Objective To explore the relationship between the expression of HIF-1 alpha,VEGF gene and cliulcal stage of endometrial cancer. Methods 30 patients with the membrane carcinoma were detected VEGF, HIF-1α expression by immunohistochemical method. The expression of different pathological type and clinical stage were analyzed. Another 10 pieces achieved from endometriosis dysplasia organization were taken as control. Results The positive rate of HIF-1 alpha, VEGF in endometriosis dysplasia and endometrial carcinoma were statistically significant differences( x2=11.87,8. 71, all P ＜ 0. 05 );There was correlated relationship between ultrasonic grading of tumor blood and HIF-1 alpha, VEGF; There was correlated relationship between Lesions and HIF-1 alpha, VEGF.Conclusion The expressions of HIF-1 alpha, VEGF were positively correlated to the degree,metastasis and prognosis of malignant endometrial carcinoma.

Objective To investigate the best models of esophageal cancer surgical approaches,lymphadenectomy ranges and postoperative comprehensive treatment.Methods From January 1998 to December 2007 in 10 years,1 162 cases of different parts with esophageal cancer were analysized which were treated with surgically adopting sequential abdomen,chest,neck three-incision approaches.Taking three-step screening way of preoperative imaging,preoperative ultrasound localigation fineneedle aspiration biopsy cytology and intraoperative rapid fieezing pathological examination were applied to make the selectivity of the first-times cervico-thoraco-abdominal three-field lymph node dissection (3FLND),first-times standard thoracoabdominal two-field lymph node dissection (2FLND) and second-times third-field cervical lymphadenectomy.Meanwhile,we implemented actively postoperative comprehensive treatment and observed the overall clinical efficacy and long-term survival.Results In the group of 1 162 cases with esophageal cancer surgery.The operating resection rate was 100 ％,Radical resection of 97.6 ％ (1 134/1 162).Perioperative overall complication rate was 16.4 ％ (191/1 162).Anastigmatic fistula was 0.6 ％ (7/1 162).Five cases dead in 30 days after surgery.The whole group of lymph node metastasis rate was 52.6 ％ (611/1 162),lymph node metastasis degree in 12.1％ (3 092/25 564).Full group of the first-times 3FLND was 348 cases.The positive rate was 94.8 ％ (330/348),Implementing the first-times 2FLND was in 814 cases and the second-times thirdfield cervical lymph node dissection was performed in 89 cases.The postoperative complications of the 3FLND was significantly higher than that of 2FLND (23.6 ％ vs 13.4 ％).The difference was statistically significant (x2 =18.37,P ＜ 0.001).However,The difference was not statistically significant between 3FLND and 2FLND (P ＞ 0.05).There is no significant difference between the first-times 3FLND with the second-times 3FLND accumulating survival (P ＞ 0.05).But different degree of lymph node metastasis determined prognosis.The difference was significant (x2 =35.57,P ＜ 0.001).In our group the postoperative comprehensive treatment application rate was 87.2 ％.Surgery combined with comprehensive treatment overall 1,3,5 years survival rates were 92.1％,69.2 ％,49.6 ％ respectively.Conclusions The sequential three-incision approaches and selectivity of lymph node dissection have the radical nature thoroughly,fewer complications,high quality of life and the long-term survival advantages.It should be a widely used method in the clinical surgery of the esophageal cancer.Implementing the three-step screening way to selecting the first-times 3FLND,the firsttimes 2FLND and the second-times third-field cervical lymphadenectomy that have targeted strongly and high accuracy,a definite object in view and avoiding patient excessive trauma.Applying the comprehensive treatment after surgery and the re-treated of patients with recurrence that can further more improve the longterm survival of patients.The comprehensive treatment should be the target direction of the future development of esophageal cancer.

Objective To establish a simple ,low cost and stable method to detect right ventricular pressure in mice .Methods A PE-50 duct length 15 cm(outside diameter :0 .9 mm ,inner diameter :0 .5 mm) was bent on one terminal and the other terminal was inserted into a 7# syringe needle to connect to a pressure transducer .This duct was intubated into right ventricle via right external jugular vein to detect right ventricular pressure in 80 SPF grade male C57BL/6 mice .Successful cases and operation time were re-corded .Besides ,40 SPF grade male C57BL/6 mice were randomized into the control group (n=20) and chronic hyperbaric hypoxia group(n= 20) .Mice in chronic hyperbaric group were raised in a hyperbaric chamber of simulated 5 000 m high altitude for 4 weeks .The control group was raised outside the chamber simultaneously .Right ventricular systolic pressure was detected with the PE duct .Left and right ventricles were detached and weighed ,and Hermann-Willson index was calculated .Results With this PE duct ,right ventricular intubation success rate was 90% (72/80) ,the operation cost approximately 3 to 5 min each mouse from the separation of blood vessels to detect the time needed for the right ventricle waveform .right ventricular systolic pressure[(39 .52 ± 4 .34 )mm Hg] and Hermann-Willson index(0 .356 ± 0 .039)of chronic hyperbaric hypoxia group were significantly higher than that of control group [(21 .24 ± 2 .7)mm Hg and (0 .256 ± 0 .020)] ,which has significant positive correlation (P<0 .01) .Conclusion It is simple ,fast ,stable ,costing low and of high success ratio to detect right ventricular pressure with this method .

