Objective:To summarize the morphological characteristics and clinical experience of pulmonary artery sling(PAS) combined with anomalous bronchial branching, and provide new considerations for surgically treating PAS.Methods:A retrospective review of surgical experience of all patients with anomalous bronchial branching from January 2012 to December 2018 at Shanghai Children's Medical Center was conducted. There are 4 types according to the morphology of anomalous bronchial branching: tracheal bronchus, bronchial trifurcation, bridging bronchus, tracheal bronchus combined with bronchial trifurcation. The proportion of patients with anomalous bronchial branching combined with PAS was counted. The rate of tracheoplasty for four types was determined. We measured the interbronchial and subcarinal/subpseudocarinal angles before and after tracheoplasty.Results:140 patients were included in our study. The tracheal diameter of 11(21%, 11/53) patients with tracheal bronchus and 4(9%, 4/44) patients with bronchial trifurcation was normal. Among these patients, 125 patients had congenital tracheal stenosis(CTS). 115 patients underwent tracheoplasty. The rate of tracheoplasty of bridging bronchus was higher than tracheal bronchus(100% vs. 60%, P=0.000). One-stage surgery was performed in 76(61%) patients who had PAS. The interbronchial and subcarinal/subpseudocarinal angles were significantly reduced postoperatively( P=0.000). Conclusion:It is difficult to explain merely with vascular compression in patients with PAS with CTS and anomalous bronchial branching. One-stage slide tracheoplasty is currently the optimal option.

s of enteral nutrition depends on the primary diseases and duration of nutmition support.Nasoenteral tube placement is safe and effective.Percutaneons endoscopic gastrostomy and needle catheter jejunostomy are the alternative approaches.

Objective To study the clinical therapeutic effect of the combined antihistamine for the treatment of allergic pharyngitis.Methods In January 2015 to December 2016 during the hospital outpatient service received by irritating cough,50 patients with pharyngeal itching for the main symptoms as the object of study,summary and analysis on the clinical symptoms of all patients,in the conventional treatment on the basis of leukotriene receptor antagonist combined antihistamines treatment,close observation after 1 week,2 weeks after treatment in patients with symptoms improved after treatment.Results The clinical main characteristic of allergic pharyngitis is the irritating dry cough,and the first pharynx is a cough.After a week of treatment,the symptoms of the patient were significantly improved,and after two weeks of treatment,the symptoms of the patient continued to be improved and the results were significant.Conclusion In clinical patients with cough,is one of the most important causes of allergic pharyngitis,if the patient is not adopted in treatment of anti-allergic drugs,can lead to therapeutic effect,but the joint antihistamines leukotriene receptor antagonist treatment,can effectively eliminate the symptoms of allergic pharyngitis,obvious effect,effectively improve the patient's quality of life.

Objective To establish a high throughput screening assay for identifying human small molecular antagonists targeted IL-6R.Methods The full length gene of the human IL-6R extracellular region was amplified by PCR and cloned into a eukaryotic expression vector to construct recombination expression plasmid pABHis -IL6R that was then transfected transiently into HEK293T cells to prepare recombination protein IL-6R.Western blotting assay and receptor-ligand binding experiment were used to analyze the bioactivity of IL-6R.A new screening method based on ELISA was established using the function of IL-6R binding to its ligand and the characteristics of Fc fragment binding to IgG-HRP.Then Z′-factor was calculated and a known antagonist ab 47215 was used to assess the stability and reliability of the new assay .Results Recombination plasmid pABHis-IL6R was constructed and soluble IL-6R was prepared.IL-6R reported herein could be recognized by an anti-IL-6R antibody and specifically bind to its ligand in a dose response manner .A Z′-factor of 0.53 was obtained that could serve high throughput screening assay .Ab47215 , as a known specific antagonist , was able to block rhIL-6 from binding to the receptor in a dose-dependent manner in the new screening assay , the IC50 of which was (0.55 ± 0.11)μg/ml.Conclusion An innovative and easy screening assay for identifying human IL-6R antagonists is established , which might help discover potent and specific antagonists .

