Objective To evaluate the value of ultrasonographic measurement of the antral crosssectional area (CSA) in assessing the preoperative gastric content volume in preschool pediatric patients.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients of both sexes,aged ＜7 yr,undergoing elective non-gastrointestinal surgery,were fasted according to the preoperative fasting guidelines recommended by American Society of Anesthesiologists.Sedation was performed with intravenously injected midazolam or with intravenously injected midazolam and propofol after admission to the operating room.The antral CSA in the supine and right lateral decubitus positions was measured using bedside ultrasonography and free tracing method.A gastric tube was inserted after gastric sonography to collect the gastric fluid,and the total volume of the gastric fluid was considered to be the gastric content volume.Results Six pediatric patients were excluded due to the unsatisfactory ultrasound image,and 44 pediatric patients were included.Gastric content volume and gastric content volume per kilogram of body weight were positively correlated with the antral CSA in the right lateral decubitus position,and the Spearman correlation coefficients were 0.48 (P＜0.01) and 0.37 (P＜0.05),respectively.There was no correlation between gastric content volume and gastric content volume per kilogram of body weight and the antral CSA in the supine position (P＞0.05).Conclusion Ultrasonographic measurement of the antral CSA in the right lateral decubitus position can be used to assess the preoperative gastric content volume in preschool pediatric patients.

OBJECTIVE To observe and compare the cytotoxicity induced by andrographolide (AD)and its water soluble derivatives:andrographolide sodium bisulfite(ASB),active pharmaceutical ingredients of Chuanhuning and Yanhuning on human renal tubular epithelial cells (HK-2),and to explore the ASB-induced endoplasmic reticulum stress(ERS)mechanism. METHODS HK-2 cells were treated with the above four drugs respectively. The survival rate was examined by methyl thiazolyltetrazolium (MTT) assay and 50% inhibitory concentration (IC50) was calculated. In ASB treated group, Hoechst33342 staining and flow cytometry analysis were used to determine cell apoptosis, intracellular superoxide dismutase(SOD)activity and malondialdehyde(MDA)content were examined, and the protein expressions of binding immunoglobulin protein (Bip),C/EBP-homologous protein (CHOP)and cysteine-containing aspartate-specific protease 4(caspase 4)were detected by Western blotting. RESULTS The four drugs inhibited HK-2 cell growth in a time-dependent and concentration-dependent manner. At 24 h,the IC50 of AD (30.6 μmol · L- 1) was lower than that of others. Active pharmaceutical ingredients of Chuanhuning and Yanhuning (16.2 and 15.6 mmol · L- 1) were very close,ASB was 29.4 mmol · L-1. ASB(0,15,30 and 60 mmol · L-1)increased the apoptotic rate and caused the decrease in SOD activity and the increase in MDA content in a dose-dependent manner. Compared with control group,the protein expression of CHOP increased (P<0.01) at 8 h with ASB (30 and 60 mmol · L-1)treatment,Bip and caspase 4 had no significant change. In addition,at 24 h, ASB(60 mmol·L-1) decreased the expression of Bip(P<0.05),ASB(30 and 60 mmol·L-1)promoted the expression of CHOP(P<0.01),and the protein expression of activated caspase 4 increased in a concentration-dependent manner(P<0.01). CONCLUSION AD and its water soluble derivatives have a toxic effect on HK-2 cells. CHOP and caspase 4 pathway related to ERS is involved in ASB-induced apoptosis.

Objective To evaluate the accuracy of ultrasonographic measurement of the subglottic airway diameter in selecting the cuffed endotracheal tube (ETT) size for the pediatric patients with congenital heart disease.Methods Sixty pediatric patients of both sexes with congenital heart disease,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,aged 1 month-7 yr,undergoing elective open heart surgery,were included in this study.The subglottic airway diameter was measured by bedside ultrasonography after induction of anesthesia.The outer diameter of the cuffed ETT was determined according to the subglottic airway diameter.The air leak test was performed after intubation to determine whether or not the ETT size selected based on ultrasonography was appropriate.When the difference between the inner diameter of the finally selected ETT and the result calculated by the Motoyama formula was less than 0.2 mm,the ETT size selected based on the Motoyama formula was considered appropriate.The agreement and correlation between the subglottic airway diameter measured by age-based formula and ultrasonography and the outer diameter of the actually selected ETT were analyzed using Bland-Altman plot and Passing-Bablok regression analysis.Results The accurate rate of the ETT selected based on the ultrasonic measurement and Motoyama formula were 80％ and 55％,respectively,and there was significant difference (P＜0.05).Conclusion Ultrasonographic measurement of the subglottic airway diameter produces higher accuracy than the classical Motoyama formula in selecting the cuffed ETT size for the pediatric patients with congenital heart disease.

