Objective To evaluate the clinical value of the level of plasma procalcitonin,blood lactic acid an1 endotoxin in patients of severe pneumonia complicated with sepsis.Methods The 40 cases of severe pneumonia complicated with sepsis(observation group)were analyzed retrospectively,they were divided into survival group included 20 cases and the death group included 20 cases.Meanwhile the 20 cases of healthy persons were selected as control group.The worst score of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) within 24 hours after admission were record.The level of plasma procalcitonin,blood lactic acid and endotoxin were compared between three groups.In addition do a correlation study between the above indexes and the score of APACHE Ⅱ.Results The level of plasma Procalcitonin,blood lactic acid and endotoxin of observation group increased significantly compared with the control group [(0.02±0.01 ng/ml,0.87 ± 0.27 mmol/L,4.15±1.63 pg/ml) vs (18.29±11.02 ng/ml,6.55 ± 3.02 mmol/L and 15.5±10.38 pg/ml),t=10.48,11.79,6.75,all P＜0.05].The level of plasma procalcitonin,blood lactic acid and endotoxin of the death group increased significantly compared with the survival group [(9.52±2.93 ng/ml,4.26±1.78 mmol/L,7.62±3.04 pg/ml) vs (27.06±8.88 ng/ml,8.84± 2.14 mmol/L and 23.39± 9.00 pg/ml),t=8.39,7.35,7.42,all P＜0.05].In the all patients of severe pneumonia complicated with sepsis,there was positive correlation among plasma procalcitonin,blood lactic acid,endotoxin and the score of APACHE Ⅱ (r=0.919,P=0.001;r=0.914,P=0.002;r=0.909,P=0.004).Conclusion The level of plasma procalcitonin,blood lactic acid and endotoxin are very important indexes in assessment of the severity and the prognosis of severe pneumonia complicated with sepsis,that has important value in clinical application.

Background and objective Carbonic anhydrase IX (CAIX) is a transmembrane protein involved in the metabolism of tumor cells. CAIX is expressed in only a few normal tissues but is overexpressed in various tumor types. Te aim of this study is to detect the serum CAIX level of patients with lung cancer, evaluate the significance of CAIX detection in the diagnosis of lung cancer, and analyze the serum CAIX level among diferent pathological types and TNM stages of lung can-cer. Methods Forty-seven patients with lung cancer and 31 healthy subjects were selected to participate in this study. Serum CAIX level was examined through enzyme-linked immunosorbent assay (ELISA). Te subjects were grouped according to histological type and TNM staging, and serum CAIX level was compared among the groups. With pathological diagnosis as the gold standard, receiver operating characteristic curve of the serum CAIX level was established for the diagnosis of lung cancer. Results Te CAIX serum level was significantly higher in patients with lung cancer than that in the healthy group (P<0.001). Te serum CAIX level in patients with squamous cell carcinoma and small cell carcinoma was also significantly higher than that in patients with adenocarcinoma. No statistically significant diferences were observed in the serum CAIX level between I+II and III+IV staging. Te AUC of serum CAIX level was 0.961. At a threshold level of 115.115 pg/mL, sensitivity and specificity were 95.7% and 90.3%, respectively. Conclusion Detection of the serum CAIX level through ELISA exhibits high sensitivity and specificity and is important for the diagnosis of lung cancer.