Objective To study the role of hydrogen sulfide(H2S)in the pathogenesis of acute lung injury (ALI)-induced oleic acid(OA)and its regulatory effects on the inflammatory msponse.Method The ALI models in SD rats were produced by intravenous injection of OA(0.1 ml/kg).Forty-nine male SD rats were divided into three groups randomly:control group,OA group and OA+sodium hydrosulfide(NaHS)group.Rats of OA group and OA+NaHS group were sacrificed at 2,4 and 6 hours after the administration of OA,respectively.Rats of control group were sacrificed at 6 hours after intravenous normal saline(0.1 ml/kg).PaO2,lung tissue wet/dry(W/D)ratio and IQA score were determined.The concentrations of H2S in lung tissue and plasma were tested by sensitive sulphur electrode.The IL-6.IL-8 and IL-10 levels were measured by doubleantibody sandwich ELSIA.Results Compared with control group,of lung tissues was observed in rats treated with OA induced ALI,which led PaO2 dropped,and lung tissue W/D ratio,PMN%in alvedolar lavage and IQA raised score in the lung at 2,4 or 6 hours after OA injection(P＜0.01).In addition,IL-6,IL-8,and IL-10significantly increased,IL-6[plasma,control:(73.95±14.68)pg/ml,2 h:(186.70±23.85)pg/ml,4 h:(238.50±26.46)pg/ml,6 h:(215.95±25.86)pg/ml,P＜0.01;lung tissue,control:(60.58±12.91)pg/ml,2 h:(160.32±24.57)pg/ml,4 h:(195.27±46.28)pg/ml,6 h:(185.66±17.42)pg/ml,P all =0.000)],IL-8[plasma,control:(80.69±20.42)pg/ml,2 h:(184.11±19.51)pg/ml,4 h:(286.20±53.34)pg/ml,6 h:(241.30±45.85)pg/ml,P＜0.01;lung tissue,control:(69.14±15.96)pg/ml,2 h:(174.10±20.36)pg/ml,4 h:(249.02±31.17)pg/ml,6 h:(237.74±34.18)pg/ml,P＜0.01] and IL-10[plasma,control:(39.78±8.97)pg/ml,2 h:(111.18±11.46)pg/ml,4 h:(115.60±13.91)pg/ml,6h:(102.41±9.93)pg/ml,P＜0.01;lung tissue,control:(71.86±14.19)pg/ml,2 h:(126.96±18.72)pg/ml,4 h:(151.88±27.61)pg/ml,6 h:(137.28±14.22)pg/ml,P all=0.000] levels.in association with a decreased H2S content of plasma lung tissue decreased in[plasma,control:(36.58±6.80)μmol/L,2 h:(21.30±2.75)μmol/L,4 h:(20.63±1.26)μmol/L,6 h:(20.00±1.60)μmol/L,P＜0.01;lung tissue,control:(27.61±2.20)μmol/L,2 h:(20.67±1.37)μmol/L,4 h:(20.79±1.10)μmol/L,6 h:(18.92±0.75)μmol/L,P＜0.01]were observed in the plasma and lung tissue of OA-treated rats compared to controls.Administration of NaHS prior to OA treatment could lessen the lung pathologic changes induced by OA and elevate the concentrations of H2S in plasma[4 h:(26.67±3.44)μmol/L vs(20.63±1.26)μmol/L,P=0.042;6 h:(26.98±4.93)μmol/L vs(20.00±1.60)μmol/L,P＜0.05]and lung tissue[4 h:(23.20±1.48)μmol/L vs(20.79±1.10)μmol/L,P=0.011;6 h:(21,43±1.79)μmol/L vs(18.92±0.75)μmol/L,P=0.016].At the same time,the levels of IL-6 in plasma(185.37±21.98)pg/ml vs(238.50±26.46)pg/ml,4 h,P=0.000;(124.22±21.84)pg/ml vs(215.95±25.86)pg/ml,6 h,P＜0.01]and IL-8(199.40±34.56)pg/ml vs(286.20±53.34)pg/ml,4 h,P＜0.01;(146.58±20.23)pg/ml vs(241.30±45.85)pg/ml,6 h,P＜0.01]decreased significantly,but the level of IL-10(154.48±18.08)pg/ml vs(115.60±13.91)pg/ml,4 h,P=0.000;(138.06±20.01)pg/ml vs(102.41±9.93)pg/ml,6 h,P＜0.01]increased significantly.Conclusions The levels of endogenous H2S drop during the course of ALI oleic acid induced in rats.Exogenous H2S could decrease the levels of inflammatory factors(IL-6and IL-8),but increase the level of anti-inflammatory factors(IL-10).It could change the ratio of inflammatory factors/anti-inflammatory factors and therefore play a protective role against oleic acid induced ALI in rats.

