[Multicenter investigation of extracorporeal membrane oxygenation application in pediatric intensive care unit in China].

Objective: To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland. Methods: In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy. Results: By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children's hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77). Conclusion: The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.

Targeting colon cancer stem cells with novel blood cholesterol drug pitavastatin.

OBJECTIVE: Previous studies have demonstrated the importance of stem cells in human cancer, including colon cancer. Pitavastatin is approved for the treatment of hyperlipidemia and has also been shown to inhibit stem cell proliferation in preliminary in vitro studies. This study was done to investigate the effects of pitavastatin on human colon carcinoma stem cells (coCSCs) in vitro and in mouse tumor xenografts in vivo. MATERIALS AND METHODS: Human colon adenocarcinoma cell lines, SW480 and SW620, were cultured to the spheroid formation. The effects of pitavastatin on colon cancer stem cells were studied using the colorimetric MTT cell proliferation assay; quantitative polymerase chain reaction was used to determine the expression of cell cycle genes, OCT4, SOX2, and NANOG; Western blots were performed to measure MDR1. Mice were injected subcutaneously with SW480 cells; the growth of these tumor xenografts was studied using volumetric analysis following pitavastatin treatment. RESULTS: Specific cell culture medium provided conditions that resulted in the expression of colon cancer stem cell markers when compared with normal cultured cells. Colon cancer stem cells were inhibited by pitavastatin treatment. Pitavastatin reduced the expression of stem cell markers of colon cancer stem cells and induced the cell apoptosis. Pitavastatin inhibited the growth of mouse tumor xenografts. CONCLUSIONS: The findings of this preliminary study have demonstrated a potential role for pitavastatin in the inhibition of stem cell proliferation in colon carcinoma. Further studies are recommended to determine the mechanism of these effects on colon carcinoma cells in vitro and in vivo.

Overexpression of the growth arrest-specific homeobox gene Gax inhibits proliferation, migration, cell cycle progression, and apoptosis in serum-induced vascular smooth muscle cells.

The Gax gene has been implicated in a variety of cell-developmental and biological processes, and aberrant Gax expression is linked to many diseases. In this study, to provide important insights for Gax-based gene therapy in vein graft restenosis and its anti-restenotic mechanism, we used rabbit vascular smooth muscle cells (VSMCs) to investigate the effects of Gax overexpression on proliferation, migration, cell cycle, and apoptosis in a serum-stimulated culture. Rabbit VSMC lines that stably overexpressed Gax were established by transfection with recombinant adenoviral vector Ad5-Gax. The effect of Gax overexpression on in vitro serum-induced VSMCs proliferation, migration, cell cycle, and apoptosis was assessed by MTT, wound healing, and flow cytometry assays, respectively. To investigate the effect of Gax overexpression on PCNA and MMP-2 in serum-induced VSMCs, immunocytochemistry, RT-PCR, and gelatin zymography were performed. The results clearly showed that Gax overexpression decreases PCNA expression in serum-induced VSMCs. Gax overexpression also significantly inhibited cell proliferation by blocking entry into the S-phase of the cell cycle, promoted cell apoptosis, and reduced cell migration activity by downregulating MMP-2 release and activity. These findings indicate that Gax would be an optimal target gene for gene therapy to treat vein graft restenosis.

Cystic echinococcosis in semi-nomadic pastoral communities in north-west China.

In order to determine the prevalence of human cystic echinococcosis (CE) in semi-nomadic traditional pastoralist groups in north-west China, 2 large community studies were undertaken in Altai and Tacheng Prefectures in 1990/91 and 1995/96, respectively. The Kekergash community (Altai) comprised mainly ethnic Kazakhs, whereas the Narenhebuke community (Tacheng) comprised mainly Mongolians. Populations were screened for CE by abdominal ultrasound scan (US) and serological tests. The total prevalence of confirmed human CE was higher in Narenhebuke (2.7%, 49/1844) than in Kekergash (0.9%, 17/1861; P < 0.01). Within each community there was no significant difference of CE prevalence between the Kazakh and Mongolian groups, although Han Chinese exhibited twice the rate of CE (4.9%) in Narenhebuke compared to the dominant Mongolian population. For each community, human CE prevalence increased with age and there was a greater risk associated with the practice of home slaughter of livestock. Dogs were screened for Echinococcus granulosus infection and re-infection levels using a highly specific coproantigen test. The proportion of dogs with positive coproantigen tests was significantly higher in Narenhebuke (36.0%, 50/139) compared to Kekergash (17.8%, 16/90). In Narenhebuke the re-infection levels of dogs, as determined by coproantigen positivity, were higher in the winter quarters (49.4%, 39/79) compared to the summer quarters (18.3%, 11/60; P < 0.01). Furthermore, coproantigen re-test positivity was 25% at 3 months and 29.2% at 7 months. Highest dog coproantigen positivity was obtained over the winter period.

