Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary diseases in children. Methods Data of 9 patients younger than 14 years who underwent ERCP at between November 2004 and May 2010 were indentified through a computer database search. Therapeutic methods, success rate and procedure-related complications were evaluated.Results A total of 9 patients underwent 17 ERCP procedures under anesthesia, including 16 therapeutic and 1 diagnostic procedure. The success rate was 94. 1% (16/17) and the complication rate was 11.8%(2/17), including 1 mild pancreatitis and 1 peri-pancreatic infection. Conclusion ERCP is an important tool with high safety and efficacy for diagnosis and treatment of pancreaticobiliary diseases in children.

Objective To explore the effect of Acorus gramimeus and its major components ?-asarone on N-methyl-D-asperate recepter 1 (NMDAR1) mRNA levels of hippocamp neurons in epileptic animal models induced by pentylenetetrazol (PTZ). Methods PTZ 60 mg/kg was injected to the abdominal cavity of three weeks Wistar rats to prepare epileptic animal models. The animal models were randomly divided into three groups: epilepsy control, A. gramimeus and ?-asarone as well as the normal control. Each group was administered through intraperitoneal injection. Both of two control groups were injected physiologic saline 1.0 mL/d, and the rest groups were injected A. gramimeus 2 350 mg/(kg?d) or ?-asarone 29 mg/(kg?d) for 7 d, respectively. All rats were treated by PTZ 60 mg/kg through intraperitoneal injection next day. After their behaviors were observed for 24 h, animals were sacrificed. The expressions of NMDAR1 mRNA in hippocamp CA1 and CA3 of all rats were detected by in situ hybridization and semiquantitative RT-PCR. Results The results of in situ hybridization showed that positive staining granules were located in the cyptoplasm of hippocamp neurons. The number of positive cells and average absorbance of A. gramimeus group or ?-asarone group was markedly less than that of epilepsy control (P

Objective To explore the effect of thyroid hormone on bone metabolism.Methods The thyroid in the rabbits had been cut off and the physics and histology of the bone in the rabbits were observed.The therapeutic effect of exterofection thyroid hormone was also observed.Results The lacking or reducing of thyroid hormone could lead to osteoporosis.The substitutive treatment of T_4 could partially inhibit the oesteopenia.Conclusion When the T_3 level equals to the level of T_4,the oesteopenia of the rabbits with thyroid being cut off may be caused by the lack of calcitonin.

Objective To observe the expression of nuclear factor-kappa B(NF-κ3)and monocyte chemnattractant protein-1(MCP-1),and the infiltration of mononuclear macrophage CD68 in lupus nephritis (LN).The association between NF-κB,MCP-1 and MΦ with kidney pathology and clinical manifestations is explored.MethodsNF-κB,MCP-1 and MΦ in renal biopsy specimens from 49 cases of LN were detected using immunohistochemical techeniques.Forty-nine cases of renal tissues were examined for NF-κB by in situ hybridization.The relationship between NF-κB,MCP-1 and MΦ with kidney pathology and clinical manifestations were analyzed.Results ①Compared with the control group ,the expression of NF-κB,MCP-1 and MΦ in LN was significantly higher(P＜0.01).The expression of MCP-1 positively correlated with MΦinfiltration and NF-κB(P＜0.01)in glomeruli and renal tubule and renal interstitium of LN.The expression of NF-κB,MCP-1 and the infiltration of MΦ in LN Ⅳ was significandy higher than non LN Ⅳ and the control group(P＜0.01,P＜0.05).There was no significant difference between renal NF-κB positive group and negative groups in the degree of the immunohistochemical and in situ hybridization examination(P＞0.05).②The histological activity index,urine protein volume(24 h)and serum creatinine in LN were significantly higher than the control group(P＜0.01),and the expression of NF-κB in LN was correlated with histological activity index,urine protein volume(24 h)and serum creatinine(P＜0.01,P＜0.01,P＜0.05).MCP-1 and CD68 expression in LN were correlated with histological activity index and urine protein volume(24 h),but not correlated with serum creatinine(P＞0.05).Conclusion NF-κB induced MΦ by activating MCP-1 may be one cause of kidney injury of LN.NF-κB signal pathway may act as a new therapeutic target for MΦinfiltration and proliferation inhibition in kidney.

