Late‐presenting congenital diaphragmatic hernia in childhood

Aim: To characterize the clinical manifestations of late‐presenting diaphragmatic hernia and its associated anomalies, diagnostic methods and outcomes. Methods: The records of patients aged 1 month–18 years old diagnosed with Bochdalek diaphragmatic hernia from February 1987–June 2008 were reviewed. Results: Fifteen children (nine boys, six girls) met inclusion criteria. Median age was 1.5 years (range, 38 days–9.9 years). Eleven (73%) had left‐sided and four (27%) had right‐sided diaphragmatic hernias. Six (40%) patients presented with respiratory symptoms, six (40%) with gastrointestinal symptoms and three (20%) with both. Five (33%) patients had failure to thrive. Six (40%) were diagnosed by chest radiography alone. The others required gastrointestinal contrast series, or chest computed tomography to confirm the diagnosis. One referred patient had been misdiagnosed as having left pneumothorax. Cases of bowel malrotation and gastric volvulus associated with the hernia were found in one patient each. One patient required mechanical ventilation because of respiratory failure before surgery. Primary repair without patch was performed in all patients. The overall survival in this series was 100%. Conclusion: Late‐presenting diaphragmatic hernia should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favourable with correct diagnosis and prompt surgical repair.     

Non-invasive Assessment of Changes in Muscle Injury by Ultrasound Shear Wave Elastography: An Experimental Study in Contusion Model

The present study investigated the potential of ultrasound shear wave elastography (SWE) in assessment of muscle stiffness in muscle injury. SWE was performed on the injured muscle in 30 New Zealand rabbits that were randomly assigned to three groups: the contusion group, which was not treated with an efficient therapeutic strategy after muscle injury; the treatment group, which was treated with a therapeutic scheme after muscle injury; and the healthy group, which was not injured and served as a control. Both the mean Young's modulus (E_mean) and the maximum Young's modulus (E_max) were obtained pre-injury and 0.5, 1, 3, 5, 7, 14 and 28 d post-injury. At these time points, a rabbit in each group was randomly selected for biopsy for histopathological observation as well as comparison with Young's modulus. Eventually, all muscle tissues were collected for histologic analysis of collagen fiber formation. The contusion group had the highest Young's modulus, followed by the treatment group and then the healthy group (p < 0.05). In both the contusion and treatment groups, E_mean and E_max gradually increased within 1–3 d after injury, followed by a gradual decrease. Compared with the healthy group, histopathologic analysis of the contusion and treatment groups revealed the myofibril destruction process, inflammatory reaction and myofibril regeneration. The amount of collagen fibers in the contusion group was maximal compared with the treated and healthy groups (p?=?0.001 and p < 0.001, respectively). There were more collagen fibers in the treatment group than in the healthy group (p?=?0.003). The abundance of collagen fibers was positively correlated with the value of Young's modulus (E_mean: r?=?0.706, p < 0.001; E_max: r?=?0.761, p < 0.001). Thus, SWE can be used to detect pathologic changes in injured muscle and to monitor therapeutic effects.     

静脉麻醉药对脂多糖诱导的神经星形胶质细胞增殖的影响及其机制

目的 检测静脉麻醉药对脂多糖诱导的神经星形胶质细胞的影响及其机制。 方法 利用MTT实验、集落形成实验和Annexin V-FITC/PI双染色法检测静脉麻醉药对脂多糖作用后的神经星形胶质细胞增殖和凋亡的影响。Western blotting技术检测相关机制。 结果 静脉麻醉药可以逆转脂多糖诱导的神经星形胶质细胞增殖。经麻醉药处理后的神经星形胶质细胞p-Akt和p-mTOR蛋白表达下降，Caspase-3和Caspase-9表达水平升高。结论 静脉麻醉药可以通过抑制mTOR通路逆转脂多糖诱导的神经星形胶质细胞增殖。