OBJECTIVE:To observe the clinical efficacy and safety of ambroxol hydrochloride in the treatment of neonatal re-spiratory distress syndrome. METHODS:108 cases of neonatal respiratory distress syndrome were randomly divided into control group and observation group,54 cases in each group. Control group were treated with conventional treatment,such as oxygen inha-lation,anti-infection and nutritional support,observation group was additionally treated with 30 mg/kg Ambroxol hydrochloride in-jection,ivgtt,qd,for continuous treatment of 4-6 d. Clinical efficacy,blood gas indexes [oxygen partial pressure(PaO2),carbon dioxide partial pressure (PaCO2)],12,24 and 48 h after treatment remission time of clinical symptoms,hospitalization time, changes of X-ray film value,tidal volume(VT)and dynamic lung compliance(Cdyn)in 2 groups were compared,and the inci-dence of adverse reactions was observed. RESULTS:The total effective rate in observation group was 94.44%,which was signifi-cantly higher than control group (51.58%),the difference was statistically significant (P<0.05);there was no significant differ-ence in the blood gas indexes in observation group after 12 h(P>0.05),PaO2 was significantly higher than control group and Pa-CO2 was significantly lower than control group 24 and 48 h after treatment,there was significant difference between 2 groups(P<0.05). Remission time of cyanosis,dyspnea,lung moist rales and hospitalization time in observation group were shorter than con-trol group,the difference was statistically significant(P<0.05). X-ray film value,Cdyn and VT levels in observation group were significantly higher than control group,the difference was statistically significant(P<0.05). The incidence of adverse reactions in observation group was 3.70%,which was significantly lower than control group(18.52%),the difference was statistically signifi-cant(P<0.05). CONCLUSIONS:Ambroxol hydrochloride shows obvious efficacy in the treatment of neonatal respiratory distress syndrome,it can improve blood gas indexes and accelerate the recovery from disease,with good safety.

Objective To explore the role of body fat distribution in the pathogenesis of obesity-related asthma.Methods Totally 125 patients with stable asthma were recruited and were divided into non-obese group (n =51),peripheral obesity group (n =34) and central obesity group (n =40) according to body mass index and waist circumference.The FEV1％,FVC,FEV1/FVC ratio,IL-6,and hs-CRP levels in peripheral blood,eosinophil and neutrophil percentage in induced sputum,as well as exhaled NO levels were determined,and asthma control test (ACT) scores were calculated.Both one-way analysis of variance and analysis of covariance were used for statistical analysis.Results The values of FVC in the central obesity group and the non-obese group were [3.98 (3.99) ±0.99] L and [4.51 (4.51) ±1.00] L,while the levels of IL-6 and hs-CRP in peripheral circulation and the percentage of neutrophils in induced sputum were [33.63 (33.28) ± 14.04] ng/L and [21.22 (21.33)±11.23] ng/L,[2.12 (2.15) ±0.73] mg/L and [0.92 (0.91) ±0.61] mg/L,52.58 (52.81) ± 14.14 and 45.41 (45.34) ± 12.84,respectively (all P ＜ 0.05).After adjusting for inhaled corticosteroids (ICS) doses,the ACT scores were also significantly higher in central obesity group (22.10 ± 1.68 vs.23.01 ± 1.62) (P ＜ 0.05).Only the hs-CRP level was found significantly higher in peripheral obesity group than in non-obese group [(1.54±0.68) mg/Lvs.(0.91 ±0.61) mg/L] (P＜0.05).Conclusion Central obesity may play the leading role in the pathogenesis of obesity-related asthma.

