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Neural endoscopic assisted micro-invasive management of Chiari I malformation

Chinese Medical Journal 2010年第14期123卷 1878-1883页

作者： DENG Kan LI Yong-ning LI Gui-lin GAO Jun YANG Zhong DI Xiao WANG Ren-zhi Department of neurosurgery Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730 China Section of pediatric and Congenital neurosurgery Department of Neurosurgery Cleveland Clinic Ohio 44195 USA

Background In order to make posterior fossa decompression for the management of Chiari I malformation simple and less invasive while using direct visualization, a novel solely endoscopic procedure has been employed for the decompression of Chiari malformation type I. The objective of this study was to present neural endoscopic posterior fossa decompression and atlas laminectomy for Chiari type I patients. Methods Twenty-one patients with Chiari type I underwent neural endoscopic posterior fossa decompression and atlas laminectomy. We described the procedure for neural endoscopic posterior fossa decompression and atlas laminectomy. All patients in this series demonstrated cerebellar tonsil herniation below the foramen magnum in addition to syringomyelia. All patients in the reviewed study underwent preoperative MRI as well as 3-month postoperative MRI. Additional follow-up MRI varied but was usually repeated 12 months to 18 months after surgery. Postoperative MRI studies were retrospectively reviewed and compared with preoperative studies. Results All patients showed clinical improvements, and none had any complications. Patients with syringomyelia had symptoms entirely disappear. Eleven patients （52.4%） experienced radiographic improvement in syringomyelia （decreased size or resolution） during the follow-up period. Nine patients （42.8%） demonstrated decreased syrinx size and four （19%） demonstrated resolved syrinx. Of the 15 patients with symptomatic syringomyelia, 11 （73.3%） experienced symptomatic improvement. The median time to symptom improvement was four months after surgery. Post surgical MRI examinations indicated complete and sufficient decompression of foramen magnum region. Conclusions Endoscope atlanto-occipital decompression surgery is an innovative, safe and effective surgical procedure. It has similar results compared to traditional surgery, however with the added advantages of being minimal invasive, having fewer complications, decreased influence on

关键词： Chiari I malformation syringomyelia neural endoscope posterior fossa decompression minimally invasive neurosurgery

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Current state and future of co-inhibitory immune checkpoints for the treatment of glioblastoma

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Cancer Biology & Medicine 2020年第3期17卷 555-568页

作者： Shaoping Shen Ling Chen Jialin Liu Lin Yang Mengna Zhang Lingxiong Wang Rong Zhang Yasushi Uemura Qiyan Wu Xinguang Yu Tianyi Liu Department of neurosurgery Chinese PLA General HospitalBeijing 100853China pediatric Center Chinese PLA General HospitalBeijing 100853China Key Laboratory of Cancer Center Chinese PLA General HospitalBeijing 100853China division of Cancer Immunotherapy Exploratory Oncology Research and Clinical Trial CenterNational Cancer CenterKashiwa 277-8577Japan

In the interaction between a tumor and the immune system,immune checkpoints play an important role,and in tumor immune escape,co-inhibitory immune checkpoints are *** checkpoint inhibitors(ICIs)can enhance the immune system's killing effect on *** date,impressive progress has been made in a variety of tumor treatments;PD1/PDL1 and CTLA4 inhibitors have been approved for clinical use in some ***,glioblastoma(GBM)still lacks an effective ***,a phase III clinical trial using nivolumab to treat recurrent GBM showed no significant improvement in overall survival compared to ***,the use of immune checkpoints in the treatment of GBM still faces many ***,to clarify the mechanism of action,how different immune checkpoints play roles in tumor escape needs to be determined;which biomarkers predict a benefit from ICIs treatment and the therapeutic implications for GBM based on experiences in other tumors also need to be ***,to optimize combination therapies,how different types of immune checkpoints are selected for combined application and whether combinations with targeted agents or other immunotherapies exhibit increased efficacy need to be *** of these concerns require extensive basic research and clinical *** this study,we reviewed existing knowledge with respect to the issues mentioned above and the progress made in treatments,summarized the state of ICIs in preclinical studies and clinical trials involving GBM,and speculated on the therapeutic prospects of ICIs in the treatment of GBM.

