Objective To investigate the learning curve of laparoscopy-assisted anorectoplasty in the treatment of high imperforate anus.Methods Sixty patients with high congenital anal atresia who were treated with laparoscopy-assisted anorectoplasty in the Capital Institute of Pediatrics from December 2008 to October 2015 by one experience surgeon were selected as observation group.Based on the criteria,the patients were divided into 4 groups(15 cases in each group) according to the sequence of the operation and every 15 cases served as a learning phase.The operating time,frequency of operation,complication rate,conversion rate to open surgery,blood loss,the rates of blood transfusion and hospital stay were compared among the 4 phases.Results The mean operation duration was (176.3 ±41.6) min,(128.8 ± 36.1) min,(127.3 ± 35.2) min,(124.0 ± 30.1) min in group A,B,C and D,respectively.The operation duration of 4 groups showed a declining trend.Group A has longer operation time than group B,C and D,the difference were statistically significant (P ＜ 0.05).In detail,the comparison of operation time between group A and group B was statistically significant (P ＜ 0.05).Furthermore,group A had significantly more median blood loss than group B,C and D,the differences were statistically significant [the 4 groups of data,respectively,group A:(17.5 ±6.5) mL,group B:(15.0±5.0) mL,group C:(14.5 ±5.5) mL,group D:(8.5 ±6.5) mL,P＜0.05].The mean capacity of blood loss was 12.7 mL.No significant difference was found in surgical complications,the rates of blood transfusion,total hospital stay,and postoperative hospital stay among the 4 groups(P ＞ 0.05).But the postoperative hospital stay decreased from 9.8 d (group A) to 7.4 d (group D).Conclusions For a well-trained surgeon in imperforate anus surgery.The learning curve of laparoscopy-assisted anorectoplasty in the treatment of high imperforate anus on about 15 cases helps to make a skillful surgeon.

Objective To investigate the changes in intracellular Ca2+ in the ureter smooth muscle cells (USMC) of rats with neuropathic urinary tract dysfunction (NUTD) and their significance.Methods Forty-five rats were randomly and averagely divided into NUTD group,experimental control (EC) group and blank control (BC) group.The NUTD group was operated with a spinal cord transection at the first lumbar level and the sacral cord was destroyed;in EC group the spinal process was partly bitten at the same position,but the spinal cord was not transected;BC group was given no operations.One week later,the video-urodynamic was performed to observe the acontractile detrusor (ACD),vesicoureteral reflux (VUR) and urinary tract dysfunction in rats among the NUTD group,EC group and the BC group.Video-urodynamic assessment was performed at the sixth week after operation.Ureter smooth muscle cells (USMC) were obtained by collagenase digestion.Intracellular Ca2 + in the USMC were observed by laser scanning confocal microscope.Then the effects of Bay K8644(10-8 mol/L,10-7 mol/L,10-6 mol/L) on cytosolic Ca2+ concentrations([Ca2+] i) in NUTD group were studied by calculating the fluorescence intensity.Results ACD and no detrusor overactivity were found in all rats in NUTD group and without vesicoureteral reflux.Immunofluorescence method confirmed that the cells were USMC.Compared with BC group (31.44 ± 2.82) and EC group (32.06 ± 3.67),the fluorescence intensity (FI) of intracellular Ca2 + in USMC was much lower in the NUTD group (9.80 ± 1.11),and there was significant difference(P ＜ 0.05).Bay K8644 (10-8 mol/L,10-7 mol/L,10-6 mol/L) increased the FI of [Ca2 +] i in a concentration-dependent manner,which were 3.80 ± 1.30,10.04 ± 2.15,19.89 ± 2.06,respectively,and there was significant difference (P ＜ 0.05).Conclusions The decrease in Ca2 + concentration in the ureter smooth muscle cells may be one of the important factors for the primary ureteral dysfunction of NUTD.And calcium channel agonist can be meaningful for adjusting abnormal Ca2+ concentration in USMC of NUTD.

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Renal interstitial fibrosis is the common pathway for a variety of chronic renal disease to final stage renal failure,the main feature of it is the large accumulation of extra cellular matrix (ECM).Myofibroblasts is the major effector cells which lead to the synthesis of ECM,an important source of myofibroblasts is epithelial-mesenchymal transition(EMT).Wnt/β-catenin signaling pathway take part in the regulation of EMT,which make it become a potential site of anti-fibrosis therapy.

