Objective To investigate effects of thoracoscopic sternal elevation by using a steel bar(Nuss procedure) in the treatment of pectus excavatum in children.Methods Under the assistance of thoracoscopy,a substernal tunnel was created using a blunt dissector via a right thoracic incision.Then a steel bar was inserted under the sternum.After the bar was placed in position,it was turned over to elevate the deformed sternum and the anterior chest wall.Results The operation was completed successfully in all the 11 cases.The operating time ranged 50~85 min(mean, 67 min).The intraoperative blood loss ranged 5~20 ml(mean,10 ml).The surgical outcomes were classified as "excellent" in 9 cases,"good" in 1 case,and "fair" in 1.Follow-up observations for 2~15 months(mean,6.4 months) in 8 cases showed satisfactory appearance.Conclusions Thoracoscopic Nuss procedure for pectus excavatum in children is a minimally invasive technique with limited surgical trauma,minimal blood loss,simple performance,rapid recovery,and good cosmetic results,being worthy of recommendation.

Objective To discuss the laparoscopic diagnosis and treatment for non-palpable undescended testis.Methods Laparoscopy was utilized in the diagnosis and treatment of 29 cases of non-palpable undescended testis(34 sides) from July 2002 to March 2005.Results The diagnosis was clarified in all the 29 cases.Intraabdominal testis was found in 21 sides(primary orchidopexy in 16 sides and two-staged Fowler-Stephens orchidopexy in 5 sides) and absent testis,13 sides.Follow-up observations for 0.5~1 year in 29 cases showed no testicular retraction or atrophy.Conclusions Laparoscopic intervention,characterized with accurate diagnosis,little invasion,and quick recovery,can be the first choice for the diagnosis and treatment of(non-palpable) undescended testis.The primary orchidopexy of testis may have satisfactory results if possible.

Objective To gain more pathophysiolgic knowledge about acute obstructive hydrocephalus and to explore its rapid and effective treatment by establishing canine acute obstructive hydrocephalus model.Methods Acute obstructive hydrocephalus model was established by injecting cyan-acrylic gel glue into the fourth ventricle via posterior fosse craniotomy in 9 male adult mongrel dogs.At the same time,lateral ventricle catheterization were performed and were fixed on the scalp to connect reservoir bag so that the changes of intracranial pressure (ICP) could be measured dynamically,and the changes of neurological function were observed.Results Acute obstructive hydrocephalus model was successfully established in 6 of the total 9dogs.ICP was (48.2 ± 6.1 ) cm H2 O at 48 hours after the injection and was (56.4 ± 5.7 ) cm H2 O at 72 hours after the injection,it increased 392％ and 459 ％ respectively.And the ICP after injection was significantly different(P ＜ 0.01 )compared with that before injection (12.3 ± 3.1 )cm H2O.Conclusion The establishment of acute obstructive hydrocephalus model has high success rate,and is easy to reduplicate; ICP could be measured dynamically and also could be reduced by releasing CSF;Thus,ventricular drainage is the most rapid and effective treatment for acute obstructive hydrocephalus.

