[Investigation on cognition, diagnosis and treatment status of chest tightness variant asthma among Chinese pediatricians].

Objective: To evaluate the awareness, diagnosis and treatment of chest tightness variant asthma (CTVA) among pediatricians in China. Methods: The survey was conducted by convenient sampling method. Pediatricians with professional title of attending physician and above from different grades hospitals in 30 provinces were invited to conduct online questionnaire surveys through WeChat, pediatricians scan QR codes to complete electronic questionnaires in the mini program from January 16th to February 4th, 2021. The contents of questionnaire included the awareness, diagnosis and treatment of CTVA, and comparing the differences between pediatricians in secondary hospitals and tertiary hospitals. Results: A total of 1 529 pediatricians participated in the survey, and 1 484 (97.06%) pediatricians completed the questionnaire and included in the analysis, including 420 males (28.30%). The awareness rate of CTVA among pediatricians was 77.83 % (1 155/1 484). Pediatricians in tertiary hospitals had higher rates of awareness of CTVA than pediatricians in secondary hospitals [81.86% (898/1 097) vs 66.41% (257/387), P<0.001] and had better execution of the guidelines [89.15% (978/1 097) vs 79.59% (308/387), P<0.001]. A total of 93.06 % (1 381/1 484) of pediatricians' first-line treatment included inhaled corticosteroids (ICS) for CTVA. Among them, a higher proportion of pediatricians in tertiary hospitals used ICS included regimens for first-line treatment of CTVA compared with pediatricians in secondary hospitals [94.90% (1 041/1 097) vs 87.86% (340/387), P<0.001]. The reported well control rate of CTVA was 32.08% (476/1 484), which was significantly lower in secondary hospitals than that in tertiary hospitals [17.31% (67/387) vs 37.28% (409/1 097), P<0.001]. Conclusion: Most pediatricians are well aware of CTVA, among which there is a certain gap in clinical practice between pediatricians in secondary hospitals and tertiary hospitals in terms of understanding, diagnosis, and treatment of CTVA.

Quality assessment of clinical practice guidelines for the management of wheezing disorders in children.

BACKGROUND: The quality of available clinical practice guidelines (CPGs) for childhood wheezing disorders have not been systematically evaluated.METHODS: CPGs were systematically evaluated by four independent reviewers using Appraisal of Guidelines Research and Evaluation (AGREE) II instrument and the Reporting Items for Practice Guidelines in HealTHcare (RIGHT) checklist. We calculated the overall agreement among reviewers with the intraclass correlation coefficient (ICC).RESULTS: A total of 35 CPGs published between January 2000 and December 2020 were evaluated. The overall agreement among reviewers was good (ICC 0.85, 95% CI 0.83-0.87). The average CPGs score was 42% (range: 25-79). The mean scores of four domains were low: 37% for Stakeholder Involvement (range: 10-85), 28% for Rigour of Development (range: 42-81), 35% for Applicability (range: 11-73) and 24% for Editorial Independence (range: 0-83). The mean reporting rate of the RIGHT checklist was 31%. The Basic Information domain had the highest reporting rate (65%); the Review and Quality Assurance domain had the lowest rate (3%).CONCLUSIONS: The quality of the CPGs was poor. Greater efforts are needed to improve quality in domains to provide high-quality guidelines that can be used as reliable tools for clinical decision-making.

[Multicenter study of human adenovirus infection in pediatric community-acquired pneumonia in China].

