Abstract:Objective:　To investigate the effect of human umbilical cord mesenchymal stem cells (HUC-MSCs) on osteoporosis rats and its mechanism. Methods:　Thirty SPF grade 6-month-old female rats were randomly divided into three groups: sham operation group (Sham group), ovariectomy group (OVX group) and HUC-MSCs intervention group (HUC-MSCs group) (4×10⁶/3 day), with 10 rats in each group. In Sham group, a small amount of abdominal fat was removed, and the other groups were removed bilateral ovaries to establish osteoporosis rat model. After successful modeling, HUC-MSCs group was intervened with stem cells for 12 w, while the other two groups were intervened with equal dose of normal saline. After the intervention, calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), c-terminal peptide of type I collagen (CTX), histomorphometric parameters of femur, bone mineral density (BMD), osteoblast surface/bone surface ratio (ObS/BS) and osteoclast surface area/bone surface (OcS/BS) were used to evaluate the improvement of osteoporosis in rats. Meanwhile, the expression of osteoprotegerin (OPG), receptor activator of nuclear factor-κB ligand (RANKL), β-catenin and Runt-related transcription factor 2 (Runx2) were detected by Western blot. Results:　The contents of serum Ca and ALP in HUC-MSCs group were significantly higher than those in OVX group (2.320±0.188 vs.1.822±0.139; 79.584±8.349 vs.43.644±5.369; all P=0.000) ; P and CTX contents were significantly lower than those in OVX group (1.651±0.068 vs.1.864±0.076, P=0.000; 119.832±18.180 vs.144.272±15.629, P=0.039) ; BMD, the number of trabecular bone, the ratio of trabecular area and ObS/BS in HUC-MSCs group were significantly higher than those in OVX group (161.114±16.726 vs.126.558±7.100, P=0.009; 1.702±0.220 vs.1.051±0.323, P=0.020; 33.111±6.101 vs.19.575±5.629, P=0.022; 45.279±3.947 vs.33.948±7.339, P=0.041) ; the bone trabecular separation and OcS/BS in HUC-MSCs group were significantly lower than those in OVX group (0.592±0.066 vs.0.845±0.165, P=0.018; 37.532±3.910 vs.44.891±3.615, P=0.026) ; the results of Western blot showed that the ratio of OPG/RANKL and the protein expression of β-catenin and Runx2 in HUC-MSCs group were significantly higher than those in OVX group (0.776±0.045 vs.0.097±0.063, P=0.000; 0.590±0.057 vs.0.202±0.088, P=0.000; 0.595±0.078 vs.0.239±0.071, P=0.001) . Conclusion:　HUC-MSCs can regulate OPG/RANKL ratio through Wnt/β-catenin/Runx2 pathway, thus promoting bone formation, inhibiting bone resorption and improving osteoporosis.

Abstract:Objective:　To investigate the effect of single butterfly fracture fragment on the healing of femoral shaft fracture treated with intramedullary nail. Methods:　From February 2010 to February 2016, 72 patients with closed femoral comminuted fracture admitted to Xuzhou Medical University Affiliated Hospital of Lianyungang, including 46 males and 26 females, with an average age of 38 (17-64 years old), 40 cases on the right side, and 32 cases on the left side. All patients were treated with femoral interlocking intramedullary nail. According to femoral shaft diameter, the displacement degree of butterfly fracture was divided into four degrees: Ⅰdegree (displacement was less than 1/3 of shaft diameter): 41 cases; Ⅱdegree (displacement was greater than 1/3 of the diameter and less than 2/3): 17 cases; Ⅲdegree (displacement was greater than 2/3 of the diameter): 9 cases; Ⅳdegree (fracture fragment turnover): 5 cases. According to RUSF score, fracture healing rate and average time of fracture healing, the effect of displacement degree of fracture fragment on fracture healing was evaluated. Results:　All the indexes of the 4 groups were statistically significant. The fracture healing was best in the group ofⅠdegree displacement, with the fracture healing rate of 87.8% and the average healing time of 4.8 months. The patients withⅢdegree displacement andⅣdegree displacement had the worst healing, and the healing rate was 22.2% and 20.0%, respectively, with an average healing time of 12.6 months and 18 months. The patients withⅡdegree displacement had the healing rate of 64.7% and the average healing time of 8.9 months. Conclusion:　The butterfly fracture withⅠdegree displacement needs no intervention, the fracture withⅣdegree displacement should be restored and as close to the bone defect as possible to avoid nonunion, andⅡdegree andⅢdegree displaced fragments should be given closed reduction to withinⅠdegree displacement as far as possible to minimize the incidence of nonunion.