Objective To investigate the effects of intravitreous injection of conbercept for macular edema secondary to retinalvein occlusion(RVO) during 6 months period.Methods A retrospective clinical study.34 patients (34 eyes) were included in this study,who were diagnosed with macular edema due to retinal vein occlusion by ophthalmologic examination,fundus photography,optical coherence tomography (OCT),fundus fluorescein angiography and other methods.The best corrected visual acuity (BCVA) was examined using the international standard visual acuity chart,and the results were converted to the logMAR visual acuity.The average logMAR BCVA was 0.90 ± 0.68,and the mean macular central retinal thickness (CMT) was (672.27±227.51) μm before treatment.All subjects received intravitreal injection of 0.5 mg conbercept (0.05 ml) at the first visit.Injections were repeated based on the visual acuity changes and the OCT findings.34 eyes received 69 times of injection,the average number of injections was 2.03 ± 1.03.BCVA,OCT were examined before and after treatment using the same method.BCVA and CMT changes,drugs and treatments associated cardiac and cerebral vascular accident,intraocular pressure elevation,retinal tears,retinal detachment,endophthalmitis and other complications after treatment were observed.Linear correlation analysis was used to analyze the correlation between prognosis BCVA and baseline BCVA,correlation between prognosis BCVA and baseline CMT,and also correlation between BCVA and CMT at different time points before and after treatment.Results At 1 week and 1,2,3,6 months after treatment,the average logMAR BCVA was 0.65±0.61,0.56±0.61,0.46±0.55,0.56±0.71,0.44±0.48 respectively.During 1,2,3,6 months after treatment,the mean logMAR BCVA were improved with statistically significant difference (Z=34.029,47.294,41.338,43.603;P＜0.05),while 1 week after treatment showed no obvious improvement (Z=21.941,P＞0.05).At 1 week and 1,2,3,6 months after treatment,the average CMT was (285.89 ± 96.69),(256.65 ± 143.39),(278.68 ± 156.92),(290.11 ± 188.17),(217.15 ± 48.04) μm respectively.At 1 week and 1,2,3,6 months after treatment,the mean CMT were all decreased with statistically significant difference (Z=68.500,98.735,93.235,91.132,109.162;P＜0.05).There was a positive correlation between the prognosis visual acuity and preoperative visual acuity (r=0.682,P＜0.05).However,there was no correlation between the prognosis vision and the degree of macular edema before treatment (r=0.078,P＞0.05).Before and 3,6 months after treatment,BCVA was negatively correlated with CMT (r=0.491,0.416,0.386;P＜0.05),while there was no correlation in other time points (r =0.145,0.217,0.177;P＞ 0.05).Systemic adverse reactions and persistent intraocular pressure elevation,iatrogenic cataract,retinal detachment,retinal tear,endophthalmitis and ocular complications were never found in the follow-up period.Conclusion Intravitreal conbercept is a safe and effective approach for RVO,which can significantly improve visual acuity and reduce CMT.