关键词： Immunotherapy glioblastoma co-inhibitory immune checkpoint checkpoint inhibitors combination therapy

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Incidence and risk factors for infantile colic in Iranian infants

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World Journal of Gastroenterology 2008年第29期14卷 4662-4666页

作者： Elham Talachian Ali Bidari Mohammad Hossein Rezaie division of pediatric Gastroenterology Ali-Asghar Children's HospitalTehran *** Iran Medical School Iran University of Medical SciencesTehran 158756177 Iran

AIM: To assess the incidence of infantile colic and its association with variable predictors in infants born in a community maternity hospital, Tehran, Iran. METHODS: In this prospective cohort study, mothers who gave birth to live newborns between February 21 and March 20, 2003 at the hospital were invited to join to the study. For every infant-mother dyad data were collected on infant gender, type of delivery, gestational age at birth, birth weight, birth order, and mother's reproductive history. Then mothers were given a diary to document the duration of crying/fussiness behav-iors of their infants for the next 12 wk. We scheduled home visits at the time the infants were 3 mo of age to collect the completed diaries and obtain additional information on infants' nutritional sources and identify if medications were used for colic relief. Cases of colic were identifi ed by applying Wessel criteria to recorded data. Chi-square and Mann-whitney U tests were used to compare proportions for non-parametric and para-metric variables, respectively. RESULTS: From 413 infants, follow-up was completed for 321 infants. In total, 65 infants (20.24%) satisfi ed the Wessel criteria for infantile colic. No statistical sig-nifi cance was found between colicky and non-colicky infants according to gender, gestational age at birth, birth weight, type of delivery, and, infant's feeding pattern. However, fi rstborn infants had higher rate for developing colic (P = 0.03). CONCLUSION: Colic incidence was 20% in this popu-lation of Iranian infants. Except for birth order status, no other variable was signifi cantly associated with in-fantile colic.

关键词： Infantile colic Incidence Iran, Risk factors

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Perforated duodenal ulcer:An unusual manifestation of allergic eosinophilic gastroenteritis

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World Journal of Gastroenterology 2015年第44期21卷 12709-12712页

作者： Kevin M Riggle Ghassan Wahbeh Elizabeth M Williams Kimberly J Riehle Department of General Surgery University of Washington Seattle division of Gastroenterology Seattle Children’s Hospital Seattle division of Pathology Seattle Children’s Hospital Seattle division of pediatric General and Thoracic Surgery Seattle Children’s Hospital

Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis(EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.

关键词： pediatric Duodenal ulcer Eosinophilic Gastroenteri

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The Impact of a Prior Norwood Procedure on Cardiac Transplantation in Failed Fontan Physiology

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Congenital Heart Disease 2024年第3期19卷 257-266页

作者： Ryan G.McQueen Nikki M.Singh Ronald K.Woods Medical College of Wisconsin Herma Heart Institute at Children’s WisconsinMilwaukeeUSA division of pediatric Cardiology Medical College of WisconsinHerma Heart Institute at Children’s WisconsinMilwaukeeUSA division of pediatric Cardiothoracic Surgery Medical College of WisconsinHerma Heart Institute at Children’s WisconsinMilwaukeeUSA

