Lung-protective effect of pressure-controlled volume-guaranteed ventilation combined with dexmedetomidine in pediatric patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the protective effect of pressure-controlled volume-guaranteed ventilation (PC-VG) combined with dexmedetomidine on the lung of pediatric patients undergoing laparoscopic surgery.Methods:Forty-eight pediatric patients of either sex, aged 2-6 yr, weighing 8-21 kg, scheduled for elective laparoscopic pyeloplasty, were divided into 3 groups ( n=16 each) using a random number table method: volume-controlled ventilation (VCV) group (V group), PC-VG group (P group), and PC-VG combined with dexmedetomidine group (PD group). In PD group, dexmedetomidine was intravenously infused for 15 min at a loading dose of 0.5 μg/kg starting from the time point before anesthesia induction followed by a continuous infusion of 0.2-0.5 μg·kg -1·h -1 until the end of operation. VCV mode was used in group V, and PC-VG mode was used in P and PD groups, ventilator settings were adjusted to the mode with a tidal volume 6-8 ml/kg, respiratory rate 15-25 breaths/min, inspiratory/expiratory ratio 1∶2, oxygen flow rate 2 L/min, fraction of inspired oxygen 60%, and P ETCO 2 was maintained at 35-40 mmHg during mechanical ventilation in three groups. At 5 min before pneumoperitoneum (T 0), 10, 60 and 120 min of pneumoperitoneum (T 1-3) and 10 min after release of pneumoperitoneum pressure (T 4), peak airway pressure (Ppeak), mean airway pressure (Pmean), compliance of lung (C L) and airway resistance (Raw) were recorded, alveolar-arterial oxygen partial pressure difference (PA-aO 2), oxygenation index (OI), and respiratory index (RI) were recorded. The occurrence of pulmonary complications was recorded within 7 days after operation. Results:Compared with V group, the Ppeak and Raw were significantly decreased and C L was increased at T 1-4, and PA-aO 2 and RI were decreased and OI was increased at T 3, 4 in P group and PD group ( P<0.05). Compared with P group, no significant change was found in the parameters of respiratory mechanics mentioned above at each time point ( P>0.05), and PA-aO 2 and RI were decreased and OI was increased at T 3, 4 in PD group ( P<0.05). There was no significant difference in the incidence of postoperative pulmonary complications among the three groups ( P>0.05). Conclusions:PC-VG combined with dexmedetomidine has a certain lung-protective effect in pediatric patients undergoing laparoscopic surgery.

Clinical analysis of antineutrophil cytoplasmic antibody-associated vasculitis in 13 children / 中华肾脏病杂志

Objective:To investigate the clinical manifestations, pathological characteristics, treatment and prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) in 13 children.Methods:The clinical and pathological data of 13 cases of AAV in children′s Hospital of Nanjing Medical University from June 2000 to December 2021 were retrospectively analyzed.Results:Among the 13 cases, 12 cases were diagnosed with microscopic polyangiitis (MPA) and 1 case was granulomatosis with polyangiitis (GPA), including 10 females and 3 males. The onset age ranged from 3 years and 11 months to 13 years and 10 months. The most frequently involved organ was the kidney (12 cases, 92.3%), followed by respiratory system (7 cases, 53.8%), skin (5 cases, 38.5%), digestive system (4 cases, 30.8%), nervous system (4 cases, 30.8%) and cardiovascular system (3 cases, 23.1%). There were 10 cases with orthotic anemia, 7 cases with positive antinuclear antibody, and 3 cases with mildly decreased complement C3. Among the 12 children with renal impairment, 9 cases were accompanied by abnormal renal function at the beginning of the disease. Renal biopsy was classified according to the Berden as follows: sclerotic in 5 cases, crescentic 3 cases, focal in 2 cases and mixed in 2 cases. All children were treated with glucocorticoid combined with immunosuppressant. During the follow-up time from 8 months to 128 months, 4 cases acquired complete remission, 8 cases achieved partial remission and 1 case recurred after complete remission, and 7 cases progressed to chronic kidney disease stage 5. Three children with complete remission underwent repeated renal biopsy, including 2 cases of mixed type and 1 case of crescent type initially, and all changed to focal type.Conclusions:AAV in children occurs mainly in school-age female, and most of AAV in children is MPA. The clinical manifestations are various. Most of them have renal damage and anemia, and lung damage is also common. Patients with skin purpura onset may be misdiagnosed as Henoch-Schonlein purpura, and AAV with ANA positive or complement reduction should exclude systemic lupus erythematosus. Once the renal function is abnormal in AAV, especially estimated glomerular filtration rate<60 ml·min -1·(1.73 m 2) -1 and the pathological classification is sclerotic type or crescent type, it is difficult to reverse even after active treatment. Early diagnosis and treatment are very important for AAV.