Objective To evaluate the efficacy of mitomycin (MMC) intravesical chemotherapy for superficial bladder carcinoma by in vitro chemosensitivity using histoculture drug response assay (HDRA).Methods Forty-one cases of superficial bladder transitional cell carcinoma(TCC) were obtained,including 30 males and 11 females with mean age of 55 years.Of them,10 cases were Ta and 31 were T1 according to TNM stage system (UICC 2002) while 9 cases were G1,22 were G2 and 10 were G3 (WHO1973).All cases had no chemotherapy history before operation and were operated to retain bladder.Tumor specimens were cultured by three-dimensional histoculture.HDRA with im-proved MTT assay was utilized for chemosenstivity test of MMC with 1 g/L concentration and 2 hours exposure.Growth inhibition rate (GI) exceeding 70% was defined as high-sensitive while less than 50% GI was defined as insensitive,others were moderate-sensitive.All cases were performed standard intravesical chemotherapy with MMC 40 mg plus 40 mt saline.Every case was followed up every 3 months.The patients were followed up for 5 years or untill recurrence.Results The MMC chem-osensitivity was different among 41 patients.Thirteen cases were insensitive including 1 of Ta,12 of T1 (P=0.009) and 1 of G1,7 of G2,5 of G3(P=0.101).Total recurrence rate was 39%(16/41) af-ter 3 to 5 years follow-up.There were 1 of Ta,15 of T1 (P=0.059) and 10 of G2 6 of G3 (P=0.016).Insensitive group recurrence rate was 77% (10/13) while sensitive group was 21% (6/28,P= 0.004).Patients in sensitive group showed a longer median time(49.2 months) than patients in insen-sitive group (16.5 months,P<0.001) according to Kaplan-Meier analysis with Log-rank test.The MMC chemosensitivity was independent prognostic factor examed by Cox regression analysis (P= 0.008).There was a 78% correlation rate of chemosensitivity by HDRA to clinical effect of MMC in-travesical chemotherapy.Conclusion HDRA could evaluate MMC intravesical chemotherapy for su-perficial bladder TCC,improve therapeutic effect and lower tumor recurrence rate.

Objective:To standardize the naming of organ at risk (OAR) and target area during cervical cancer radiotherapy based on AAPM TG-263.Methods:After self-programming of Matlab software to implement the reading and resolution of radiotherapy structure files, the naming of each substructure was automatically output, recorded and restored. After naming all substructures, the structure names were classified by keywords. According to TG-263, a standard naming conversion table of OAR and target area was developed, and the classified structure names were standardized through procedures. Finally, the standardized named radiotherapy structure files were output and imported into the treatment planning system (TPS).Results:The radiation structure of 144 patients with cervical cancer was successfully transformed and displayed correctly in TPS. Before the transformation, the naming of OAR and target area lacked of uniform norms and standards, and the naming of the same structure significantly differed. After the transformation, 43 naming methods of OAR and 74 naming methods of the target area were unified into 20 and 8 naming methods, which were more convenient for staff understanding and communication.Conclusion:The standardization of cervical cancer radiotherapy structure naming can reduce the inconsistency of naming and provide reference for the standardized naming of pelvic tumors.

Objectives To explore the expression of the receptor for advanced glycation end products (RAGE) in pancreas and the serum concentration of RAGE in rats with acute necrotizing pancreatitis (ANP).Methods Sixty four male Spraque-Dawley rats were randomly divided into control group,ANP 6,18,24,36,48,72,96 h group with 8 rats in each group.The rat model of ANP was established by injecting 20％ L-arginine intraperitoneally at the dose of 250mg/100g body weight for twice at the interval of 1 h.Rats in control group were injected intraperitoneally with the same amount of saline.The pancreas samples were histologically examined by light microscope and scored.The amount of ascites,levels of serum amylase and RAGE was determined; Real-time PCR was performed to detect the expression of RAGE mRNA in pancreatic tissue.Results Pancreatic injuries aggravated with time.The amount of ascites increased from ( 1.98 ± 0.64) ml at 6h to (8.69 ±0.62)ml at 96 h.Serum amylase level began to increase at 6h after L-arginine intraperitoneal injection and reached the peak value at 18 h[(5069.88 ± 603.25 ) U/L],and returned to normal at 36 h.The serum concentration of RAGE and RAGE mRNA expression in pancreatic tissue were ( 18.33 ± 2.99) ng/ml and 0.41 ±0.13 in the control group.The corresponding values increased at 6 h in ANP group,which were (30.31 ±5.03) ng/ml and 1.57 ±0.19,and they were significantly higher than those in the control group (P ＜0.05) ; they reached the peak value at 24 h[( 105.41 ±21.31 ) ng/ml and 4.23 ±0.73],which were significantly higher than those in other ANP groups ( P ＜ 0.05 ) ; at 96 h they decreased to the lowest point [( 33.54 ± 6.96) ng/ml and 1.19 ± 0.19],which were still significantly higher than those in the control group (P ＜ 0.05 ).Conclusions The expression levels of RAGE in pancreatic tissues and serum level of RAGE increase within 36 h of ANP onset,then decrease gradually,but they are always higher than normal values.

