Barthel指数(MBI)分别评估4组患儿的粗大运动功能、平衡功能及日常生活活动能力,并对评估结果进行分析比较.结果 治疗3个月后4组患儿的GMFM-88 D和E能区总分、BBS、MBI得分较治疗前均有提高(P＜0.01),其中GMFM-88 D和E能区总分、BBS得分:观察组A＞观察组B＞观察组C＞对照组,且差异具有统计学意义(F=14.083,13.051,P＜0.001).MBI得分:观察组A＞观察组B(观察C)＞对照组,差异具有统计学意义(F=6.177,P=0.001),而观察组B、观察组C间差异无统计学意义(t=0.057,P＞0.05).结论 在脑瘫患儿中采用下肢康复机器人训练联合家庭姿势管理更为有效的改善患儿的粗大运动功能、平衡功能及日常生活活动能力,该综合疗法值得在临床推广应用.

目的 探讨足月小样儿与足月正常儿妊娠中期唐氏筛查血清标志物的差别,以及唐氏筛查指标对足月小样儿的发生预测依据.方法 基于河南省妇幼健康信息管理系统出生医学证明模块中出生日期为2017年1月1日至2020年12月31日的数据,选取接受唐氏筛查的孕15～20周孕妇分娩的新生儿共计1 656 474例,其中足月小样儿13 783例.按照孕妇年龄相同、分娩孕周相同、新生儿性别相同的原则从足月正常儿中按照1:1抽取13 324对新生儿进行配对病例对照研究,分析孕妇血中的甲胎蛋白(alpha fetoprotein,AFP)、人绒毛膜促性腺激素β-二聚体(human chorionic gonadotropin beta dimer,β-hCG)、游离雌三醇(uncojugated estriol,uE3)中位倍数值(median multiple values,MOM)及唐氏筛查风险值.结果 足月正常儿的MOM值与足月小样儿 MOM值的差:AFP 为(-0.11±0.80),β-hCG为(-0.13±1.44),uE3 为(0.14±0.86).唐氏筛查中 AFP、β-hCG、uE3单项指标MOM值异常均是足月小样儿的影响因素.足月小样儿2项MOM值异常率是足月正常儿的3.63倍(327/90).足月小样儿uE3降低人数(2051例)是足月正常儿(756例)的2.71倍.结论 孕中期唐氏筛查的uE3MOM值降低或多项MOM值指标异常的孕妇发生足月小样儿的可能性增加.妊娠期应加强此类孕妇的围产保健,预防足月小样儿的出生.

目的 探讨极早产儿发生输血相关性坏死性小肠结肠炎(TA-NEC)的危险因素.方法 选择2013年4月至2021年4月新生儿重症监护室收治的接受输注红细胞的极早产儿为研究对象.符合TA-NEC组纳入标准的极早产儿为TA-NEC组;按1:2比例匹配同期同性别、胎龄(±3 d)、出生体重(±200 g)、输血日龄(±3 d)的非NEC极早产儿作为对照组.比较两组间临床特点差异,探讨TA-NEC发生的危险因素.结果 共纳入204例极早产儿,男138例、女66例,平均胎龄(29.0±1.5)周,中位出生体重1100.0(951.0～1200.0)g.TA-NEC组68例,对照组136例.多因素条件logistic回归分析结果 显示,宫内窘迫、绒毛膜羊膜炎、晚发型败血症是极早产儿发生TA-NEC的独立危险因素(P<0.05),完全经口喂养是其独立保护因素(P<0.05).结论 患有宫内窘迫、绒毛膜羊膜炎和/或晚发型败血症的极早产儿在输注红细胞后48 h内更容易发生NEC.预防围生期缺氧和败血症,在安全前提下完成到完全经口喂养的过渡,对降低极早产儿TA-NEC的发生率有积极作用.

Objective:To document the clinical features of children with cerebral palsy (CP) using magnetic resonance imaging (MRI).Methods:The gross motor functioning of 325 children diagnosed as having CP was graded using the gross motor function classification system (GMFCS). The GMFCS grades were correlated with MRI results in univariate and multivariate logistic regression analyses. The significance of any relationship between the MRI results and co-morbidities was tested using chi-squared tests.Results:Cerebral dysplasia, cerebroventricular enlargement, periventricular leukomalacia (PVL), abnormal signals in the thalami, and morphological changes after hypoxic ischemic encephalopathy were all found to be significantly correlated with GMFCS grading. Moreover, the chi-squared tests indicated that PVL children, children with thinning of the corpus callosum and/or abnormal signals in the thalami were significantly more likely to have visual, auditory or speech impairment complications and/or mental retardation.Conclusions:The findings from MRI correlate well with types of CP, GMFCS grades and co-morbidities among CP children. MRI can be an effective tool for early diagnosis and prognosis of CP in children, indicating needs for clinical rehabilitation.

