The role and significance of digital reconstruction technique in liver segments based on portal vein structure / 中华外科杂志

Objective@#To study the segment of liver according to the large amount of three-dimensional(3D) reconstructive images of normal human livers and the vascular system, and to recognize the basic functional liver unit based on the anatomic features of the intrahepatic portal veins.@*Methods@#The enhanced CT primitive DICOM files of 1 260 normal human livers from different age groups who treated from October 2013 to February 2017 provided by 16 hospitals were analyzed using the computer-aided surgery system.The 3D liver and liver vascular system were reconstructed, and the digital liver 3D model was established.The vascular morphology, anatomical features, and anatomical distributions of intrahepatic portal veins were statistically analyzed.@*Results@#The digital liver model obtained from the 3D reconstruction of CAS displayed clear intrahepatic portal vein vessels of level four.Perform a digital liver segments study based on the analysis of level four vascular distribution areas.As the less anatomical variation of left hepatic portal vein, the liver was classified into four types of liver segmentation mainly based on right hepatic portal vein.Type A was similar to Couinaud or Cho′s segmentation, containing 8 segments(537 cases, 42.62%). Type B contained 9 segments as there are three ramifications of right-anterior portal vein(464 cases, 36.82%). The main difference for Type C was the variation of right-posterior portal vein which was sector shape(102 cases, 8.10%). Type D contained the cases with special portal vein variations, which needs three-dimensional simulation to design individualized liver resection plan(157 cases, 12.46%). These results showed that there was no significant difference in liver segmental typing between genders(χ2=2.179, P=0.536) and did not reveal any significant difference in liver segmental typing among the different age groups(χ2=0.357, P=0.949).@*Conclusions@#The 3D digital liver model can demonstrate the true 3D anatomical structures, and its spatial vascular variations.The observation of anatomic features, distribution areas of intrahepatic portal veins and individualized liver segmentation achieved via digital medical 3D visualization technology is of great value for understand the complexity of liver anatomy and to guide the precise hepatectomy.

Relationship of Ghrelin gene polymorphism with congenital anorectal malformation and Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the relationship of Ghrelin gene polymorphism with the occurrence of human anorectal malformations (ARMs) and Hirschsprung disease(HSCR).</p><p><b>METHODS</b>PCR and DNA sequencing were used to detect the single nucleotide polymorphism (SNPs) of 3 loci (rs139684563, rs149447194, rs186599567) genotype of Ghrelin gene in 100 children with ARMs, 100 children with HSCR, and 100 healthy children (normal group). Genovariation and gene mutation were analyzed with case-control method.</p><p><b>RESULTS</b>Three loci SNPs were in accordance with Hardy-Weinberg genetic equilibrium. No significant differences were found in rs139684563 allele and genotype frequencies between the cases and the normal groups (P>0.05). The allele and genotype frequencies of rs149447194 and rs186599567 were significantly different between cases and normal group (P<0.05). DNA sequencing results showed that wild-type homozygous deletion (176th and 191th base A deletion, respectively) were found in rs149447194 and rs186599567of ARMs and HSCR children, and single base substitution was detected in rs149447194 of ARMs children (194th codon nucleotide CCT to CTC).</p><p><b>CONCLUSIONS</b>The rs149447194 and the rs186599567 polymorphism changes may be associated with the pathogenesis of ARMs and HSCR.</p>

Identification of exon mutations of the CDX1 gene in children with congenital anorectal malformation / 中华消化外科杂志

Objective To explore the distribution of exon mutations of CDX1 gene in children with congenital anorectal malformation (ARM).Methods In a case-control study conducted between June 2003 and March 2009,108 children with congenital ARM and 120 normal children undergoing health examinations who were admitted to the Shengjing Hospital of China Medical University (85 children with congenital ARM and 60 normal children) and the Affiliated Hospital of Hebei University (23 children with congenital ARM and 60 normal children) were assigned to the case group and the control group,respectively.PCR was performed to extend exons of the CDX1 gene and then sequence analysis was conducted after genomic DNAs were extracted from the peripheral blood.Categorical data with normal distribution were presented as (x) ± s and analyzed using the t test,count data were analyzed using the chi-square test.Results Exon sequencing was performed in the case group.Four children with 4 mutations of CDX1 located at coding regions were detected,including 1 with archostegnosis,1 with rectoperineal fistula,1 with rectovestibular fistula and 1 with rectourethral fistula.Four mutations located at the highly conserved homology domain of the CDX1 gene.The mutations of 1 child located at exon 1 of CDX1 gene (c.213-214Ins GAA).The mutations of 2 children located at the splicing region to exon 3 of the CDX1 gene (c.6G ＞ C,c.27G ＞ T).The mutations of 1 child located at the idiocratic splicing region to exon 3 of the CDX1 gene(c.18A ＞ C).No mutation was detected in the controls.Mutations of the CDX1 gene at c.213-214Ins GAA,c.6G ＞ C,c.27G ＞ T,and c.18A ＞ C,respectively,resulted in amino acid substitutions at 96-98Ins E,K199N,R206S,and Q203H in the protein.Conclusion Exon 1 or 3 mutations of the CDX1 gene is identified in children with congenital ARM,and CDX1 gene may be a susceptibility gene for ARM.

Bowel management in children with functional constipation / 中华实用儿科临床杂志

Functional constipation is one of the most common complaints in children,with a prevalence ranging from 0.7％ to 29.6％,occurring in all pediatric age groups,from newborns to young adults.It seriously affected the children's quality of life.Bowel management is an important method for the treatment of children with functional constipation including dietary modification,defecation habit practice,oral laxatives and enema administration.