Objectiye To investgate the effects of isoflurane preconditioning on expression of Toll-like receptor 4 (TLR4) and myeloid differentiation factor 88 (MyD88) during focal cerebral ischemia-reperfusion (IR) in rats. Methods Thirty male SD rats weighing 250-300 g were randomly divided into 3 groups ( n = 10 each):sham operation group (group S);focal cerebral IR group and isoflurane preconditioning group (group IP). The animals were anesthetized with intraperitoneal pentobarbital 40 mg/kg. In group IR and IP a nylon thread with rounded tip was inserted into right internal jugular vein and threaded cranially until resistance was met. Mid-cerebral artery was occluded (MCAO) for 2 h followed by 24 h reperfusion. In group IP the animals inhaled 2% isoflurane98 % O2 for 1 h once a day for 5 consecutive days at 24 h before MCAO. Neurologic function was assessed and scored and cerebral infarct volume was measured at 24 h of reperfusion. The animals were sacrificed at 24, 48 and 72 h of reperfusion respectively. The right ischemic frontal lobes were removed for determination of TLR4, MyD88and NF-κB expression by Western blot analysis. Results MCAO significantly worsened neurologic function. The neurologic function deficit scores were significantly increased and the TLR4, MyD88 and NF-κB expression were significantly up-regulated in group IR as compared with group S (P ＜ 0.05). Isoflurane preconditioning significantly decreased cerebral infarct volumes and neurologic function deficit scores and down-regulated the expression of TLR4, MyD88 and NF-κB in group IP as compared with group IR ( P ＜ 0.05). Conclusion Isoflurane preconditioning can reduce inflammatory response and focal cerebral IR injury by down-regulating the expression of TLR4and Myd88.

Objective To evaluate the role of hippocampal neuronal nitric oxide synthase(nNOS)-postsynaptic dense protein 95(PSD95)coupling in short-term memory retrieval disorder induced by sevoflu-rane in mice.Methods Sixteen clean-grade healthy Kunming mice of both sexes,aged 2-3 months,weighing 30-35 g,were divided into 2 groups(n＝8 each)according to the random number table method:sevoflurane group(S group)and nNOS-PSD95 uncoupling agent ZL006 group(Z group).After successful establishment of dark avoidance memory,3.3％sevoflurane and 40％O2 were inhaled for 2 h in both groups,and normal saline 1.5 ml was intraperitoneally injected in group S and ZL006 1 mg/kg in group Z at 30 min before anesthesia.The step-through latency and error times were recorded before anesthesia and at 12 h after the end of anesthesia.The mice were then sacrificed,and hippocampal tissues were taken for de-termination of the expression of nNOS and PSD95(by Western blot)and co-expression of nNOS and PSD95(by immunoprecipitation).Results Compared with that before anesthesia,the step-through latency was significantly shortened,and the error times were increased at 12 h after anesthesia in group S(P＜0.05),and no significant change was found in the above indicators in group Z(P>0.05).Compared with group S,the step-through latency was significantly prolonged,error times were decreased,the co-expression of nNOS and PSD95 was down-regulated(P＜0.05),and no significant change was found in the expression of nNOS and PSD95 in group Z(P>0.05).Conclusion The mechanism by which sevoflurane induces short-term memory retrieval disorder may be related to promoting the coupling of nNOS to PSD95 in the hippocam-pus of mice.

