Objective To study the application CT scans in Nuss procedure for pectus excavatum. Metlhods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008 The preoperative CT scan was carried out for evaluation of the deformity degree and morphology classification of chest wall malformation, the deformity in relation with adjacent tissue and associated different disorder. Results Nuss procedure was successfully performed in all 648 patients. The preoperative CT scan showed medium deformity of the pectus excavatum in 73 cases ( 11.27% ) and severe deformity in 575 cases (88.73%). Morphologic classification of the pectus excavatum were symmetric type in 407cases (62.81% ) , eccentric type in 83( 12.81% ) ,and unbalanced type in 158( 24.38% ). 116 cases with pectus excavatum were associated with other different disorders, among them 55 cases ( 17.9% )were diagnosed by CT scan. 28 cases received stimultanously operation for their abnormalities. Conclusion CT scan is a useful tool for evaluation the deformity degree and morphology classification, direct the operation, reduce the complications and find other different disorders. It should be a routine examination before Nuss procedure.

Objective To investigate the expression of stathmin and evaluate its influence to anti-microtubule adjuvant chemotherapy in non-small-cell lung cancer(NSCLC).Methods The clinical data and survival status of 78 NSCLC patients were collected,and their paraffin-embedded tissue were detected immunohistochemically with a rabbit anti-human stathmin polyclonal antibody.The clinical significance of stathmin expression and its influence to overall survival rate were analyzed statistically between patients who received paclitaxel or vinblastine adjuvant chemotherapy.Results The positive expression of stathmin could only be observed in the cytoplasm of cancer cells.Among 78 patients,40 (51.3 ％ ) patients were stained stathmin-positive.The positive rate of stathmin was significantly higher in male than female,in central type than peripheral type,in pleura-involved than non-involved,and in dead patients than survival patients ( P ＜ 0.05 ),but showed no significant differences in patients with different age,differentiated grade,pathological type,clinical stage,or lymph-node metastasis status.The expression of stathmin had a significant influence to overall survival rate(x2 =4.348,P ＜0.05 ),and those stathmin-negative patients showed a longer survival time.In stathmin-negative patients,those who received adjuvant chemotherapy with vinblastine exhibited a shorter survival time than those with paclitaxel,but the P =0.06.In stathmin-positive patients,the survival rate or time showed no difference between groups with paclitaxel and vinblastine.The differentiated grade,metastasis to lymph node and expression of stathmin were independent risk factors influencing survival rate.The positive expression of stathmin could only be observed in the cytoplasm of cancer cells.Among 78 patients,40 (51.3 ％ )patients were stained stathminpositive.The positive rate of stathmin was significantly higher in male than female,in central type than peripheral type,in pleura-involved than non-involved,and in dead patients than survival patients ( P ＜ 0.05 ),but showed no significant differences in patients with different age,differentiated grade,pathological type,clinical stage,or lymph-node metastasis status.The expression of stathmin had a significant influence to overall survival rate(x2 =4.348,P ＜ 0.05 ),and those stathmin-negative patients showed a longer survival time.In stathmin-negative patients,those who received adjuvant chemotherapy with vinblastine exhibited a shorter survival time than those with paclitaxel,but the P =0.06.In stathmin-positive patients,the survival rate or time showed no difference between groups with paclitaxel and vinblastine.The differentiated grade,metastasis to lymph node and expression of stathmin were independent risk factors influencing survival rate.Conclusion Our study suggested that the detection of stathmin in resected NSCLC tumor tissues may be helpful for prediction of prognosis,but helpless for making a choice between paclitaxel and vinblastine.NSCLC patients with stathmin-negative,no metastasis to lymph node or good-differentiated grade may have a better prognosis.

Objective To access the development of thoracic volume of pectus excavatum use of Nuss operation used CT-basedpulmonary volumetric evaluation.Methods 98 patients with pectus excavatum in Beijing Children's Hospital under Nuss operation were documented.All patients had CT scan pre-and postopration.The CT-scan's data were calculated as lung's volume by handdraw-layers summation method.The lung's volume result was compared,and enquiry the position in CT lung volume developmental scale.Results The lung's volume was elevated 28.3％ after operation.The development of thoracic volume was keep with age,70％ was maintained and 15％ was elevated.Conclusion Nuss operation can prevent the decrease of thoracic volume in pectus excavatum.

Objective To investigate the effect of acute high altitude exposure on lung functions and the relationship between lung functions and acute mountain sickness ( AMS) .Method We collected the lung function and Lewis Lake data of 73 subjects (aged 18 to 26,male) at 400 m above sea-leve and those at high altitude(exposure to 3900 m, 5 d).Results Compared with sea-level, lung functions decreased in forced vital capucity (FVC), maximum midexpiratory flow(MMF), V50, V25 while forced expiratory volume in 1 second(FEV1), peak expiratory flow(PEF), V75 did not change.FVC, FEV1, PEF, MMF were used to analyze the relationship between lung functions and AMS .There was no difference in lung functions between AMS group and NON AMS group at sea-level, but lung functions of AMS group were significantly lower than those of NON AMS group in FVC , MMF at high altitude .There was difference between AMS group and NON AMS group in the rate of change of FVC and MMF .Logistic regression analysis showed that the rate of change of FVC was an independent risk factor , while correlation analysis showed that the change of FVC and the change of oxygen saturation were relevant.Conclusion Lung functions showed restrictive decrease after acute high altitude exposure .Changes of lung func-tions will increase hypoxia and susceptiblity to AMS .