The conservative management of pneumoperitoneum in children / 中国小儿急救医学

Objective Pneumoperitoneum is usually the result of hollow visceral perforation and requires emergent laparotomy.However,about 10％ of patients lack a pathologic cause requiring surgical intervention and can be resolved with conservative management.The aim of this study is to discuss the indications for conservative management of pneumoperitoneum in children.Methods We retrospectively reviewed the data of 5 children with pneumoperitoneum without peritonitis treated in our pediatric surgery department between January 2009 and December 2010.Results There were 5 children with an average age 5.4 years.Radiologic examinations demonstrated pneumoperitoneum and visceral perforations were suspected in the local hospitals.The abdominal examination revealed no peritoneal signs in all patients.Among them,peritoneal aspirations were implemented in 4 patients and the results were negative.One of five patients underwent laparotomy that demonstrated no visceral perforation.The remaining four were successfully managed conservatively and the pneumoperitoneum was completely resolved between 3 and 9 days.All children were without abdominal symptoms and signs throughout at least 2 years follow-up.Conclusion The presence of free intraperitoneal air does not always indicate hollow visceral perforation and the need for emergent laparotomy.It appears that therapeutic effectiveness can be readily achieved with conservative management in children with pneumoperitoneum without peritonitis.

Long-term outcomes of individualized biofeedback training based on the underlying dysfunction for patients with imperforate anus.

BACKGROUND: The aim of this study was to design an individualized biofeedback program based on the underlying dysfunctions and to assess the short-term and long-term clinical and quality-of-life outcomes for patients with imperforate anus. METHODS: Thirty-one patients were treated using an individualized biofeedback program according to their different dysfunctions after having completed the assessment of the anorectal function. Many special biofeedback training methods that consist of strengthening the perianal muscles biofeedback, sensory discrimination biofeedback, synchronizing external sphincter contraction biofeedback, and improving defecation dynamic biofeedback were selected to make up the individualized biofeedback training program. The clinical scores and quality-of-life scores were assessed in the short-term and long-term follow-up. RESULTS: The clinical scores and quality-of-life scores of patients before training, after biofeedback training, at short-term follow-up, and at long-term follow-up were 3.2 +/- 1.1 and 8.7 +/- 1.1, 5.2 +/- 0.6 and 11.0 +/- 0.8, 5.1 +/- 0.6 and 10.8 +/- 0.9, and 4.6 +/- 0.7 and 10.1 +/- 0.7, respectively. After biofeedback training, the strength of the perianal muscles were increased significantly, the abnormal rectal threshold sensation and defecation dynamic reverted to normal in all patients, and 82% patients who have no external anal sphincter reflex acquired the new reflex. In the short-term follow-up, 12 (57%) patients maintained the clinical outcome, and only 9 (43%) patients have regressions slightly. At long-term follow-up, 7 (33%) patients maintained the clinical outcome very well, and 14 (67%) patients had regressed. Although the clinical and quality-of-life scores have decreased slightly at follow-up, they were still significantly increased compared with those before biofeedback training. CONCLUSIONS: The individualized biofeedback is more suitable for improvement of the clinical outcome and the quality of life, and maintained a good clinical outcome and quality of life on the short-term and long-term follow-ups.

A preliminary study on the colonic dynamics in children of chronic constipation / 中国普通外科杂志

Objective To explore the colonic motor function of children with chronic constipation. Methods Twenty-five constipation children were enrolled in this study receiving determination of the colonic transit time and the anorectal vector manometry. Patients were then divided into subgroups with prolonged transit time and that with normal transit time. The value of anorectal manometry was assessed in these two subgroups. Results The total gastrointestinal transit time (TGITT), Left colonic transit time (LCTT)and rectosigmoid colonic transit time (RSTT) in constipation children were significantly longer than those measured in 33 healthy controls: (92?56) h vs. (29?8) h,P

The assessment of anal sphincter function after surgical correction of anorectal malformation by using three dimensional manometric vector volume / 中国普通外科杂志

Objective This study was to assess the anal sphincter function of postoperative patients with anorectal malformation by using vector volume manometry Methods The anal manometric vector volume were assessed in 40 cases by three dimensional PC Polygram HR system Results Results were graded as good, fair and poor group according to the clinical anal function score Anal sphincter pressures were (85?44)mm?Hg, ( 71? 38)mm?Hg and (42?28)mm?Hg respectively Anal sphincter pressure in control group was (161?64)mm?Hg ( P

Stooling patterns and colonic motility after transanal one-stage pull through operation for Hirschsprung's disease in children / 中国普通外科杂志

Objective To explore the stooling patterns and colonic motility after transanal onestage pull through operation for Hirschsprung' s disease in children. Methods Follow-up of more than 6 mos was obtained in all 58 children. The stooling pattern was investigated through questionnaire. Barium enema and colonic transit time with the simplified radio opaque markers were performed. Results Frequent stools was found in 4 cases, postoperative soiling in 9, constipation in 5 and Hirschsprungassociated enterocolitis in 3. No patients suffered from postoperative incontinence. Barium enema showed normal shape of the colon in most children, the sigmoid loops decreased or disappeared and was believed to be related to the length of removed colonic segment. Defecography showed the anorectal angle was larger and fixed than that of preoperative and control group[(123?15)?vs. (85?8)?vs. (79?12)?,P 168 h, P 0. 05 ]. TCTT and RSTT in symptomatic group were significantly shorter [ (25?6) h vs. (29?8) h,P