[Objective]To investigate the effect of ivabradine,an inhibitor of peripheral HCN channel,on remifentanil-induced hyperalgesia in mice.[Methods]The model of remifentanil-induced hyperalgesia was established by intravenously infusing remifentanil 2 μg/(kg·min)for 1 h through tail vein of adult male C57/BL6 mice.To observe the effect of ivabradine on remifentanil induced hyperalgesia,ivabradine(5 mg/kg)was injected subcutaneously 30 minutes before remifentanil infusion.Forty mice were equally and randomly divided into 4 groups:saline group,remifentanil group,remifentanil+vehicle group and remifentanil+ivabradine group.In each group,six mice were used to test mechanical and thermal pain thresholds at 24 h before(baseline)and on 1 d,3 d,5 d after remifentanil or saline infusion.Four mice of each group were used to detected c-Fos positive cell in spinal dorsal horn by immunofluorescence on 1 d after remifentanil or saline infusion.[Results]Compared with the saline group,a significant decrease in mechanical or thermal threshold was observed on 1 d and 3 d after remifentanil infusion(P<0.001),and the number of c-Fos positive neurons in the lumbar dorsal horn increased significantly(P<0.001).Compared with vehicle group,subcutaneous injection of ivabradine effectively inhibited remifentanil induced hyperalgesia(P<0.001)and blocked the increase of c-Fos positive neurons in the lumbar dorsal horn on 1 d following remifentanil treatment(P<0.001).[Conclusions]Ivabradine could effectively prevent remifentanil-induced hyperalgesia in mice.The possible mechanism underlying this effect is that ivabradine suppresses the enhanced peripheral nociceptive input onto spinal cord neurons.

Objective To analyze the correlation between anxiety symptoms and abnormal brain function in patients with chronic obstructive pulmonary disease(COPD)under long-term chronic hy-poxia.Methods Twenty-one patients with COPD complicated with anxiety were prospectively select-ed as COPD group,and 26 healthy individuals matched for gender and age were selected as control group.Both groups underwent high-resolution 3D-T1-weighted imaging(3D-T1WI),T2-fluid-attenua-ted inversion recovery(T2-FLAIR),and blood oxygen level dependent(BOLD)sequence examina-tion.DPARSF and SPM8 software were used to analyze the amplitude of low-frequency fluctuations(ALFF)in the brain of the two groups.Results In the COPD group,the ALFF value in the left parahippocampal gyrus-cingulate gyrus increased,and the ALFF value in the right superior frontal gy-rus decreased(P＜0.05).Pearson correlation analysis found that there was a negative correlation be-tween the ALFF value in the right superior frontal gyrus and the anxiety score(r=-0.485,P=0.03).Conclusion Chronic hypoxic patients with COPD have brain functional impairment in the right superior frontal gyrus,and the degree of impairment is positively correlated with anxiety symp-toms.There may also be compensatory enhancement of brain function activity in the parahippocampal gyrus-cingulate gyrus.

Objective To analyze the correlation between anxiety symptoms and abnormal brain function in patients with chronic obstructive pulmonary disease(COPD)under long-term chronic hy-poxia.Methods Twenty-one patients with COPD complicated with anxiety were prospectively select-ed as COPD group,and 26 healthy individuals matched for gender and age were selected as control group.Both groups underwent high-resolution 3D-T1-weighted imaging(3D-T1WI),T2-fluid-attenua-ted inversion recovery(T2-FLAIR),and blood oxygen level dependent(BOLD)sequence examina-tion.DPARSF and SPM8 software were used to analyze the amplitude of low-frequency fluctuations(ALFF)in the brain of the two groups.Results In the COPD group,the ALFF value in the left parahippocampal gyrus-cingulate gyrus increased,and the ALFF value in the right superior frontal gy-rus decreased(P＜0.05).Pearson correlation analysis found that there was a negative correlation be-tween the ALFF value in the right superior frontal gyrus and the anxiety score(r=-0.485,P=0.03).Conclusion Chronic hypoxic patients with COPD have brain functional impairment in the right superior frontal gyrus,and the degree of impairment is positively correlated with anxiety symp-toms.There may also be compensatory enhancement of brain function activity in the parahippocampal gyrus-cingulate gyrus.