目的 观察清醒期、睡眠期婴儿痉挛症(infantile spasms,IS)患儿痉挛发作期间不同频段脑功能网络属性特征路径长度(characteristic path length,CPL)的变化,探讨激素冲击治疗对IS患儿脑功能网络的作用.方法 IS患儿19例(IS组),均行甲泼尼龙或促肾上腺皮质激素冲击治疗;记录IS组激素冲击治疗前、后清醒期、睡眠期、清醒发作期、睡眠发作期脑电图数据,应用matlab软件分析delta、theta、alpha、beta、gamma频段CPL.选取同期行视频脑电图检查结果正常的儿童10例为对照组,比较2组清醒期、睡眠期脑电图delta、theta、alpha、beta、gamma频段CPL.随访1年,观察IS患儿激素冲击治疗后痉挛发作的控制情况.结果 随访1年,痉挛发作完全控制11例,治疗无效8例.激素冲击治疗前IS组患儿清醒期脑电图delta频段CPL[130.79(121.61,144.74)×10-3]高于对照组[128.50(119.11,140.78)×10-3](Z=-2.645,P=0.008),beta、gamma 频段 CPL[89.72(78.65,65 535.00)×10-3、94.22(83.98,65 535.00)×10-3]均低于对照组[107.87(90.37,65 535.00)×10-3、98.33(88.53,65 535.00)×10-3](Z=-9.236,P＜0.001;Z=-3.282,P=0.001);睡眠期脑电图 delta、beta 频段 CPL[129.17(118.06,140.99)×10-3、82.80(74.14,113.68)×10-3]均低于对照组[131.90(122.48,141.69)×10-3、92.38(76.94,65 535.00)×10-3](Z=-2.688,P=0.007;Z=-5.079,P＜0.001).清醒期IS组患儿激素冲击治疗后脑电图beta、gamma频段CPL[94.37(83.64,65 535.00)×10-3、97.98(88.04,65 535.00)×10-3]均高于激素冲击治疗前(Z=-4.503,P＜0.001;Z=-3.611,P＜0.001);睡眠期IS组患儿激素冲击治疗后脑电图beta频段CPL[89.65(79.43,65 535.00)×10-3]高于激素冲击治疗前(Z=-7.311,P＜0.001).IS患儿激素冲击治疗后清醒发作期脑电图delta、alpha、beta、gamma频段CPL[111.73(106.44,117.92)×10-3、110.75(103.97,130.07)×10-3、81.35(74.07,97.43)×10-3、92.61(79.01,65 535.00)×10-3]均低于冲击治疗前[118.16(110.58,130.23)×10-3、115.19(104.83,162.77)×10-3、90.53(76.98,65 535.00)×10-3、96.17(82.78,65 535.00)×10-3](P＜0.05);睡眠发作期脑电图 delta 频段 CPL[116.50(109.31,128.12)×10-3]高于冲击治疗前[113.66(107.56,121.60)×10-3](Z=-4.412,P＜0.001),theta 频段 CPL[131.56(114.90,177.63)×10-3]低于冲击治疗前[153.11(127.55,65 535.00)×10-3](Z=-6.109,P＜0.001).结论 IS患儿清醒期、睡眠期脑电图beta频段传输效率增强,激素冲击治疗可降低发作间期beta频段、睡眠发作期delta频段的传输效率,增强清醒发作期delta、alpha、beta、gamma频段的传输效率,改善脑电图高峰失律、减少高频振荡募集可能.

Objective:To compare the differences in sleep structure between healthy children and children with cerebral palsy (CP) using polysomnography (PSG).Methods:Fifty-six children aged 1-15 hospitalized for cerebral palsy formed the experimental group, while 30 healthy children served as controls. Both groups were given 24-hour PSG, and their sleep structures were compared and analyzed.Results:The incidence of sleep disorders in the children with cerebral palsy (55.4%) was significantly higher than among the healthy children (20.0%). The average sleep latency was significantly higher than among the healthy children, while the duration and the percentage of the rapid eye movement (REM) stage were significantly lower than among the healthy children. Total sleep time [(458.47±95.62)min], sleep efficiency [(74.26±13.63)%], duration of REM [(68.90±42.70)min] and REM percentage [(13.87±7.12)%] were all significantly lower for the children with severe cerebral palsy than for those with mild or moderate disorder. Their time to wake up after falling asleep was significantly longer. Moreover, the duration of REM and the REM percentage of children with dyskinetic cerebral palsy were significantly lower than for those with spastic cerebral palsy.Conclusions:The incidence of sleep disorders among children with cerebral palsy is higher than among healthy children. They have more difficulty in falling asleep and have a shorter REM stage. Children with severe cerebral palsy and involuntary cerebral palsy have more sleep problems.

