Objective To evaluate the efficacy and safety of parent-controlled analgesia for postoperative pain management in pediatric patients. Methods Five hundred and seven ASA Ⅰ or Ⅱ pediatric patients aged 10 months to 8 yr, weighting 8.5-34.0 kg, undergoing lower limb operations performed under general anesthesia combined with caudal block were assigned into 2 age groups: group PCIA-P ( < 6 yr, n = 308) and group PCIA ( ≥6yr, n = 199). Anesthesia was induced with intravenous midazolam 1 mg/kg, ketamine 2 mg/kg and propofol 2 mg/kg. Laryngeal mask airway (LMA) was introduced or the patients were intubated. After induction, caudal block was performed with 0.25% bupivacaine 2.5 mg/kg with adrenaline 1:400 000. The patients received PCA with morphine after operation. The PCA pump was controlled by parent in group PCIA-P and by patient in group PCIA. The PCA regimen included a background infusion of morphine at a rate of 15μg~(-1)·kg~(-1)·h, a bolus of 15μg/kg and a 10 min lockout interval. The vital signs, pain score, sedation score, number of attempts, morphine dosage and side effects were recorded. Results The two groups were comparable with respect to the rate of satisfactory analgesia, level of sedation, number of attempts, morphine dosage and side effects. The rates of satisfactory analgesia were 72.7% and 80.2% in group PCIA-P vs 77.9% and 78.9% in group PCIA at 24 and 48 h after operation respectively ( P > 0.05) . Conclusion Parent-controlled analgesia could be used safely and effectively in children after orthopedic surgery.

Objective:To investigate the predictive value of acute gastrointestinal injury (AGI) score for the severity of acute pancreatitis (AP), infectious pancreatic necrosis and patients′ death.Methods:Clinical data of 719 patients with AP were collected from the AP database of the National Clinical Research Center for Digestive System Diseases from January 2016 to June 2018. According to the severity of the disease, they were divided into MAP group (506 cases), MSAP group (112 cases) and SAP group (101 cases). AGI, APACHEⅡ, MCTSI and BISAP scores were calcululated in the three groups. Receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated. The predictive value of the above four scoring systems for the hospitalization days, disease severity, infectious pancreatic necrosis and death was analyzed, respectively.Results:There were no cases of infectious pancreatic necrosis or death in the MAP group, but there were 9 cases of infectious pancreatic necrosis and 2 deaths in the MSAP group and 19 cases of infectious pancreatic necrosis and 8 deaths in the SAP group. There was a strong correlation between AGI score and AP patients′ hospitalization days ( r=0.619). AUC of AGI, APACHEⅡ, MCTSI and BISAP score in predicting the AP patients′ severity (MSAP+ SAP) was 0.967 (95% CI 0.951-0.982), 0.769(95% CI 0.720-0.899), 0.842(95% CI 0.809-0.875), 0.862 (95% CI0.832-0.893). AUC for forecasting infectious pancreatic necrosis was 0.803, 0.677, 0.692, 0.724, and the 95% CI was 0.724-0.882, 0.573-0.781, 0.582-0.636, 0.801-0.812. AUC for predicting death in patients with AP were 0.915, 0.597, 0.659, 0.812, and the 95% CI were 0.843-0.986, 0.444-0.751, 0.498-0.698 and 0.882-0.926. AGI score had the highest predictive value, followed by BISAP score, and the correlation between these two scores was the closest. The predictive value of AGI combined with BISAP score for infectious pancreatic necrosis and patient death (AUC were 0.837, 0.942, 95% CI were 0.770-0.903, 0.897-0.987) was better than that of AGI and BISAP score alone. Conclusions:AGI score combined with BISAP score is more effective in predicting the severity of AP, the occurrence of infectious pancreatic necrosis or patient death.

Objective To investigate the methylation patterns of secreted apoptosis-related protein 2 (SARP2) gene extron 1 in patients with pancreatic adenocarcinoma and its clinical value in diagnosis and prognosis. Methods The samples were collected from 23 patients with pancreatic carcinoma, 6 with chronic pancreatitis and 7 normal controls. The extracted DNA was treated with sodium bisulfite and analyzed by PCR for methylation patterns in the CpG islands of SARP2 gene. Results The incidence of methylation in CpG islands of SARP2 gene was significant higher in pancreatic carcinoma (37.9%) than that in paracaneerous (15.2%), pancreatic (15.2%) and normal (0%) tissues (P<0.05). The methylation in some CpG sites (region 1) had specificity to pancreatic cancer. The methylation of SARP2 gene was not associated with sex, age, tumor size, stage and metastasis. But the hypermethylation of CpG was related with the tumor size and differentiation. Conclusions The distribution of CpG hypermethylation in SARP2 gene extron 1 is not equilibrium. Some CpG hypermethylation has specificity to pancreatic carcinoma, and may be served as potential targets as well as prognosis indexes for pancreatic cancer.

