Aim To observe the effects of ketamine on Na+,K+-ATPase,Ca2+-ATPase and NOSase activity in different cerebral cortex in convulsive mice.Methods The mice were randomly divided into blank group,normal saline(NS) group and ketamine 25 mg?kg-1 (KetⅠ),50 mg?kg-1(KetⅡ) group. The animals of blank group were killed directly.Convulsion was induced by intraperitoneally(ip) strychnine(1.5 mg?kg-1) in other groups,and correspond drugs were administered ip before five minutes.Action variety of mice was observed. Animals were killed on 30 minutes after strychnine injection.The activity of Na+,K+-ATPase,Ca2+-ATPase,TNOSase and iNOSase were assessed by spestrophotometric analysis in different cere-bral cortex(forehead,parietal and occipital area).Results Ketamine group could decrease mortality completely. The duration of tonic state in KetⅡ group was significantly shorter than that in KetⅠgroup.Compared with blank group,Na+,K+-ATPase and Ca2+-ATP ase activities were decreased in the group of NS and KetⅠ,and recovered normal level in the group of KetⅡ at parietal and occipital area. TNOS ase activity was decreased by 1/3 in KetⅡ group(P

Objective:To explore the feasibility of using ligation clip-assisted modified " expansion and co-llapse method" to determine the intersegment plane in thoracoscopic resection of the external posterior basal segment (S 9+ 10) in children with congenital pulmonary airway malformation (CPAM). Methods:Retrospective study.The clinical data of 12 CPAM children who underwent thoracoscopic S 9+ 10 resection in Children′s Hospital Affiliated to Shandong University from July 2019 to May 2021 were collected and analyzed.There were 7 males and 5 females.The age at operation ranged from 3.50 to 11.50 months.The body weight of patients ranged from 6.5 to 11.5 kg.In all the patients, the ligation clip-assisted modified " expansion and collapse method" was applied during the operation to determine the intersegment plane (S 9+ 10 was in the expansion state and the remaining lungs were in the collapse state) before thoracoscopic S 9+ 10 resection.After S 9+ 10 resection, the surgical treatment and postoperative recovery were summarized and analyzed. Results:All the operations were completed under thoracoscopy, and there was no conversion to thoracotomy.In 11 patients, the intersegment plane was accurately determined by the ligation clips-assisted improved " expansion and collapse method" , and the S 9+ 10 segment was successfully resected.Of these 11 cases, 8 cases had right S 9+ 10 resection and 3 cases had left S 9+ 10 resection.In the process of using the ligation clip-assisted improved " expansion and collapse method" to determine the intersegment plane, the operator needed to clamp the ligation clip after the anesthesiologist expanded the lung completely.Because the operation was not stable enough, the ligation clip fell off and did not clamp S 9+ 10, resulting in operation failure.The operation was changed to the traditional " expansion and collapse method" . Besides, the basal segment bronchus was cut off by mistake, so the right basal segment had to be resected.The operation time ranged from 85 to 205 min, with a median of 149 min.Intraoperative bleeding ranged from 5 to 15 mL, with a median of 10 mL.The indwelling time of drainage tubes ranged from 2 to 4 days, with a median of 3 days.The postoperative hospital stay ranged from 5 to 8 days, with a median of 6 days.Postoperative pathological examination results suggested 4 cases of type 1, 6 cases of type 2 and 2 cases of type 3.There were 2 cases of simple subcutaneous emphysema without postoperative complications such as bleeding, bronchopleural fistula and atelectasis.The follow-up time ranged from 6 to 28 months, with a median of 15 months.The chest CT of all children showed no residual lesions and no residual cavities in the involved hemithorax. Conclusions:Ligation clip-assisted improved " expansion and collapse method" for determining the intersegment plane is suitable for CPAM children with a narrow thoracic space, and the operation is simple and effective.It is relatively safe and feasible to use this method in S 9+ 10 resection.

Objective:To assess the effectiveness and characteristics of intratumoral radioactive seed implantation in pancreatic cancer pain management.Methods:Clinical data of 160 patients with pancreatic cancer receiving radioactive seed implantation were retrospectively analyzed. Both pre- and postoperative pain intensities were evaluated using the visual analog scale (VAS) .Results:About 71.88% (115) of 160 patients experienced abdominal or low back pain. Postoperative pain in 104 patients was relieved at various degrees after radioactive seed implantation with an analgesic efficacy of 90.43% (the efficacy for abdominal and low back pain relief was 86.52% and 96.34%, respectively). The between-group difference was statistically significant. Pain relief was observed 1-7 days postoperatively, and the maximal degree of pain relief was achieved 2-14 days after treatment initiation.Conclusion:Intratumoral implantation of radioactive seeds was microinvasive, quick-acting, and effective in pancreatic cancer pain management.