Abstract:Objective:　To explore the clinical efficacy of spinal endoscopy in the treatment of lumbar posterior ring apophysis fracture, and analyze the correlation between the improvement of clinical symptoms before and after surgery and the imaging changes of the spinal canal for providing a theoretical basis for clinical full decompression. Methods:　A total of 42 patients with posterior ring apophysis fracture of lumbar 4-5 segments meeting the inclusion and exclusion criteria from December 2015 to December 2019 were collected in the study. All patients were treated with spinal endoscopy, partial discectomy and complete resection of separated and broken bones under the transforaminal endoscope. All patients received visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores 3 months before and after operation, and the therapeutic effect of modified MacNab was evaluated after operation. At the same time, preoperative and postoperative imaging examinations were performed to record the changes in data, and statistical data analysis was made. Results:　The operation was smooth, with no open transition, dural sac tear, or nerve root injury. The operation time was 35 min to 80 min, with 3 to 17 times of intraoperative fluoroscopy, and the amount of bleeding during the operation was about 10 mL to 20 mL. Postoperative imaging showed that the dural sac and nerves were completely decompressed and 42 cases of severed bone masses were completely removed. The patients were followed up after operation, and the excellent and good rate was 95.24% according to the MacNab efficacy evaluation standard. After 3 months of follow-up after operation, the VAS score decreased from (7.19±0.40) points before surgery to (2.58±0.83) points (P<0.01), the ODI score decreased from (56.52±3.55) % before surgery to (19.83±5.00) % (P<0.01), and the JOA score increased from (8.48±2.42) points before surgery to (21.71±2.86) points (P<0.01) . There were significant differences in spinal canal transverse diameter, spinal canal median sagittal diameter, and spinal canal cross-sectional area in CT before and after surgery, as well as in inter-articular diameter, spinal canal cross-sectional area, and dural sac cross-sectional area in MRI before and after operation (P<0.01) . Conclusion:　Firstly, spinal endoscopy can be used to treat posterior ring apophysis fracture of the 4-5 segments of the lumbar vertebrae through a safe and effective minimally invasive approach, which can achieve satisfactory clinical results. Secondly, improvement of the median sagittal diameter of the spinal canal, the inter-articular diameter, and the cross-sectional area of the spinal canal have a strong correlation with clinical efficacy before and after surgery. The improvement of imaging data can be used as a static method for judging clinical efficacy, meanwhile, accurate targeted puncture and thorough nerve decompression are also guarantees of good surgical efficacy.