BACKGROUND:Bone mineral density(BMD) is still regarded as the standard of early diagnosis and treatment of osteoporosis(OP) at present.But it is found in detection that different sex,age and skeleton location have different OP detection rate,so it is necessary to analyze the difference. OBJECTIVE:To compare the difference of OP detection rate at different skeleton location between males and females with the increase of age. DESIGN:A cross-sectional study taking patients as the subjects. SETTING:Endocrine department of an artillery general hospital of Chinese PLA. PARTICIPANTS:A total of 147 patients,including 54 males and 93 females, aged from 50 to 78 years old,who were hospitalized in our outpatient clinic from September 2000 to January 2002,were selected and divided into 3 groups according to age,50 to 59 years old group (n=46,13 males and 33 females),60 to 69 years old group (n=66,26 males and 40 females) and 70 to 79 years old group (n=35,15 accordance with the OP diagnostic criteria recommended by WHO[1]. Exclusive criterion: secondary OP patients caused by chronic disease of liver,kidney, heart, and gastrointestinal tract and some endocrine disease such as diabetes,hyperthyroidism and so on. INTERVENTIONS:Every subject filled in the history questionnaire in detail.Height and body mass were measured accurately and body mass index(BMI) was calculated (kg/m2).A new type of Norland Excell plus dual-energy X-ray absorptiometry(DEXA) was used to detect BMD(g/cm2) of L2- 4 and proximate femur(neck of femur, Ward's triangle,greater trochanter).The detected values were compared with the normal data of young adults of the same sex and the T value(SD) was obtained. RESULTS:OP in lumber vertebra was predominant in female climacteric(χ 2=10.14,P< 0.01),and the detection rate of OP in lumber vertebra and neck of femur increased with age(χ 2=7.41, P< 0.05).OP in simple neck of femur increased significantly in males after 60 yeas old(χ 2=9.11,P< 0.05). Females were more liable to suffer from OP in simple lumber vertebra and in both lumber vertebra and neck of femur(χ 2=8.04,P< 0.05;χ 2=14.26,P< 0.01).Age had significant negative correlation with BMD in neck of femur,Ward's triangle and great trochanter of females(r=- 0.364,- 0.389, P< 0.01;r=- 0.504,P< 0.001),while BMI was positively correlated with L2- 4,neck of femur and great trochanter significantly(r=0.306,0.329,0.338,P< 0.05). CONCLUSION:Detection rate of OP changes with skeleton detecting location and age.It is very significant to recognize and evaluate these objective phenomena correctly for the diagnosis and treatment of OP.

Objective To understand the current status of disinfection and sterilization of medical institutions at all levels in 30 counties in Chongqing ,and to guide the work that medical institutions regulate and improve the quality of disinfection and steriliza‐tion ,and urge the relevant departments to strengthen the monitoring of disinfection quality of medical institutions .Methods Using field investigation and sampling inspection method ,the disinfection quality of medical institutions at all levels in 30 counties of Chongqing city was monitored and analyzed .Results From 30 districts and counties ,the medical institutions were sampled from 28 510 parts ,the overall average pass rate of 93 .3% .The qualified rate of medical institutions at all levels from high to low were as follows ,the village health room (96 .7% ) ,urban community medical institutions (96 .6% ) ,district level medical institutions (96 .1% ) ,individual clinic (90 .9% ) ,private hospitals (93 .7% ) and township (street) medical institutions (86 .5% ) .Different types of medical institutions got different qualified rate ,and the difference was statistically significant(χ2 =666 .84 ,P<0 .01) .Pro‐ject with the lowest qualified rate was radiation intensity of ultraviolet lamp(52 .8% ) ,secondly was indoor air (80 .4% ) and differ‐ent projects′qualified rate was significantly different(χ2 =1 706 .81 ,P<0 .01) .Conclusion Medical and health institutions at all levels′s disinfection quality were generally good ,but the village health room monitoring coverage ,ultraviolet light intensity and oth‐er individual monitoring projects need to be improved .