Objective To investigate the diagnostic value of measurement of SARP2 methylation in peripheral blood for detection of pancreatic cancer in human. Methods Peripheral vein blood of 12 patients with primary pancreatic cancers, 10 patients with chronic pancreatitis and 6 health volunteers were collected. Serum free DNA were extracted from blood samples, and were modified with bisulfate, and SARP2 gene extron 1 were amplified through BSP and sequencing of the production. Results There were 12 patients (83 %) with pancreatic cancer and 10 patients (40%) with chronic pancreatitis had obvious methylation in SARP2 gene in peripheral blood. The rate of CpG methylation in SARP2 gene extron 1 of pancreatic cancer, chronic pancreatitis and health volunteers was 16. 8% , 10. 4% and 2. 2% respectively. There was statistically significant difference among the three groups (P<0.01 or P< 0.05). Conclusions Aberrant methylation of SARP2 gene could be detected in peripheral blood in patients with pancreatic cancer, the detection of SARP2 gene methylation may have potential clinical implication for diagnosis of pancreatic cancer.

Objective To assess the methylation patterns in CpG islands of SPARC genes and its relationship with clinicopathological parameters. Methods Bisulfite treatment of genomie DNA and sequencing analysis was used to study methylation patterns in the CpG islands of SPARC genes in fresh tissues from 6 cases of chronic pancreatitis, 6 normal pancreatic tissues, 17 pancreatic adenocarcinoma and the cancer adjacent tissues, as well as 6 normaI blood samples for normal control, and compared the results with clinicopathological parameters. Results WBC DNA showed no methylation of SPARC gene CpG islands. The methylation rates in CpG islands of SPARC genes in pancreatic adenocarcinoma, the cancer adjacent tissues, chronic pancreatitis and normal pancreatic groups (2, 3, 4, 5, 6, 7 CpG sites) were 61.6%, 47.1%, 37.5%, 24.7%, respectively. The methylation rates in CpG islands (1, 8, 9, 10, 11, 12 sites) were 52.0%, 28.7%, 16.7% and 0. The difference were statistically significant between the pancreatic adenocarcinoma and chronic pancreatitis as well as normal pancreas groups (P＜0.001), and the difference were not statistically significant between the pancreatic adenocarcinoma and the cancer adjacent tissues. CpG hypermethylation were not related to risk factors such as smoking, alcohol, history of CP, the tumor size, differentiation and TNM staging, lymph node metastasis. Conclusions CpG in SPARC gene extron 1 was hypermethylated in pancreatic cancer, and this may be an early event in the development of pancreatic cancer.

Objective To evaluate the influence of Helicobacter pylori (Hp) eradication on clinical manifestations, endoscopic features and pathological findings of chronic gastritis. Methods This was a multiple-center, prospective and randomized cohort study. Patients with non-atrophy chronic gastritis from January 2009 to December 2010 were randomized into 3 groups as Hp positive group with eradication, Hp positive group without eradication and Hp negative group. Clinical manifestations, endoscopic findings and pathologic changes of inflammation were compared before and after administration of gastric mucosal protective agent for 8 weeks. Results A total of 211 patients were recruited. Changes of symptom score, endoscopic erosion and mucosal inflammation were significantly different before and after treatment in 3 groups. The decrease in symptom scores of eradication group was ( 3.56 ± 1.37 ), which was significantly higher than that of non-eradication group (2. 80 ± 1.30, P ＜0. 01 ). The decrease of mucosal inflammation and inflammatory activity scores in eradicate group was 1.08 ± 1.34 and 1.42 ± 1.09, respectively, which were also significantly higher than those of the eradication group (0. 49 ± 1.47 and 0. 61 ± 1.34, P ＜0. 01 ). But the improvement of endoscopic erosion in 2 groups showed no significant difference. There were no significant differences in these variables between non-eradication group and Hp-negative group ( P ＞ 0. 05 ). Conclusion For chronic non-atrophic gastritis patients with positive Hp infection, combination of mucosal protective agents and Hp eradication can achieve better improvement in symptoms and gastric inflammation repair.

