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.

To investigate the dynamic homing process and characteristics of macrophages in different organs of immune-mediated aplastic anemia (AA) model mice. Macrophages in donor lymph nodes were sorted by magnetic beads and labeled with PKH67. After modeling according to the preparation method of the AA model, peripheral blood rountine analysis, bone marrow biopsy and HE staining results were analyzed to verify the modeling effect. On days 4, 8, and 12 of modeling, the bone marrow, spleen, and lymph node mononuclear cells were collected, and dynamic changes of PKH67-labeled macrophages in donor mice were analyzed by flow cytometry. In this study, dynamic changes in PKH67-labeled macrophages in the pathogenesis of AA model mice were explored. Macrophages in donor mice homed to the lymph nodes, expanding and differentiating in the lymph nodes, and finally transported to the bone marrow and spleen. Through proteomics mass spectrometry analysis, the related immune inflammatory response pathway of macrophages involved in the activation of the AA bone marrow microenvironment was preliminarily revealed, which provides a basis for the pathological macrophages involved in the pathogenesis of AA model mice.

Objective:To investigate the value of cellular immune status before initial 131I treatment for predicting treatment response in young and middle-aged patients with papillary thyroid cancer (PTC). Methods:From March 2018 to April 2019, 150 young and middle-aged patients with PTC (46 males, 104 females, age (40.0±9.8) years) who underwent total thyroidectomy and neck lymph node dissection in the Affiliated Hospital of Qingdao University were enrolled retrospectively. All patients underwent radioablation 1-2 months after operation, and the serum lymphocyte subsets (CD3 + , CD4 + , CD8 + , CD4/CD8) as well as natural killer (NK) cells were detected 1 d before the initial 131I treatment. Patients were divided into excellent response (ER) group and non-ER group according to the response of 6-12 months after 131I treatment. Clinicopathological characteristics, preablative stimulated thyroglobulin (psTg), initial 131I dose and lymphocyte subsets that might affect the response to 131I treatment were analyzed (independent-sample t test, Mann-Whitney U test, χ2 test, multiple logistic regression analysis). ROC curve analysis was used to evaluate the predictive value of significant factors for non-ER. Results:Of 150 patients, 84 cases were in ER group (56.00%), and 66 cases (44.00%) were in non-ER group. Age ( z=-2.86, P=0.004), M stage ( χ2=13.64, P<0.001), psTg ( z=-8.94, P<0.001), initial 131I dose ( z=-7.60, P<0.001), CD4 + ( t=2.50, P=0.014), CD4/CD8 ( z=-2.22, P=0.027) of the two groups were significantly different. Multivariate analysis showed that psTg (odds ratio ( OR)=1.27, 95% CI: 1.16-1.40, P<0.001) and CD4/CD8 ( OR=0.39, 95% CI: 0.15-0.99, P=0.048) were independent factors for predicting 131I treatment response. The cut-off values of psTg and CD4/CD8 for predicting non-ER were 6.78 μg/L and 1.67, respectively. Conclusions:Cellular immune status before initial 131I treatment may predict treatment response in young and middle-aged patients with PTC. It indicates non-ER response when Tg is higher than 6.78 μg/L and CD4/CD8 is lower than 1.67.

By searching the literature on the application of entrustable professional activities in college education in China and globally, this article comprehensively analyzes the concept of entrustable professional activities, the development of evaluation items, the effectiveness of clinical application, the problems to be improved, and research prospects, so as to provide a useful reference for the reform and evaluation of competency-oriented medical education in China and the application of entrustable professional activities that can be repeated and promoted in clinical teaching.

Objective:To investigate the preoperative diagnostic value of 99Tc m-methoxyisobutylisonitrile (MIBI) planar imaging and SPECT/CT imaging for primary hyperparathyroidism (PHPT), and analyze the relevant factors affecting the imaging results. Methods:From June 2016 to September 2019, a total of 62 patients (15 males, 47 females, age range: 27-80 years) confirmed as PHPT by postsurgical pathology in Affiliated Hospital of Qingdao University were retrospectively enrolled. The diagnostic efficacies of 99Tc m-MIBI planar imaging and SPECT/CT imaging were compared using χ2 test. The differences of preoperative serum parathyroid hormone (PTH), Ca and the maximum diameter of lesion between the positive and negative groups of planar imaging were analyzed using independent-sample t test and Mann-Whitney U test. The region of interest (ROI) method was applied to calculate the uptake ratio of lesions to normal tissues at the early phase (T/Ne) and delayed phase (T/Nd) in positive cases of planar imaging. Pearson or Spearman correlation analysis was used to evaluate the correlation of T/Ne, T/Nd with preoperative serum PTH, Ca and the maximum diameter of lesion. The receiver operating characteristic (ROC) curves of preoperative serum PTH, Ca and positive planar imaging were drawn and the cut-off values were obtained. Results:The sensitivity of planar imaging and SPECT/CT imaging was 69.35%(43/62) and 87.10%(54/62) respectively ( χ2=5.729, P=0.017). The preoperative serum PTH, Ca levels and the maximum diameter of lesion in patients with positive planar imaging (253.32(107.00, 331.70) ng/L, 2.78(2.51, 2.87) mmol/L, (2.01±0.88) mm) were higher than those with negative planar imaging ((111.86±44.29) ng/L, (2.59±0.21) mmol/L, (1.42±0.55) mm; z values: -2.802, -1.978, t=3.300, all P<0.05). T/Ne was positively correlated with preoperative serum PTH ( rs=0.511, P<0.001) and the maximum diameter of lesion ( r=0.381, P=0.012), and T/Nd was positively correlated with preoperative serum PTH ( rs=0.538, P<0.001), Ca ( rs=0.348, P=0.022) and the maximum diameter of lesion ( r=0.463, P=0.002). The area under the ROC curve between preoperative serum PTH, Ca and planar imaging was 0.725 and 0.646, respectively. Preoperative serum PTH had a better predictive value with the optimal cut-off value of 150.4 ng/L. Conclusions:Preoperative serum PTH, Ca and the maximum diameter of lesion are positively correlated with 99Tc m-MIBI uptake in PHPT patients with positive planar imaging results. When preoperative serum PTH is lower than 150.4 ng/L, planar imaging is prone to false negative. SPECT/CT imaging has a significant value in preoperative diagnosis and the combination of PTH and CT can improve the positive rate.

