Objective To evaluate the safety and efficacy of super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided renal access in pediatric with renal calculus.Methods From May to August 2015, 20 pediatric patients with upper tract stones underwent the SMP by ultrasound guidance.The patients aged 11-144 months , median age 31.5 months, The stone size ranged 0.8-2.5 cm, mean(1.48 ±0.59) cm.Among the 20 children, single pelvis stones were in 8, multiple stones in 10 and upper ureter stones in 2.All patients had no previous surgery treatment.The SMP system consists of a F6.0 -7.5 nephroscope and a modified F12-14 access sheath with suction-evacuation function.Nephrostomy tract dilation was performed up to F12-14 and lithotripsy procedure was performed by using pneumatic lithotripter.Nephrostomy tube or double J stent was placed only if clinically indicated.Results The stone size was 0.8-2.5 cm ,mean (1.48 ± 0.59)cm.Among the 20 children, there were 8 patients with single pelvis stone, 10 with multiple stones and 2 with upper ureter stones.All the patients were completed successfully without surgery conversion.Mean operative time ranged 6-40 minutes ,mean(17.6 ± 11.6) minutes.The stone free rate was 100％ after the evaluation in the postoperative day.The hemoglobin drop was 2-16 g/L,mean (7.6-± 4.1) g/L.No major complications occurred, neither patient required transfusion.The tubeless PCNL without double J stents and nephrostomy tubes placed were achieved in all patients.Only 14 patients had a ureter catheter placement for one day.The average hospital stay ranged 1-4 days, mean (2.4 ± 0.8) days.Conclusions SMP could be a safe and effective treatment for kidney stone up to 2.0 cm in pediatric cases with advantages of short recovery time, high stone free rate and no catheter placement.SMP could be the ideal procedure for children with upper urinary tract calculus.

Objective:To evaluate the effect of dexmedetomidine on the hippocampal brain-derived neurotrophic factor (BDNF)/tyrosine kinase receptor B (TrκB) signaling pathway in a rat model of cerebral ischemia-reperfusion (I/R).Methods:Forty-five clean-grade healthy Sprague-Dawley rats, half male and half female, aged 5-6 months, weighing 200-250 g, were divided into 3 groups ( n=15 each) using a random number table method: sham operation group (group S), cerebral I/R group (group I/R), and dexmedetomidine + I/R group (group Dex). A rat model of cerebral I/R injury was established by occluding the middle cerebral artery for 90 min followed by restoring perfusion. In group Dex, dexmedetomidine 50 μg/kg was intraperitoneally injected at 30 min before ischemia, while the equal volume of normal saline was intraperitoneally injected in S and I/R groups. Neurological deficit scores were evaluated at 12 h of reperfusion. The rats were anesthetized and sacrificed, and the hippocampus was isolated for determination of the percentage of cerebral infarct size (by TTC method), expression of BDNF and TrκB (by Western blot), and expression of BDNF mRNA and TrκB mRNA (by real-time polymerase chain reaction) and for microscopic examination of cell apoptosis (by TUNEL method). Results:Compared with group S, the neurological deficit scores and percentage of cerebral infarct size were significantly increased, the number of apoptotic hippocampal neurons was increased, and the expression of BDNF and TrκB protein and mRNA was down-regulated in I/R and Dex groups ( P<0.05). Compared with group I/R, the neurological deficit scores and percentage of cerebral infarct size were significantly decreased, the number of apoptotic hippocampal neurons was reduced, and the expression of BDNF and TrκB protein and mRNA was up-regulated in group Dex ( P<0.05). Conclusions:The mechanism by which dexmedetomidine alleviates cerebral I/R injury may be related to activating hippocampal BDNF/TrκB signaling pathways in rats.

Objective:To study the correlation between OPRM1 A118G gene polymorphism (rs1799971) and the dosage of opioid analgesics in patients after lumbar decompression.Methods:From July 2017 to September 2018, 147 patients undergoing selective posterior lumbar decompression under general anesthesia in the People's Hospital of Xinjiang Uygur Autonomous Region were treated with sufentanil intravenous controlled analgesia(PCIA). The gene polymorphism was detected by PCR.The VAS, Ramasy sedation score, total dosage of sufentanil and adverse reactions of sufentanil in 48 h after operation were observed.Results:The genotype frequencies of AA, GA and GG were 30.6%, 55.5% and 13.9%, respectively, the difference was statistically significant(χ 2=6.324, P=0.423), and G and A allele frequencies were 41.7%, 58.3%, respectively, the difference was statistically significant(χ 2=5.559, P=0.184). There were no statistically significant differences in SpO 2, Ramasay sedation score and VAS score among the groups after operation(all P>0.05). The total dosage of sufentanil in OPRM1 mutant GG[(151.0±23.4)μg] and GA[(132.0±19.1)μg] was higher than that in AA[(123.0±16.2)μg] within 48 h of PCIA, the differences were statistically significant( t=5.206, 2.817, all P<0.05). Conclusion:The OPRM1 A118G gene polymorphism(rs1799971) is correlated with the dosage of opioid analgesics after lumbar decompression.