Comparison of different approaches to fascia iliaca compartment block for postoperative analgesia in elderly patients undergoing total hip arthroplasty / 中华麻醉学杂志

Objective To compare the efficacy of ultrasound-guided fascia iliaca compartment block(FICB)above inguinal ligament and longitudinal inguinal FICB for postoperative analgesia in elderly patients undergoing total hip arthroplasty(THA).Methods Sixty American Society of Anesthesiologists physical statusⅠ orⅡ patients of both sexes,aged 65-76 yr,with body mass index of 19-26 kg/m2,scheduled for elective unilateral THA,were divided into 2 groups(n＝30 each)using a random number ta-ble method: FICB above inguinal ligament group(S group)or longitudinal inguinal FICB group(G group).After the end of surgery,patients received ultrasound-guided FICB using a short-axis in-plane technique in S group and longitudinal inguinal FICB using a long-axis in-plane technique in G group,and patients received 0.4％ropivacaine as a loading dose of 40 ml,followed by continuous infusion of 0.2％ropivacaine 5 ml/h for 48 h.Ultrasound imaging time,puncture injection time and operating time of FICB were recorded.The efficacy of nerve block,effective pressing times,cumulative consumption of ropiva-caine,satisfaction with analgesia,and development of related complications were recorded at 6,12,24,36,48 and 72 h after surgery(T1-6).Results Compared with group G,the requirement for rescue anal-gesia with dezocine was significantly decreased,the effective pressing times at T3-5 and cumulative consump-tion of ropivacaine at T3,4 were reduced,and the success rate of obturator nerve block was increased at T1-6 in group S(P＜0.05).There were no significant differences in the success rate of the femoral nerve and lat-eral femoral cutaneous nerve block,satisfaction with analgesia and development of related complications be-tween the two groups(P>0.05).Conclusion Ultrasound-guided FICB above inguinal ligament increases the success rate of the obturator nerve block,provides better efficacy for postoperative analgesia and is more helpful for early postoperative functional exercise and recovery than the longitudinal inguinal FICB in the pa-tients undergoing THA.

Etiology analysis on a laboratory confirmed human rabies case with atypical symptoms / 中华实验和临床病毒学杂志

Objective@#To investigate and analyze the clinical features, epidemiologic information and pathogenic characteristics of a rabies patient.@*Methods@#Clinical data of the patient(boy) was collected and epidemiological survey was conducted, fluorescence quantitative reverse transcription-polymerase chain reaction (FQRT-PCR) and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect the samples of saliva, cerebrospinal fluid (CSF), skin tissue with hair follicle at the back of the neck for rabies laboratory diagnosis.@*Results@#Early symptoms of the boy were vomiting, diarrhea, fever and irritability, followed by coma and death. The boy had nasal trauma one month ago and the domestic dog died of illness during the same period. He did not accept the rabies post-exposure prophylaxis (PEP). The result of the saliva sample was positive by FQRT-PCR. The predicted segments of the glycoprotein(G), nucleoprotein (N) genes of rabies virus were amplified from the positive saliva sample of the patient by RT-PCR. Compared with rabies virus strains in Henan province, the nucleotide homology and amino acid homology in G gene segment were 96.5%-98.8% and 96.5%-99.2% respectively.@*Conclusions@#The case was diagnosed in laboratory as rabies case. The pathogenic rabies virus strain was endemic in Henan province. The nasal trauma, the dead domestic dog were probably related to the infection of the boy.

Comparison of different approaches to fascia iliaca compartment block for postoperative analgesia in elderly patients undergoing total hip arthroplasty / 中华麻醉学杂志

