Objective To compare the eficacy and safety of flexible laryngeal mask (FLMA) and endotracheal tube (ETT) in children undergoing adenoidectomy and tonsillectomy. Methods Forty children with snoring disease scheduled for selective adenoidectomy and tonsillectomy surgery under intravenous compound inhalation general an-esthesia were divided randomly into either FLMA group or ETT group. MAP,HR and SpO2 were recorded before an-esthesia induction(T0 ), 1 (T1 ),3 (T2 ),5 (T3 ) min after intubation,1(T4 ),3 (T5 ) min after extubation. Param-eters for respiratory mechanics included peak airway pressure (Ppeak ), mean airway pressure (Pmean ), end tidal CO2 (PetCO2 ),and airway sealing pressure. All of the above indicators were recorded 5 min (T6 ) after intubation, 10 (T7 ),20 (T8 ) min after put in mouth gag,5 (T9 ) min after removing mouth gag. Meanwhile,chievement ratio of first time insertion,incidence of regurgitation aspiration,bucking,laryngospasm,wheezing when extubation and af-ter extubation,anesthesia time,surgery time,extubation time were recorded. Complications such as nausea and vomi-ting,pharyngeal pain,hoarseness were followed up 24 hours after surgery. Results MAP, HR during T1 , T2 , T3 , T4 ,T5 were significantly higher in group T than T0 , and those in group FLMA (P<0.05). MAP, HR were not sig-nificantly changed in group FLMA during each time. Ppeak , Pmean was significantly lower in group FLMA than that in group ETT. The extubation time was shorter and the incidence of coughing and pharyngalgia after operation was low-er in group FLMA than that in group ETT. Conclusion Compared with endotracheal intubation, on the basis of not affecting surgical operation, FLMA is an effective, safe anesthesia for adenoidectomy and tonsillectomy surgery in children, with the advantages of hemodynamic stability, mild airway trauma,and is a easy handling method, with minor laryngeal stimulation during intubation and extubation, more stable hemodynamics, reliable respiratory me-chanics and low incidence of postoperative upper airway complications.

Humans ; Lymphoma ; diagnosis ; therapy ; Molecular Targeted Therapy

Objective To explore the possible role of neuropilin-1 (NRP-1) and extracellular regulated protein kinases (ERK) in the mechanisms underlying the promotive effect of vascular endothelial growth factor (VEGF) on the proliferation of HaCaT cells.Methods HaCaT cells were cultured in vitro and transfected with a NRP-1 expression plasmid EX-O0008-M02.Reverse transcription (RT)-PCR and Western blot were performed to detect the mRNA and protein expression of NRP-1 in HaCaT cells respectively before and after the transfection.Some HaCaT cells were divided into three groups to be transfected with liposome (liposome control group),control plasmid pReceiver-M02 (plasmid control group),and objective plasmid EX-O0008-M02 (objective plasmid group),respectively,and each of the three groups was classified into several subgroups to be treated with phosphate buffer solution (PBS),U0126 (MEK1/2 inhibitor) and VEGF alone or in combination.After additional culture,methyl thiazolyl tetrazolium (MTT) assay was performed to determine the proliferative activity of HaCaT cells,Western blot to quantify the expression of total and phosphorylated ERK1/2 as well as proliferating cell nuclear antigen (PCNA) protein in HaCaT cells.Intergroup differences were assessed by one-way analysis of variance (ANOVA),and multiple comparisons and correction were done by using the least significant difference (LSD) test.Results RT-PCR and Western blot analysis confirmed that the transfection with NRP-1 effectively promoted the mRNA and protein expression of NRP-1 in HaCaT cells.A significant increase was observed in cellular proliferative activity (absorbence value at 570 nm) in the objective plasmid group compared with the liposome control group and plasmid control group (0.88 ± 0.14 vs.0.63 ± 0.07 and 0.62 ± 0.13,F =8.755,P ＜ 0.05),also in the VEGF-stimulated objective plasmid group compared with the VEGF-stimulated plasmid control group (1.14 ± 0.18 vs.0.88 ± 0.10,F =4.591,P ＜ 0.05).The U0126 pretreatment markedly suppressed the VEGF-induced proliferation of A375 cells in the objective plasmid group (0.50 ± 0.13 vs.1.14 ± 0.18,F =42.106,P ＜ 0.01).As Western blot analysis suggested,the objective plasmid significantly enhanced the VEGF-induced increase in ERK1/2 phosphorylation degree and PCNA expression intensity in HaCaT cells compared with the control plasmid,but the enhancing effect of objective plasmid was effectively inhibited by U0126.Conclusion The activation of ERK1/2 signaling pathway may play a key role in the NRP-1 protein-mediated promotive effect of VEGF on the proliferation of HaCaT cells.