上尿路尿路上皮癌(Upper tract urothelial carcinoma,UTUC)是一种泌尿系相对罕见的疾病,其双侧发病则更为罕见.病因学上,UTUC和膀胱癌有一些共同的致病因素,但两种疾病在临床特征和外科治疗上则不尽相同.随着泌尿外科腹腔镜手术的普及,腹腔镜下根治性肾-输尿管切除术和膀胱袖口状切除术(Laparoscopic nephroureterectomy with bladder cuff excision,LNUBCE)已经成为泌尿外科治疗UTUC的主流方法.机器人外科手术系统因其直观清晰的手术视觉效果和较高的灵敏度,弥补了腹腔镜手术存在的缺陷,使机器人根治性肾-输尿管切除术和膀胱袖口状切除术(Robotic nephroureterectomy with bladder cuff excision,RNUBCE)逐渐被大家所接受.本文对近年机器人手术系统在双侧上尿路尿路上皮癌治疗中的应用和研究进展进行综述.

目的 探讨机器人辅助腹腔镜肾上腺切除术治疗大体积(≥5 cm)肾上腺嗜铬细胞瘤的安全性、可行性.方法 回顾性分析郑州大学第一附属医院泌尿外科2015-01—2021-08收治的大体积肾上腺嗜铬细胞瘤患者的临床资料.分为机器人辅助腹腔镜肾上腺切除术组(RALA组,28例)和腹腔镜肾上腺切除术组(LA组,29例).比较2组患者的术中及术后恢复情况,统计术后并发症发生率.结果 2组患者的一般资料,以及术中出血量、输血率、血管活性药物使用率、血流动力学不稳定发生率和术后ICU转入率、引流管拔除时间、并发症发生率的差异均无统计学意义(P>0.05).RALA组的手术时间和术后住院时间均短于LA组,差异有统计学意义(P<0.05).结论 对于大体积肾上腺嗜铬细胞瘤患者,机器人辅助腹腔镜与传统腹腔镜肾上腺切除术具有相同的安全性、可行性.但机器人辅助腹腔镜肾上腺切除术具有更加灵活、高效,以及能缩短手术时间和术后住院时间等优势.

目的 了解脑瘫患儿高危因素、临床特点及其与癫痫发生的关系,探讨脑瘫患儿共患癫痫的危险因素.方法 回顾性收集从2019年1月-2022年2月在郑州大学第三附属医院住院治疗的脑瘫患儿的病例资料,将患儿分为脑瘫共患癫痫组和未共患癫痫组,采用x2检验分析两组间高危因素、临床特点等资料,应用多因素Logistic回归对共患癫痫的危险因素进行分析.结果 共纳入630例脑瘫患儿,其中男421例,女209例;脑瘫共患癫痫组患儿155例,未共患癫痫组患儿475例,癫痫发生率24.6％.脑瘫共患癫痫组患儿在宫内窘迫、窒息、多胎及新生儿先天性畸形史方面的发生率高于未共患癫痫组患儿(x2=4.788、9.368、5.255、12.111,P＜0.05),两组患儿在脑瘫分型、头颅MRI分类、粗大运动功能分级方面差异有统计学意义(x2=213.686、14.640、481.531,P＜0.05).多因素Logistic回归结果显示,痉挛型四肢瘫(OR=14.090,95％CI:1.950～101.813)、新生儿先天性畸形史(OR=1.891,95％CI:1.155～3.095)、围生期窒息史(OR=1.527,95％CI:1.034～2.255)可能是脑瘫患儿共患癫痫的危险因素(P＜0.05).结论 脑瘫患儿共患癫痫的发病率较高,病情重,识别危险因素可以为针对性的临床治疗提供依据.