Objective: To investigate the predominant genotypes and epidemiological characteristics of human adenovirus (HAdV) in pediatric community-acquired pneumonia (CAP) in China. Methods: This was a repeated cross sectional study. Between November 2014 and November 2016, nasopharyngeal aspirates (NPAs) or throat swabs from each hospitalized pediatric patients diagnosed as CAP in 12 hospitals in Northern and Southern China were collected. Respiratory specimens were screened for 18 respiratory viruses including HAdV by using Luminex xTAG RVP Fast V2 multiplex Assay. Typing of HAdV and analysis for the epidemiological characteristic of HAdV were performed. Results: (1) A total of 2 723 hospitalized pediatric patients with CAP were enrolled in this study and 156 (5.7%, 156/2 723) respiratory specimens were positive for HAdV, and 74 (6.6%, 74/1 128) and 82 (5.1%, 82/1 595) were in Northern and Southern China, respectively. There was no significant difference in the positive detection rate between the Northern and Southern China. (2) In Northern China, the HAdV positive rate of children at the age of <6 months, 6 months-<1 years, 1-<3 years, 3-<5 years and ≥5 years was 5.9%(6/101), 6.7%(7/104), 10.3%(34/331), 4.1%(11/266) and 4.9%(16/326), respectively, and the incidence of HAdV infection peaked in children aged 1-3 years (χ(2)=11.511, P=0.021). While in Southern China the HAdV positive rate of children at the age of <6 months, 6 months-<1 years, 1-<3 years, 3-<5 years and ≥5 years was 2.2% (7/312), 4.6% (12/259), 6.3% (31/494), 7.3% (18/245) and 4.9%(14/285), respectively. There was no significant difference in the positive detection rate among age groups. (3) In 2015, the highest detection rate of HAdV in northern China was 12.5% (25/200) in winter, and in Southern China was 6.7% (35/525) in spring and 5.3% (19/357) in summer. (4) In 108 cases of HAdV positive specimens typing was done and 80 in cases classification was successfully performed.Totally 7 genotypes of HAdV, including HAdV-3 (n=32), HAdV-7 (n=9), HAdV-1 (n=12), HAdV-2 (n=15), HAdV-5 (n=10), HAdV-6 (n=1) and HAdV-4 (n=1), were detected. The predominant HAdV genotypes were HAdV-3 (30.8%, 8/26) and HAdV-7 (26.9%, 7/26) in Northern China, while HAdV-3 (44.4%, 24/54) and HAdV-2 (22.2%, 12/54) were the most prevalent genotypes in Southern China. Conclusions: HAdV is an important viral pathogen in pediatric CAP. The predominant HAdV genotypes and peak seasons of HAdV infections were different between Northern and Southern China. The predominant HAdV genotypes were HAdV-3 and HAdV-7 in Northern China, while HAdV-3 and HAdV-2 in Southern China. The peak season of HAdV infections was winter in Northern China. However, HAdV infections are more common in spring and summer in Southern China.

[Development of influenza control programs in children].

Based on the characteristics of influenza occurred in 2017 and 2018, we discussed the current development and update on the etiology, mechanism, clinical characteristics, laboratory examination, treatment and prevention for influenza in children, in order to draw attention on the awareness and capacity in prevention and treatment programs targeting child influenza among physicians and health workers.

[Clinical characteristics of bronchopulmonary foregut malformation].

Objective: To analyze the clinical characteristics, diagnosis and treatment of bronchopulmonary foregut malformation(BPFM). Method: The clinical manifestations, imaging findings and treatment of 8 patients with BPFM were analyzed retrospectively from January 2006 to May 2016 in Beijing Children's Hospital. Result: The age of children varied from 2 months to 7 years and 3 children were male while 5 female. Symptoms showed cough in 6 cases, fever in 4 cases, bucking when intaking of fluids or foods in 3 cases, tachypnea in 1 case, wheezing in 1 case, vomiting in 1 case, haematemesis in 1 case Pulmonary signs were decreased breath sounds in 4 cases, phlegm rale in 3 cases, shortness of breath in 2 cases, wheeze in 1 case, and retraction in 1 case. The upper gastrointestinal series showed abnormal fistulous tracts arising from the esophagus or the gastric fundus and extending into the mass in the lung. CT showed pulmonary sequestration and prompted the tube between lung and esophagus. Six children underwent pneumonectomy and esophageal fistula repair. They were discharged and their symptoms were improved. Two cases of children were discharged from a hospital without surgery. Conclusion: Bronchopulmonary foregut malformation usually has its onset in early stage of life. The most common symptoms include recurrent pneumonia or bucking when intaking of fluids or foods. CT can demonstrate the bronchopulmonary sequestration and evaluate the communication with the gastrointestinal tract. The upper gastrointestinal series can demonstrate the abnormal tract directly. Pneumonectomy and esophageal fistula repair are the treatment of this disease.

An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases.

AIM: The aim of the present study was to report our experience of totally implantable central venous access devices (TICVAD) implantation using two techniques and attempt to define the better technique. MATERIALS AND METHODS: From January 1998 to September 2003, 1131 patients were reviewed and divided into two groups with implantation by cephalic vein cut-down (group A) done by general surgeons and subclavian vein puncture with the Seldinger technique (group B) done by vascular surgeons. The operative time, early and late complications of these two groups were compared. Data were analysed by Student's t-test. RESULTS: The average of operative time was 43 min in group A (35-70 min) and 40 min in group B (35-60 min) (P>0.05). No post-operative pneumothorax, hemothorax and fragmentation occurred in group A; the incidence of peri-operative complication was higher in group B. The overall and early complications of group A were significantly lower than that of group B (P<0.0001). CONCLUSION: This retrospective study showed that the cephalic vein cut-down approach for TICVAD placement avoided the risks of pneumothorax, hemothorax and catheter fragmentation.

