Objective:To discuss the improvement effect of Shenshuai Yingyang Capsule in the renal osteodystrophy model rats and its effect on the bone morphogenetic protein(BMP)-7/Smads signaling pathway,and to clarify the relationship between renal function and bone metabolism in the renal osteodystrophy model rats.Methods:Fifty SPF SD rats were selected,and 10 of which were randomly chosen as control group,and the remaining 40 rats were used to establish the renal osteodystrophy model.Thirty successful modeling rats were divided into model group,positive control group,and Shenshuai Yingyang Capsule group,and there were 10 rats in various groups.The rats in control and model groups were given saline,the rats in positive control group were given 0.01 mg·kg-1 calcitriol,and the rats in Shenshuai Yingyang Capsule group were given 1.2 g·kg-1 Shenshuai Yingyang Capsule,all the rats were treated for 12 weeks.HE staining was used to observe the pathomorphology of femur tissue of the rats in various groups;automatic biochemical analyzer and chemiluminescence were used to detect the kidney function and calcium-phosphorus metabolism indicators in serum of the rats in various groups;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the expression levels of BMP-7 and Smad1/5/8 mRNA in femur tissue of the rats in various groups;Western blotting method was used to detect the expression levels of BMP-7,phosphorylated BMP-7(p-BMP-7),Smad1/5/8,and phosphorylated-Smad1/5/8(p-Smad1/5/8)proteins in femur tissue of the rats in various groups.Results:The HE staining results showed that there was normal trabecular arrangement in control group with unchanged osteoblasts and osteoid area.In model group,the trabecular width and average osteoid area were increased,while the number of osteoblasts was decreased.In positive control and Shenshuai Yingyang Capsule groups,the trabecular width and average osteoid area were decreased,and the number of osteoblasts was increased.Compared with control group,the levels of blood urea nitrogen(BUN)and serum creatinine(Scr)of the rats in model group were increased(P<0.05);compared with model group,the levels of BUN and Scr of the rats in positive control and Shenshuai Yingyang Capsule groups were decreased(P<0.05);compared with positive control group,the levels of BUN and Scr of the rats in Shenshuai Yingyang Capsule group were decreased(P<0.05).Compared with control group,the level of calcium ion(Ca2+)in serum of the rats in model group was decreased(P<0.05),and the levels of phosphorus ion(P3-),parathyroid hormone(PTH),and alkaline phosphatase(ALP)were increased(P<0.05);compared with model group,the levels of Ca2+in serum of the rats in positive control and Shenshuai Yingyang Capsule groups were increased(P<0.05),and the levels of P3-,PTH,and ALP were decreased(P<0.05);compared with positive control group,the level of Ca2+in serum of the rats in Shenshuai Yingyang Capsule group was increased,and the levels of P3-,PTH,and ALP were decreased(P<0.05).The RT-qPCR results showed that compared with control group,the expression levels of BMP-7 and Smad1/5/8 mRNA in femur tissue of the rats in model group were decreased(P<0.05);compared with model group,the expression levels of BMP-7 and Smad1/5/8 mRNA of the rats in positive control drug group and Shenshuai Yingyang Capsule group were increased(P<0.05);compared with positive control group,the expression levels of BMP-7 and Smad1/5/8 mRNA in femur tissue of the rats in Shenshuai Yingyang Capsule group were increased(P<0.05).The Western blotting results showed that compared with control group,the expression levels of BMP-7,p-BMP-7,Smad1/5/8,and p-Smad1/5/8 proteins in femur tissue of the rats in model group were decreased(P<0.05);compared with model group,the expression levels of BMP-7,p-BMP-7,Smad1/5/8,and p-Smad1/5/8 proteins in femur tissue of the rats in positive control group and Shenshuai Yingyang Capsule group were increased(P<0.05);compared with positive control group,the expression levels of BMP-7,p-BMP-7,Smad1/5/8,and p-Smad1/5/8 proteins in femur tissue of the rats in Shenshuai Yingyang Capsule group were increased(P<0.05).Conclusion:Shenshuai Yingyang Capsule can improve the kidney function and calcium-phosphorus metabolism disorders in the renal osteodystrophy model rats,promote the proliferation of the bone marrow stromal cells,and enhances the bone metabolism;its mechanism may be related to the activation of BMP-7/Smads signaling pathway.

