Objective:To retrospectively analyze the anesthetic management characteristics of children undergoing resection of pheochromocytoma and paraganglioma (PPGL).Methods:The clinical data from patients undergoing resection of PPGL and confirmed histologically from January 1, 2010 to June 30, 2023 were retrospectively collected. The baseline characteristics, intraoperative conditions and postoperative complications were recorded.Results:The clinical data from 47 pediatric patients were analyzed. The overall incidence of hemodynamic instability events was 68% (32 cases). Lowering preoperative blood pressure to normal levels and the maximum diameter of tumor≥6 cm was helpful in reducing the incidence of the intraoperative hemodynamic instability events ( P<0.05). Postoperative hypotension developed in 7 cases, acute left heart failure in 1 case, arrhythmia in 1 case, adrenocortical insufficiency in 4 cases, and pulmonary infection in 13 cases. Conclusions:Thorough preoperative preparation, evidence-based anesthetic management, and meticulous postoperative vital sign monitoring can increase the perioperative safety for children undergoing resection of PPGL, thereby reducing the incidence of complications.

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking

The data of pediatric patients who underwent scoliosis surgery from July 2016 to July 2019 were collected retrospectively.The pediatric patients were divided into traditional ventilation group (T group) and lung-protective ventilation group (P group) based on the ventilator settings.Standardized tidal volume(V T)was obtained by V T/ideal body weight (IBW). Patients with standardized V T ≥ 8 ml/kg and without positive end-expiratory pressure (PEEP) were included in group T, and patients with V T <8 ml/kg and PEEP 4-8 cmH 2O were included in group P. The propensity score was used to match the baseline information and intraoperative variables in the two groups.A total of 415 pediatric patients accepted screening, and 171 cases were successfully matched, including 92 cases in group T and 79 cases in group P. Compared with group T, the incidence and grade of pulmonary complications were significantly decreased at day 30 after operation, postanesthesia care unit stay time was shortened, body temperature was decreased at 24 h after operation, V T, standardized V T and oxygenation index were decreased, P ETCO 2, PEEP, ventilation frequency and I∶ E were increased ( P<0.05), and no significant change was found in IBW, PaCO 2, incidence of postoperative surgical complications and anesthesia-related complications, plasma C-reactive protein concentration and white blood cell count at 24 h after operation, hospitalization time and hospitalization cost in group P ( P>0.05). In conclusion, the lung-protective ventilation strategy low V T combined with PEEP can decrease the risk of postoperation lung complications and is helpful in improving prognosis in the pediatric patients undergoing scoliosis surgery as compared with traditional mechanical ventilation strategy.

OBJECTIVE:To provide reference for rational use of antibiotics in the clinic of our hospital. METHODS:Drug re-sistance of Gram-negative bacillus in the inpatients of our hospital were analyzed retrospectively during May 2013-Dec. 2015 as well as the situation of producing metallo-β-lactamase(MBLs). RESTUTS:A total of 2089 strains of Gram-negative bacillus were detected in our hospital during 2013-2015,among which there were 1456 strains of enterobacteria (69.70%) and 633 strains of non-fermentative bacteria,mainly involving Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter bau-mannii and Enterobacter cloacae. A total of 406 strains of carbapenems-resistant bacteria were detected (19.44%),including 367 strains of non-fermentative bacteria and 39 strains of enterobacteria. The resistant rates of carbapenems-resistant strains to 16 antibi-otics were all higher than 50%,but those of non-carbapenems-resistant strains were in relative low level. Except for aztreonam,re-sistant rates of carbapenems-resistant strains to other 15 antbiotics were all higher than those of non-carbapenems-resistant strains, with statistical significance(P<0.05). A total of 36 strains of producing MBLs were detected(8.87%),including 13 strains of pro-ducing MBLs drug-resistant P. aeruginosa and 23 strains of producing MBLs drug-resistant A. baumannii;producing MBLs drug re-sistant enterobacteria had not been found. CONCLUSIONS:Gram-negative bacillus are mainly enterobacteria in our hospital;car-bapenems-resistant strains are mainly non-fermentative bacteria,resistant rate of them are commonly higher than that of non-drug-re-sistant strain. The situation of producing MBLs is serious,and enzyme producing strains are mainly non-fermentative bacteria. It is necessary to strengthen drug resistance of pathogen and enzyme producing strain monitoring,avoid the generation and spreading of drug-resistant strains due to irrational use of antibiotics.