BACKGROUND: Hyperbaric oxygen can reduce brain ischemic-reperfusion injury, and this effect is closely related to the modulation of hyperbaric oxygen on microglias.OBJECTIVE: To explore the influence of hyperbaric oxygen on the activity of in vitro cultured brain microglias and secretion of interleukin-1, tumor necrosis factor α and nitric oxide (NO).DESIGN: Completely randomized grouping design, control experiment.SETTING: Teaching and Research Section of Diving Medicine, Teaching and Research Section of Immunity, Teaching and Research Section of Pathology, and the Experimental Animal Center, the Second Military Medical University of Chinese PLA.MATERIALS: This experiment was carried out at the laboratory of Diving Medicine as well as Teaching and Research Section of Immunity, the Second Military Medical University of Chinese PLA, between May 1999 and January 2000. Thirty neonatal SD rats of 1-day birth age were selected for the experiment.METHODS: [1] Brain microglias from newborn SD rats were cultured with digestion method, and microglias were identified with non-specific phosphodiesterase staining and cellular immunochemical staining. [2] Primary microglias were inoculated on 48-well culture board by 2×105/well and randomized into 5 groups: control group without hyperbaric oxygen pretreatment, and hyperbaric oxygen (0.2 MPa 1 hour) pretreatment 3, 7, 10,14 days groups. Cells in groups with hyperbaric oxygen pretreatment at the above various time points were then further divided into 2 subgroups, with one added with culture medium containing bacterium lipopolysaccharide of 1 mg/L (for microglia activation), but not in the other group. [3] Interleukin-1 activity was determined using thymocyte proliferation method. The activity of tumor necrosis factor-α was assessed with L929 cell toxicity test.Nitrous acid content detected by Griess method represented NO content.[4] t-test was used to compare the differences in non-paired quantitative data between the two groups.MAIN OUTCOME MEASURES: The activity of interleukin-1 and tumor necrosis factor a and NO content in resting and evoked brain microglias in rats at various time points of hyperbaric oxygen pretreatment.RESULTS: Thirty SD rats entered the result analysis. [1] The activity of interleukin-1 and tumor necrosis factor α and NO content in resting brain microglias: The two groups did not differ obviously. [2] Interleukin-1activity and NO content in lipopolysaccharide-evoked brain microglias: They were significantly lower in 10-day and 14-day hyperbaric oxygen pretreatment groups than those in control group [10-day group: 0.409±0.014,(5.21±0.77) μnol/L; 14day group: 0.381±0.004, (4.93±1.02) μmol/L, P ＜ 0.05].[3] The activity of tumor necrosis factor α in evoked brain microglias: It was obviously lower in 14day hyperbaric oxygen pretreatment group than in control group [(51.20±1.13) %, (70.10±2.26) %, P ＜ 0.05].CONCLUSION: Pretreatment with 0.2 MPa hyperbaric oxygen can suppress the secretion of interleukin-1, tumor necrosis factor α and NO by evoked microglias, but has not obvious effects on resting microglias.

Objective To compare and evaluate the methods of building model of cervical spondylosis of vertebral artery type (CSA)rats by measuring the learning and memory ability,anxiety and depression,and degree of nervous tension of three kinds of CSA model rats.Methods We randomly divided 120 rats into mixed modeling group,bone graft compression modeling group,mechanical balance disorder modeling group,and blank control group with 30 rats in each.Morris water maze,elevated plus maze test and open field test were used to detect and compare the rats’abilities of learning and memory,anxiety and depression,and degree of nervous tension.We then evaluated the three CSA rat models.Results Compared with those in the blank group,the learning and memory abilities in the mixed modeling, bone graft compression and mechanical balance disorder modeling rats were significantly decreased,the anxiety and depression and degree of nervous tension were significantly increased (P<0.05).Compared with bone graft compression and mechanical balance disorder modeling groups,the mixed modeling group could restore the characteristics of CSA.Conclusion The three kinds of modeling methods can successfully reproduce the CSA animal model;the mixed modeling is superior and thus worthy of promotion.