Objective:The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood(FFN)to those without a prior Norwood(FF).Methods:A single-institution retrospective review of all patients with Fontan failure who under-went cardiac transplantation from 2003–2021 was completed-22 underwent prior Norwood(FFN)and 11 did not(FF).Descriptive and inferential statistics were calculated for operative course and patient ***:The operative course of the FFN cohort appeared to be more complex(not statistically significant,but clinically relevant)-this group exclusively experienced sternal re-entry events(3 of 22 patients)and concomitant neo-aor-tic reconstruction(6 patients),had a longer duration of surgery(median of 682 min vs.575.5 min),more time on circulatory arrest(median of 25.5 min vs.12.5 min),and more frequent use of open sternal management[50%of patients(11/22)vs.27.3%of patients(3/11)].Postoperatively,these patients underwent more mediastinal explora-tions[other than sternal closure;40.9%of patients(9/22)vs.18.2%of patients(2/11)],spent more time on mechanical ventilation(median of 5 days vs.2 days),had a longer length of stay(median of 30 days vs.19 days),and required more catheter-based re-interventions[22.7%of patients(5/22)vs.9.1%of patients(1/11)].Conclu-sion:Although underpowered,our results suggest that the operative course of FFN patients is more challenging,based mostly on neo-aortic arch *** turn,this likely leads to a more complex postoperative *** are currently collaborating with other institutions to increase the cohort size and power of the study.

关键词： Fontan Fontan failure Norwood cardiac transplantation

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Vanishing cerebral vasculitis in a patient with Lewy pathology

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The Journal of Biomedical Research 2017年第6期31卷 559-562页

作者： Natalia Liapounova Kamran H.Azar J.Max Findlay Jian-Qiang Lu division of pediatric Neurology University of AlbertaEdmontonAlbertaCanada Department of Pathology The North East Health Services Delivery AreaFort St.JohnBritish ColumbiaCanada division of neurosurgery University of AlbertaEdmontonAlbertaCanada Neuropathology Section Department of Laboratory Medicine and PathologyUniversity of AlbertaUniversity of AlbertaEdmontonAlbertaCanada

Immune-mediated mechanisms are involved in the pathogenesis of both cerebral vasculitis and Parkinson’s disease（PD, brainstem-predominant Lewy pathology）, but the presentation of cerebral vasculitis with comorbid Lewy pathology has not yet been reported. Here we present a case of pathologically confirmed vasculitis in a 73-year-old male patient whose postmortem examination revealed Lewy pathology diagnostic of PD. This case study suggests a comorbidity of cerebral vasculitis and Lewy pathology, as well as potential pathogenic interactions between these two disorders with immune-mediated mechanisms.

关键词： vasculitis cerebrovascular disease Parkinson’s disease Lewy pathology synucleinopathy immune pathogenesis

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Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy

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World Journal of Clinical Cases 2016年第8期4卷 219-222页

作者： Ashish P Saini Stephen E Cyran Steven M Ettinger Linda B Pauliks division of pediatric Cardiology Department of Pediatrics Penn State Hershey Medical College division of Cardiology Heart and Vascular InstitutePenn State Hershey College of Medicine

A 15-year-old boy with transposition of the great arteries(TGA) and neonatal arterial switch operation(ASO) presented with complete occlusion of the left main coronary artery(LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram(CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies.

关键词： Transposition of the great vessels Arterial switch operation Coronary angiography Ergometry Coronary occlusion

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Complications in children with percutaneous endoscopic gastrostomy (PEG) placement

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World Journal of pediatrics 2019年第1期15卷 12-16页

作者： Brigitta Balogh Tamás Kovács Amulya Kumar Saxena division of pediatric Surgery Department of PediatricsUniversity of SzegedKorányi fasor 14-15Szeged 6725Hungary Department of pediatric Surgery Chelsea Children's HospitalChelsea and Westminster NHS Fdn TrustImperial College LondonLondonUK