Life-threatening bleeding in a facial fracture.

Life-threatening bleeding in facial fractures is considered rare, and most reports do not recommend a precise treatment guideline. Although various methods have been suggested, they are unpredictable in efficacy and may lead to irreversible shock. To avoid irreversible shock, early detection and correct, effective treatment are mandatory. The authors report a patient who presented with a complex midface fracture after falling on June 23, 1999. Life-threatening oronasal bleeding developed 1 hour after arriving at the emergency room. Initial nasal packing failed to stop the nasal bleeding. After resuscitation, the patient's vital signs were stable but bleeding persisted. Angiography showed diffuse extravasation of contrast medium over the territory of the right internal maxillary artery. Embolization was performed successfully to stop the bleeding. The authors review the literature regarding the incidence, diagnosis, and treatment of life-threatening facial fracture. In the literature, the lack of a precise definition leads to various results by various treatments. The authors have formulated a succinct treatment guideline. They favor angiographic embolization as the first choice of treatment when tight nasal and/or oral packing fails.

Large scalp and skull defect in aplasia cutis congenita.

Aplasia cutis congenita (ACC) is a rare disease, which may involve any site on the body but usually the vertex with scalp and even skull involvement. Superficial lesions may heal spontaneously and seldom result in morbidity or mortality. However, in patients with large scalp and skull defects, there are risks of infection and bleeding. Both surgical and conservative treatment have been proposed. We report a case of successful treatment of ACC by early debridement and wound closure with split-thickness skin graft (STSG) in the neonatal stage followed by replacement of the STSG with a hairy scalp flap by means of tissue expansion at the age of 3 years. The original skull defect, 7 x 10 cm in size, decreased to 1.2 x 1.2 cm after a 4.5-year follow-up. No complications, such as haemorrhage or meningitis, were encountered. The final result was satisfactory.

Severe colonic complications in acute pancreatitis.

BACKGROUND: Colonic complications in patients with acute pancreatitis may be very severe and have rarely been analyzed in Chinese patients. METHODS: We retrospectively evaluated 1,637 patients with acute pancreatitis who were admitted to the Veterans General Hospital-Taipei from January 1986 to December 1995 in order to identify those with severe colonic complications. The clinical, radiologic and pathologic features and surgical findings in these patients are reviewed. RESULTS: Eight of 1,637 patients with acute pancreatitis had severe colonic complications. Six of them were diagnosed between two and eight weeks after the onset of clinical pancreatitis. All had a Ranson's score of at least 3. Four patients, including one with hematochezia, had a strong positive reaction for occult blood in stool specimens. Computed tomography (CT) revealed necrotizing pancreatitis and colonic wall swelling in all eight patients. Colonic involvement was discovered by CT in two patients prior to surgery, one with colocutancous fistula and the other with colonic perforation. The other six patients were found to have colonic involvement incidentally at the time of laparotomy. All of the colonic involvements were located near the splenic flexure. In addition to necrosectomy, three patients underwent segmental hemicolectomy and the remaining five patients had simple closure of the perforation. Diverting loop ileostomy or colostomy was also carried out in all patients. Three patients (34%) died of overwhelming sepsis superimposed on the subsequent multiple organ failure between 44 and 122 days after the onset of pancreatitis. CONCLUSIONS: Severe colonic complications of acute pancreatitis are rare. Although preoperative diagnosis is difficult, CT may be helpful to make an early diagnosis. These complications should be suspected in patients with severe acute pancreatitis when acute lower gastrointestinal hemorrhage or positive stool occult blood is found two to eight weeks after the onset of pancreatitis or when CT reveals necrotizing pancreatitis and colonic wall swelling; this will allow early surgical intervention.