This study is to evaluate the application of the comprehensive capacity assessment system based on post competence in competitive recruitment of family doctors. Thirty five general practitioners participating in the family doctor post competition in 2019—2020 were graded and ranked by both the post competition method and the comprehensive capacity assessment system of family doctors. The top 32 candidates in terms of total scores were selected as the successful candidates for the family doctor job competition. Kappa test was used to assess the consistency of competition results between the two methods. Among 32 candidates who were qualified according to the 2019—2020 family doctors post competition method, 31 (96.9%) were also qualified for the family doctor′s comprehensive capacity assessment system ( Kappa=0.635, P<0.01). The results indicate that the comprehensive capacity assessment system for family doctors based on post competency is rational and objective, and can be used for competitive recruitment of family doctors in community health service center.

Objective:To report pediatric endoscopic retrograde cholangiopancreatography (ERCP) intubation techniques and to analyze the influencing factors of pediatric ERCP in China.Methods:Retrospective analysis was performed on 90 cases of pediatric and adult ERCP operations respectively at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to June 2020. The anatomic data, intubation time, and endoscopic intubation measures were reviewed. The anatomic differences in duodenal papilla between the children and adults were analyzed to find the factors affecting ERCP intubation time in children.Results:There were 88 cases of successful infantile intubation with the success rate of 97.8%, and 90 cases of successful adult intubation with the success rate of 100.0%. The intubation time in the pediatric group was 187±67 s, and that in the adult group was 247±86 s with significant difference ( t=5.220, P<0.001). The duodenal diameter of pediatric patients was 3.38±1.57 cm, and that of adult patients was 5.94±1.87 cm with significant difference ( t=9.832, P<0.001). The horizontal distance from the duodenal bulb to the papilla in pediatric patients was 2.44±1.15 cm, which was significantly shorter than 4.22±1.43 cm in adult patients ( t=9.077, P<0.001). Most duodenal papillae in children were hemispherical [flat 26.1% (23/88), hemispherical 51.1% (45/88), cylindrical 22.7% (20/88)], while most of those in the adult patients were cylindrical [flat 9.1% (8/88), hemispherical 23.9% (21/88), cylindrical 67.0% (59/88)]. The factors influencing the intubation time of ERCP in children by univariate analysis included the shape of duodenal papilla, duodenal papilla hardness, visual region, distance from junction of duodenal bulb and descending part to duodenal papilla, distance from duodenal papilla to endoscope, and degree of incising. Conclusion:Shorter and stiffer duodenal papillae in children with normal papilla orientation are associated with shorter intubation time. These indicators are favorable factors for intubation.

Objective To compare the parameters of bilateral tubal ligation by LESS and multi-incision laparoscopy and their prognosis of IVF-ET. Methods From Jun. 2016 to Dec. 2017,32 patients underwent LESS bilateral tubal ligation and 60 patients under-went multi-incision laparoscopic bilateral tubal ligation were enrolled. The demographic data ,operative parameters ,and postoperative prognosis of IVF- ET in the two groups were summarized and compared. Results The mean operating time in LESS group was prolonged and its operative hospital stay was significantly decreased compared to multi-incision laparoscopic group. No significant difference was observed in the intraoperative blood loss in two groups. Moreover,no significant differences were found in the AFC,AMH,Gn stimulation days,total Gn dosage,Ovum number,good quality embryo rate,embryo implantion rate,clinical pregnancy rate and early spontaneous abortion rate in two groups. Conclusions For experienced laparoscopic surgeons,LESS is a safe and feasible procedure with similar perioperative outcomes to multi-incision laparoscopic surgery.

Objective To evaluate the diagnostic value of T cells spot test of tuberculosis infection (T-SPOT .TB) on blood and cerebrospinal fluid for tuberculous meningitis (TBM ).Methods One hundred and fifteen adult patients with suspected tuberculous meningitis were retrospectively enrolled from March 2013 to March 2017 in Huashan Hospital affiliated to Fudan University .Among them ,30 were diagnosed with TBM (7 definite ,19 highly probable and 4 possible) ,37 with other infectious meningitis and 29 with non-infectious meningitis .The diagnostic sensitivity ,specificity ,positive predictive values (PPV) and negative predictive values (NPV) of T-SPOT .TB on peripheral mononuclear cells (PBMC) and cerebrospinal fluid mononuclear cells (CSF-MC ) were analyzed using Fisher exact test , and the diagnostic performance was evaluated by using receiver operating characteristic (ROC ) curve and area under the curve (AUC).Results When including the 30 TBM cases and 66 non-TBM cases into analysis , the sensitivities and specificities , PPV and NPV of PBMC and CSF-MC for diagnosing TBM were as follows :93 .1% and 66 .7%,77% and 87 .7%,65 .9% and 71 .4%,95 .9% and 85 .1%,respectively . When including the 30 TBM and 37 other infectious meningitis into analysis , the sensitivities and specificities ,PPV and NPV of the PBMC and CSF-MC for diagnosing TBM were as follows :93 .1% and 66.7%,68 .6% and 86 .5%,71.1% and 80 .0%,92 .3% and 76 .2%,respectively .By ROC curve analysis ,the AUC of blood and CSF were 0 .882 (95% CI :0 .795－0 .969) and 0 .814 (95% CI :0 .704－0 .925) ,respectively .Using a cut-off value of 32 spot forming cells (SFC) per million CSF-MC for T-SPOT .TB on CSF-MC showed a sensitivity of 66 .7%,a specificity of 91 .9%,PPV of 87 .0% and NPV of 77 .3% .The positive likelihood ratio and negative likelihood ratio were 8 .22 and 0 .363 respectively . Conclusions T-SPOT .TB on CSF-MC has a role in diagnosing TBM .And 32 SFC per million CSF-MC might be the optimal cut-off value to differentiate TBM and non-TBM .