Pulmonary arterial hypertension (PAH)is a disease of unknown etiology that leads to a progressive increase in pulmonary vascular resistance (PVR),if untreated,ultimately right heart failure and high mortality.It is concerted pulmonary vascular contraction and vascular remodeling are the 2 main courses of physiology and pathology leading to PAH,especially the significant role of proliferation of pulmonary arterial smooth muscle cells.A lot of relevant factors are revealed to take a participation into regulating the proliferation of pulmonary arterial smooth muscle cells and finally PAH.

Orthostatic hypertension (OHT)in children was first proposed by Chinese scholars in 2012.The diagnostic criterion was revised in 2015.OHT in children was not rare in clinical practice.Children and adolescents are susceptible to OHT when they suddenly change posture or standing for a long time.The mechanisms of OHT were not clear.Dizziness,headache,nausea and vomiting were the main manifestations of OHT.Severe symptom in childhood OHT includes syncope.The prognosis of OHT was good,but the abnormal blood pressure will last to adults.Further study in OHT will help to predict the risk of cardiovascular and cerebrovascular diseases and help to evaluate target or-gan injury.The treatment of OHT has been explored,and non -medical treatment is the main option.Study in medical treatment for OHT has not been conducted.Now,the diagnostic criteria in children,epidemiologic status,clinical fea-tures and treatment of OHT were focused to deepen the understanding of OHT in children and improve the clinical standard of the disease.

Objective To observe the regulatory effect and significance of hydrogen sulfide (H2 S)on low -density lipoprotein receptor (LDLR).Methods Mouse primary hepatocytes were divided into control group,low -den-sity lipoprotein (LDL)group and LDL +sodium hydrosulfide (NaHS,the donor of H2 S)group.The cells in LDL group were treated with LDL (50 mg/L)and the cells in LDL +NaHS group were pretreated with NaHS (100 μmol/L)for 0.5 hours and then treated with LDL (50 mg/L).Real -time PCR and Western blot were used to detect the expres-sions of LDLR mRNA and protein,respectively.Mouse primary hepatocytes were divided into control group,1,1′-dioctadecyl -3,3,3′,3′-tetramethyl -indocarbocyanine perchlorate low -density lipoprotein (DiI -LDL)group and DiI -LDL +NaHS group.The cells in DiI -LDL group were incubated with DiI -LDL (10 mg/L)for 3 hours.The cells in DiI -LDL +NaHS group were pretreated with NaHS (100 μmol/L)for 1 hour before DiI -LDL (10 mg/L) was added.Confocal method was used to measure the uptake of DiI -LDL by mouse primary hepatocytes,and fluores-cent quantitative method was performed to detect the content of DiI -LDL in the supernatant of mouse primary hepato-cytes.Results The levels of LDLR mRNA and protein in the mouse primary hepatocytes were significantly downregu-lated compared with those in the control group (t =5.733,P <0.01;t =2.527,P <0.05);after NaHS was adminis-tered,LDLR mRNA and protein level in the mouse primary hepatocytes were significantly upregulated (t =-7.639, P <0.01;t =2.388,P <0.05).In the mouse primary hepatocytes,compared with that in the control group,the uptake of DiI -LDL by cells in DiI -LDL group was increased;the uptake of DiI -LDL by mouse primary hepatocytes in DiI -LDL +NaHS group was significantly increased in comparison with that in the DiI -LDL group.Compared with that in the control group,the DiI -LDL content of culture supernatant in the DiI -LDL group was significantly increased (t =-39.156,P <0.01);after treatment with H2 S donor,the content of DiI -LDL in the culture supernatant was sig-nificantly decreased in comparison with that in the mouse primary hepatocytes without H2 S donor treatment (t =17.202,P <0.01).Conclusion H2 S upregulated the expression of LDLR protein in the mouse primary hepatocytes.