Abstract:Objective:　To investigate the clinical effect of posterior decompression and reduction of lumbar spine and circular fusion for the treatment of lumbar double-segment spondylolisthesis and the changes in the sagittal fitting relationship between lumbar spine and pelvis. Methods:　A total of 67 patients with double-segment lumbar spondylolisthesis who underwent posterior decompression, reduction, circular fusion and internal fixation of the lumbar spine in the Department of Joint Trauma Surgery, First Affiliated Hospital of Hainan Medical College from January 2014 to January 2018 were retrospectively included in this study. The patient's preoperative and final follow-up for lumbar and leg pain visual analogue scale (VAS) and lumbar spine dysfunction Oswestry disability index (ODI) scores were recorded, and their lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) were determined and comparatively analyzed. Results:　Twelve months after the operation, the VAS score of the patient's low back pain decreased from (5.1±0.6) points to (2.1±0.5) points, and the ODI decreased from (44.5±2.2) points to (18.6±1.0) points. The differences between the two changes were all statistically significant (P<0.001) . LL decreased from 47.3°±5.1°to 32.1°±6.0°, SS decreased from 40.3°±3.3°to 26.8°±7.5°, PT decreased from 34.5°±3.0°to 13.6°±5.0°, and PI decreased from 63.2°±8.1°to 43.3°±6.6°, with significant differences among the four parameters (P<0.001) . There was no significant correlation between LL and SS, PT and PI before operation (P>0.05) . At 12 months postoperatively, LL was positively correlated with SS (P<0.05), SS was negatively correlated with PT (P<0.05), and SS was negatively correlated with PI (P<0.05) . Conclusion:　Posterior lumbar decompression, reduction, circular fusion and internal fixation for the treatment of lumbar double-segment spondylolisthesis is beneficial to alleviate lumbar and leg pain, promote the recovery of spinal nerve function, and re store the lumbar-pelvic sagittal alignment.

Abstract:Objective:　To screen out the Hub gene and analyze its correlation with osteoporosis by sequencing the genes of MC3T3-E1 cells under continuously compressive pressures (CCP) . Methods:　MTT assay was used to detect cell proliferation and immunofluorescence assay was used to screen out the best experimental conditions. RNA was extracted by TRIzol method and sequenced. And by Mfuzz clustering, enrichment analysis, GSVA analysis, NCBI GEO database, Genecards database and molecular signatures database, the differentially expressed genes in MC3T3-E1 cells under CCP were analyzed and compared, the Hub gene was screened, and the molecular mechanism associated with osteoporosis signal pathway was compared and analyzed. Results:　The proliferation of MC3T3-E1 cells decreased significantly under CCP, and tubulin and actin inhibited significantly in the cytoskeleton of cell model groups treated with 1.0 MPa for 8 hours and 0.5 MPa for 24 hours. After comparing the blank group and the model group, 29 164 different genes were found, of which 14 489 were up-regulated and 14 675 were down-regulated. These differential genes involved 1 658 GO functions, including 1 096 GO_BP (biological process), 255 GO_CC (cell component) and 307 GO_MF (molecular function), and there were 305 signal transduction pathways regulated by differential genes in MC3T3-E1 cells under CCP. The final screened Hub genes were BTK, CSF1R, MATK, NOS1 and PDGFRB. The expression of MATK in osteoporosis was significant (P<0.05) . The areas under AUC curve corresponding to the five core genes were BTK (0.900), CSF1R (0.850), MATK (0.950), NOS1 (0.650) and PDGFRB (0.800) . According to GSVA analysis of five core genes, MATK was involved in three key signaling pathways: INFLAMMATORY-RESPONSE, HEDGEHOG-SIGNALING and KRAS-SIGNALING-DN. Conclusion:　CCP can decrease the proliferation activity of MC3T3-E1 cells, and reduce the influence of tubulin and actin in cytoskeleton. MATK may be a gene that regulates the osteogenesis of MC3T3-E1 cells under CCP, and is related to three key signal transmission pathways of osteoporosis.