Objective:To analyze the effect and safety of levonorgestrel-releasing intrauterine system(LNG-IUS) for the premenopausal patients with breast cancer who took tamoxifen as adjuvant therapy.Methods:From June 2014 to June 2016, 84 patients with breast cancer who met the inclusion criteria in the First People′s Hospital of Xiaoshan District were randomly divided into two groups according to the digital table.The treatment group (39 cases) underwent LNG-IUS insertion, while the control group (45 cases) received no LNG-IUS insertion.The general condition of patients before the use of tamoxifen and LNG-IUS was evaluated.Transvaginal ultrasound was used to measure the thickness of endometrium, hysteroscope was used for pathological examination of endometrium and the measurement of ER/PR expression, and blood lipid level was also detected.All above was done before the treatment of tamoxifen and LNG-IUS, 1 year after treatment and 2 years after treatment.Results:Before the therapy, there were no statistically significant differences between the two groups in general condition and uterine cavity condition(all P>0.05). After 1 year, the incidences of endometrial polyp, endometrial hyperplasia/secretion, benign lesion and endometrial atrophy in the treatment group were 2.6%, 5.1%, 15.4%, 76.9%, respectively, which in the control group were 6.7%, 20.0%, 17.8%, 55.6%, respectively.the differences between the two groups were statistically significant(χ 2=4.06, 4.22, all P<0.05). After 2 years, the incidences of endometrial polyp, endometrial hyperplasia/secretion, benign lesion and endometrial atrophy in the treatment group were 0.0%, 2.6%, 84.6%, respectively, which in the control group were 11.1%, 15.6%, 60.0%, respectively, the differences between the two groups were statistically significant(χ 2=4.608, 4.092, 6.203, all P<0.05). Conclusion:LNG-IUS can prevent the benign endometrial lesions of breast cancer patients caused by tamoxifen therapy after surgery, and can decrease the incidence of endometrial polyp and endometrial hyperplasia/secretion, while increase the incidence of endometrial atrophy, without increasing the recurrence risk of breast cancer.

Objective:To investigate the characteristics of renal disease spectrum in children aged 0-3 years old, and to evaluate the clinical value of renal biopsy in children aged 0-3 years old with renal diseases.Methods:It was a retrospective analysis study. The children aged 0-3 years old with kidney diseases receiving renal biopsy and having complete clinical data in Shanghai Children's Hospital from January 1, 2009 to December 31, 2020 were enrolled. The clinical and pathological data of the children were collected. The spectrum of renal diseases, clinical phenotype, renal pathology, and the relationship between renal pathology/genotype and clinical phenotype were analyzed.Results:A total of 117 children aged 0-3 years old with kidney diseases were enrolled in the study, accounting for 6.5% (117/1 790) of all children (0-18 years old) with renal biopsies during the same period. There were 77 males and 40 females. The age was (2.20±0.51) years old (5-35 months). All cases of renal biopsies in children aged 0-3 years old were successful without serious complications. Nephrotic syndrome was the common clinical phenotype of kidney diseases in children aged 0-3 years old (59.0%, 69/117), followed by hematuria and proteinuria (29.1%, 34/117). Primary glomerular disease (69.2%, 81/117) was the major clinical type of renal diseases, followed by hereditary kidney diseases (29.1%, 34/117), in which Alport syndrome was the main hereditary kidney disease (79.4%, 27/34). Renal pathological types of children aged 0-3 years old were mainly distributed in minimal change disease (30.8%, 36/117), followed by glomerular minor lesion (26.5%, 31/117), mesangial proliferative glomerulonephritis (15.4%, 18/117), and focal segmental glomerulosclerosis (10.3%, 12/117). Among 40 children aged 0-3 years old with hematuria with/without proteinuria, 25 cases were diagnosed as Alport syndrome by abnormal immunofluorescence of type IV collagen in renal tissues. Among the 28 children with kidney diseases who underwent genetic testing, 23 cases had gene mutations, mainly in COL4A5 gene (60.9%, 14/23), among which 4 children had gene mutations in 8 children with refractory nephrotic syndrome. Among the children aged 0-3 years old with clinical manifestations of hematuria, the proportion of gross hematuria in children diagnosed with Alport syndrome (59.3%, 16/27) was significantly higher than that in children without Alport syndrome (20.0%, 3/15, χ2=5.999, P=0.014). Conclusions:Primary glomerular disease is the principal type of kidney diseases in children aged 0-3 years old, followed by hereditary kidney disease. Attention should be paid to children aged 0-3 years old with gross hematuria. Renal biopsy in children aged 0-3 years old is safe and reliable, and it is an essential means for the diagnosis of renal diseases. Renal biopsy combined with gene testing can better understand the etiology of kidney diseases and guide treatment in children aged 0-3 years old.