Objective:To investigate the incidence rate, surgical rate and spontaneous cure of indirect inguinal hernia in children of Xinjiang region.Methods:Children, aged from 4?14 years, coming from 24 kindergartens, 18 primary schools and 9 junior middle schools of 3 countries and 5 cities in Xinjiang Uygur Autonomous Region were recruited to participate as respondents. The survey time for baseline data collection was from May 2013 to June 2014 and the retrospective cross-sectional survey was conducted. Parents of children were investigated by questionnaire, and children were examined on site. Observation indicators: (1) results of questionnaire survey; (2) illness and treatment of children involved in the study; (3) follow-up. Follow-up was conducted using telephone interview. Children who had been diagnosed and not been treated surgically at the time of questionnaire survey were followed up to detect disease progression and treatment in the past 5 years. If the symptoms of a child had disappeared during follow-up, parents of the child should accompany the child to hospital for physical examination and B-ultrasound examination to confirm the diagnosis, and then follow-up was conducted by telephone interview. The follow-up was up to January 2020. Count data were described as absolute numbers and percentages, and compari-son between groups was conducted using the chi-square test. Odds ratio and 95% confidence interval were calculated. Results:(1) Results of questionnaire survey. A total of 19 132 question-naires were distributed, and 19 132 complete questionnaires were recovered. Of the 19 132 children who completed the questionnaire survey, there were 9 670 males and 9 462 females. (2) Illness and treatment of children involved in the study. ① Incidence of indirect inguinal hernia in children with different sexes. Of the 19 132 children, 498 cases were diagnosed as indirect inguinal hernia, including 368 boys and 130 girls, with the prevalence as 3.806%(368/9 670) and 1.374%(130/9 462), respectively. There was a significant difference in the prevalence of indirect inguinal hernia between boys and girls ( χ2=111.54, P<0.05). The proportion of boys and girls in children with indirect inguinal hernia was 73.896%(368/498) and 26.104%(130/498), respectively, with the ratio of 2.8:1. The prevalence of boys was higher than girls ( odds ratio=2.84, 95% confidence interval as 2.32?3.48).② Age of children at first onset. Of the 498 children with indirect inguinal hernia, 59 cases were aged 1?4 years at first onset including 54 boys and 5 girls, 264 cases were aged 5?8 years including 196 boys and 68 girls, 148 cases were aged 9?12 years including 104 boys and 44 girls, 27 cases were aged 13?14 years including 14 boys and 13 girls. There was a significant difference in the age of children at first onset between boys and girls ( χ2=17.33, P<0.05). ③ Pathogenic factors in children with indirect inguinal hernia. Of the 498 children with indirect inguinal hernia, 457 cases had complete family history and crying history, and 41 cases were missing. Family history: of the 457 children with indirect inguinal hernia who had complete family history, there were 175 cases with the family history of indirect inguinal hernia and 282 cases without the family history. Of the 478 healthy children surveyed in the same period, there were 25 cases with the family history and 453 cases without the family history. There was a significant difference in the family history between the 457 children with indirect inguinal hernia and the 478 healthy children ( χ2=515.89, P<0.05). Crying history: of the 457 children with indirect inguinal hernia who had complete crying history, there were 194 cases with obvious crying history and 263 cases without obvious crying history. Of the 496 healthy children surveyed in the same period, there were 99 cases with obvious crying history and 397 cases without obvious crying history. There was a significant difference in the crying history between the 457 children with indirect inguinal hernia and the 496 healthy children ( χ2=56.51, P<0.05). ④ Surgical treatment. Of the 498 children with indirect inguinal hernia, 233 cases underwent surgical treatment including 217 boys and 16 girls, 265 cases were followed up without surgical treatment including 151 boys and 114 girls. The surgical rate for indirect inguinal hernia in boys and girls was 58.967%(217/368) and 12.308%(16/130), respectively, showing a significant difference between them ( χ2=84.01, P<0.05). The operation ratio of boys and girls was 13.6:1, and the surgical rate of boys was higher than girls ( odds ratio=10.24, 95% confidence interval as 5.83?17.98). (3) Follow-up. All the 265 children without surgical treatment for indirect inguinal hernia were followed up for 5 years. During the follow-up, there were 142 of 151 boys with surgical treatment and 9 boys without surgical treatments, showing negative in spontaneous cure. There were 27 of 114 girls with surgical treatment and 87 girls without surgical treatment, showing 55 cases positive in spontaneous cure and 32 cases still with indirect inguinal hernia. There was a significant difference in spontaneous cure between the 151 boys and the 114 girls ( χ2=143.79, P<0.05). Conclusion:In Xinjiang region, the incidence rate and surgical rate of indirect inguinal hernia are lower in girls compared with boys, and the spontaneous cure rate is higher in girls compared with boys.