OBJECTIVE: To establish the quality standard of Lithocarpus polystachys.METHODS: TLC was used for the qualitative identification of L.polystachys.The content of total flavonoids of L.polystachys was determined by UV spectrophotometry and the content of phloridzin was determined by HPLC.RESULTS: The TLC spots of polyamide were clear and well separated.The maximum absorption wavelength of phlorizin was 284 nm.The content of total flavonoids of 6 batches of L.polystachys ranged from 103.12 mg?g-1 to 183.54 mg?g-1.The linear ranges of phlorizin were 0.099 8～1.197 6 ?g (r=0.999 7) with an average recovery of 97.23%(RSD=1.57%,n=6).CONCLUSION: Established quality standard is applicable for the quality control of L.polystachys.

Objective To introduce a new posterior-anterior approach used to establish tibial tunnel for all-inside posterior cruciate ligament (PCL) reconstruction and evaluate its short-term therapeutic effects.Methods We retrospectively analysed the 15 patients (15 knees) with PCL injury who had been treated at Department of Orthopaedics,Zhejiang Provincial People's Hospital from January 2017 to January 2018.They were 9 men and 6 women,with a mean age of 46.3 years (from 23 to 60 years).Of them,8 left and 7 right sides were injured.The intervals from injury to surgery averaged 33.6 days (from 4 to 120 days).Their injury was complicated with medial meniscus tear in 3 cases,lateral meniscus tear in one case,lesion of medial collateral ligament in 2 cases and lesion of lateral medial collateral ligament in one case.After preoperative physical examination and MRI confirmed complete PLC tear in all of them,they were treated by arthroscopic all-inside PCL reconstruction in which a new posterior-anterior approach was used to establish the tibial tunnel.Lysholm scoring and International Knee Documentation Committee (IKDC) scoring were used preoperatively and postoperatively to evaluate the knee functions.Results Their follow-ups averaged 8.3 months (from 6 to 12 months).Operation time averaged 55 minutes (from 45 to 70 minutes).All the patients got rid of the knee instability after surgery.All their posterior drawer tests and sag signs turned to be negative.At the final follow-up,their range of motion of the knee ranged from 110° to 130° (average,118°);their average IKDC score was 88.1 ±3.3 (from 82 to 93),significantly higher than the preoperative value (52.3 ±2.1) (P ＜ 0.05);their average Lysholm score was 90.6 ± 3.1 (from 84 to 96),significantly higher than the preoperative value (43.1 ± 2.3) (P ＜ 0.05).Conclusions This new method can avoid neurovascular damage and overcome the killer turn because it provides adequate exposure of the tibial PCL footprint and accurate placement of the tibial tunnel.It is also very convenient because the new posterior-anterior approach can be used to establish the tibial tunnel in all-inside PCL reconstruction without special tools like tibia1 PCL guide and retrograde drill.Its short-term clinical results have proved to be satisfactory.

BACKGROUND:The pathogenesis of knee intraarticular adhesion is yet unknown. Excessive proliferation of fibroblasts is considered to cause knee intraarticular adhesion. OBJECTIVE:To study the preventive effects of methotrexate on knee intraarticular adhesion through fibroblast apoptosis induced by endoplasmic reticulum stress. METHODS:The viability of the cultured fibroblasts treated with methotrexate(10-5-10-9mol/L)or PBSwas determined after 24 hours. Fibroblast apoptosis was detected by Hoechst33342 staining. Endoplasmic reticulum stress-and apoptosis-related proteins, including cleaved-PARP, CHOP, Bax and Bcl-2, were determined by western blotassay. Eighteen healthy male New Zealand white rabbits were used to establish the knee intraarticular adhesion models, and equaly randomized into three groups, and received topical application of 2 or 1 g/L methotrexate, or normal saline (control). The preventive effects of methotrexate on knee intraarticular adhesion and CHOP expression in scar tissue were observed. RESULTS AND CONCLUSION:Methotrexate inhibited the proliferation and viability of fibroblasts in a dose-dependent manner. The number of apoptotic fibroblasts was significantly increased compared with control group. Protein expression of cleaved-PARP, CHOP, and bax was increased, while protein expression of bcl-2 was decreased with time. The animal experiment showed that preventive effects of 2 g/L methotrexate on knee intraarticular adhesion were superior to 1 g/L methotrexate treatment. CHOP expression in the scar tissue in the methotrexate groups was higher than the control group and that was higher in high-dose methotrexate group. Our results suggest that methotrexate prevents knee intraarticular adhesionviaendoplasmic reticulum stress-induced fibroblast apoptosis.

Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.

Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.

Objective By measuring the thoracic cage index with chest X-ray film in 3-17 years old healthy children,analyzing the bivariate correlations with age,to provide the reference data for evaluating and following up of chest wall deformity.Methods A retrospective study was conducted for 450 cases of health physical examination from May 2013 to March 2016 in our institution.The anterior intercostal space width(IS),the anterior rib width(RW),and thickness of the rib in the middle(RT) on the right side of 3-7 ribs have been measured in each patient.Statistical describing for each measurement index has been made,and Pearson correlation analysis was used to analyze the correlation between measurement values and ages.Results Each measurement index is strong positive correlated with age (0.6 ＜ r ＜ 0.8,P ＜ 0.05).Conclusion The anterior intercostal space width,the anterior rib width and the thickness of the ribs in the middle have a growing trend with age in children.It is indeed a useful way to measure thoracic cage data by using the chest X-ray film quantitative evaluation method.The measured values can be used as reference indexes.