Objective To observe the blood biochemical and histological changes before and after pancreas freezing, to provide evidence for cryosurgery for pancreatic cancer. Methods Fifteen healthy pigs were divided into deep frozen group (n = 5), shallow frozen group (n = 5), non-frozen group (n = 3) and normal group (n = 2). After anesthesia and Iaparotomy, a probe of the Argon-Helium Surgical System was inserted into the pancreas, 100% and 10% argon output power were used in deep and shallow frozen group, respectively;and the temperature were - 130 ～ - 140℃ and - 110 ～ - 120℃, respectively;which results in an ice-ball with 15 ～ 20 mm in diameter. Then helium gas was inputted to increase the temperature to 10 ～ 20℃ for three minutes;then the whole process was repeated. A probe was inserted into the pancreas in the non-frozen group only and only laparotomy was performed in non-grozen group normal group and normal group. Serum amylase, IL-6, CRP levels before and after the experiment was determined;the pigs were sacrificed at day 7 and the pancreas was harvested for light microscope and electron microscope examination. Results The frozen pancreatic tissue became pitchy necrosis zone, and it could be distinguished from non-frozen tissue;there were obvious tissue necrosis in the center and para-center of frozen area, and the ultra-structure were destroyed and disappeared, mitochondria degranulation and rough endoplasmic reticulum degrannlation were observed. Serum amylase was elevated in 13 (86.7%) pigs and most returned to normal at 6th day. Serum IL-6 was slightly elevated in 5 (33.3%) pigs. There was no significant difference among all the groups in term of serum CRP. All the pigs were alive until the time of sacrifice. Conclusions Cryosurgery has affirmative fatal ablative effects on pancreatic tissue, and it is safe with no serious complications.

Objective:To analyze the CT and MRI features of primary hepatic sarcomatoid carcinoma.Methods:A retrospective study was conducted on 16 patients with primary hepatic sarcomatoid carcinoma who presented to Wenzhou People's Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University from January 2009 to June 2019. There were 8 males and 8 females, with age ranging from 35 to 71 years (average 56.8 years). The site, size, shape, margin, density of signal, adjacent tissue changes and degree enhancement of tumor were analyzed.Results:Tumors in the liver in the 16 patients were all solitary, with 11 in the right and 5 in the left liver. The maximum diameter of tumor ranged from 3 to 16cm (average 8.5cm). On plain CT scanning ( n=16), the tumors were round or oval in 6, and lobulated or irregular in 10 patients. The margins of the tumors were clear in 10 and unclear in 6 patients. All tumors showed low density, with 15 tumors showing uneven density, with necrosis and liquefaction of different sizes in the center, while 1 tumor showing uniform density. On plain MRI scanning ( n=4), four tumors had clear margins, with necrosis and liquefaction seen in the center of the tumors. The solid part showed a slightly lower signal on T 1 weighted imaging and a slightly higher signal on T 2 weighted imaging. The liquefaction focus of central necrosis showed higher signal intensity on T 2 weighted imaging. Enhanced scanning ( n=12 on CT enhancement and n=4 on MRI enhancement), the margins of the tumors were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Strip septate and margin enhancement in the tumor were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 1 patient. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous phase. In the delayed phase, enhancement in the tumor decreased, but there was continuous enhancement of the margin and interval of the tumor in 1 patient. Conclusions:Hepatic sarcomatoid carcinoma showed dual imaging characteristics of sarcoma and cancer. The imaging features of hepatic sarcomatoid carcinoma depended on the proportion of sarcomatoid components. Large intrahepatic tumors showed necrotic cystic degeneration, moderate or significant persistent enhancement in striped septum and margin of tumor.