[Molecular diagnosis of two Chinese cystic fibrosis children and literature review].

OBJECTIVE: To investigate the clinical manifestations and molecular features of cystic fibrosis in Chinese children. METHOD: A retrospective analysis of two pediatric cystic fibrosis cases diagnosed by gene test in Beijing Children's Hospital, Capital Medical University from 2010 to 2015, and Chinese cystic fibrosis reported patients searched of"cystic fibrosis, Chinese"on Chinese databases (CNKI, Wanfang Data) and PubMed from 1975 to 2015.The clinical manifestations and molecular features were analyzed. RESULT: One of the two newly diagnosed cystic fibrosis cases was a 10-year old girl who suffered from reccurent cough with expectoration and associated with cirrhosis.Sweat tests showed increased chloride twice with the lower level of 306.82 mmol/L.The other was an 8-month old boy with reccurent pneumonia from neonate, failure to thrive and fatty diarrhea.Two children had various degrees of bronchiectasis and massive sticky secretion on the bronchoscopy.They had no family history and their parents had no consanguineous marriage.CFTR mutations of c. 595C>T and c. 2290C>T were found in gene tests.On the database, twenty-one reports involving thirty-six Chinese patients (16 males and 20 females) were retrieved.Together with this group of 2 cases, a total of 38 cases were involved.The age at diagnosis was 4 months to 28 years with a median age of 10 years.All patients had reccurent respiratory infections, twenty-seven cases (71%) had malnutrition, fifteen (39%)had chronic diarrhea, and 16 cases (42%) had other digestive manifestations, including jaundice (4 cases), hepatomegaly (11 cases), ascites (2 cases) and pancreatic atrophy (3 cases). Five cases had a positive family history and six cases had a suspicious family history.Consanguineous marriage was found in three families.Sweat test revealed elevated chloride (52-327 mmol/L) in 28 cases.Eight of the 16 patients who performed pancreatic exocrine function examination showed pancreatic insufficiency.Eighteen of the 20 patients described the image manifestation of bronchiectasis.The age at death of 13 patients(34%) was 4 months to 25 years with a median of 11 years.Twenty-nine rare CFTR mutations were found in 25 tested patients, and c. 1766+ 5G>T(5 cases), c.2083dupG and c. 2684G>A (3 cases) held the top three mutation patterns. CONCLUSION: Respiratory symptoms and bronchiectasis are the main manifestations of Chinese cystic fibrosis patients, although some of them may be associated with malnutrition, digestive symptoms and pancreatic insufficiency. CFTR mutations are various and rare in Caucasians.

Evidence of transmission of Mycobacterium tuberculosis by random amplified polymorphic DNA (RAPD) fingerprinting in Taipei City, Taiwan.

AIMS: To determine, by strain identification of Mycobacterium tuberculosis, whether transmission has occurred between individuals or whether new strains are present. METHODS: A rapid protocol for random amplified polymorphic DNA (RAPD) analysis was developed. This protocol was applied to 64 strains of M tuberculosis that had been confirmed by culture and microbiological methods. RESULTS: There are five groups of M tuberculosis prevalent in Taipei city, Taiwan. The major types are groups I and III. Groups I and II had been prevalent until the end of last year when, according to our group analysis, they had been eradicated. However, group III was continuously present from the middle of 1995 to the middle of 1996, and group IV was present at the end of both years, which indicated that both groups were transmitted continuously. These clustered strains had demographic characteristics consistent with a finding of transmission tuberculosis. Also, there were 13 of 64 strains with unique RAPD fingerprints that were inferred to be due primarily to the reactivation of infection. In the drug resistance analysis, the major type represented included group III and part of group IV. CONCLUSIONS: Our preliminary data imply, not only that the prevalence of M tuberculosis in Taipei city is due to transmission rather than reactivation, but that drug resistance also may play a role in tuberculosis transmission.

Rectal carcinoid tumors--treatment and prognosis.