Objective: To investigate the prognostic value of dynamic monitoring of RUNX1-RUNX1T1 transcript in pediatric patients with t (8;21) acute myeloid leukemia (AML) . Methods: The clinical features and RUNX1-RUNX1T1 transcript levels of 55 pediatric t (8;21) AML patients, newly diagnosed from Jan. 2010 to Apr. 2016, were analyzed retrospectively. The relationship between the minimal residual disease (MRD) and prognosis was analysed by dynamic monitoring of RUNX1-RUNX1T1 transcript levels using real-time quantitative PCR (RQ-PCR) technology. Results: The RUNX1-RUNX1T1 transcript levels in bone marrow cells at diagnosis was not related to relapse. After one course of induction therapy, patients with a more than 2 Log reduction of RUNX1-RUNX1T1 transcript levels (>2 Log) had lower 5 years cumulative incidence of relapse (CIR) [ (24.3±8.4) % vs (52.6±9.7) %, χ²=9.046, P=0.003], relapse-free survival (RFS) [ (71.6±12.7) % vs (48.1±13.2) %, χ²=5.814, P=0.016], and better overall survival (OS) [ (76.9±12.5) % vs (48.9±14.7) %, χ²=6.346, P=0.012], compared to patients with a less than 2 Log reduction (a<2 Log) . Multivariate Cox survival analysis suggested that a>2 Log reduction in RUNX1-RUNX1T1 transcript levels after a course of induction therapy was an independent prognostic factor for RFS (HR=0.263, 95%CI 0.081-0.851, P=0.026) and OS (HR=0.214, 95% CI 0.057-0.808, P=0.023) . During consolidation therapy and follow-up period, molecular relapse of 16 cases and hematologic relapse of 13 cases were identified by continuous dynamic monitoring of RUNX1-RUNX1T1 transcript levels, with a median interval of 4.0 (1.5-5.8) months from the molecular relapse to hematologic relapse. 2 cases of molecular relapse who received timely allogeneic hematopoietic stem cell transplantation did not experience hematologic relapse. Conclusion Dynamic monitoring RUNX1-RUNX1T1 transcript levels by RQ-PCR technique can subdivide patients into relatively low and high risk group, early screen patients at high risk of relapse and provide a scientific basis for precision stratification and risk-adapted therapy for pediatric t (8;21) AML children.

Objective To evaluate the effect of obstructive jaundice on recovery from sevoflurane anesthesia in pediatric patients. Methods A total of 80 pediatric patients scheduled for elective surgery were included, 42 pediatric patients with biliary atresia scheduled for Kasai operation served as obstructive jaundice group ( group OJ ) , and 38 pediatric patients scheduled for other operations served as control group ( group C) . Pediatric patients were 1-4 months old and full?term infants, and weighed 3.2-8.0 kg. Anesthesia was maintained with inhalation of 2%-4% sevoflurane during surgery, and pediatric patients inhaled 4% sevoflurane staring from peritoneum closure until the end of surgery. The duration from closing sevoflurane vaporizer to BIS value reaching 60, 70, 80 and 90 was recorded. The duration from stop of sevoflurane inhalation to BIS value returning to 60, 70, 80 and 90 was recorded. The duration from termination of sevoflurane inhalation to the time for tidal volume returning to 6 ml∕kg, to the time for muscle strength recovering to grade Ⅲ, to spontaneous eye opening and to tracheal extubation, and the corresponding BIS values were recorded. BIS value while entering the operating room, BIS value at the end of surgery, and the highest BIS value during recovery from anesthesia were recorded. The occurrence of delayed emergence from anesthesia was recorded. Results Compared with group C, the duration from termination of sevoflurane inhalation to spontaneous eye opening and to tracheal extubation were significantly prolonged, and BIS value at the end of surgery was decreased, and no significant change was found in the other parameters in group OJ. No pediatric patients developed delayed emergence from anesthesia in the two groups. Conclusion When only sevoflurane is used for inhalation anesthesia, although the time for recovery from anesthesia is prolonged, it shows no significant difference clinically in pediatric patients with obstructive jaundice.