Macrophages are vital in maintaining tissue homeostasis in the lungs by modulating and regulating immune responses.Based on different origins and anatomical locations,macrophages in the lungs are categorized into alveolar macrophages,interstitial macrophages,perivascular macrophages,and inflammatory macrophages.Alveolar macrophages are located in the alveolar spaces and are primarily responsible for maintaining alveolar surfactant homeostasis,defending against pathogens and regulating immune responses.Interstitial macrophages can maintain homeostasis,regulate immunity and anti-inflammation in the lung tissue.Perivascular macrophages play a crucial role in inhibiting lung inflammation,improving pulmonary fibrosis,and regulating lung tumor progression due to antigen-presenting and immunomodulatory effects.Inflammatory macrophages,which are differentiated from monocytes during inflammation,regulate the inflammatory process.This article reviews the origins of various subpopulations of macro-phages in the lung tissue and their physiological and pathological functions as well as discusses the underlying mechanisms and potential therapeutic targets.

OBJECTIVETo analyze complications after laparoscopic Ladd operation for intestinal malrotation, related causes and possible solutions.

METHODSClinical data of 81 neonates who underwent laparoscopic Ladd operations for intestinal malrotation in the Children's Hospital, Zhejiang University School of Medicine between January 2015 and January 2018 were reviewed. The abdominal complications and findings during operation and reoperation were analyzed.

RESULTSOperations were successfully completed in all patients, and there was no patient converted to open surgery. The annular pancreas in 6 cases and duodenal diaphragm in 4 cases were confirmed during the operation. The recurrent volvulus developed in 3 patients (3.7%), of whom 2 cases were confirmed to have midgut necrosis during open surgery 1 week and 3 months after laparoscopic Ladd operation, and both finally died; 1 case was corrected by second laparoscopic operation. Cecal perforation occurred in 1 patient (1.2%), which was caused by intensive high frequency coagulation of the appendiceal stump. One patient (1.2%) developed chylous ascites and improved after conservative treatment. Adhesive small bowel obstruction was observed in 3 cases (3.7%), and all relieved after conservative treatment.

CONCLUSIONSLaparoscopic Ladd operation for intestinal malrotation in neonates was effective, and the incidence of abdominal complications may be minimized by experienced skills and strict perioperative management.

OBJECTIVETo evaluate the efficacy and safety of transumbilical single-site laparoscopic surgery for congenital duodenal obstruction (CDO) in neonates.

METHODSA retrospective analysis of clinical data of 15 patients with CDO undergoing transumbilical single-site laparoscopic treatment during November 2017 and January 2018 (single-site group), and 20 patients with CDO undergoing conventional three-hole laparoscopic treatment during August 2017 and October 2017 (three-hole group) was performed. All patients were from the Children's Hospital, Zhejiang University School of Medicine. The operation time, time of initial feeding, time of adequate feeding, length of hospital stay after operation and postoperative complications were compared between two groups.

RESULTSThe operations were completed in all patients. No patient converted to laparotomy, and no massive hemorrhage was observed during operation. The operation time of single-site group was (90±10) min for patients with duodenal diamond-shaped anastomosis and (81±15) min for patients with Ladd operation, while those of three-hole group were (85±9) min and (72±11) min, respectively. Postoperative initial feeding time of single-site group was (5.0±1.0) d, and that of the three-hole group was (4.8±0.8) d. The adequate feeding time was (9.0±1.2) d in the single-site group, and (9.3±0.8) d in the three-hole group. The length of hospital stay after operation was (11.2±2.5) d in the single-site group, and (11.5±2.8) d in the three-hole group. There was no significant difference in operation time, postoperative initial feeding time, adequate feeding time and length of hospital stay after operation between two groups (all >0.05).

