Objective To compare the noxious stimulations induced by insertion of Proseai laryngeal mask airway(PLMA)and classic laryngeal mask airway(CLMA)in children.Methods Forty-seven ASA Ⅰ or Ⅱ children,aged 3-12 yr and undergoing surgery under general anesthesia,were randomly divided into 2 groups:PLMA group(group P,n =23)and CLMA group(group C,n =24).General anesthesia was induced with target-controlled infusion(TCI)of propofol.When the effect-site concentration of propofol was equal to the plasma concentration predetermined.PLMA or CLMA insertion was attempted.The target plasma concentration of propofol was predetermined according to Dixon's up-down method,with 0.2 μg/ml as a step size.The initial target plasma concentration of propofol was 6 μg/ml and 4.4 μg/ml for groups P and C,respectively.The preedetermined target plasma concentration of propofol and the satisfaction of insertion conditions for each child were recorded.Results The 50％ effective concentration(EC50)of propofol to achieve satisfied condition of PLMA and CLMA insertion were 5.87(95％ CI,5.62-6.11)and 4.53(95％ C1,4.38-4.69)μg/nl,respectively,and the difference was significant(P ＜ 0.01).Conclusion The noxious stimulation induced by insertion of PLMA in children aged 3-12 years is stronger than that of CLMA.

Objective To explore the diagnosis and treatment of gastrointestinal stromal tumors(GISTs).Methods Clinical and pathological data of the 32 GISTs cases treated over the recent 5 years in our hospital were reviewed retrospectively.Results Stomach was the most frequent site for GISTs.Abdominal pain was the most common symptom.Before operation,81.3%(26/32) of the cases were misdiagnosed.All of the cases underwent surgical resection.10 recurrent GIST patients received a second resection,and 8 patients(underwant) three or more resections.Follow-up was made from six months to 5 years,and 8 patients died.Conclusions The diagnosis of GISTs is difficult and mainly depends on histopathology and(immunohistochemistry).Surgical resection is the principal treatment of GISTs.Reoperation is effective for the treatment of recurrent cases.

Objective To investigate the correlation between atlE gene and biofilm formation of Staphylococcus epidermidis . Methods 64 strains of clinically isolated Staphylococcus epidermidis in our hospital from June 2015 to June 2016 were collected . The biofilm formation test was used to detect bacterial biofilm .PCR was use to amplify atlE gene .Then the correlation between the atlE gene with biofilm formation was analyzed .Results 24 strains of biofilm positive bacterium were detected ,the detection rate was 37 .5% ;31 strains of atlE gene was detected ,the detection rate was 48 .4% ;atlE gene was significantly correlated to biofilm formation(P＜0 .05) .Conclusion Staphylococcus epidermidis has the ability to form biofilm ;atlE gene has a relation with biofilm formation of Staphylococcus epidermidis .

Objective:To investigate the safety and feasibility of day-care percutaneous nephrolithotomy (day-PCNL).Methods:The records of 46 consecutive patients underwent PCNL procedures for renal calculus from October 2017 to June 2019 at our institution were analyzed retrospectively. Their mean age was (46.7±8.5) years. Of all the 46 patients, 31 were males and 15 were females. Average BMI was (22.7±2.1) kg/m 2, with 37 cases of ASA scoreⅠ and 9 cases of score Ⅱ. Among the 46 patients, there were 27 cases of pelvis stones and 19 cases of upper ureteral stones, and 27 cases on the left side and 19 cases on the right side, with the maximum stone diameter of(2.31±0.52)cm. Patients underwent a clear diagnosis and surgical planning in the outpatient clinic, and the relevant preoperative examination, anesthesia evaluation and operative appointment. were completed. Patients came to the hospital at 9 o'clock on the day of operation, and underwent operation immediately after preoperative preparation. Under the paravertebral anesthesia, the F5 ureteral catheter was placed under the cystoscope in the lithotomy position, then the patients were placed in the prone position for percutaneous tract dilation. The F18 tract was established under the ultrasound guidance. Lithotripsy was performed by using F9.8 ureteroscopy and holmium laser. After an overnight observation, the patients were discharged when reaching the criteria including normal voiding, movement recovery, no fever or pain, no severe hematuria, no dizziness or headache, no cough, no nausea or vomiting, and answer fluently. The operative duration, perioperative complications, postoperative pain score (VAS score), and stone free rate at the first month were recorded. Results:All patients underwent successfully operations. Three individuals required full admission (longer than 24 h) due to pyonephrosis or postoperative fever, and the other 43 were discharged within 24 hours. Only one F18 tract was established for all patients, and the average operation time was (32.2±14.8)min. No pain was reported during the operation. The hemoglobin drop was (12.6±14.7)g/L, and no severe hemorrhage or transfusion occurred. The VAS pain score was (28.7±10.2) within 4 hours after the operation and (36.2±11.5) on the next morning. Stone free rate at 1 month was 95.3%. During 3 months follow-up period, no serious complication such as ureteral stricture, urinary leakage, or septic shock occurred.Conclusion:The day-care PCNL is safe and effective in appropriately selected patients, including single renal stone or upper ureteral stone less than 3cm.