Objective:To evaluate the pregnancy outcomes of fetal tethered cord (TC) prenatally diagnosed by MRI.Methods:Clinical data of 38 fetuses diagnosed as having TC by MRI, including 36 singletons and two fetuses who were both one of dichorionic diamniotic twins, were retrospectively collected and analyzed in the Obstetrics and Gynecology Hospital of Fudan University from January 2015 to August 2019. According to whether conus medullaris was located above the bladder or reached the lower edge of the bladder, all cases were divided into high or low groups. Pregnancy outcomes were compared between the two groups using Fisher's exact test and Student's t-test. Results:(1) The gestational age at MRI was (25.5±4.7) weeks. Among the 38 cases, 14 (36.8%) were isolated TC, 24 (63.2%) were complicated by other anomalies. The meningocele was responsible for the most (39.5%, n=15). The results of the ultrasound were consistent with those of MRI in 24 cases (63.2%). While in the other 14 cases (36.8%), the ultrasound only showed vertebral body's abnormal morphology, after which further MRI examination revealed a tethered cord. (2) Twenty-nine women (76.3%) chose to terminate the pregnancy. One patient (2.6%) underwent fetal reduction at 23 gestational weeks (one normal twin was delivered prematurely), and one (2.6%) was lost to follow-up. Seven (18.4%) cases continued the pregnancies to delivery. The postnatal follow-up period was 8.1 months (4.0 to 54.9 months). Two infants without comorbidities showed normal growth and development. Another three cases underwent surgeries after birth, and two cases died in the neonatal period. (3) The average width of the medullary cone was (2.5±0.8) cm. There was no significant difference in the spinal cord width between the high [(2.5±0.8) cm, n=34] and low group [(2.7±1.1) cm, n=4]. Six pregnancies (17.6%) in the high group was continued to delivery, and one of the neonates died of severe hydrocephalus. One patient in the low group (1/4) was delivered, while the baby died of neonatal asphyxia. Conclusions:Fetuses with isolated TC are prone to have a good prognosis. Further study should focus on the relation between the high or low position of the conus medullaris and pregnancy outcomes.

Objective To establish a high-performance induction culture system for Raw264.7 cells to differentiate into osteoclasts(OC)invitro by improving the cell culture program.Methods The Raw264.7 cells were cultured withα-MEM medium containing 50 μg · L-1 M-CSF, 100 μg · L-1 RANKL, and 1 × 10-8 mol · L-1 1α,25-(OH)2 D3 in 5% CO2 for 12 d at 37℃. The cells were digested transiently every time before the medium was changed after every three days. The morphologic changes of the Raw264.7 cells were observed by inverted microscope.The maturation and phagotrophic function of OC were identified by HE,TRAP,FITC-phalloidin staining and immunofluorescence.Results The cells remained to grow in single layers all the time in most areas of the well during the whole induction by the improved culture program. The observation results of inverted microscope and HE staining showed that the growth area of the polykaryotic OC reached to 70% of the well on day 1 2. FITC-phalloidin staining showed that in the maturation of the OC, the cluster-shaped podosomes in the pseudopodia gradually transformed into rings,which finally fused to form a large belt surrounding the periphery of the cytoplasm. The calcitionin receptor (CTR) expressed by OC was markedly enhanced compared with the precursor cells by immunofluroescence staining,and a large number of red granules appeared in the cytoplasm of OC with TRAP staining on day 1 2. These results comfirmed that the obtained OC were maturated and owned phagotrophic function. Conclusion A high-performance induction culture system for Raw264. 7 cells to differentiate into OC in vitro induced by combination of 50μg · L-1 M-CSF, 100 μg · L-1 RANKL,and 1 × 10-8 mol·L-1 1α,25-(OH)2 D3 is established by improving the cell culture program.

Objective:The clinical manifestations, types of gene mutations, therapeutic effects and prognostic characteristics of 15 children with cblC type methylmalonic acidemia (MMA) and hydrocephalus were analyzed to improve the clinical understanding of the disease, so as to provide a basis for the treatment of the disease.Methods:From April 2015 to January 2019, 15 patients with MMA and hydrocephalus in Department of Pediatric Surgery, Peking University First Hospital were enrolled, and all gene detection showed clbC type.All the 15 patients underwent ventriculoperitoneal shunt.After surgery, the clinical manifestations and imaging findings were applied as the basis to adjust the pressure of the diverter valve appropriately.Clinical data and gene mutation characteristics of 15 children with cblC type and hydrocephalus were retrospectively analyzed, and the therapeutic effects and prognosis were summarized and analyzed as well.Results:There were 8 males (53.3%) and 7 females (46.7%), aged from 2 to 33 months.All the cases were followed up from 11 to 55 months, without death case and serious postoperative complications of hydroce-phalus.The head circumference of 3 cases (20.0%) was in the normal range, 1 case (6.7%) was greater than the normal range, and 11 cases (73.3%) were less than the normal range.Four patients (26.7%) were transferred to the pediatric intensive care unit after surgery.c.609G>A mutation was the most common in this study, with 7 cases (46.7%) of c. 609G>A homozygous mutation, and 5 cases (33.3%) of c. 609G>A heterozygous mutation.Clinical symptoms of intracranial hypertension were relieved or disappeared.The head circumference progressive enlargement was stopped.The anterior fontanelle tension greatly decreased, all " setting-sun" sign of eyes disappeared, and vision loss and hearing loss were better compared with the pre-operation.Four cases (26.7%) displayed normal intelligence and exercise, and 11 cases (73.3%) were left with mild to severe psychomotor retardation.During the follow-up pe-riod, the head CT showed that the ventricle was remarkably narrowed, and interstitial brain edema obviously improved.Conclusions:Ventriculoperitoneal shunt in the treatment of cblC type MMA with hydrocephalus has positive effects.The head circumference of most cblC type MMA with hydrocephalus is less than the normal range.c.609 G>A is the most common mutation in cblC type MMA with hydrocephalus.Perioperative " metabolic crisis" can result in serious complications.