Objective To investigate the feasibility of retroperitoneoscopy in the treatment of adrenal masses in infants under 6 months old.Methods From January 2020 to November 2023,retroperitoneoscopic surgery was performed in 5 infants under 6 months old with adrenal tumors.Their age was from 1 month and 18 days to 4 months and 27 days,and their body weight was 5-8 kg.The lesion was found by prenatal ultrasonography in 1 case and by abdominal ultrasonography for other reasons after birth in 4 cases.Ultrasound and CT indicated a diameter of 1.7-5.5 cm for the adrenal masses.Results The operations of adrenalectomy and tumor resection were completed under retroperitoneoscopy.The operative time was 65-135 min(median,94 min).The intraoperative blood loss was less than 10 ml.The postoperative drainage tube retention time was 3-6 d(median,5 d).Pathological diagnosis showed 4 cases of adrenal neuroblastoma and 1 case of adrenal hyperplasia.Follow-ups for 1-36 months(median,3 months)with abdominal ultrasound and CT scanning showed no recurrence or metastasis.Conclusion Retroperitoneoscopy is relatively safe for the treatment of adrenal tumors in infants under 6 months old(tumors with acceptable boundaries).

Objective To summarize the clinical experience of thoracoscopic treatment of anterior mediastinal enterogenous cysts.Methods From July 2019 to July 2023,27 children diagnosed as having anterior mediastinal enterogenous cysts were treated with total thoracoscopic surgery through the lateral thoracic approach(three port method)in our department.The patients were placed in a healthy lateral position.The observation hole was located in the 5th intercostal space under the scapula,and the other 2 operating holes were established based on the location of the lesion and the endoscopic diamond-shaped method,both of which were 5 mm trocars.The CO2 pneumothorax was established at a pressure of 6 mm Hg.The visceral pleura of the cyst was opened with an electric hook,the cyst was fixed and pulled by intestinal forceps,and the cyst was completely removed by forceps and electric hook separation alternately.Results No conversion to thoracotomy was required.Complete resection was performed in 26 cases,and residual cyst wall existed in 1 case.Esophageal muscular layer was opened in 9 cases.During the operation,cysts obstructed the surgical field of view in 5 cases,which was not conducive to observation.The cyst puncture and fluid extraction were performed.The operation time was 45-120 min(median,70 min).The amount of blood loss was 3-10 ml(median,5 ml).Postoperative hospitalization lasted for 2-5 d(median,3d).The 27 cases were followed up for 1-43 months(median,22 months),and there was no recurrence.The compressed trachea in 2 cases was all recovered,with emphysema fully recovered.Conclusions Thoracoscopic treatment of anterior mediastinal enterogenous cysts in children is safe and feasible.When the surrounding structure of the lesion is complex,it can be combined with bronchoscopic or gastroscopic surgery if necessary.

Objective:To explore the clinical typing, diagnostic method and treatment plan of congenital tracheal stenosis (CTS) combined with communicating bronchopulmonary foregut malformation (CBPFM) in children.Methods:The clinical data of 2 children with CTS and CBPFM who were treated in the Center for Respiratory Intervention of Children′s Hospital Affiliated to Shandong University in May 2021 and January 2022 were retrospectively analyzed.Studies were retrieved from domestic and foreign databases, so as to summarize the clinical characteristics of CTS complicated with CBPFM and investigate the typing method of CBPFM.Results:One patient was a 4-year-old girl, who sought the medical advice due to " recurrent cough and asthma for more than 4 years" . She was diagnosed with typeⅡ CBPFM at the right side and CTS.Surgical thoracoscopic right pneumonectomy plus oesophageal repair was performed.The other patient was a 7-month-and-2-day-old female, who visited the hospital for " difficult eating, dyspnea and purple lip cyanosis for 7 months" . This patient was diagnosed with typeⅡ CBPFM at the left side and CTS.Slide tracheoplasty and left pneumonectomy+ oesophageal repair were performed successively.Eight English and one Chinese studies were collected.Twenty-one children with CBPFM and 12 children with CTS and CBPFM were included.Eleven CTS cases with sufficient diagnostic evidence were complicated with typeⅠA and typeⅡCBPFM.Conclusions:CTS and CBPFM can lead to severe wheezing and dyspnea.Clinicians should enhance their awareness and be more cautious.There may be a potential link between CTS and typeⅠA and typeⅡCBPFM, and further investigation is required.

OBJECTIVETo summarize experience in the treatment of complex congenital intestinal atresia in children, so as to investigate the key points and effect of the operation.

METHODSMedical notes of 49 children with complex intestinal atresia treated between January 2012 and January 2018 were reviewed. The information of age, sex, age at operation, full-term or premature, birth weight, clinical manifestation, auxiliary examination, preliminary diagnosis, treatment process, discharge diagnosis, pathological results and prognosis of patients were analyzed.