Objective:Efficacy and safety of robot-assisted laparoscopic adrenalectomy as a treatment for large adrenal tumors.Three-dimensional(3D) reconstruction can effectively assist in preoperative planning of robotic adrenalectomy and reduce potential complications.Methods:We retrospectively reviewed the relevant information of patients who had a preoperative 3D reconstruction and underwent RA for adrenal masses larger than 10 cm. Thirteen male patients and sixteen female patients were included. The median(range) age was 43(25, 57) years old and the median tumor diameter was 12.1(10.3, 16.2) cm. The patients underwent preoperative CT enhancement scanning, and three-dimensional images were reconstructed based on the examination data. Robot-assisted laparoscopic adrenalectomy was performed under general anesthesia in 29 cases in this cohort.Results:All surgeries were completed successfully without major complications such as massive bleeding, secondary surgery, or even patient death. The median operative time was 131 (80, 245) min, and the median intraoperative bleeding was 330 (50, 2 200 ml) ml. 9 patients received blood transfusions. There were 11 cases of pheochromocytoma (37.9%), 10 cases of adenocarcinoma (34.5%) as well as 2 cases of teratoma (6.9%) and 6 cases of cortical carcinoma (20.7%). The patients were followed up for a median of 30 months after surgery. Except for 3 cases lost to follow-up and 2 patients with cortical cancer who developed recurrence or metastasis after surgery and died at 16 and 23 months after surgery, respectively, the remaining 24 cases have survived to date.Conclusions:RA is a safe and effective treatment for huge adrenal tumors. The 3D reconstruction could help the preoperative planning of RA and reduce potential complications.

Objective:To study the expression level of programmed death ligand 1 (PD-L1) in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and its correlation with the clinical characteristics and prognosis.Methods:The clinical data of 75 patients with cHCC-CCA undergoing surgery in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2019, including 61 males and 14 females, with a median age of 55 years (36 to 77). Immunohistochemistry was conducted to determine the PD-L1 expression in tumor. The status of PD-L1 expression, clinicopathological data and prognosis of patients were analyzed.Results:In low-differentiated cHCC-CCA tissues, the proportion of PD-L1 expression (21.1%, 8/38) was higher than that in moderately to well-differentiated cHCC-CCA tissues (2.70%, 1/37, χ2=4.366, P=0.037). The median disease-free survival (DFS) and overall survival (OS)of PD-L1 positive patients were 12.3 and 15.1 months, respectively, lower than those of PD-L1 negative patients (14.4 and 23.3 months). The difference of DFS was statistically significant ( χ2=4.052, P=0.044). In multivariate analysis, major vascular invasion (DFS: HR=1.965, 95% CI: 1.119-3.450, P=0.019; OS: HR=1.781, 95% CI: 1.022-3.105, P=0.042) and lymph node metastasis (DFS: HR=2.451, 95% CI: 1.1033-5.814, P=0.042; OS: HR=2.652, 95% CI: 1.120-6.279, P=0.027) were identified as independent prognostic factors affecting DFS and OS. Conclusions:The proportion of PD-L1 positive is higher inthe low-differentiated cHCC-CCA tissue compared to that in moderately to well-differentiated cHCC-CCA. The major vascular invasion and lymph node metastasis are independent factors affecting the prognosis of patients with cHCC-CCA.

Ulcerative Colitis (UC) has been reported to be related to Porphyromonas gingivalis (P. gingivalis). Porphyromonas gingivalis peptidylarginine deiminase (PPAD), a virulence factor released by P. gingivalis, is known to induce inflammatory responses. To explore the pathological relationships between PPAD and UC, we used homologous recombination technology to construct a P. gingivalis strain in which the PPAD gene was deleted (Δppad) and a Δppad strain in which the PPAD gene was restored (comΔppad). C57BL/6 mice were orally gavaged with saline, P. gingivalis, Δppad, or comΔppad twice a week for the entire 40 days (days 0-40), and then, UC was induced by dextran sodium sulfate (DSS) solution for 10 days (days 31-40). P. gingivalis and comΔppad exacerbated DDS-induced colitis, which was determined by assessing the parameters of colon length, disease activity index, and histological activity index, but Δppad failed to exacerbate DDS-induced colitis. Flow cytometry and ELISA revealed that compared with Δppad, P. gingivalis, and comΔppad increased T helper 17 (Th17) cell numbers and interleukin (IL)-17 production but decreased regulatory T cells (Tregs) numbers and IL-10 production in the spleens of mice with UC. We also cocultured P. gingivalis, Δppad, or comΔppad with T lymphocytes in vitro and found that P. gingivalis and comΔppad significantly increased Th17 cell numbers and decreased Treg cell numbers. Immunofluorescence staining of colon tissue paraffin sections also confirmed these results. The results suggested that P. gingivalis exacerbated the severity of UC in part via PPAD.
Animals ; Colitis, Ulcerative/microbiology* ; Mice ; Mice, Inbred C57BL ; Porphyromonas gingivalis/pathogenicity* ; Protein-Arginine Deiminases ; Virulence Factors