Because of their location, rectal carcinoid tumors present a special therapeutic challenge for the surgeon. Only about 15% of these tumors manifest metastases and the others can be cured by complete local excision; hence performing a low anterior resection or an abdominoperineal resection for all patients would result in excessive rates of morbidity and death. Present-day treatment programs call for radical cancer resections only for lesions 2 cm in diameter or larger and local resection for all others. However, in a review of 595 patients, including 29 from the University of Chicago Hospitals, it was determined that this practice results in undertreatment of 24% (19/78) of all rectal carcinoid tumors that were associated with metastases, for 5% of all lesions smaller than 2 cm also had metastases. Invasion of the muscularis propria, we found, was an excellent additional prognostic sign for tumor progression. If the criteria for radical cancer resection included both size (all tumors 2 cm or larger and invasion of the muscularis propria in all smaller lesions, only 6% (5/78) of all aggressive tumors would have been missed and only 1.2% of all individuals with rectal carcinoid tumors would have received too limited an operation. It is hoped that the use of these new criteria will improve present-day survival statistics for patients with rectal carcinoid tumors.

Differences in gastric emptying between highly selective vagotomy and posterior truncal vagotomy combined with anterior seromyotomy.

Gastric emptying has been reported to be both delayed and unchanged following posterior truncal vagotomy combined with anterior seromyotomy (PTV + AS). When compared to highly selective vagotomy (HSV), our clinical experience was that PTV + AS not uncommonly produced postprandial distress. We studied gastric emptying of both liquids and solids 3 and 12 months following HSV and PTV + AS to determine what if any differences there were in gastric emptying between the two procedures. We compared these results with those from studies done in both normal subjects and unoperated duodenal ulcer patients. In 26 duodenal ulcer patients with perforation (n = 18) or bleeding (n = 8), who were treated with HSV (n = 10) or PTV + AS (n = 16), gastric emptying of liquids and solids was evaluated at 3 months and 12 months postoperatively. At 3 months, gastric emptying of liquids was delayed in both the HSV and PTV + AS groups as compared to values in both normal subjects and unoperated duodenal ulcer patients. The emptying of solids was markedly delayed by PTV + AS in contrast to HSV at 3 months (167.1 +/- 28.4 minutes vs. 79.9 +/- 16.7 minutes; P <0.05). The lag duration was not affected. A limited number of patients studied at 12 months showed similar and near-normal emptying of solids in both the HSV and PTV + AS groups (67.5 +/- 7.0 minutes vs. 70 +/- 6.6 minutes). PTV + AS in contrast to HSV produces more marked delayed emptying of liquids and solids at 3 months; with time (1 year) these values return to near normal.

Reemergence of thyroidectomy as treatment for Graves' disease.

Hyperthyroidism of Graves' disease may be treated very effectively by antithyroid pills, such as PTU and Tapazole, by radioactive iodine therapy, and by subtotal thyroidectomy. Each form of therapy has advantages and disadvantages, and thus treatment should be individualized. While therapy with radioactive iodine would appear to be ideal since it does not require an operation and is less expensive than surgical management, it suffers from a high rate of progressive hypothyroidism and from the fact that the time until a euthyroid state is obtained is often prolonged. In addition, the long-term carcinogenic risk of the therapy for thyroid neoplasia has never been completely defined since the data most often quoted have a mean follow-up time of only eight years. Furthermore, new "low-dose" radioiodine regimens may be more dangerous in this regard. Subtotal thyroidectomy, while not totally without complications, remains a rapid, safe, and effective treatment for Graves' disease. The careful use of propranolol has facilitated the preparation of some patients and has lessened the risk of operation. Thyroidectomy should remain the treatment of choice for young adults with this disease.

Investigation of how different halos influence pin forces.

STUDY DESIGN: This study investigated the effect of the size and material of halo rings on the pin force produced at the halo pin-calvarium complex. SUMMARY OF BACKGROUND DATA: Loosening of halo pins has been a problem with using the halo-vest apparatus to stabilize cervical spine fractures. METHODS: One standard halo pin and seven different halo rings were used to test the anterior pin hole of each ring at a constant torque of 8 inch-pounds (0.9 Nm). RESULTS: Pin force fluctuated from halo to halo, and decreased as the nut was tightened. CONCLUSIONS: Identical torques applied to different halos will not guarantee the same magnitude of pin force for halo fixation.