Objective To investigate the effect of atorvastatin on atherosclerosis formation of common carotid artery and its possible mechanism. Methods A total of 36 male apolipoprotein E gene knockout (ApoE-/-) mice were randomly divided into 3 groups: a control group, a model group, and an atorvastatin group. The mice of the control group were fed with normal diet and received a sham operation, while the mice in the model group and the atorvastatin group were given high fat diet and received a right common carotid artery cannulation. At 5 weeks after procedure, the mice in the model group and the atorvastatin group were intragastric administration of normal saline and atorvastatin (10 mg/kg daily), respectively. At 8 weeks after procedure, the blood from femoral arteries was obtained for biochemical detection, then right common carotid arteries were taken out for histopathological study. Real-time quantitative polymerase chain reaction (PCR) was used to detect the expression levels of NF-κB mRNA in the plaques. Western blotting was used to detect phosphorylated NF-κB p65. Results The lipid levels in the model group and the atorvastatin group were significant higher than those in the control group (al P<0. 05). The lipid level in the atorvastatin group was lower than that in the model group, but there was no significant difference (P> 0. 05 ). The histopathological study showed that the obvious plaque formation and the necrotic core and neovessels in plaques were observed in the model group; obviously thickened intima and more intact endothelial cel s in the vessel wal were observed in the atorvastatin group. The plaque burden in the model group and the atorvastatin group was significantly higher than that in the control group (al P<0. 001), while the plaque burden in the atorvastatin group was significantly less than that in the model group (P<0. 001). Real-time fluorescence quantitative PCR detection showed that the expression levels of NF-κB mRNA in the model group and the atorvastatin group were significantly higher than that in the control group (al P<0. 001), and the expression level of NF-κB mRNA in the atorvastatin group was significant lower than that in the model group (P= 0. 022). Western blotting showed that the expression level of the phosphorylated NF-κB p65 was significantly higher than that of the control group (P<0. 001), and the expression level of the phosphorylated NF-κB p65 was significantly lower than that in the model group (P<0. 001). Conclusions Atorvastatin may reduce atherosclerosis in the common carotid artery in ApoE-/-) mice by down-regulating NF-κB.

Objective To study the expression of RhoA and C-myc in gastric carcinoma , and to discuss the action in infiltration and metastasis of gastric carcinoma as well as their dependability. Methods RhoA protein expression and C-myc protein expression were detected by immunohistochemical method in 46 cases of gastric carcinoma and 20 cases of normal tissues..RhoA protein expression was compared with clinical pathologic parameters as related to C-myc. Results The positive rate of RhoA,C-myc were significantly higher in gastric carcinoma than in normal tissue (P < 0.05). The expression of RhoA and C-myc were associated with the loss of tumor differentiation, lymph node metastasis and deep invasion (P<0.05). There was a significant correlation between RhoA and C-myc (r=0.62, P<0.05). Conclusions The data suggests that the expression level of RhoA protein was closely related to biological behavior of gastric carcinoma. RhoA and C-myc were possibly both correlated with the infiltration and metastasis of gastric carcinoma.

Objective To develop and validate a mortality risk prediction model for patients infected with avian influenza A H 7N9 virus.Methods A stratified and random sampling method was adopted for selection of subjects .A total of 102 patients infected with avian influenza A H7N9 virus, who were admitted to the designated hospitals in Zhejiang Province during March 2013 and March 2015, were enrolled.Standard questionnaires were used to collect data about demographic , epidemiologic and clinical characteristics , and the data were retrospectively reviewed . Univariate analysis and stepwise logistic regression analysis were used to identify the mortality risk factors of patients infected with avian influenza A H7N9 virus, and nomogram was applied to develop the risk prediction model .The accuracy of the prediction model was assessed using Concordance index (C-index) and receiver operating characteristic (ROC) curve. Results Stepwise multiple logistic regression analysis showed that age ≥60 years (χ2 =3.98, OR=2.99, 95%CI:1.05-9.21, P<0.05), increased initial neutrophil count (χ2 =6.66,OR=5.06, 95%CI:1.56-18.83, P<0.05), C-reactive protein≥120mg/L (χ2 =8.63, OR=5.15, 95%CI:1.79-16.31, P<0. 01), poor hand hygiene (χ2 =6.83, OR =10.29, 95%CI:2.18-81.49, P <0.01) and 5 days of incubation period or shorter (χ2 =7.23, OR=4.75, 95%CI:1.59-15.80, P<0.01) were independent risk factors for mortality of patients .Based on the above study , a risk prediction model of nomogram was developed.Poor hand hygiene (grade A, 100.0 points) ranked on the top of all risk factors, followed by C-reactive protein≥120 mg/L (grade B, 76.5 points), increased initial neutrophil count (grade C, 70.5 points), 5 days of incubation period or shorter (grade D, 62.0 points) and age ≥60 years (grade E, 51.0 points).The C-index and the area under the curve were 0.833 and 0.817 for the nomogram model , respectively;and the nomogram model fitted well .Conclusion Nomogram model can effectively predict and estimate the risk of death for patients infected with avian influenza A H 7N9 virus.