Objective To prospectively study the effects of different fluid resuscitation on kidney function in pediatric patients with sepsis.Methods One hundred and eighteen pediatric patients with sepsis shock who needed fluid resuscitation in Intensive Care Unit,Zhengzhou Children′s Hospital from June 2012 to June 2015 were selected, and they were randomly divided into group A,B and C by random number in the table.The patients received fluid resus-citation of hydroxyethyl starch,50 g/L albumin and 9 g/L saline.After that,neutrophil gelatinase associated lipocalin (NGAL),α-1 microglobulin,urea nitrogen,creatinine,urine volume,the incidence of acute kidney injury (AKI),and the renal replacement therapy rate accepted by the patients were recorded.Then all the data were analyzed with SPSS 19.0 software.Results Serum levels of NGAL and α-1 microglobulin in group A [(103.50 ±1.23)μg/L,(3.32 ± 0.20)mg/L]were higher than those in group B [(93.54 ±1.42 )μg/L,(2.71 ±0.18 )mg/L]and group C [(79.57 ±1.54)μg/L,(2.08 ±0.14)mg/L],which were statistically different(all P <0.05 );serum levels of NGAL and α-1 microglobulin in group B were higher than those in group C,which were statistically different(all P <0.05).Serum levels of urea nitrogen and creatinine in group A[(5.23 ±0.34)mmol/L,(112.00 ±7.12)μmol/L] were higher than those in group B [(3.56 ±0.31)mmol/L,(77.25 ±5.34)μmol/L]and group C[(2.95 ±0.42) mmol /L,(72.12 ±6.34)μmol/L],which were statistically different (all P <0.05);serum levels of urea nitrogen and creatinine in group B were higher than those in group C,which were not statistically different(P >0.05).The urine volume in group A [(0.50 ±0.12)mL/(kg·h)]was less than that in group B[(0.90 ±0.23)mL/(kg·h)]and group C[(1.30 ±0.14)mL/(kg·h)],which was statistically different(all P <0.05);the urine volume in group B was less than that in group C,which was not statistically different(P >0.05).In three groups,there were 13 cases (34.2%)with AKI in group A,9 cases(23.1%)with AKI in group B,and 8 cases(19.5%)with AKI in group C, the incidence of AKI in group C was less than that in group B and group C,which was statistically different(χ2 =12.74,10.43;all P <0.05).All the groups all had children accepted renal replacement therapy,there were 8 cases (21.1%)in group A,7 cases(17.9%)in group B,and 6 cases (14.6%)in group C,and the cases who accepted renal replacement therapy rate in group C were less than those in group A and group B,which was statistically different(χ2 =11.36,8.73;all P <0.05).Conclusions The adverse effect of 9 g/L saline on kidney function is less than hydrox-yethyl starch and 50 g/L albumin,and hydroxyethyl starch has more adverse effects on kidney.Thus,9 g/L saline is a better option for fluid resuscitation in pediatric sepsis patients.

Objective To investigate the feasibility and safety of transcatheter closure of coronary artery fistula (CAF)with Amplatzer vascular PlugⅡ(AVPⅡ)in pediatric patients.Methods Between June 2012 and October 2015,5 children aged 0.9 to 7.0 years old and weighted 10 to 21 kg with CAF were admitted to the Department of Pediatric Cardiology in Shandong Provincial Hospital Affiliated to Shandong University.Aortic root angiography was used first to confirm the origin,shape,branches,drainage and the diameter of the orifice of CAF by deploying the pigtail catheter.The AVPⅡwas retrogradely deployed into targeted artery through guiding catheter and aortic angiography was performed before releasing the plug.Results All the 5 children underwent transcatheter closure by AVPⅡsuccessful-ly.Two cases were involved with right coronary -right ventricular fistula,1 case of left anterior descending coronary -right ventricular fistula (residual fistula after surgical repair),and 1 case of left circumflex coronary -left atrial fistula. Four children had a single fistula,and 1 case had double fistulas.The diameter of the orifice ranged from 2.00 to 5.96 mm,and the selected occluders from 8 to 14 mm.The ratio of diameter of occluder to fistula orifice ranged from 2.3 to 3.4.All the patients were followed up for 4 to 44 months.Two patients developed instant minor and modera-te aortic re-gurgitation.No other complications such as thrombosis,embolization,residual shunt,arrhythmia,coronary dissection or perforation occurred.Conclusions Transcatheter closure of CAF by AVPⅡin pediatric patients is feasible and safe. Aortic regurgitation should be noted,especially during the procedure.