Objective: To evaluate the role of hippocampal neuronal nitric oxide synthase (nNOS)-postsynaptic dense protein 95 (PSD95) coupling in short-term memory retrieval disorder induced by sevoflurane in mice. Methods: Sixteen clean-grade healthy Kunming mice of both sexes, aged 2-3 months, weighing 30-35 g, were divided into 2 groups (n=8 each) according to the random number table method: sevoflurane group (S group) and nNOS-PSD95 uncoupling agent ZL006 group (Z group). After successful establishment of dark avoidance memory, 3.3% sevoflurane and 40% O₂ were inhaled for 2 h in both groups, and normal saline 1.5 ml was intraperitoneally injected in group S and ZL006 1 mg/kg in group Z at 30 min before anesthesia.The step-through latency and error times were recorded before anesthesia and at 12 h after the end of anesthesia.The mice were then sacrificed, and hippocampal tissues were taken for determination of the expression of nNOS and PSD95 (by Western blot) and co-expression of nNOS and PSD95 (by immunoprecipitation). Results: Compared with that before anesthesia, the step-through latency was significantly shortened, and the error times were increased at 12 h after anesthesia in group S (P<0.05), and no significant change was found in the above indicators in group Z (P>0.05). Compared with group S, the step-through latency was significantly prolonged, error times were decreased, the co-expression of nNOS and PSD95 was down-regulated (P<0.05), and no significant change was found in the expression of nNOS and PSD95 in group Z (P>0.05). Conclusion The mechanism by which sevoflurane induces short-term memory retrieval disorder may be related to promoting the coupling of nNOS to PSD95 in the hippocampus of mice.

Objective:To evaluate the changes in the electrical conduction of ventricular myocardium during hypothermic ischemia-reperfusion (I/R) in rats with arrhythmia.Methods:Healthy clean-grade adult male Sprague-Dawley rats, aged 2-3 months, weighing 200-300 g, were studied.The hearts were removed and retrogradely perfused with oxygenated K-H solution in a Langendorff apparatus. Sixteen isolated hearts were divided into 2 groups ( n=8 each) using a random number table method: normal control group (group C) and hypothermic I/R group (group I/R). In group C, the heart was perfused with K-H solution at 37 ℃ for 120 min.In group I/R, the heart was perfused with K-H solution at 37 ℃ for 30 min, and then perfusion was stopped, cardiac arrest was induced through injecting Thomas solution (4 ℃), the area around the heart was protected with low temperature (4 ℃) Thomas solution, and hearts were perfused with 4 ℃ Thomas solution at 30 min after cardiac arrest and with 37 ℃ K-H solution for 30 min staring from 60 min after cardiac arrest.The rats in group I/R were further divided into high-risk subgroup (I/R-H subgroup) and low-risk subgroup (I/R-L subgroup). The time of spontaneous recovery of heart beat and development of arrhythmia were recorded.At the end of reperfusion, the atrioventricular conduction 2∶1 block point (2∶1B) and ventricular electrical conduction velocity (CV) were measured and recorded by program-controlled electrical stimulation. Results:Compared with group C, CV and 2∶1B were significantly decreased in IR-L and IR-H subgroups ( P<0.05). Compared with IR-L subgroup, the time for restoration of spontaneous heart beat was significantly prolonged, the incidence of ventricular fibrillation and arrhythmia score were increased, and CV and 2∶1B were decreased in IR-H subgroup ( P<0.05). Conclusion:The electrical CV of ventricular myocardium is decreased during hypothermic I/R, which may be the mechanism of reperfusion-induced ventricular arrhythmia in rats with arrhythmia.

Objective:To investigate the value of 18F-FDG PET/CT imaging signs and metabolic parameters in predicting tumor spread through air spaces (STAS) of stage Ⅰ lung adenocarcinoma. Methods:From January 2019 to December 2021, clinical, imaging and metabolic parameters of 381 patients (126 males, 255 females, age (61.2±9.2) years) with stage Ⅰ lung adenocarcinoma were retrospectively analyzed in the Affiliated Hospital of Qingdao University. According to the postoperative pathological results, patients were divided into STAS positive group and STAS negative group. According to the operation time, patients were divided into training set ( n=254) and verification set ( n=127). χ2 test or Mann-Whitney U test was used to compare the differences of different parameters between patients with STAS positive and negative, and binary logistic regression analysis was used to select the predictors of STAS status. The prediction model was established, and ROC curve was used to evaluate the predictive efficacy. Results:There were 49(19.3%, 49/254) patients with STAS positive and 205(80.7%, 205/254) patients with STAS negative in the training set, while those were 35(27.6%, 35/127) and 92(72.4%, 92/127) in the verification set. In the training set, the differences of age ( z=-2.30, P=0.021), type of lesions ( χ2=6.81, P=0.009), spiculation ( χ2=12.64, P<0.001), bronchus truncation ( χ2=6.98, P=0.008), ground glass ribbon sign ( χ2=26.93, P<0.001) and SUV max ( z=-4.62, P<0.001) between the two groups were statistically significant. Multivariate logistic regression analysis showed that age (odds ratio ( OR)=1.048, 95% CI: 1.004-1.094, P=0.032), ground glass ribbon sign ( OR=3.857, 95% CI: 1.693-8.788, P=0.001) and SUV max ( OR=1.133, 95% CI: 1.001-1.282, P=0.049) were independent predictors of STAS status in stage Ⅰ lung adenocarcinoma patients. The logistic regression model was P=1/(1+ e - x), x=-5.292+ 0.480×age (year)+ 1.493×ground glass ribbon sign+ 0.170×SUV max. The AUCs of the model in the training set and verification set were 0.770 and 0.801, with the sensitivity of 81.6%(40/49) and 82.9%(29/35), and the specificity of 69.8%(143/205) and 65.2%(60/92), respectively. Conclusion:Age, ground glass ribbon sign and SUV max have good predictive effects on the occurrence of STAS in stage Ⅰ lung adenocarcinoma.