Objective:To explore the expression of miR-216a in patients with acute pancreatitis (AP) associated with acute lung injury (ALI) and its influence on endothelial cells permeability.Methods:40 AP patients admitted in Department of Gastroenterology of the First Affiliated Hospital of Navy Medical University from December 2015 to March 2016 were collected and were classified into AP with ALI (AP-ALI group, n=13) and AP without ALI (AP group, n=27) according to the presence or absence of ALI. 8 normal volunteers were enrolled in the control group. Blood samples were collected and the plasma samples were separated. Plasma RNA was extracted. miR-216a level in plasma was detected by RT-PCR. Plasma exosomes were extracted by exosome extraction kit and identified by the electron microscopy. Exosome RNA was extracted. miR-216a level in exosome was detected by RT-PCR. Plasma exosomes of AP-ALI patients were co-cultured with human umbilical vein endothelial cells (HUVEC, AP-ALI-HUVEC group) and anti-miR-216a transfected HUVECs (AP-ALI-anti-miR-216a HUVEC group) for 24 hours, respectively, and untreated HUVECs served as control group. Trans-endothelium electrical resistance (TEER) was measured by Millicell Ers-2 epithelial volt-ohmmeter to evaluate the cell permeability. Results:RT-PCR results showed that the expression level of plasma miR-216a in AP-ALI group (14.45±1.64) was significantly higher than that in AP group (11.08±1.6) and the control group (5.37±1.54) ( P<0.01). Under electron microscope, plasma exosomes were goblet like vacuoles, with the size of about 50-90 nm. The plasma exosomal miR-216a level in the AP-ALI group (14.03±1.58) was significantly higher than that in the AP group (10.86±1.31) and the control group (5.01±0.79), and the difference was statistically significant ( P<0.01). The resistance value of HUVEC in the control group was referred as 1, and the resistance ratio of HUVEC in AP-ALI-HUVEC group was 0.74±0.04, which was significantly lower than that of HUVEC in AP-ALI-anti-miR-216a HUVEC group (1.02±0.08), the difference was statistically significant ( P<0.01). Conclusions:miR-216a was highly expressed in plasma exosomes of AP patients with ALI. miR-216a can increase endothelial cell permeability, which may be associated with ALI during AP.

Objective:To investigate the normal range of fetal ventricles and posterior cranial fossa development in the second and third trimesters and their variations with gestational age using quantitative MRI analysis.Methods:This retrospective study enrolled 675 pregnant women who underwent prenatal MRI examination with an average gestational week of 29.0±8.5 in the Third Affiliated Hospital of Guangzhou Medical University from January 2016 to January 2020. MRI data of all the subjects were collected and analyzed, including left lateral ventricle trigonometric width (LLVTW) and right lateral ventricle trigonometric width (RLVTW), third ventricle width (TVW), fourth ventricle width (FVW), the anterior-posterior diameter of the fourth ventricle (APDFV), cavum septum pellucidum width (CSPW), cisterna magna width (CMW), etc. Spearman, Pearson correlation analysis, and t-test were used for the statistical analysis. Results:(1) Totally 675 fetuses were recruited, including 392 female and 283 male fetuses. No statistical difference of gestational weeks at MRI was found between male and female fetuses. (2)The mean value of TVW and CMW of the female fetuses were significantly higher than those of male fetuses [(0.60±0.05) vs (0.63±0.04) cm, t=－5.059; (0.57±0.14) vs (0.67±0.15) cm, t=－7.445; both P<0.001]. Spearman correlation analysis showed that TVW and CMW were negatively correlated with fetal gender ( r=－0.179 and－0.312, both P<0.001). (3)Pearson correlation analysis showed that LLVTW, RLVTW, TVW, FVW, APDFV, CSPW, and CMW were all positively correlated with gestational weeks ( r=0.310, 0.267, 0.205, 0.801, 0.829, 0.216 and 0.284, all P<0.001). FVW and APDFV were significantly linearly correlated with gestational weeks (r=0.801 and 0.829, both P<0.001). (4) There was no significant change in LLVTW and RLVTW in the second trimester, but a slight increase was found in the third trimester. TVW showed a scattered distribution in the second and third trimesters and increased slightly with the gestational week at 26 to 27 +6 gestational weeks. FVW and APDFV increased linearly while. CSPW increased slowly with gestational weeks in the second and third trimesters. CMW increased slightly with gestational weeks in the second and third trimesters but showed little change in the third trimester. Conclusions:The development of fetal ventricles and posterior cranial fossa in the second and third trimesters show a growth trend of varying degrees with the increase of gestational weeks. TVW and CMW are significantly negatively correlated with the fetal gender.