Inhibition of the synthesis of eicosanoid-like substances in a human oral cancer cell line by interferon-gamma and eicosapentaenoic acid.

The objectives were to examine the production of eicosanoids in a Chinese human oral cancer cell line (OEC-M1) and to test the effects of interferon-gamma (IFN-gamma), eicosapentaenoic acid (EPA) and enzyme inhibitors on this biosynthesis. The eicosanoids were identified by reverse phase-high performance liquid chromatography. Two predominant peaks appeared in the chromatograms. One compound (P-1) was identified by ultraviolet absorption at a lambda(max) of 278nm with shoulders at 272 and 284nm. The other compound (P-2) was identified by ultraviolet absorption at a lambda(max) of 284 nm with shoulders at 278 and 290 nm. The production of P- was significantly inhibited by the addition of IFN-gamma (200 and 400 U/ml), and EPA (10 to 40 microM). It was only partially inhibited (p < 0.05) by indomethacin (INDO) (0.5 and 1 microM), nordihydroguaiaretic acid (NDGA) (30 and 60 microM/ml), and eicosa-5,8,11,14-tetraynoic acid (ETYA) (20-60 microM). It was almost completely inhibited by indomethacin (2 and 3 microM), and dexamethasone (0.6 and 6 microM). The production of P-2 was almost completely inhibited by IFN-gamma (200 and 400 U/ml), and partially inhibited (p < 0.05) by EPA (10 and 20 microM), NDGA (30 and 60 microM), ETYA (20 and 40 microM), dexamethasone (0.6 and 6 microM). The production of both peaks was significantly reduced by excluding arachidonic acid (AA), and almost completely inhibited by heating at 100 degrees C for 10 min during incubation. These results demonstrate that two eicosanoid-like compounds are synthesized by the OEC-M cell line and that their production can be modulated by IFN-gamma, EPA, indomethacin, NDGA, ETYA, and dexamethasone.

[Testicular morphological and biochemical changes after Fowler-Stephens orchiopexy in rats].

Fowler-Stephens orchiopexy is the most common method of treating high-positioned undescended testes. Its success rate has been reported to be as high as 50-70% based on palpation or in a few circumstances on biopsy. Although it is convenient to evaluate testicular function by palpation and/or biopsy, this method is very subjective and is not scientific enough. To determine testicular function more precisely and objectively, we performed the Fowler-Stephens orchiopexy on Sprague-Dawley rats and observed the morphological and biochemical changes, including assays of LDH, SDH and the testosterone level. In our morphological study, with the use of Fowler-Stephens orchiopexy, only 17% (3/18) of the rat tests could be salvaged. The others revealed either necrosis or fibrosis. Testicular LDH, checked at the 4th postoperative week, revealed 0.62 +/- 0.04 U/mg which was statistically different (p less than 0.05) from that of the control group and the hemicastrated group (0.77 +/- 0.05 U/mg and 0.76 +/- 0.07 U/mg, respectively). The SDH obtained from the testes also revealed significant differences between the study group and the control and hemicastrated groups. Values obtained were 2.67 +/- 0.15 mU/mg, 3.77 +/- 0.4 mU/mg and 3.77 +/- 0.33 mU/mg, respectively (p less than 0.05). Using electrophoresis, 3 out of 18 rats had typical X bands, which is the classical picture of a normal mature testis. In contrast, the others showed faint X bands at the 2nd postoperative week, which subsequently faded thereafter. During testicular ischemia, the Leydig cells are more resistant than the Sertoli cells and the germinal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

The strength of Achilles tendon repair: an in vitro study of the biomechanical behavior in human cadaver tendons.

Eighteen fresh frozen human Achilles tendons were used to test the ultimate strength of repaired tendon "ruptures." Three methods, the Kessler, the Bunnell, and the locking loop, were used to test the initial strength of Achilles tendon repair. The Kessler and Bunnell methods are current standard clinical configurations described for Achilles tendon repair. Under uniform and standardized laboratory conditions, the specimens were loaded to failure. The locking loop suture method was substantially stronger than either of the other two standard configurations. The latter two did not differ significantly from each other. The results of this study may be clinically relevant in terms of the choice of the repair method for surgically treated Achilles tendon ruptures.

Topical application of clobetasol 17-propionate from various cream bases by using Wistar rat as an animal model.