Objective:To explore the regulatory effect of miR-873-5p micro-RNA targeting voltage-dependent anion channel protein 1 (VDAC1) in neurons and its mechanism.Methods:Murine nerve cells were randomly divided in vitro into a control group, a model group, a mimetic negative carrier (miR-con) group and an miR-873-5p group. The epileptiform hippocampal nerve cell model was induced in all of the cells except those in the control group using magnesium-free medium. The control group was normally cultured, while the miR-con and miR-873-5p groups were transfected with miR control and miR-873-5p RNA respectively. Real-time fluorescent quantitative polymerase chain reactions were used to detect the expression of miR-873-5p and VDAC1 mRNA. Western blotting was employed to detect VDAC1, B-cell lymphoma/leukemia-2 protein (Bcl-2), Bcl-2 associated X protein (Bax) and cleared caspase-3 in the neurons. The levels of reactive oxygen species (ROS), malondialdehyde (MDA) and glutathione (GSH) were measured using the DCFH-DA fluorescent probe, the thiobarbituric acid method and enzyme-linked immunosorbent assay respectively. Any apoptosis was detected using flow cytometry, while the targeting of miR-873-5p on VDAC1 was verified using the double fluorescence zymase reporter gene method.Results:Compared with the control group, a significant decrease in the average expression of miR-873-5p, Bcl-2 and in GSH and MDA levels was observed in the model group, but there was a significant increase in the average level of VDAC1, Bax, cleaved caspase-3 and ROS and in the rate of apoptosis. Compared with the miR-con group, a significant decrease in the average expression of Bax, cleaved caspase-3, ROS and in the apoptosis rate was observed in the miR-873-5p group, but there was a significant increase in the average level of Bcl-2, GSH and MDA. Moreover, it was verified that miR-873-5p reduced the expression of VDAC1.Conclusion:miR-873-5p protects damaged neurons by inhibiting their apoptosis through negatively regulating the target gene VDAC1 and the oxidative stress response.

Objective:To discuss the diagnosis and treatment of urothelial carcinoma of the prostate.Methods:The clinical data of 25 patients with prostate urothelial carcinoma from January 2011 to November 2019 were retrospectively analyzed.Among the 25 patients, the age of onset was 39 to 85 years old, with an average of (63.4±11.2) years old, 13 patient presented with gross hematuria, 9 patients presented with dysuria, and 3 presented with bladder irritation. The PSA of 25 patients was within the normal range (less than 4 ng/ml). 17 cases of pelvic MRI showed abnormal signals in the bladder and prostate area, 3 cases indicated that prostate cancer had invaded the bladder, and 14 cases considered bladder cancer Invasion of the prostate suggests a cauliflower-like abnormal signal in the bladder area. 6 of this 14 patients have a history of bladder cancer. All 25 patients underwent surgical treatment, and 14 underwent transurethral diagnostic resection, of which 6 cases accepted radical cystectomy later. One patient underwent radical cystectomy combined with pelvic lymph node dissection 15 days after the first operation.9 cases received radical cystectomy.2 cases undergoing transurethral palliative resection due to multiple metastases before the operation.Results:The postoperative pathological diagnosis of 25 cases were all prostate urothelial carcinoma, 13 cases were accompanied by bladder urothelial carcinoma, secondary prostate urothelial carcinoma, and 12 cases were primary prostate urothelial carcinoma. After the operation, 13 patients were further treated. Among the patients with secondary prostate urothelial carcinoma, 7 patients received bladder perfusion, 2 patients received GC chemotherapy, 1 patient received local pelvic radiotherapy.25 patients were followed up for 2 to 36 months with an average of (21.5±10.1) months. Among them, lymph node metastasis were seen in 17/25 patients. lymph node metastasis were found in 7/25 before surgery, and 1/25 found lymph node metastasis during surgery. Among the patients with distant metastases afterwards, multiple metastases throughout the body (4/14), lung metastases only (6/14), and bone metastases only (4/14), the 1-year survival rate was 88% (22/25), the 2-year survival rate was 40% (10/25), and the 3-year survival rate was 28% (7/25).Conclusions:The diagnosis depends on histopathological examination. Early diagnosis may help improve prognosis. The first choice is a comprehensive treatment based on radical surgery.