CONCLUSIONSTransumbilical single-site laparoscopic surgery for CDO in neonates is safe and effective, and the postoperative abdominal scar is more hidden.

OBJECTIVE: To summarize the clinical characteristics and treatment of type Ⅲ-b congenital intestinal atresia (CIA). METHODS: The clinical data of 12 type Ⅲ-b CIA treated in the Children's Hospital of Zhejiang University School of Medicine from January 2015 to December 2017 were analyzed retrospectively. RESULTS: Of the 12 patients diagnosed as type Ⅲ-b CIA in operation, treatment was refused during operation by their parents in 2 cases. For one child, only the proximal intestine was partly resected in the first operation, dilatation and dysplasia of the duodenum was diagnosed and total duodenum was resected and sutured in the second operation, as the child had postoperative intestinal obstruction. For one child, due to the long distal normal intestine, distal apple-peel like intestine was partly resected without mesenteric reformation. For the rest 8 children total duodenum resection and mesenteric reformation were performed. During the postoperative follow-up, one case was early rejected for further treatment by parents, one case died from complex congenital heart disease, 5 cases had the complication of short bowel syndrome. All 8 survival children received parenteral nutrition support after operation, 5 of whom received parenteral nutrition support for more than 42 days, and they were followed up for 1-3 years after discharge. The short-time efficacy was satisfactory. CONCLUSIONS For children with type Ⅲ-b CIA, the distal apple-peel like intestine should be preserved as much as possible, the mesenteric reformation should be performed and the proximal dilated bowel should be partly resected and sutured. Postoperative nutritional support and early intestinal rehabilitation contribute to the compensation for rest intestines.
Child ; Humans ; Intestinal Atresia ; complications ; surgery ; therapy ; Intestines ; surgery ; Parenteral Nutrition ; Retrospective Studies ; Short Bowel Syndrome ; complications ; Treatment Outcome

OBJECTIVE: To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates. METHODS: Clinical data of 114 neonates with annular pancreas admitted in the Children's Hospital of Zhejiang University from January 2009 to December 2018 were reviewed. The demographic parameters (gestational age, birth weight), clinical manifestations, onset time, results of antenatal examination, associated anomalies, radiological findings, operations, postoperative complications were analyzed. RESULTS: One hundred and two cases were examined by abdominal echography, in which 68 cases showed duodenal obstruction, 4 cases showed annular pancreas. Plain abdomen X-ray examination performed in 113 cases before operation, 76 cases presented double-bubble sign, 12 cases presented single-bubble sign and 5 cases had high-position intestinal obstruction. Upper gastrointestinal radiography (UGI) was performed in 103 cases, which suggested duodenal obstruction in 102 cases. Operations were performed in all cases, of which 69 cases were operated under laparoscopy including 1 case converted to open laparotomy. The mean fasting time after surgery was (7.8±2.7) d, and the mean length of hospital stay was (16.9±10.1) d. Five patients had postoperative complications. The incidence of postoperative complications in antenatal abnormal group was lower than that in the antenatal non-abnormal group (<0.05); the average fasting time in laparoendscopic surgery group was shorter than that in traditional laparotomy group (<0.05). CONCLUSIONS Neonates with recurrent vomiting early after birth should be highly suspected to have annular pancreas. The fetal chromosome examination should be performed with abnormal antenatal screening. Surgery is the only effective way to diagnose and treat annular pancreas, and laparoscopic surgery could be the first choice for experienced doctors.
Duodenal Obstruction ; diagnostic imaging ; surgery ; Humans ; Infant, Newborn ; Laparoscopy ; Pancreas ; abnormalities ; diagnostic imaging ; pathology ; surgery ; Pancreatic Diseases ; diagnostic imaging ; pathology ; surgery ; Retrospective Studies