Objective: To explore the impact of PI3K-Akt-eNOS signaling on atrial fibrillation inducibility in diabetic rats. Method: Eight-week-old male diabetic rats were randomized assigned into GK group, IGF group and L-NAME group (n=8 each) which respectively received normal saline (NS), insulin like growth factor (IGF-1) or L-NAME+IGF-1 through tail vein daily for 4 weeks. Eight 8-week-old male homologous Wister-Kyoto(WKY) rats treated with intravenous NS served as control group (WKY group). Blood glucose was measured once per week. The left atrial diameter (LAD) was measured by echocardiography, the atrial electrical parameters, including the P-wave duration, the atrial effective refractory period (AERP) and its dispersion (AERP-d), the incidence and the duration of atrial fibrillation induced by atrial burst pacing, were evaluated by electro-physiological instrument at 4 weeks post various treatments. Rats were then sacrificed, left atrial (LA) cell morphology was determined on HE stained sections, LA interstitial collagen was determined on Masson stained sections. The protein expression of phosphatidylinositol 3-kinase (PI3K) and phosphate endothelial nitric oxide synthase (p-eNOS) were detected by Western blot. Results: (1) At the beginning of the study, the random blood glucose (GLU) level was significantly higher and LAD was large in GK, IGF and L-NAME groups than in WKY group;after 4 weeks, GLU level and LAD dimension of IGF group were lower than GK and L-NAME groups (P<0.01 or 0.05). (2) One rat in L-NAME group died during operation. Four weeks later, the incidence of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 7/8, 2/8, 6/7 and 3/8. The median duration of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 11.9(9.3, 13.1), 0(0, 1.8), 11.5(4.4, 12.0), and 0(0, 3.0) s. Compare with WKY group, the P-wave duration and PR interval were significantly longer, AERP-d, incidence, and duration of atrial fibrillation were significantly higher in GK group (P<0.01), these changed were significantly reversed in IGF group compared to GK and L-NAME groups (all P<0.01). Heart rate and AERP were similar among the 4 groups on (P>0.05). (3) Four weeks later, the CSA and CVF of LA were significantly larger in GK group than in WKY group (P<0.01), which were significantly reversed in IGF group (P<0.01 vs. GK group), and the beneficial effects of IGF disappeared by co-treatment with L-NAME (P<0.01 vs. IGF group). (4) Four weeks later, compare with WKY group, the protein expression of PI3K (P<0.01) and p-eNOS (P<0.05) of LA were significantly downregulated in GK group, which could be significantly upregulated by IGF (P<0.01 and 0.05 vs. GK group), these effects diminished by co-treatment with L-NAME (P<0.01 or 0.05 vs. IGF group). Conclusion Increased atrial fibrillation susceptibility in diabetic rat is linked with structural and electrical remodeling in LA, possibly mediated through downregulated PI3K-Akt-eNOS signaling.

Objective:To analyze the trend, hotspots and frontiers of diabetic retinopathy (DR) therapy by bibliometric method.Methods:Data were taken from the Web of Science website of Science Citation Index. Articles from 2017 to 2021, which were related to the therapy of diabetic retinopathy (DR), were included. The bibliometric analysis softwares, VOSviewer and CiteSpace were used to generate and analyze visual representations of the complex data input, including high-frequency keywords, keywords with the strongest citation bursts and co-occurrence networks of keywords.Results:A total of 3,845 articles were included. The amounts of papers published from 2017 to 2021 is 633, 651, 708, 893, and 960 respectively, increasing over years. Chinese scholars published the most articles, followed by the United States. The number of articles funded by the National Natural Science Foundation of China ranks third. There were 47 high-frequency keywords clustered into DR treatment, pathogenesis of DR, diagnosis of DR, Oxidative stress, diabetic macular edema (DME), type 2 diabetes, optical coherence tomography and deep learning. Those keywords were research hotspots and new keywords were constantly emerging. Among the top 11 burst words, the burst values of "intravitreal bevacizumab", "vascular endothelial growth factor (VEGF)", "choroidal neovascularization", "inhibition", and "receptors" were all over 10. Highly cited references showed a significant clustering tendency, which were treatment of DME, review of DR, clinical research of anti-VEGF drug therapy.Conclusions:The amount of paper related to DR therapy is on the rise; the specific treatment methods for the pathogenesis of DR are constantly research hotspots. In addition, formulating treatment strategies to reduce macular edema and other complications of diabetes, applying optical coherence tomography, deep learning and other technologies to improve the efficiency of DR diagnosis and treatment, improve targeted drug delivery systems, and finding new target points were research frontiers.