Objective:To investigate the factors related to recurrence and prognosis of retroperitoneal liposarcoma.Method:The clinical data of patients with primary retroperitoneal liposarcoma who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2011 to January 2020 were analyzed retrospectively. There were 42 males and 47 females and patients’median age was 53 (26-78). Sixty-five cases were treated by operation in our hospital, and 24 cases were primarily treated by the operation in another hospital. The clinical manifestations of the initial diagnosis included retroperitoneal mass in 41 cases, abdominal distension in 12 cases, abdominal pain in 10 cases, fever in 11 cases, nausea, vomiting and poor appetite in 8 cases, frequent urination and dysuria in 6 cases, and bilateral lower limb edema in 1 case. Preoperative CT imaging showed that the tumor body was located in the retroperitoneal kidney area in 58 cases, while in the retroperitoneal space or the pelvic extraperitoneal space in 31 cases. There were 55 single cases and 34 multiple cases. The median tumor length was 20(3-52) cm. Among the primarily treated 65 patients, 47(72.3%) were considered as primary retroperitoneal liposarcoma by preoperative imaging examination. Among the 89 patients treated by surgery, 78 underwent endoscopic surgery, among which 21 underwent laparoscopic surgery, 38 cases of retroperitoneal laparoscopic surgery, 19 cases of Da Vinci robot-assisted laparoscopic surgery. Open operation was performed in 11 cases. There were 87 patients undergoing radical resection and 2 patients undergoing palliative resection. Forty-two patients underwent intraoperative combined resection of the adjacent organs. The recurrence and survival status of patients were followed up.Results:All the 89 patients underwent the operation successfully, with the median operative blood loss of 200 (10-2000) ml. There were 23 cases being diagnosed of well differentiated liposarcoma, 40 cases of dedifferentiated, 20 cases of myxoid/round, 5 cases of myxoid liposarcoma, and 1 cases of mixed type. Pathologically, there 42 cases with low grade histology and 47 cases with high grade histology. In this study, 89 patients were followed up for 3 to 108 months, and the median follow-up time was 28 months. The 5-year recurrence free survival rate, disease-free survival rate and overall survival rate of the patients were 16.7%, 16.1% and 52.6%, respectively. There were 57 patients presenting local recurrence, 1 patient of lung metastasis, and 1 patient of liver metastasis, and the median disease-free survival time was 24 months. There were 42 patients died of the disease, with a median survival time of 64 months. Univariate analysis showed that intraoperative blood loss( P<0.01), whether multiple cases( P<0.01), pathologic types( P<0.01), and histological grades ( P<0.01) were related to disease-free survival.The intraoperative blood loss( P<0.01), multiple cases( P<0.05), pathologic types ( P<0.05), and recurrence ( P<0.01)were related with overall survival. Gender, age, tumor size, tumor location, whether primary surgery, radical resection or combined resection of adjacent organ had no effect on the prognosis of patients ( P>0.05). Cox regression model multivariate analysis revealed that surgical bleeding ( RR=2.360, 95% CI 1.313-4.241, P=0.004), multiple tumor ( RR=1.899, 95% CI 1.068-3.375, P=0.029), and pathological type ( RR=4.976, 95% CI 1.622-15.264, P=0.005) were independent factors affecting disease-free survival. The recurrence was an independent factor affecting the overall survival of patients ( RR=31.495, 95% CI 1.062-933.684, P=0.046). Conclusions:Retroperitoneal liposarcoma is a rare disease with high recurrence rate. The intraoperative blood loss, whether multiplicity and pathological type are independent factors affecting the disease-free survival, and recurrence is independent factors affecting the overall survival.

目的:观察儿童型下肢康复机器人联合情景互动训练对运动障碍性疾病患儿运动功能的影响。方法:采用随机数字表法将60例运动障碍性疾病患儿分为观察组及对照组。2组患儿均给予常规康复干预，包括运动再学习技术(MRP)、减重步行训练、MOTOmed下肢训练及神经肌肉电刺激等，观察组患儿在此基础上辅以下肢康复机器人训练及情景互动训练，每天训练1次，每周训练6 d，治疗12周为1个疗程。于治疗前、治疗1个疗程后分别采用粗大运动功能量表(GMFM)及Berg平衡量表(BBS)对2组患儿进行疗效评定。结果:治疗后发现观察组、对照组患儿BBS评分[分别为(17.97±2.94)分和(13.36±1.70)分]、GMFM-D区评分[分别为(15.95±1.17)分和(11.95±1.28)分]、GMFM-E区评分[分别为(15.73±1.16)分和(12.10±1.52)分]均较治疗前明显改善( P<0.05)，并且上述指标均以观察组患儿的改善幅度较显著，与对照组间差异均具有统计学意义( P<0.05)。 结论:在常规康复干预基础上辅以下肢康复机器人及情景互动训练，能进一步改善运动障碍性疾病患儿粗大运动功能及平衡能力，该联合疗法值得临床推广、应用。