Objective To investigate the current status and characteristics of the immersion experience of medical students and related influencing factors. Methods The stratified random sampling method was used to conduct a survey using an immersion experience questionnaire among 732 medical students in a full-time university. Epidata 3.1 software was used for data double entry and management, and SPSS 19.0 statistical software was used for data processing and statistical analysis. The questionnaire internal consistency reliability test was used to assess the validity of the questionnaire and a logistic regression analysis was used to identify the influencing factors for the immersion experience of medical students. Results Learning immersion experience was at a moderate level among the medical students (3.13±0.64). Level of performance (OR=1.177, 95％CI=0.988-1.402), degree of satisfaction with learning (OR=1.674, 95％ CI=1.341-2.089), and professional interest (OR=2.153, 95％CI=1 . 776-2 . 610 ) were the positive influencing factors for learning immersion (P<0.05) and were positively correlated with learning immersion experience . Grade , source of origin , duty , learning stress , school satisfaction, and life satisfaction had no influence on learning immersion experience (P>0.05). Conclusion Learning immersion experience is at a moderate level among medical students. Improvement of medical students' performance, learning satisfaction,and professional interest helps to improve their immersion experience. Strengthening the attention to work immersion and enhancing learning immersion experience among medical students are beneficial to medical student education and cultivation of qualified medical talents.

Objective:To evaluate the efficacy and safety of omeprazole and sodium bicarbonate suspension in the treatment of peptic ulcer.Methods:This present study was a multicenter, randomized, double-blind, double-dummy, positive drug parallel controlled phase Ⅱ clinical trial. According to different indications, the trial was divided into gastric ulcer (GU) and duodenal ulcer (DU) studies. Patients were stratified-block randomly divided with a 1∶1 ratio into experimental group and control group. The patients in the experimental group were administrated with omeprazole and sodium bicarbonate suspension omeprazole (20 mg for DU or 40 mg for GU, and 1 680 mg sodium bicarbonate) once a day. The patients in the control group received omeprazole magnesium enteric-coated tablet20 mg for DU or 40 mg for GU once a day. The treatment period was 4 weeks for DU and 8 weeks for GU. The main efficacy indicator was ulcer healing rate under endoscopy. The time of pain disappearance and the total effective rate of clinical symptom relief were used as the secondary efficacy indicators, and the incidence of adverse reactions was used as the safety indicator. The data set included full analysis set (FAS), per-protocol set (PPS) and safety set (SS). Independent sample t test, Wilcoxon rank sum test, chi square test, Fisher exact test method and non-inferiority test were used for statistical analysis. Results:Two hundred and seventy two DU patients and 237 GU patients were included in the FAS, 247 DU patients and 201 GU patients were included in the PPS, and 272 DU patients and 235 GU patients were included in the SS. The results of FAS analysis showed that after 4 weeks treatment, the healing rate of DU under endoscopy in the experimental group was 91.91% (125/136) and that in the control group was 94.85% (129/136), and the difference was not statistically significant ( P>0.05). After 8 weeks treatment the healing rate of GU under endoscopy in the experimental group was 86.44% (102/118) and that in the control group was 87.39% (104/119), and the difference was not statistically significant ( P>0.05). The results of non-inferiority analysis showed the lower limit of 95% confidence interval of difference in effective rate between the two groups was over -10% (-8.84% for DU and -9.54% for GU), which indicated that the effective rate of experimental group was not inferior to that of the control group. The results of PPS analysis were consistent with the results of FAS. The results of FAS analysis showed the median time of abdominal pain disappearance of DU patients in the experimental group and the control group was both 6 d, and the difference was not statistically significant ( P>0.05). The median time of abdominal pain disappearance of GU patients in the experimental group and the control group was both 8 d, and the difference was not statistically significant ( P>0.05). After 4 weeks of treatment, the total effective rates of clinical symptom relief of DU of the trial group and the control group were 95.59% (130/136) and 97.79% (133/136), respectively, and the difference was not statistically significant ( P>0.05). After 8 weeks of treatment, the total effective rates of clinical symptom relief of GU of the experimental group and the control group were 95.76% (113/118) and 93.28% (111/119), respectively, and the difference was not statistically significant ( P>0.05). The results of SS analysis showed that the incidence of adverse reactions of DU patients in the trial group and the control group was 5.15% (7/136) and 2.21% (3/136), respectively, and the difference was not statistically significant ( P>0.05). The incidence of adverse reactions of GU patients in the experimental group and the control group was 12.71% (15/118) and 6.84% (8/117), respectively, and the difference was not statistically significant ( P>0.05). Conclusions:Omeprazole and sodium bicarbonate suspension is not inferior to omeprazole magnesium enteric-coated tablet in healing efficacy under endoscopy in peptic ulcer, and has a good safety.