Objective To study the application of pediculated skin flaps in the treatment of com-plicated long urethratresia. Methods From March 1999 to May 2006, a total of 18 male patients with complicated long urethratresia were treated by using the pediculated skin flaps. The causes of urethratresia were 7 cases of postoperative pelvic fractures with posterior urethral stricture, 4 cases of transurethral intravesical chemotherapy, 3 cases of postoperative bulbar urethral stricture, 2 cases of gonorrhea, and 2 cases of long-time urethral catheter placement. Four cases were urethratresia nf cor-pus penis, 7 cases were anterior urethral obliteration, 7 cases were posterior urethral and anterior ure-thral obliteration. Urethro-perineal fistulas were found in 8 cases, posterior urethrorectal fistulas in 7 cases, false passage formations in 8 cases. The average length of urethratresia was 15.1 cm (range 8. 7 to 23. 0 cm). The urethral scar was rasected, the posterior urethrorectal fistula was repaired, and different kinds of pediculated skin flaps depending on the length of urethratreaia was used. Results All the patients were followed up for 12 to 18 months (mean 14 months). Fifteen patients voided well 3 months postoperatively, none of the urography showed stricture. The mean peak urinary flow rate was 16. 9 ml/s (range from 16. 5 to 21.7 ml/s). Of the other 3 cases, 1 case experienced difficult voi-ding due to the long and circuitous tabularized skin flap but recovered after proper shortening;1 case had restenosis for the infection of anastomosis but voided well after excision and reanastomnsis;1 casehad a urinary fistula resulting from hematoma and infection, but was successfully treated by the neo-plasty of the urinary fistula. The mean peak urinary flow rate was 17.0 ml/s (range 15.0 to 22.0 ml/s) for 17 patients 6 months postoperatively, except for one who experienced genuine urinary incon-tinence. At 9-18 months after operations, the mean peak urinary flow rate was 17.5 ml/s (range 15.8 to 22.5 ml/s) for 17 patients. Conclusion The single-stage urethroplasty based on pediculated skin flaps is a reliable and durable method for complicated long urethratresia.

Objective To analyse the clinical characterization of intraductal papillary mucinous neoplasm of pancreas (IPMNs) and to improve the understanding of IPMNs.Methods Three hundred and sixty-one patients with IPMN at Shanghai Changhai Hospital between 1993 and 2012 were retrospectively analyzed.Results Among 361 cases of IPMNs,241 were men and 120 were female,with a female to male ratio of 2.6∶1.Mean age of the patients was 62 years old (16 ～ 87 years old).The duct type included the main duct in 102 patients (28.3％),a branch duct in 109 (30.2％),and mixed ducts in 150 (41.6％).The most common symptom at presentation is pancreatitis,which occur in 167 patients (46.3％).The sensitivity for the detection of IPMN was 80.2％ by ERCP,76.9％ by MRCP,63.9％ by CT,and 50.5％ by EUS.One hundred and twenty-nine patients (35.7％) were operated and diagnosed with 87 (67.2％) IPMA,21 (16.4％) IPMB,10(8.2％) IPMC(CIS) and 10 (8.2％) had invasive carcinomas.The 5-year survival rates of IPMA,IPMB,IPMC,and invasive carcinomas were 100％,100％,66.5％,and 44.7％,respectively.Conclusions IPMNs were fregrently occured is 60 years old,half of patients had acute pancreatitis history and the frequtly attack,mixed type is most anatomy type,and the outcome after surgery is good.

The 17α-hydroxylase/17, 20-lyase deficiency (17-OHD) is a rare disease. The clinical characteristics and gene mutation of 2 late-diagnosed 17-OHD patients with testicular tumor admitted to our hospital from March 2018 to February 2019 were analyzed retrospectively. The two 17-OHD patients were female (46, XY). Laparoscopic abdominal exploration found undeveloped testicles in grey-yellow or grey-red in the groin and iliac fossa. The testicles were removed and showed malignancy in pathology study. Sequencing of the CYP17A1 gene identified c.1247G>A/c.1427T>C and c.985_987delTACinsAA/c.1306G>A complex heterozygous mutations. Taking together, the possibility of 17-OHD should be considered in patients with hypertension, hypokalemia, adrenal adenomatoid hyperplasia together with 46, XY gonadal dysplasia, so as to make early diagnosis and treatment, and avoid dysplastic testicular turning to malignancy.