Objective To analyze the expressions of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) in the peripheral blood of patients with active tuberculosis (ATB ) or latent tuberculosis infection (LTBI) ,and to evaluate its diagnostic value in differentiation of ATB and LTBI .Methods Forty-eight patients including 18 ATB cases and 30 LTBI cases were continuously enrolled from Wuxi No . 5 People′s Hospital and Huashan Hospital affiliated to Fudan University from January 2011 to March 2013 .Flow cytometry was applied to detect the CTLA-4 expression in CD4+CD25+ FoxP3+ T cells in the peripheral blood of the 48 subjects .CTLA-4 levels were compared using non-parametric Mann-Whitney U test .Results The median percentage of CTLA-4+ Treg in CD4+ CD25+ Foxp3+ Treg cells of ATB patients was 18 .95％ (quantile range :13 .86％ ,27 .73％ ) ,and that in LTBI patients was 6 .67％(quantile range :5 .74％ ,9 .59％ ) ,which was statistically significant (U=18 .0 , P< 0 .01) .Receiver operating curve (ROC) based on the CTLA-4 expression indicated that the area under the curve was 0 .96 , with the optimum cut-off value of 13 .25％ .Thus ,the sensitivity and specificity for the diagnosis of ATB were 86 .7％ and 94 .4％ ,respectively .Conclusion CTLA-4 has highly sensitivity and specificity for the differential diagnosis of ATB and LTBI whose interferon-gamma releasing assays are all positive ,which may also provide meaningful clue for the study of pathogenesis of ATB .

Objective: To evaluate the efficacy and safety of high-dose fluconazole alone or combined with flucytosine as initial therapy for cryptococcal meningitis (CM) in non-human immunodeficiency virus (HIV)-related patients. Methods: Twenty-five non-HIV-infected patients with CM from June 2015 to September 2018 in Huashan Hospital, Fudan University, who were initially treated with high-dose fluconazole with or without flucytosine for at least seven days were retrospectively reviewed.Clinical features and antifungal (600-800 mg/d) regimens were recorded, clinical responses and drug-related adverse events were evaluated. Mann-Whitney test and Fisher′s exact probabilities test were applied to compare variables between groups. Results: Of the 25 patients enrolled in this study, 15 had predisposing factors. Headache (25 cases), fever (21 cases), vomiting (13 cases) and neck stiffness (13 cases) were common manifestations. Abnormalities of cranial computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were found in 22 cases.Nineteen patients were treated with high-dose fluconazole plus flucytosine for initial therapy, and six patients were treated with high-dose fluconazole alone. The course of initial regimens with high-dose fluconazole was 42 (29, 120) days. At the end of initial therapy, partial response in 20 patients, stable response in three patients and death in two patients were observed, and the overall effective rate was 80%(20/25). In treatment failure group of initial treatment, the proportion of patients with baseline cerebrospinal fluid opening pressure over 300 mmH₂O (1 mmH₂O=0.009 8 kPa) and with altered mental status were both significantly higher compared with those in treatment success group. Fluconazole related adverse drug events were observed including elevated transaminases (one case), gastrointestinal symptoms combined with hypokalemia (two cases), and systemic rash (three cases). Except for three patients with rash reduced the dosage of fluconazole, no other patients were given dosage adjustment. Conclusion High-dose fluconazole alone or combined with flucytosine is effective and safe for the initial therapy of non-HIV-related CM patients.

Objective:To analyze the career development path and related problems of general practitioners (GPs)in the community.Methods:In October 2019, general practitioners with different positions working in Malu Town Community Health Service Center of Shanghai Jiading district were selected by typical sampling to participate in a focus group interview. Based on the saturation principle, 5 general practitioners were invited for in-depth interviews on their career development and related issues. The original data were analyzed with Colaizzi′s seven-step analysis method.Results:The career development of the general practitioners working in the community was divided into three stages: start stage, experience-accumulation stage and career-differentiation stage. In the start stage (the first 0-24 months), the GPs mainly got familiar with the community health service center through community rotation. In the experience-accumulation stage (1-5 years after entering the community health service center), GPs accumulated clinical experience from outpatient clinic, ward, and being family doctor, etc; at the same time, they accumulated management experience through part-time public health management, research and education management, secondment in district health committee. In the professional differentiation stage (5 years or more after entering the community health service center), GPs may take a position of full-time management, or department head. The three respondents had confusion in certain career development stages, including confusion in clinical skills upgrading and balance between clinical and management duties.Conclusions:The study suggests that general practitioners in the entry stage need to be given timely clinical rotation as well as research and teaching training; in the career differentiation stage, it is necessary to incorporate upgrading clinical service and management capability with policy development directions and institutional development needs to promote the successful career differentiation of general practitioners.