Objective@#To compare the efficacy of ultrasound-guided fascia iliaca compartment block(FICB) above inguinal ligament and longitudinal inguinal FICB for postoperative analgesia in elderly patients undergoing total hip arthroplasty (THA).@*Methods@#Sixty American Society of Anesthesiologists physical statusⅠ orⅡ patients of both sexes, aged 65-76 yr, with body mass index of 19-26 kg/m2, scheduled for elective unilateral THA, were divided into 2 groups (n=30 each) using a random number table method: FICB above inguinal ligament group (S group) or longitudinal inguinal FICB group (G group). After the end of surgery, patients received ultrasound-guided FICB using a short-axis in-plane technique in S group and longitudinal inguinal FICB using a long-axis in-plane technique in G group, and patients received 0.4% ropivacaine as a loading dose of 40 ml, followed by continuous infusion of 0.2% ropivacaine 5 ml/h for 48 h. Ultrasound imaging time, puncture injection time and operating time of FICB were recorded.The efficacy of nerve block, effective pressing times, cumulative consumption of ropivacaine, satisfaction with analgesia, and development of related complications were recorded at 6, 12, 24, 36, 48 and 72 h after surgery (T1-6).@*Results@#Compared with group G, the requirement for rescue analgesia with dezocine was significantly decreased, the effective pressing times at T3-5 and cumulative consumption of ropivacaine at T3, 4 were reduced, and the success rate of obturator nerve block was increased at T1-6 in group S (P<0.05). There were no significant differences in the success rate of the femoral nerve and lateral femoral cutaneous nerve block, satisfaction with analgesia and development of related complications between the two groups (P>0.05).@*Conclusion@#Ultrasound-guided FICB above inguinal ligament increases the success rate of the obturator nerve block, provides better efficacy for postoperative analgesia and is more helpful for early postoperative functional exercise and recovery than the longitudinal inguinal FICB in the patients undergoing THA.

Quality control of chromosome preparation in the chromosome aberration test in vitro / 中国比较医学杂志

Objective To study the influencing factors and quality control of chromosome preparation during chromosome aberration test in vitro,and to summarize and analyze the method and key points of successful preparation of chromosome specimens in vitro. Methods Chinese hamster lung cells(CHL)were used for cell culture and chromosome preparation. Mitomycin and cyclophosphamide were used as positive mutagens. After routine hypotonic treatment,fixation, and squash preparation, finally, to read the film under the microscope. Results The CHL chromosome aberration test showed that both the chromosome aberration rates of mitomycin- and cyclophosphamide-treated cells were significantly increased(>20%),while the aberration rates in the negative control group were less than 5%, either with and without metabolic activation. The success rate was high and the prepared chromosomes were well dispersed with a moderate length. Conclusions Many factors can affect the specimen preparation in chromosome aberration test. Every step is very important,and it should be strictly following the operating procedures. It is of importance to grasp the principle of each step and to operate carefully,patiently and scientifically in order to prepare good specimens.

Clinicopathological features and prognosis of minimal change nephropathy with IgA deposition in children / 中华实用儿科临床杂志

Objective To analyze the clinicopathological features and prognosis of minimal change nephropa-thy with IgA deposition(MCD-IgA)in children.Methods The clinical and pathological data of 10 cases in Chil-dren's Hospital of Nanjing Medical University from January 2010 to December 2015 with MCD-IgA were retrospective-ly analyzed,and 24 cases of minimal change nephrotic syndrome(MCD-NS)and 21 cases of IgA nephropathy clini-cally manifested with nephrotic syndrome(NS-IgAN)were selected as controls.Results (1)Clinical manifesta-tions:there were no significant differences in age,gender,incidence of hematuria,level of 24 hours urine protein,serum albumin and cholesterol levels and elevated serum IgA ratio in MCD-IgA compared with MCD-NS group.Compared with MCD-IgA and MCD-NS,NS -IgAN group showed older age of onset[(8.6 ± 2.1)years vs.(4.8 ± 2.4) years,(4.0 ± 1.6)years],higher level of serum albumin[(22.8 ± 4.3)g/L vs.(19.0 ± 1.9)g/L,(16.8 ± 3.0) g/L],and lower level of serum total cholesterol[(7.9 ± 1.9)mmol/L vs.(9.9 ± 2.7)mmol/L,(9.8 ± 2.1)mmol/L], and all the differences were significant(all P<0.05).NS-IgAN group was all associated with gross hematuria.(2) Pathology:the light microscope lesions in MCD-IgA and MCD-NS group were mild,but it was usually associated with severe histologic lesions in NS-IgAN,such as endocapillary proliferation,segmental sclerosis,crescent formation,tuft necrosis and chronic tubulointerstitial lesions;in MCD -NS group,immunofluorescence was negative. In MCD -IgA group,IgA deposition intensity was weak(less than + +),and 3 cases(30.0%)were accompanied with C3deposi-tion.In NS-IgAN group,IgA deposition intensity was stronger(more than + + +),and most of the cases were accom-panied with C3and other immunoglobulins deposition.Under electron microscope,both MCD-IgA and MCD-NS showed wide foot process effacement,and a small amount of mesangial electron dense deposit was detected in 9 cases of MCD-IgA.In NS-IgAN group,large amount of electron dense deposit was found in the mesangial region,and only 8 cases (38.0%)showed more than 50% of foot process effacement.(3)Prognosis:in MCD-IgA group,9 patients were ster-oid-dependent or frequently relapsed,1 case showed steroid-resistance,6 patients required additional agents.Except 1 case lost,with an average of(61.5 ± 28.8)months were followed up,8 patients achieved complete remission;In MCD-NS group,20 cases were steroid-dependent or frequently relapsed,4 cases were steroid-resistant,23 cases re-quired additional immunosuppressive agents.Followed up for an average of(36.4 ± 12.5)months,22 cases(91.7%) achieved complete remission;In NS-IgAN group,all cases were steroid-resistant and combined with cyclophospha-mide treatment;followed up for an average of(38.6 ± 15.2)months,19 cases(90.5%)achieved complete remission. Conclusions The clinical manifestations and prognosis of MCD-IgA were similar to MCD-NS,but the clinical and pathological findings of MCD-IgA were different from those of NS-IgAN.It is deduced that the nature of MCD-IgA is still a MCD,and that the IgA deposition may be nonspecific.