RESULTSAll patients underwent surgical treatment, including 42 cases with laparotomy (85.7%) and 7 with laparoscopic surgery (14.3%); 1 case undergoing laparoscopic surgery was converted to laparotomy due to meconium peritonitis. The mean operation time was (147±43) min (70-270 min); the mean fasting time after surgery was (8±3) d (4-16 d); the mean parenteral nutrition time was (12±6) d (3-30 d). Eleven cases were discharged against medical after operation and lost to follow-up. Among rest 38 children, 1 child (2.6%) received intestinal resection and ostomy five days after operation due to gastrointestinal perforation; 1 child (2.6%) received conservative treatment one month later due to adhered intestinal obstruction and left hospital with cure; 1 child (2.6%) received enterodialysis and ileostomy eight days after operation due to anastomotic leak, and received the operation for the closure of fistula after three months; 4 children had complications including fluid and electrolyte disorders, anemia, hypoproteinemia and so on, and recovered after conservative treatments. Postoperative follow-up showed that 1 child with duodenal atresia had lower body weight at 6 month after operation, but the body weight returned to normal when the child was one year old; 1 child with preterm labor of 32 weeks was treated with enteral nutrition, and gradually restored the normal diet after 6 months. Growth retardation was not observed in other children.

CONCLUSIONSWith active treatment and reservation of normal bowel tube as much as possible during the operation, the prognosis of children with complex intestinal atresia is usually favorable.

Objective:To analyze the factors affecting delayed chemotherapy in children with Burkitt lymphoma (BL) and their influence on prognosis.Methods:Retrospective cohort study. Clinical data of 591 children aged ≤18 years with BL from May 2017 to December 2022 in China Net Childhood Lymphoma (CNCL) was collected. The patients were treated according to the protocol CNCL-BL-2017. According to the clinical characteristics, therapeutic regimen was divided into group A, group B and group C .Based on whether the total chemotherapy time was delayed, patients were divided into two groups: the delayed chemotherapy group and the non-delayed chemotherapy group. Based on the total delayed time of chemotherapy, patients in group C were divided into non-delayed chemotherapy group, 1-7 days delayed group and more than 7 days delayed group. Relationships between delayed chemotherapy and gender, age, tumor lysis syndrome before chemotherapy, bone marrow involvement, disease group (B/C group), serum lactate dehydrogenase (LDH) > 4 times than normal, grade Ⅲ-Ⅳ myelosuppression after chemotherapy, minimal residual disease in the interim assessment, and severe infection (including severe pneumonia, sepsis, meningitis, chickenpox, etc.) were analyzed. Logistic analysis was used to identify the relevant factors. Kaplan-Meier method was used to analyze the patients' survival information. Log-Rank was used for comparison between groups.Results:Among 591 patients, 504 were males and 87 were females, the follow-up time was 34.8 (18.6,50.1) months. The 3-year overall survival (OS) rate was (92.5±1.1)%,and the 3-year event-free survival (EFS) rate was (90.5±1.2)%. Seventy-three (12.4%) patients were in delayed chemotherapy group and 518 (87.6%) patients were in non-delayed chemotherapy group. The reasons for chemotherapy delay included 72 cases (98.6%) of severe infection, 65 cases (89.0%) of bone marrow suppression, 35 cases (47.9%) of organ dysfunction, 22 cases (30.1%) of tumor lysis syndrome,etc. There were 7 cases of chemotherapy delay in group B, which were seen in COPADM (vincristine+cyclophosphamide+prednisone+daunorubicin+methotrexate+intrathecal injection,4 cases) and CYM (methotrexate+cytarabine+intrathecal injection,3 cases) stages. There were 66 cases of chemotherapy delay in group C, which were common in COPADM (28 cases) and CYVE 1 (low dose cytarabine+high dose cytarabine+etoposide+methotrexate, 12 cases) stages. Multinomial Logistic regression analysis showed that the age over 10 years old ( OR=0.54,95% CI 0.30-0.93), tumor lysis syndrome before chemotherapy ( OR=0.48,95% CI 0.27-0.84) and grade Ⅲ-Ⅳ myelosuppression after chemotherapy ( OR=0.55,95% CI 0.33-0.91)were independent risk factors for chemotherapy delay.The 3-year OS rate and the 3-year EFS rate of children with Burkitt lymphoma in the delayed chemotherapy group were lower than those in the non-delayed chemotherapy group ((79.4±4.9)% vs. (94.2±1.1)%, (80.2±4.8)% vs. (92.0±1.2)%,both P<0.05). The 3-year OS rate of the group C with chemotherapy delay >7 days (42 cases) was lower than that of the group with chemotherapy delay of 1-7 days (22 cases) and the non-delay group (399 cases) ((76.7±6.9)% vs. (81.8±8.2)% vs. (92.7±1.3)%, P=0.002).The 3-year OS rate of the chemotherapy delay group (9 cases) in the COP (vincristine+cyclophosphamide+prednisone) phase was lower than that of the non-chemotherapy delay group (454 cases) ((66.7±15.7)% vs. (91.3±1.4)%, P=0.005). Similarly, the 3-year OS rate of the chemotherapy delay group (11 cases) in the COPADM1 phase was lower than that of the non-chemotherapy delay group (452 cases) ((63.6±14.5)% vs. (91.5±1.3)%, P=0.001). Conclusions:The delayed chemotherapy was related to the age over 10 years old, tumor lysis syndrome before chemotherapy and grade Ⅲ-Ⅳ myelosuppression after chemotherapy in pediatric BL. There is a significant relationship between delayed chemotherapy and prognosis of BL in children.