Objective To investigate the functions of blood plasma homocysteine (Hcy) and high sensitivity C-response protein (hs-CRP) in the chronic obstructive pulmonary disease (COPD) in pathogenesis plays,and observe whether there was associations with disease severity and the correlations.Methods Forty-one patients with COPD were collected from August 2010 to February 2011,and 35 healthy persons as control group.Blood plasma Hcy,hs-CRP,forced expiratory volume in one second account predicted (FEV1％ predicted),and arterial pressure of oxygen (PaO2,arterial blood gases analysis) were measured in COPD patients and controls.Results Plasma Hcy concentration was (22.07 ± 12.13) μmol/L in COPD patients,but (9.89 ±4.41) μmol/L in controls,there were significant differences between two subjects (t =1.674,P ＜0.01).COPD patients had a higher serum hs-CRP concentration (8.60±3.85) mg/L than control's (4.24 ±0.57) mg/L (t =1.682,P ＜ 0.01).Along the descent of FEV1％ predicted,plasma Hcy and hs-CRP were elevated gradually,both sides show a negative correlation (r =-0.45,-0.49,P ＜ 0.05).And plasma Hcy and hs-CRP present a positive correlation in COPD patients (r =0.68,P ＜ 0.01).Conclusion Plasma Hcy was significantly elevated in COPD patients,positive correlation related to COPD severity and positive correlation related to serum hs-CRP.

Objective To investigate the change of MMP-9,TIMP-1,ICAM-1 and VCAM-1 expression in serum from patients with COPD,as well as the correlation between the expressions of these factors and lung function.Methods Enzyme-linked Immunosorbent Assay(ELISA)was used to determine the levels of MMP-9,TIMP-1,ICAM-1 and VCAM-1 in serum from 58 patients with COPD and 30 samples from healthy donors in order to better understand the correlation between the expression of these factors and airflow obstruction.Results The serum levels of MMP-9,TIMP-1,ICAM-1 and VCAM-1[(128.89?115.84),(228.28?107.13),(203.98?70.37) and (352.98?117.73)?g/L]from patients with COPD were statistically and significantly higher than the control group[(30.65?18.43),(133.69?41.41),(148.35?23.77) and (233.57?36.65)?g/L],P

BACKGROUNDTo study the levels of expression, coexpression, and clinical significancer of four multidrug resistance factors in lung cancer.

METHODSThe P glycoprotein (P-gp), multidrug-resistance-associated protein (MRP), lung resistance protein (LRP), glutathione S-transferase (GST-π) of 60 lung cancer patients were detected by using immunohistochemical method.

RESULTSThe positive rate of the drug resistance factor was 53.3% (32/60), 63.3% (38/60), 70.0% (42/60), and 80.0% (48/60) for P-gp, MRP, LRP, and GST-π respectively. Patients with NSCLC had significantly higher expression of the drug resistance factors than those with SCLC. On the other hand, no relationship was observed between the expression of drug resistance factors and TNM stage and cell differentiation. The coexpression rate was as follows: P-gp+MRP, 41.6% ; P-gp+LRP, 35.0%; MRP+LRP, 53.3%; MRP+GST-π, 50.0%; LRP+GST-π, 58.3%; P-gp+GST-π, 45.0%; P-gp+MRP+LRP+GST-π, 20.0%. Among them, a relationship was detected between P-gp and MRP ( rs =0.756, P < 0.01), between P-gp and LRP ( rs =0.686, P < 0.01), between MRP and LRP ( rs =0.669, P < 0.01), between MRP and GST-π( rs =0.546, P < 0.01), between LRP and GST-π ( rs =0.848, P < 0.01), between P-gp and LRP ( rs =0.689, P < 0.01), and between P-gp and GST-π ( rs = 0.535 , P < 0.01).

CONCLUSIONSThe MDR in lung cancer patients is affected by various multidrug resistance factors. The drug resistance factors' expression is related to histology, but not to TNM stage and cell differentiation.

Objective To investigate the expression and clinical significance of multidrug resistance gene(MDR1),multidrug-resistance-associated protein (MRP),lung resistance protein (LRP),glutathione S-transferase-?(GST-?)mRNA in non-small cell lung cancer. Methods From Oct.1996 to Oct.2001,RT-PCR was used to investigate the mRNA expression of the above four genes.We followed up the survival time one by one and calculated the probability of survival. Results The total positive rate of the four multidrug resistance gene was 53.1%,65.3%,67.3%,83.3%.There was a significant difference between the coexpression and the single positive rate( P 0.05).With the increasing expression of the MDR the curves moved to left,the survival time and probability reduced. Conclusion The coexpression of the MRG results in the MDR and affects the prognosis directly.It can be used as a criterion to evaluate the prognosis.