Henoch-Sch(o)nlein purpura nephritis in children: an update on the diagnosis and treatment / 中华实用儿科临床杂志

Henoch-Sch(o)nlein purpura (HSP) is the common form of systemic vasculitis in children,which characterized by the deposition of immunoglobulin E within the small vessels.The long-term prognosis of HSP depends on the severity of renal involvement.Renal involvement in HSP affects 10％-100％ patients and the clinical manifestations vary from microscopic hematuria to nephritic/nephritic syndrome even renal dysfunction.Early diagnosis,early treatment and long-term follow-up affect the prognosis of HSP patients.As for the treatment of HSP nephritis (HSPN),there have been many reports dealing with the immunosuppressive agents.Now glucocorticoid is the first-line treatment for HSPN,and other immunosuppressive agents offer more choices to treat HSPN especially for severe HSPN.But,the use of immunosuppressive agents still needs large sample multicenter randomized controlled trials and evidence-based study.

Exploration on the selection of positive materials in active systemic anaphylaxis in guinea pigs / 中国比较医学杂志

ObjectiveTheaimofthisstudywastoprovideabetterpositivecontrolforallergictestbycomparing the allergic effect of two kinds of positive materials , human albumin and ovalbumin , on active systemic anaphylaxis in guinea pig.Methods Guinea pigs were randomly divided into 14 groups, and were given human albumin , ovalbumin (2, 10, 100 mg/animal), or 0.9%sodium chloride injection as test substances , to assess the symptoms and incidence of systemic allergic responses induced by different sensitizing substances in different challenge doses and different challenge intervals.Results In the range of 2 to 100 mg/animal, the guinea pigs showed a 100%incidence rate of positive allergic reaction to human albumin and ovalbumin , the severity of anaphylactic symptoms was increasing along with the increase of sensitizing doses and challenge doses , and the allergic reaction was more strong induced by the same dose of ovalbumin than human albumin .Conclusions Our findings indicate that in the active systemic anaphylaxis test in guinea pigs , we recommend ovalbumin as the positive control in a dose of 2 mg/animal.

Early autophagy activation inhibits podocytes from apoptosis induced by aldosterone / 中华肾脏病杂志

Objective To explore the protection of early autophagy activation on podocyte injury induced by aldosterone.Methods In vitro cultured mouse podocyte clones (MPC5) were treated with aldosterone for 6,12,24,48 h respectively.Apoptosis of podocytes was detected by Annexin V combined with flow cytometry.After 24 h treatment with aldosterone,the existence of apoptotic body and autophagosome was observed by electron microscopy.The protein expressions of LC3,caspase-3 and nephrin were examined by Western blotting.The mRNA expression of Beclin-l was detected by real-time PCR.Results The induction of apoptosis and autophagy by aldosterone in podocytes was in timedependent mannner.After 24 h treatment with aldosterone,the apoptosis was increased by 26.5％ (P ＜ 0.05)and the expression of nephrin was decreased by 28.0％ (P ＜ 0.05) compared to control group.Aldosterone remarkably induced the expression of Beclin-1 at 6 h and promoted the transformation of LC3-Ⅰ to LC3-Ⅱat 12 h (P ＜ 0.05).Compared to simple aldosterone treatment,the apoptosis rate of podocyte was increased by 39.0％ (P ＜ 0.05) and the expression of nephrin was declined by 19.5％ (P ＜ 0.05) after 3-methyladenine (3-MA) pre-treatment.Conclusions Aldosterone can induce autophagy and apoptosis in podocytes.Autophagy occurs earlier (12 h) than apoptosis (24 h).The occurrence of autophagy can inhibit the apoptosis,so the autophagy pathway may be a new research topic of glomerular disease treatment.