Objective:To explore clinicopathological features and prognosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in children induced by antithyroid drugs.Methods:The clinicopathological features, treatment and prognosis of 3 children with AAV induced by antithyroid drugs in the Department of Pediatric Nephrology and Rheumatology of the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, and the literatures were reviewed.Results:(1) Among the 3 cases, there were 2 females and 1 male, whose ages were 12.6, 13.9 and 13.1 years old, respectively. All patients had medication history of propylthiouracil (PTU) and/or methimazole (MMI) before onset. Initial manifestation was pallor and renal involvements with nephrotic proteinuria, hematuria and renal function abnormality, while 2 of them had hypertension. Extrarenal manifestations were also presented: case 1 presented with rash, arthralgia and cardiac insufficiency; case 2 had brain involvement with repeated convulsions; case 3 presented with arthralgia and lung involvement. They were all tested positive for p-ANCA and MPO-ANCA. Initial renal histopathology of the 3 cases were consistent with ANCA-associated glomerulonephritis, which were classified into sclerosis, crescentic and mixed class respectively. After 8 months of treatments, repeated renal biopsy of case 3 had demonstrated progression to sclerosis class. Antithyroid drugs (PTU or MMI) were discontinued in 3 cases, and the children were all treated with corticosteroid combined with intravenous pulse cyclophosphamide therapy. Plasma exchange was performed in case 2 and case 3 due to rapidly progressive glomerulonephritis and disease recurrence (suspected pulmonary hemorrhage), respectively. Case 3 was treated with rituximab combined with mycophenolate mofetil after recurrence. The extrarenal symptoms relieved quickly after treatments in all cases. P-ANCA and MPO-ANCA became negative in case 1 and case 2 after 6 months of treatments but they were persistently positive in case 3. Three cases were followed up for 24 months, 10 months and 12 months, respectively: case 1 develop chronic kidney disease (CKD) stage 2 with normal urinalysis; case 2 develop CKD stage 5 and had sudden death at home at 10-month follow-up; case 3 develop CKD stage 4 with nephrotic proteinuria and microscopic hematuria. (2) There were totally 30 pediatric cases with AAV induced by PTU and MMI, including 27 reported cases in the literature and 3 cases in this study. Symptoms of AAV appeared in children after an average administration of (37.5±4.0) months of PTU (range from one month to 96 months and 8 months of MMI alone). Kidney (28 cases, 93.3%) and lung (12 cases, 40.0%) were commonly involved, while brain (2 cases, 6.7%) was rarely involved. The pathological changes of kidney were crescent nephritis (5/23) and necrotizing pauci-immune complex nephritis (11/23). The total remission rate was 93.3% (28/30) after antithyroid drugs withdrawal and treatment with corticosteroids and immunosuppressive therapy, however, there were still severe cases with progression to CKD stage 5, and death. (3) Thirty cases were divided into complete response group ( n=19) and incomplete response group ( n=11) according to the treatment response. Compared with complete response group, the proportions of massive proteinuria (8/11 vs 5/19), fibrinoid necrosis (7/9 vs 4/14), deposition of immune complex in renal tissues (6/9 vs 2/14) and administration of immunosuppressants (10/11 vs 5/19), and degree of tubular atrophy (0/1/2/3 grade, 2/4/2/1 vs 9/5/0/0) in incomplete response group were higher (all P<0.05). Conclusions:PTU and MMI can both induce AAV in children, and AAV may occur after short-term course of administration. Kidney and lung are commonly involved while brain involvement is rarely seen. Timely withdrawal of antithyroid drugs and proper treatments with corticosteroids and immunosuppressants can result in high remission rate, though there are still some severe cases. Nephrotic-range proteinuria, renal fibrinoid necrosis, immune-complex deposition and tubular atrophy may be the risk factors of AAV for poor prognosis.