Public health importance of cystic echinococcosis in China.

Cystic echinococcosis has been recorded in 21 out of China's 31 provinces, autonomous regions and municipalities (approximately 87% of territory). It constitutes one of the major public health problems, especially in several northwestern provinces and autonomous regions. This paper reviews the general situation, diagnosis, treatment, education and control programmes and international cooperation. Special attention is given to the Xinjiang, an endemic area about one sixth of the country's area with a human population of approximately 16 million.

Construction of retroviral vector carrying HSV-tk gene under control of human AFP enhancer core sequence and human pgk promotor.

AIM: To construct retroviral vector bringing HSV-tk gene under control of human AFP enhancer core sequence and human pgk promoter. METHODS: Internal SV40 promoter was deleted by SalI from retroviral vector pMNSM to construct pMNM. HSV-tk gene driven by pgk promoter was released by BamH I from an eukaryotic expression vector pBPGK-tk, and inserted into polylinker site of pMNM to construct pMNP-tk retroviral vector. Human α-fetoprotein gene enhancer core sequence was released by EcoR I from pGEM. 7Z-AFPe plasmid was inserted into the immediate upstream of pgk promoter of pMNP-tk vector. Construction of hepatoma specific retroviral vector pMNAP-tk was completed. RESULTS: The structure of pMNP-tk and pMNAP-tk vector was confirmed by restriction analysis. CONCLUSION: The vector is of great significance for hepatoma specific prodrug transformation gene therapy.

Carcinoid tumors of the gastrointestinal tract in Chinese of Taiwan: an analysis of fifty cases.

BACKGROUND: Gastrointestinal carcinoids are uncommon and potentially metastasizing neoplasms. Many series have been reported but few of them concern Chinese people. In this paper we present data on 50 Chinese with gastrointestinal carcinoids, living in Taiwan, to analyze their clinical features and prognostic factors. METHODS: From 1971 to 1995, 50 Chinese patients with primary gastrointestinal carcinoids were seen at Veterans General Hospital-Taipei. All patients had pathological proof of carcinoids. RESULTS: There were 35 males and 15 females with a mean age of 55.9 +/- 2.1 years (range 20-76). The primary sites of the tumors, in order of frequency, were rectum (66%), duodenum (14%), stomach (8%), appendix (4%), ileum (4%), colon (2%) and cecum (2%). The cumulative 5-year survival rate was 73%. Carcinoids > or = 2cm in diameter were more frequently symptomatic and metastatic, and tended to have a lower survival rate than those < 2cm in diameter (p = 0.06). Carcinoids which had invaded the serosa were more frequently symptomatic and metastatic, and had a lower survival rate than intramural carcinoids (p < 0.05). CONCLUSIONS: Rectal carcinoids were the most common gastrointestinal carcinoids in the Chinese living in Taiwan. Carcinoids > or = 2cm and carcinoids invading the serosa correlated well with symptom presentations and metastases. Intramural carcinoids had a better prognosis than carcinoids invading the serosa. Carcinoids < 2cm was a potentially positive factor of prognosis.

Adenomyomatosis of the gallbladder.

BACKGROUND: Adenomyomatosis of the gallbladder in Chinese patients has rarely been analyzed. METHODS: The clinical, radiological and pathological features of 18 patients with histologically-proven adenomyomatosis, collected during a 5-year period, were retrospectively analyzed. RESULTS: According to the extent and site of involvement, adenomyomatosis of the gallbladder was conventionally classified into three types: localized, generalized and segmental. In our series, the disease was localized in 17 patients (15 in the fundus and 2 in the neck), generalized in one patient and segmental in none. Only 5 patients showed sonographic features correlative to pathologic findings, and 2 of them were correctly diagnosed before operation. Only mild nonspecific abnormalities of liver function test or urine analysis were noted in some patients with gallbladder adenomyomatosis. The clinical manifestations were not related to coincidental diseases in 11 patients. All these 11 patients, with gallstone in 9 and without in 2, complained of epigastralgia, right upper quadrant abdominal pain or dyspepsia, which relieved all after cholecystectomy. CONCLUSIONS: Some patients with adenomyomatosis may be symptomatic and relieved by cholecystectomy. In patients with adenomyomatosis of the gallbladder and right upper quadrant pain of abdomen without other explanation, cholecystectomy may be considered. Infrequent accurate diagnosis in Chinese patients calls for a high suspicion of the disease entity in clinical practice.