Objective: To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population. Method: This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded. Any side effect associated with NCPAP were recorded. For categorical variables, comparisons were performed using Fisher test. Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables. The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis. Result: Totally 145 children were included, and 13 children were excluded due to incomplete data. One hundred and two children(77.3%)were ≤12 months; 91 children (68.9%) were from rural area. NCPAP ventilation was effective in 123 children, with a response rate of 93.2%, were all discharged with a better condition; it was ineffective in 9 children(6.8%), and they were all intubated and went on mechanical ventilation, 5 were discharged with a better condition, and 4 died after gaving up treatment. The gender, age, body weight, residence, main symptoms, main signs, imaging diagnosis, medications, partial pressure of oxygen(PaO₂), breath and heart rate before NCPAP treatment of two groups had no significant differences(allP>0.05). The rates of combining underlying diseases, trouble with feeding and cyanosis, and the partial pressure of carbon dioxide(PaCO₂ ) before NCPAP ventilation were higher in NCPAP ineffective group ((59±11 )vs.( 49±11) mmHg, 1 mmHg=0.133 kPa, t=-2.597, P=0.028); while the PaO₂/fraction of inspiration O₂ (FiO₂ ) before NCPAP was lower((150±37) vs. (207±63) mmHg, t=2.697, P=0.008). The breathing, heart rate and PaCO₂ of NCPAP effective group decreased significantly, while the PaO₂ and PaO₂/FiO₂ increased significantly after 2, 8, 24 h of NCPAP ventilation(all P=0.000). PaCO₂ in children with hypercapnia before NCPAP ventilation in NCPAP effective group decreased significantly ((48±9), (47±12), (45±11)vs.(58±7)mmHg, all P=0.000). All children tolerated well to NCPAP ventilation, and there were no severe side effects or complications associated with NCPAP ventilation. Conclusion NCPAP ventilation is safe and effectively improved the oxygenation and hypercapnia in infants with CAP. But it may not work well in children with underlying diseases, manifest as difficulty in feeding/cyanosis and extremely high PaCO₂ or low PaO₂/FiO₂, and they may need early intubation.

Objective:To investigate the value of proteinuria in evaluating the severity of pre-eclampsia (PE) and assessing the maternal and neonatal outcomes of PE.Methods:The clinical records of 265 pregnant women who were diagnosed with PE at Peking Union Medical College Hospital from January 2011 to June 2021 were retrospectively analyzed. According to 24-hour urine protein (24-hUPro) results, pregnant women were divided into two groups: the non-proteinuric group (24-hUPro<0.3 g, n=10) and proteinuric group (24-hUPro≥0.3 g, n=255). The proteinuric group was further divided into 3 subgroups based on proteinuria levels: mild group (0.3 g≤24-hUPro<2.0 g, n=119), moderate group (2.0 g≤24-hUPro<5.0 g, n=59), and severe group (24-hUPro≥5.0 g, n=77). The demographic and clinical data, laboratory indicators, pregnancy complications, maternal and neonatal outcomes were compared between different groups. Results:In proteinuric subgroups, increased proteinuria was associated with earlier onset gestations, higher incidence of headache, peripheral tissue edema, serosal effusion, intrauterine growth restriction, and abnormal umbilical cord blood flow (all P<0.05). There were no significant differences in the incidence of placental abruption, eclampsia and maternal mortality among the three subgroups, but there were significant differences in the incidence of neonatal birth weight and multiple neonatal complications (all P<0.05). Compared with the proteinuric group, the non-proteinuric group showed later onset gestation (median:34.7 vs 37.6 weeks) and gestational age of delivery (median:36.0 vs 38.4 weeks), lower proportion of ocular vascular lesions [56.7% (135/238) vs 2/9], higher birth weight (median: 2 325 vs 2 750 g), and lower rate of neonatal intensive care unit occupancy [54.3%(127/234) vs 1/10;all P<0.05]. Conclusions:The proteinuria plays an important role in assessing the severity of PE and maternal and neonatal outcomes, but it is not the only indicator. The non-proteinuric PE pregnant women might still lead to severe maternal and neonatal outcomes.