Clinicopathological features and treatment of C1q nephropathy in children / 中华肾脏病杂志

Objective To investigate the clinicopathological characteristics and treatment of C1q nephropathy in children.Methods Data of 23 C1q nephropathy cases in Nanjing Children's Hospital during recent eight years were retrospectively reviewed. Results The incidence of C1q nephropathy was 4.78％ in primary glomerulonephritis proven by biopsy.Among 23 patients,15 were boys and 8 were girls.The mean age at onset was (5.0±3.4) years old with a range of 0.9-12.4 years.The clinical manifestations included nephrotic syndrome(NS) in 18 cases (78.3％),nephrotic-range proteinuria in 4 cases(17.4％) and microhematuria in 1 case.Two patients with NS and one patient with nephrotic-range proteinuria also presented microhematuria.One patient with NS who received oral herbal medicine for two weeks developed acute renal insufficiency at the same time of diagnosis.Three cases had a family history of kidney disease,among them two patients(presented nephrotic range proteinuria) were siblings,their father had proteinuria as well,and routine genetic examination confirmed familial Denys-Drash syndrome in association with C1q nephropathy.One NS patient's sister had nephrotic-range proteinuria too,but renal biopsy was not performed.No patient had hypertension.None of the patients had low C3 or C4 levels,and serological markers of systemic lupus erythematosus were absent.Light microscopy showedminimalchangedisease (MCD)in13cases (56.5％), mesangialproliferative glomerulonephritis(MsPGN) in 6(26.1％) and focal segmental glomerulosclerosis(FSGS) in 4(17.4％).Immunofluorescence displayed C1q co-deposits of IgG(78.3％),IgM(78.3％),IgA (34.8％) and C3 (47.8％),and a full-house pattern was found in 6 patients (26.1％).Electron microscopy revealed 4 out of 19 had mesangial deposits,except for 4 patients whose glomerulus could not be found.Children with either NS(18 cases) or nephrotic-range proteinuria(2 cases)received prednisone,among them,15 were steroid-resistant,4 were steroid-dependent,only 1 was steroid-sensitive.Those with steroid-resistant(15 cases) or steroid-dependent(3 cases) received further immunosuppression with cyclophosphamide(CTX) or cyclosporine A (CsA).One NS case of steroid-dependent received prednisone re-induction therapy.The siblings associated with DenysDrash syndrome and one case presented microhematuria were commenced on angiotensin-converting enzyme inhibitor(ACEI).Of the 19 patients with sufficient follow-up date,15 cases (78.9％)achieved complete remission,2 cases(10.5％) achieved partial remission,and 2 cases (10.5％) were ineffective.Median follow-up was 15 months.Remission of the NS occurred in 94.4％ (17/18)while nephrotic-range proteinuria was 50.0％(2/4).Remission of MCD was 100.0％,MsPGN was 83.4％(5/6),but FSGS was only 50.0％(2/4).Conclusions C1q nephropathy is rare,and often manifests as steroid-resistant or steroid-dependent NS and nephrotic-range proteinuria.The most common histological feature is MCD,and some as MsPGN or FSGS.A combination of prednisone and immunosuppressive agent is always effective for MCD and MsPGN,but FSGS always has a poor response.

Clinical Observation of Dianning Tablet in the Treatment of Refractory Epilepsy / 中国药房

OBJECTIVE: To approach efficacy of Dianning tablet in the treatment of refractoriness epilepsy.METHODS: 180 patients with refractoriness epilepsy were randomized into treatment group,control group Ⅰand control group Ⅱ(n=60).Treatment group were given Dianning tablet produced by our hospital.Control group Ⅰwere treated with carbamazepine tablet and clonazepam tablet while control group Ⅱ were treated with valproate sodium tablet and clonazepam tablet.The efficacies of three groups were compared after 6 months.RESULTS: Treatment group was better than control groups in total effective rate,seizure frequency and improvement of EEG (P