Interaction of laminin with Entamoeba histolytica cysteine proteinases and its effect on amebic pathogenesis.

The Entamoeba histolytica 27-kDa cysteine proteinases exhibit striking binding specificities for immobilized laminin over other components of the extracellular matrix, such as collagen and fibronectin. Inactivation of the proteinase with the active-site inhibitor L-trans-epoxysuccinyl-leucylamido(4-guanidino)butane abolishes laminin binding by the enzyme, and conversely, laminin inhibits cleavage of a fluorogenic dipeptide substrate of the amebic cysteine proteinase, suggesting that the substrate binding pocket of the enzyme is involved in the binding of laminin. The addition of laminin but not fibronectin or collagen to E. histolytica trophozoites significantly reduces amebic liver abscess formation in severe combined immunodeficient mice, further supporting the hypothesis that E. histolytica cysteine proteinases play an important role in amebic pathogenesis. The specific interaction of amebic proteinases with laminin may be exploited in designing new inhibitors of these enzymes.

[Observation of the effects of LAK/IL-2 therapy combining with Lycium barbarum polysaccharides in the treatment of 75 cancer patients].

Seventy nine advanced cancer patients in a clinical trial were treated with LAK/IL-2 combining with Lycium Barbarum polysaccharides (LBP). Initial results of the treatment from 75 evaluable patients indicated that objective regression of cancer was achieved in patients with malignant melanoma, renal cell carcinoma, colorectal carcinoma, lung cancer, nasopharyngeal carcinoma, malignant hydrothorax. The response rate of patients treated with LAK/IL-2 plus LBP was 40.9% while that of patients treated with LAK/IL-2 was 16.1% (P < 0.05). The mean remission in patients treated with LAK/IL-2 plus LBP also lasted significantly longer. LAK/IL-2 plus LBP treatment led to more marked increase in NK and LAK cell activity than LAK/IL-2 without LBP. The results indicate that LBP can be used as an adjuvant in the biotherapy of cancer.

Albendazole chemotherapy for human cystic and alveolar echinococcosis in north-western China.

Human echinococcosis is highly endemic in north-western China; the main treatment is by surgery. In this paper, we report the results of chemotherapy with albendazole (ABZ), 15-20 mg/kg/d orally, for 30 d with intervals of 10 d between treatments for 3-6 courses. For multi-organ cystic echinococcosis (CE) and alveolar echinococcosis (AE), patients were given 12-18 courses of ABZ. Patients were divided into 4 groups: (i) ABZ surgery group, albendazole with surgery for 21 CE cases: (ii) non-ABZ surgery group, 80 CE cases treated by surgery alone; (iii) ABZ CE group, albendazole treatment alone in 58 CE cases, and (iv) ABZ AE group, 14 AE patients treated by albendazole and surgical intervention and 5 AE patients treated by albendazole alone. Twenty-seven of 34 (79.4%) cysts in group (i) patients showed increased necrotic changes and decreased viability of the cysts compared to group (ii). However, 10 of 84 (11.9%) cysts in group (ii) patients showed spontaneous evidence of necrosis at surgery. In group (iii), ABZ treatment alone was successful in 14 (24.1%), resulted in improvement in 29 (50%) and had no effect in 15 (25.9%) patients. Seven cases in group (iv) improved, with diminished size of lesions which were non-viable. The remaining 7 cases in group (iv) showed evidence of cyst viability at surgery; 2 could not be saved after a further 15 courses of albendazole. Of the five AE patients in group (iv) who received only ABZ, one improved, 2 stabilized, one deteriorated and one died. Albendazole chemotherapy, while not completely effective, has an important role in treatment of both cystic and alveolar echinococcosis.