Objective:To investigate the role of macrophages (M?) in the pathogenesis of modified immune-mediated aplastic anemia (AA) mice model.Methods:Before the establishment of the F1 AA mice model by total-body irradiation combined with allogeneic lymphocyte infusion, the mice of the CLO+AA group were treated with clodronate (CLO) liposomes to remove macrophages, and those of the PBS+AA group were treated with phosphate-buffered saline (PBS) liposomes and used as control. The severity of AA was observed by bone marrow (BM) pathological examination and peripheral blood cell count. Flow cytometry (FCM) was used to detect the CD4 +/CD8 + T lymphocyte subsets in the BM and M? subsets in the BM and spleen of each group. The levels of IFN-γ, TNF-α, G-CSF, GM-CSF, EPO, and TPO in the peripheral blood were detected using enzyme-linked immunosorbent assay. Finally, the relationships between inflammatory factors and M? subsets were analyzed. Results:The BM fatty conversion of mice in the CLO+AA group was significantly alleviated compared with the PBS+AA group. Hemoglobin counts were (91.50±31.63) and (110.65±24.15) g/L, respectively, and the platelet counts were (90.85±121.90) × 10 6/L and (461.13±483.45) ×10 6/L, respectively. The differences were all statistically significant (all P<0.05) . After removing macrophages, the proportions of CD4 + and CD8 + T lymphocytes in BM of mice in the CLO+AA group decreased, but the reduction of CD8 + T cells was more significant. The proportions of CD4 + T cells and CD8 + T cells in BM of the PBS+AA group were (18.5±10.17) % and (36.23±6.40) %, respectively, and in the CLO+AA group were (7.58±8.00) % and (6.67±5.78) %, respectively. Similarly, the percentage of macrophages in the spleen and BM in the CLO+AA group was significantly reduced compared with the PBS+AA group, most of which were M1 macrophages ( P<0.05) . The levels of IFN-γ in peripheral blood of the PBS+AA and CLO+AA groups were (602.37±104.62) ng/L and (303.01±87.22) ng/L, respectively, the levels of TNF-α were (34.46±1.42) ng/L and (23.25±4.21) ng/L, respectively, the levels of GM-CSF were (9.32 ± 2.00) ng/L and (64.85±12.25) ng/L, respectively, the levels of G-CSF were (5 891.78±2 632.39) ng/L and (17 784.16±488.36) ng/L, respectively, the levels of EPO were (9 667.31±4 501.95) ng/L and (2 078.02±897.56) ng/L, respectively, and the levels of TPO were (6.36±2.09) ng/L and (11.67±2.86) ng/L, respectively (all P<0.05) . Conclusions:This study confirmed that macrophages were involved in the pathogenesis of AA, and the degree of BM damage in AA mice was improved by removing macrophages in advance. The imbalance of M1/M2 macrophages and the changes of IFN-γ and TNF-α may be important mechanisms that eventually lead to AA.