Objective:To explore the independent risk factors that predict 10-year mortality in patients with stable chronic obstructive pulmonary disease(COPD).Methods:The baseline data from a prospective cohort study were analyzed and long-term follow-up were performed. Patients with confirmed diagnosis of stable COPD were consecutively enrolled in the outpatient clinic from January 2010 to December 2010, and were followed up until December 31, 2020. Cox regression analysis was used to determine the independent risk factors for all-cause mortality and mortality from respiratory causes in stable COPD patients.Results:A total of 182 stable COPD patients were enrolled and followed up for a median of 89 months. The 10-year mortality was 51.1%(93/182), and 9 patients died within one year. The leading cause of death was respiratory disorder, followed by cardiovascular and cerebrovascular diseases. The risk factors independently associated with all-cause mortality included old age( HR=1.936,95% CI: 1.610~2.328, P<0.01), increased baseline COPD Assessment Test(CAT)( HR=1.331,95% CI: 1.049-1.689, P=0.02) and the increased CAT in one year( HR=1.314,95% CI: 1.197-1.420, P<0.01). The risk factors independently associated with respiratory cause mortality included increased baseline CAT( HR=1.719,95% CI: 1.026-2.880, P=0.04), emphysema index(LAA%)( HR=1.062,95% CI: 1.007-1.120, P=0.03), and one year inecreased CAT( HR=1.342,95% CI: 1.198-1.505, P<0.01)was a protective factor. Conclusions:Old age, baseline CAT, one year increased in CAT and LAA% were independent influencing factors for 10-year mortality of stable COPD patients.

OBJECTIVE： To study the improvement effect and related mechanism of pyragrel sodium on nerve function of cerebral ischemia-reperfusion injury model rats. METHODS： Totally 72 SD rats were randomly divided into sham operation group， model group， positive control group （dizocilpine 0.8 mg/kg）， pyragrel sodium low-dose， medium-dose and high-dose groups （20， 30， 45 mg/kg）， with 12 rats in each group. Except sham operation group received sham operation， rats in the other groups were treated with middle cerebral artery ligation to induce cerebral ischemia-reperfusion injury model. The rats in the sham operation group and the model group were injected with the constant volume of normal saline， for consecutive 6 d， and the interval of administration was 24 hours. After 24 h reperfusion and last medication， neurological deficit score and postural reflex score in rats were evaluated. The situation of cerebral injury （including whole brain， insular cortex， putamen， striatum， somatic cortex， amygdala， motor cortex） was evaluated by using micropositron emission tomography. The rats were sacrificed， and the situation of cerebral infarction was observed by TTC and cerebral infarction volume was calculated. Na+-K+-ATPase， Ca2+-ATPase activity and Glu content were detected by ELISA. RESULTS： Compared with sham operation group， neurological deficit score and postural reflex score increased significantly in model group 24 h after ischemia-reperfusion and after last medication （P＜0.05 or P＜0.01）. After 24 hours of cerebral ischemia-reperfusion and the last medication， SUV of brain tissue， SUV ratio of right left brain of different cerebral areas were decreased significantly （P＜0.01）. After last medication， the percentage of cerebral infarction volume was increased significantly （P＜0.01）； the activities of Na+-K+-ATPase and Ca2+-ATPase were decreased significantly （P＜0.01）， while Glu content was increased significantly （P＜0.01）. Compared with model group， above indexes of pyragrel sodium low-dose， medium-dose and high-dose group， positive control group were all improved significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： Pyragrel sodium can improve cerebral ischemia-reperfusion injury and nerve function， which is related to the activity up-regulation of Na+-K+-ATPase and Ca2+-ATPase， the down-regulation of Glu content.