The effect of clobetasol 17-propionate (CP), a potent corticosteroid, participating in various cream bases on the permeation through rat skin was tested in vitro. Three commercially available formulations and three cream bases prepared in our laboratory according to Pharmacopoeia or registered patent were evaluated in this present study. The amount of CP in the receptor phase of diffusion cell was negligible in the beginning of administration due to the process of saturation of drug in skin reservoir, then the CP molecules pass through the skin directly because of the saturation of receptors in skin reservoir followed the higher flux of CP in the later period. It was suggested that the incorporation of penetration enhancers was the possible reason mainly controlling the flux of CP creams. Nevertheless, CP residue in skin and the lag time of formulations prepared in our laboratory were not significantly higher than those of commercial ones, which indicated penetration enhancer could not dominate the local pharmacological effectiveness of CP though they played a main part on the skin penetration capacity of formulations. The antiinflammatory activity of CP was assessed in the ear of Wistar rat. According to the result of antiinflammatory activity, all formulations showed significant inhibition on oedema suggesting the role of drug itself may be more important than that of vehicle in controlling the therapy efficacy.

Water extract of Zizyphus Jujube attenuates ischemia/reperfusion-induced liver injury in rats (PP106).

AIMS: Ischemia and reperfusion (I/R) injuries in the liver remain important clinical problems. Free oxygen radicals and nitrosative stress have been shown to be involved in the pathogenesis I/R-related liver injury. The purpose of this study was to characterize the effects of an extract of Zizyphus Jujube (ZJ), which has strong antioxidant effects, on I/R-induced liver injury. MATERIALS AND METHODS: Ischemia (I) was induced in rat livers by clamping the common hepatic artery and portal vein for 40 minutes, after which flow was restored, and the liver was reperfused for 90 minutes. Blood samples were collected prior to I and after reperfusion to assay blood levels of alanine transaminase (ALT), lactic dehydrogenase (LDH), oxygen radical (OH), and nitric oxide (NO). In the pharmacologic intervention group a water extract of the fruit of ZJ was administered orally to rats (100 mg/mL for 7 days) that were subsequently exposed to the I/R liver injury. RESULTS: The data showed that reperfusion (R) of the liver produced increases in blood concentrations of ALT (41.9+/-8.2 vs 338.0+/-89.6; P<.01; N=7) and LDH (317+/-129 vs 4073+/-950; P<.001; N=7). Oxygen radicals (55.1+/-14.3 vs 262.4+/-60.3; P<.001; N=7) and NO (69.3+/-14.9 vs 121.6+/-27.1; P<.01; N=7) also increased significantly in this R group. In the ZJ intervention group the liver injury, oxidative stress, and nitrosative stress were all significantly attenuated. CONCLUSION: These results suggested that I/R-induced liver injury with white blood cell activation, oxidative stress, and nitrosative stress. Pretreatment with an extract of ZJ, which shows high antioxidant effects, significantly attenuated the I/R-induced liver injury.

The study of reinnervation of gastric vagus nerves after lesser curvature and fundus myotomy in cats.

The aim of this study was to investigate the reinnervation of gastric vagus nerves after lesser curvature and fundus myotomy (LCFM) in cats. After injection of the retrogradely tracing agent horseradish peroxidase (HRP) into the stomach wall along the predicted line of LCFM, the neuronal cell bodies of the afferent and efferent fibers were well-defined in both the nodose ganglia (NG) and dorsal motor nucleus of the vagus nerve (DMNx), respectively. The animals were divided into three subgroups. After LCFM, at intervals of 0 day, 2, 4, 6, 8, 10 and 12 weeks, respectively, they were processed for a HRP histochemical study in both subgroups A and B. In subgroup A, HRP was directly injected into both sides of the stomach wall distal to the dissecting plane of LCFM. A further corpoantral circumferential myotomy (CACM) was performed in subgroup B to eliminate the possibility of collateral sprouting via antropyloric vagus innervation before applying HRP to the same sites as those of subgroup A. Both LCFM and CACM with an overlapping suture were performed in subgroup C, and HRP was then injected into sites similar to those of subgroup A on the twelfth postoperative week. HRP-labeled cells were found in the NG on the sixth week and in the DMNx on the eighth week in subgroups A and B. The labeled cells increased in number until the twelfth week in both subgroups A and B. However, cells found in subgroup A were always more numerous than those found in subgroup B in both the NG and DMNx at equivalent time intervals. No labeled cell was found in the NG or DMNx in subgroup C during the 12 week study period.(ABSTRACT TRUNCATED AT 250 WORDS)