ObjectiveThis study aims to explore the effect of ultrasound-guided superficial parasternal intercostal plane block on the quality of recovery and postoperative analgesia in patients undergoing sternotomy cardiac surgery. MethodsA total of 64 patients undergoing sternotomy cardiac surgery were selected for this study. They were randomly divided into two groups： one group received a superficial parasternal intercostal plane block with ropivacaine （the ropivacaine group）， while the other was given normal saline （the normal saline group）. The primary outcome was the Quality of Recovery-15 （QoR-15） score on postoperative day 1 in both groups， accompanied by a comparative analysis of the pain score and opioid usage. ResultsCompared with the normal saline group， the ropivacaine group exhibited a significantly higher QoR-15 score on postoperative day 1［（89.60±13.24） vs （81.18±12.78）， P=0.012］. The numerical rating scale at rest was significantly lower［（3.03±0.72） vs （4.26±0.93）， P<0.001］， and the numerical rating scale during coughing was also significantly reduced ［（4.40±0.89） vs （5.44±1.05）， P<0.001］. Concurrently， the cumulative morphine equivalent consumption during the initial 24 h postoperatively was significantly lower in patients who were administered the ropivacaine ［14.15 （4.95～30.00） mg vs 40.50 （19.25～68.18） mg， P=0.002］， and there was also a notable decrease in the rescue analgesia ［0.00 （0.00～0.00） mg vs 0.00 （0.00～100.00） mg， P=0.007］. ConclusionUltrasound-guided superficial parasternal intercostal plane block can significantly enhance the overall quality of recovery in patients undergoing sternotomy cardiac surgery on postoperative day 1. The technique contributes to improved postoperative analgesic effects and a reduction in opioid usage， thereby facilitating early postoperative recovery.

Objective:To explore the characteristics of eye tracking movement on circumscribed interests in preschool children with autism spectrum disorder (ASD), providing some reference for behavior correction and rehabilitation training.Methods:Fifty ASD children and fifty-two age-matched typically developing children(TDC) were investigated by the childhood autism rating scale(CARS), the autism diagnostic observation schedule(ADOS), the autism diagnostic interview-revised (ADI-R) and Gesell Developmental Schedule, (GDS). Eye movement during the visual search task was captured by the Tobii Pro X3-120 eye tracker.All data were analyzed by the IBM SPSS Statistics 20.0.Eye movement patterns were compared between TDC and ASD children using the independent-sample t test, and the correlations were then analyzed between abnormal eye movement characteristics and their core syndrome. Results:The total scores of CARS, ADOS and ADI-R in ASD group were 34.13±4.59, 14.44±2.59 and 39.91±12.11 respectively.During passive viewing of complex non-social picture arrays, ASD and TDC group explored total number of images were 9.28±2.72 and 12.67±2.45.The fixation time per image explored in ASD and TDC group were (0.67±0.37)ms and (0.54±0.15)ms.Moreover, the number of discrete fixations per image explored in ASD and TDC group was 2.80±1.00 and 2.48±0.48.Compared with the TDC group, ASD children demonstrated circumscribed attention ( t=6.610, P<0.01) with more perseveration ( t=-2.363, P=0.021) and detail-orientation ( t=-2.360, P=0.021). Exploration was negatively correlated with the total score of ADOS ( r=-0.480, P<0.01), CARS ( r=-0.487, P<0.01), communication score of ADOS( r=-0.290, P=0.041), social score of ADOS( r=-0.491, P<0.01), game score of ADOS( r=-0.397, P=0.004)and communication score of ADI-R( r=-0.331, P=0.025)in the ASD group. Conclusion:Compared with TDC, the eye movement pattern shows the circumscribed interests of ASD children, who not only explore fewer objects but also demonstrate circumscribed attention with more perseveration and detail-orientation.Moreover, the more severe the symptoms of ASD children, the fewer objects the children explore and the more stereotyped the circumscribed interest.