Objective To evaluate interventional therapy in the treatment of interposition graft stenosis or occlusion after mesocaval shunts.Methods The clinical data of 19 cases of artificial vessel stenosis or occlusion after mesocaval shunts for portal hypertension at our department from march 2009 to march 2012 were retrospectively analyzed.Results In the 19 cases with artificial vessels stenosis or occlusion developed after mesocaval interposition shunts for portal hypertension,there were 5 cases in which acute thrombosis occurred within a week after the surgery.Catheter directed thrombolysis was successfully conducted.In 6 cases in which shunt stenosis developing 1 to 8 years after surgery were managed by balloon dilatation or stent angioplasty successfully.The shunt graft occlusion occurred in 8 cases after 1 to 4 years of surgery was successfully managed and the shunt was reopened by balloon dilatation or stent angioplasty in 6 cases,and in 2 the procedure was failed for the guide wire can't go through the anastomotic site of artificial vessel-superior mesenteric vein.In 11 cases embolization of the esophagogastric varices was successfully carried out for postoperative standard anticoagulation.During a period of 3 months to 3 years follow-up,stenosis recurred 1 year after balloon dilatation in one case,and stenosis was managed by angioplasty successfully.Conclusions Interventional radiological techniques by percutaneous puncture through femoral vein-inferior vena cava-artificial vessel-portal vein (including catheter directed thrombolysis,balloon dilatation,stent placement,etc) are less traumatic,highly successful in the treatment of shunt stenosis or occlusion after mesocaval shunts in portal hypertension.

Objective To explore risk factors of cardiac surgery in neonates with low body weight.Methods Retrospective analysis was made in neonates weighing less than 3 kg at surgery(n =192;group 1) and 3 to 6 kg(n =517;group 2),who had undergone open cardiac repairs from January 2006 to December 2015 at our institution.Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention.Patients were also analyzed according to preoperative risk scores.Univariate versus multivariate risk analysis was performed.Results Hospital early mortality in group 1 was 25.0％ (n =48) versus 14.5 ％ (n =75) in group 2 (P =0.001).Compared with group 2,neonates in group 1 had a significantly higher mortality for simple arterial switch procedure.Lower body weight remained strongly associated with mortality risk after stratifying the population by preoperative risk scores category levels 2.Within group 1,age,weight at surgery,preoperative risk score and type of procedure were not associated with significant differences in early mortality.Cardio-pulmonary bypass time,aortic cross-clamp time and the presence of a surgical complication were independent risk factors for early mortality in group 1.Conclusion Among neonates weighing less than 3.0kg who underwent open cardiac surgery,perioperative hemodynamic status,reflected by bypass time,cross-clamp time,and surgical complications,strongly influenced early mortality.In contrast,low body weight itself was not associated with early mortality.

Objective To compare the dissolution curves of metronidazole tablets from 38 national manufactures and original drugs of Britain in four dissolution mediums,and provide the reference for the quality and clinical effect consistency evaluation of metronidazole tablets.Methods Paddle method was adopted at 50 r · min-1 in four dissolution mediums with the volume of 900 mL.The dissolution profiles were determined by ultraviolet spectrophotometry.The cumulative dissolution percentages were calculated and the dissolution curves were drawn.Similarity factor (f2)was used for comparing of the differences between dissolution curves.Results The dissolution profiles of 4 manufactures in pH 1.2 and 9 manufactures in pH 4.5 were similar (f2 ≥ 50)to that of original drugs,only 1 and 3 were similar to original drugs in water and pH 6.8,respectively.There are no companies whose dissolution curve were similar to that of original drugs in 4 dissolution mediums.Conclusion Great difference exists between domestic manufactures and pharmaceutical enterprises of origin in dissolution behaviors of metronidazole tablets.In order to ensure the consistency between the metronidazole tablets generics and original drugs of Britain in quality and clinical effect.It is advisable for the relevant companies to improve their product quality by improving the formulation and preparation.