Introduction The aim of this study was to analyze the complication rates and mortality in association with different operative techniques of percutaneous endoscopic gastrostomy (PEG),age,underlying diseases and other risk ***,analysis of the indications of PEG insertion and the underlying comorbidities was also *** This study performs a literature analysis of PEG-related complications in *** was searched on PubMed(R) (1994-2017) using terms 'percutaneous endoscopic gastrostomy','complications','mortality' and 'children'.Results Eighteen articles with 4631 patients were *** mean age was 3 years (0-26 years).Operative techniques were:pull technique in 3507 (75.7%),1 stage PEG insertion in 449 (9.7%),introducer technique in 435 (9.4%),image-guided technique in 195 (4.2%) and laparoscopic-assisted PEG in 45 (1.6%).Most frequent indications for PEG insertion were dysphagia (n =859,32.6%),failure to thrive (n =723,27.5%) and feeding difficulties (n =459,17.4%).Minor complications developed in n 1518 patients (33%),including granulation (n =478,10.3%),local infection (n =384,8.3%) and leakage (n =279,6%).In 464 (10%) patients,major complications occurred;the most common were systemic infection (n =163,3.5%)and cellulitis (n =47,1%).Severe complication like perforation occurred in less than 0.3%.Patients with lethal outcomes (n =7,0.15%) had severe comorbidities;and the cause of mortality was sepsis in all *** or young age did not affect complication *** with ventriculoperitoneal (VP) shunt had higher risk of major *** high-risk patients,laparoscopic-assisted PEG insertion had less major and severe complication than traditional pull *** PEG is a safe operative technique;although minor complications are relatively common and occur in up to 1/3 of patients,there is a fairly low rate of severe ***-thirds of PEG patients have at least one ***

关键词： Children Complications Percutaneous endoscopic gastrostomy

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Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease

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World Journal of Gastroenterology 2017年第4期23卷 646-652页

作者： Erin D Boschee Jason YK Yap Justine M Turner Department of pediatrics University of Alberta Edmonton Clinic Health Academy University of Alberta Hospital division of pediatric Gastroenterology Department of PediatricsUniversity of Alberta

AIMTo determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD).METHODSEndoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children’s Hospital from 2010-2012 were retrospectively *** charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%.CONCLUSIONIn the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.

关键词： Endoscopy Histology Esophagus Gastric biopsy Celiac disease

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Activation of dopamine 2 receptors modulates glutamate decarboxylases 65 and 67 during stroke recovery in mice

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Neuroprotection 2023年第2期1卷 160-169页

作者： Daniela Talhada Robert Nilsson Severin Walser Georgios Michalettos Karsten Ruscher Laboratory for Experimental Brain Research Department of Clinical SciencesDivision of NeurosurgeryLund UniversityLundSweden LUBIN Lab-Lunds Laboratorium för Neurokirurgisk Hjärnskadeforskning Department of Clinical SciencesDivision of NeurosurgeryLund UniversityLundSweden

Backgrounds:Treatment with levodopa enhances recovery of lost neurological functions in preclinical stroke models and ***,we studied whether dopamine signaling modulates GABAergic neurotransmission in parvalbumin-positive interneurons after experimental ***:Following block randomization,mice were subjected to experimental stroke induced by photothrombosis(PT).Two days after the insult,mice were treated either with the D1 receptor antagonist by R(+)-SCH-23390(0.1 mg/kg),the selective D1 receptor agonist(R)-(+)-SKF-38393 hydrochloride(1 mg/kg),the D2 receptor agonist R(−)-2,10,11-trihydroxy-Npropyl-noraporphine hydrobromide hydrate(TNPA)(1 mg/kg),the D2 receptor antagonist S-(−)-eticlopride hydrochloride(0.3 mg/kg),or vehicle(saline)by daily intraperitoneal injection for five consecutive days,*** of function was assessed by paw placement and foot fault test before and on Days 2 and 7 after ***:Mice treated with TNPA showed a statistically significant improvement of recovery compared to all other treatment *** of gamma-aminobutyric acid(GABA)was quantified by levels of full-length and cleaved glutamate acid decarboxylase 67 and 65(GAD65 and GAD67)in the peri-infarct area and homotypic regions of the contralateral *** to the other treatments,TNPA significantly reduced the level of the GAD67 isoform both in the ischemic and contralateral *** of GAD65 were found significantly higher in the contralateral hemisphere in TNPA-treated mice after PT accompanied by an increase in the 58 kDa-truncated ***:Our results point toward reduced GABA synthesis in a D2 receptor-mediated mechanism possibly contributing to counteract functional inhibition after stroke.

关键词： calpain dopamine glutamate decarboxylase photothrombosis stroke recovery

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