Objective:To evaluate the efficacy of ultrasound-guided bilateral erector spinae plane (ESP) block for pediatric patients undergoing Nuss procedure with general anesthesia.Methods:Thirty-two American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 4-15 yr, undergoing Nuss procedure with general anesthesia, were divided into ESP block plus general anesthesia group (group EG, n=16) and general anesthesia group (group G, n=16) using a random number table method.Bilateral ESP blocks were performed after anesthesia induction in group EG.Intravenous analgesia was performed postoperatively in both groups.Face Legs Activity Cry Consolability (FLACC) scores both at rest and during coughing were recorded on admission to postanesthesia care unit (PACU) and at 1, 6, 12, 24 and 48 h after operation.When FLACC score at rest >4, ibuprofen 5.0-7.5 mg/kg was taken orally according to the requirements of pediatric patients and their parents.The intraoperative amount of propofol and remifentanil used and postoperative requirement for fentanyl and ibuprofen were recorded.The development of postoperative hypoxia (SpO 2 <90%), nausea and vomiting, and urinary retention was recorded.The development of puncture site infection, hematoma and subcutaneous emphysema was recorded.The tracheal extubation time, duration in PACU and length of postoperative hospital stay were also recorded. Results:Compared with group G, FLACC scores at rest within 12 h after operation and during coughing within 6 h after operation were significantly decreased, the intraoperative consumption of remifentanil was reduced, the postoperative requirement for fentanyl and ibuprofen was decreased, the incidence of hypoxemia was decreased, the tracheal extubation time and duration in PACU were shortened ( P<0.05), and no significant change was found in the consumption of propofol, incidence of nausea and vomiting, or length of postoperative hospital stay in group EG ( P>0.05). Conclusion:Ultrasound-guided bilateral ESP block can reduce the consumption of opioids in the perioperative period and enhance the analgesic efficacy with a higher safety, which is helpful in promoting short-term outcomes for pediatric patients undergoing Nuss procedure with general anesthesia.

Objective: To investigate the response to ¹³¹I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation. Methods: From May 2016 to October 2018, 108 DTC patients (28 males, 80 females, age: (45.7±10.4) years) with negative psTg who underwent ¹³¹I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled. All patients had iodine-positive lymph nodes, which were showed by SPECT/CT imaging 5-6 d after ¹³¹I treatment. The treatment response was evaluated at 6-24 month after ¹³¹I treatment. Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first ¹³¹I treatment. Independent-sample t test, χ² test and Mann-Whitney U test were used to analyze differences of factors (e.g. age, gender, extraglandular infiltration) between the 2 groups, and then multivariate logistic regression was performed to find the influence factors for treatment response. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in ¹³¹I treatment response. Results: A total of 82 patients (75.93%, 82/108) achieved ER, and 26 (24.07%, 26/108) was non-ER patients. There were significant differences in age (t=-2.540, P=0.016), extraglandular infiltration (χ²=5.764, P=0.016), T stage (χ²=19.857, P<0.001), N stage (χ²=14.145, P=0.001), risk stratification of recurrence (χ²=11.487, P=0.003), ultrasound results before ¹³¹I treatment (χ²=44.819, P<0.001), dose of the first ¹³¹I treatment (U=780.0, P=0.018), size (long diameter) of iodine-positive lymph node (U=184.0, P<0.001), and psTg level (U=776.0, P=0.037) between ER and non-ER groups. Multivariate logistic regression showed that age, size of iodine-positive lymph node and ultrasound results before ¹³¹I treatment were closely related to ¹³¹I treatment response. The odds ratio (OR) values (95% CI) were 1.123 (1.025-1.231), 4.275 (1.893-9.653) and 260.86 (8.123-8 376.764), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for non-ER were 100%(26/26), 70.73%(58/82), 77.78%(84/108), 52.00%(26/50) and 100%(58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm. Conclusion The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER. Age, ultrasound results before ¹³¹I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.

Anemia, Aplastic ; Animals ; Disease Models, Animal ; Forkhead Transcription Factors ; Interleukin-2 Receptor alpha Subunit ; Medicine, Chinese Traditional ; Mice ; Phosphorylation ; Proto-Oncogene Proteins c-akt ; STAT3 Transcription Factor ; T-Lymphocytes, Regulatory

Objective To evaluate the efficacy of Ambu AuraOnce laryngeal mask airway (LMA) in Chinese patients undergoing general anesthesia.Methods Fifty-six female patients, aged 20-64 yr, weighing 45-75 kg, of American Society of Anesthesiology physical status Ⅰ or Ⅱ (Mallampati Ⅰ-Ⅲ), scheduled for elective breast surgery under general anesthesia, were equally and randomly divided into either Ambu AuraOnce LMA group (group A) or LMA Supreme group (group S) using a random number table.After induction of anesthesia, Ambu AuraOnce LMA was inserted in group A, and LMA Supreme was placed in group S.After successful placement of LMA, correct position was confirmed by fiberoptic laryngoscopy.Intermittent positive pressure ventilation was performed during surgery to maintain pulse oxygen saturation ＞ 95％ and partial pressure of end-tidal CO2 at 30-45 mmHg.The success rate, insertion time, extubation time, airway sealing pressure, peak airway pressure and occurrence of air leakage of LMA were recorded.After removal of the LMA, the blood stains on the LMA were checked, and the occurrence of hypoxemia, regurgitation, nausea, vomiting and bucking was recorded.The occurrence of sore throat, hoarseness and dysphagia was also recorded within 24 h after surgery.Results There were no significant differences in terms of insertion time, overall success rate, success rate at first attempt, removal of LMA time, airway sealing pressure, and incidence of air leakage of LMA, hypoxemia, blood stains on the LMA, sore throat, hoarseness and dysphagia between the two groups.The rate for correct position of LMA confirmed by fiberoptic laryngoscopy was significantly higher in group A than in group S.Conclusion Ambu AuraOnce LMA can safely and effectively be applied for airway management in Chinese patients undergoing general anesthesia.