Objective:To compare the consistency in diagnosing and staging acute kidney injury (AKI) in children with chronic kidney disease (CKD) according to three criterias.Methods:Children with CKD hospitalized in the First Affiliated Hospital of Sun Yat sen University from January 2013 to December 2019 were analyzed retrospectively. These patients underwent serum creatinine examination more than twice during hospitalization. The AKI diagnosis and staging were performed for each patient according to the 2007 pRIFLE, 2012 KDIGO and 2018 pROCK criteria respectively. All the children were followed up for 1 year after discharge through outpatient visit, re-hospitalization or online consultation. The clinical characteristics and prognosis of CKD children with or without AKI that were diagnosed by 3 criteria were compared. Analysis of variance and chi-squared tests were used for the comparison among groups. Concordance between the different diagnostic criteria was evaluated using Cohen′s kappa coefficient.Result:A total of 2 551 children with CKD were included in this study, with an age of (8±4) years. There were 1 628 boys and 923 girls. Nephrotic syndrome was the most prevalent primary disease (55.4%), followed by lupus nephritis (11.2%) and purpura nephritis (8.2%). Among all stages of CKD, CKD category G1 was the most common type (2 146 cases, 84.1%), followed by CKD category G2 (221 cases, 8.7%). AKI occurence rates according to pRIFLE, KDIGO and pROCK criteria were 33.9% (866/2 551), 26.2%(669/2 551) and 19.5% (498/2 551) respectively (χ2=136.3, P<0.01). The diagnostic consistency within three criteria for AKI was high in children with CKD ( κ=0.702), but AKI staging consistency was low ( κ=0.329). Both the diagnosis and staging consistency of three AKI criteria were poor in children with CKD category G5 (all κ<0.400). The length of hospital stay (LOS), hospitalization costs, the occurence of intensive care unit (ICU) admission and in-hospital mortality were significantly higher in children with AKI diagnosed by different criteria ( P<0.05). After 1-year follow-up, the repeated admission rate and CKD staging progress significantly increased in children with AKI ( P<0.05). In children with baseline serum creatinine≥200 μmol/L, compared with children who did not experience AKI during hospitalization, the LOS and the hospitalization costs in children who were diagnosed AKI according to pRIFLE or pROCK criteria was significantly higher ( P<0.05). However, there was no significant difference in the LOS and hospitalization costs between children with or without AKI who were diagnosed according to KDIGO criteria (all P>0.05). Conclusions:AKI diagnosed by all of the three criteria (pRIFLE, KDIGO and pROCK criteria) was associated with the poor prognosis in children with CKD. However, in those whose baseline serum creatinine≥ 200 μmol/L, AKI diagnosed by pRIFLE and pROCK criteria could better reflect the poor outcomes than by KDIGO criteria.

Objective: To investigate the expression of galectin-3 protein in human breast cancer tissues and the effect of silencing galectin-3 gene on the migration, invasion and apoptosis of human breast cancer MCF-7 cells. Methods: The relative expression of galectin-3 protein in 15 cases of breast cancer tissues and corresponding para-cancerous tissues were detected by Western blotting; The expression of galectin-3 protein in paraffin sections of 100 cases of breast cancer tissues were detected by immunohistochemistry, and the correlation between galectin-3 expression and the clinicopathological characteristics of breast cancer patients was also analyzed. Galectin-3 siRNA were transfected into human breast cancer MCF-7 cells by liposome, then Real-time PCR and Western blotting were used to detect the mRNA and protein expression of galectin-3. The effect of galectin-3 gene silencing on cell migration and invasion ability of MCF-7 cells were detected by Transwell method. The effect of galectin-3 gene silencing on apoptosis of MCF-7 cells were detected by flow cytometry. Results: Western blotting detection showed that the relative expression of galectin-3 protein in breast cancer tissues were significantly higher than that in para-cancerous tissues (P<0.05); Immunohistochemistry detection showed that the positive expression rate of galectin-3 protein in breast cancer tissues was 67.00%, the positive expression rates in the lymph node metastasis, hormone receptor (ER, PR) negative groups were significantly higher (P<0.05), and the positive expression rate of galectin-3 protein were increased with the increase of TNM stage and histological grade (P<0.05); Galectin-3 siRNA transfection could significantly reduce the mRNAand protein expression of galectin-3 in MCF-7 cells (P<0.05), and reduce the invasion and migration ability but significantly improve the rate of apoptosis of MCF-7 cells (P<0.05). Conclusion: Galectin-3 is highly expressed in breast cancer tissues, and its silence can inhibit the invasion and metastasis of MCF-7 cells and induce apoptosis of MCF-7 cells. Galectin-3 can be used as a new target for biological therapy of breast cancer.