Abstract:Objective:　To explore the feasibility and clinical effect of laparoscopic sacrum fixation with swallow-tailed mesh in the treatment of middle and/or combined posterior pelvic cavity defects. Methods:　The clinical data of 4 patients with middle and/or combined posterior pelvic cavity defects treated by laparoscopic sacrum fixation with swallow-tailed mesh in Chongqing Health Center for Women and Children in 2019 were analyzed retrospectively. In this study, self-made mesh and self-designed puncture cone were used to complete the operation. Results:　Four patients were diagnosed as middle pelvic cavity combined with posterior pelvic defects, including 3 cases of uterine prolapse with vaginal posterior wall expansion, and 1 case of vaginal vault prolapse with enterocele. All patients received swallow-tailed sacrum fixation and successfully suffered from the operation, without auxiliary vaginal repairment and conversion to open abdomen, and no complications of intestinal tube and other organ damage during the operation. The average time of operation was 166 min, and the average amount of bleeding was 68 mL. All the patients were discharged smoothly 5-6 days after operation. According to the follow-up, ultrasound showed that the pelvic organs were in normal position, the mesh coverage was flat, the rectal and vaginal examination mesh was flat without tension, and the posterior wall of the vagina was soft without swelling. Conclusion:　The swallow-tailed sacrum fixation can repair and strengthen the levelⅠdefects as well as the levelⅡandⅢdefects, which is an effective method for the treatment of the middle pelvic cavity defects and the combination of the middle and the posterior pelvic cavity defects, and is also suitable for the diagnosis and treatment of the posterior pelvic cavity defects.

Abstract:Objective:　To explore whether intrathecal injection of tropisetron alleviates chronic neuropathic pain and p38 mitogen-activated protein kinase (p38MAPK) expression in rats with spared nerve injury (SNI) by activating alpha 7 nicotinic acetylcholine receptor (α7nAChR) . Methods:　Adult male SD rats weighing 180-220 g were randomly divided into 5 groups (n=12/each group): sham operation group, nerve injury group, tropisetron group, α7nAChR antagonist methyllycaconitine citrate group (MLA group), and MLA+tropisetron group. The right sciatic nerve was exposed only in the sham operation group, and the right sciatic nerve injury models were made in the nerve injury group, tropisetron group, MLA group and MLA+tropisetron group. On the 14th day after the establishment of the pain model, the drugs were administered intrathecally, and the pain behavior was observed and tested at different time. One hour after administration, the rats were sacrificed and the L4-6 segments of spinal cord were removed. The distribution and expression of α 7nAChR in spinal dorsal horn were observed by tissue immunofluorescence staining. Western blot was used to detect the changes of α7nAChR, p-p38 and p38 protein expression. Results:　The paw mechanical withdrawal threshold (PMWT) and paw thermal withdrawal latency (PTWL) in tropisetron group and MLA+tropisetron group were significantly higher than those before administration, and that in MLA+tropisetron group was lower than that in tropisetron group. There was no significant change in PMWT and PTWL in MLA group before and after administration. The immunofluorescence results of α7nAChR showed that the positive area in the nerve injury group was significantly lower than that in the sham operation group. The positive staining in tropisetron group and MLA+tropisetron group was significantly higher than that in nerve injury group. Western blot results showed that the expression of α 7nAChR in tropisetron group and MLA+tropisetron group was significantly higher than that in nerve injury group, while the expression level of p-p38 protein in tropisetron group was significantly lower than that in nerve injury group. There was no significant difference in the expression level of p38 protein among all groups. Conclusion:　Intrathecal injection of tropisetron can relieve chronic neuropathic pain in SNI rats, and α7nAChR antagonist MLA can block its pain-relieving effect to some extent. The mechanism may be related to the selective activation of α7nAChR and inhibition of p38MAPK signal pathway by tropisetron.

Abstract:Objective:　To analyze the biological processes and signal pathways of differential genes related to ferroptosis in the liver of ApoE^-/-hyperlipidemic mice, to construct a molecular regulatory network of liver ferroptosis, and to reveal the pathogenesis of hyperlipidemia at the transcriptional level. Methods:　This study selected 7 C57BL/6J mice as control group and 7 ApoE^-/-mice as model group. The control group and model group were fed with normal diet and high-fat diet respectively. After 16 weeks, the serum levels of triglyceride (TG), cholesterol (TC), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were detected, and the liver samples were analyzed by HE staining and transcriptome analysis. The distribution of ferroptosis-related differential genes was analyzed by Graph-Pad Prism 8.0.2 software. The protein-protein interaction network model was constructed by STRING11.0 platform. GO biological function enrichment and KEGG pathway enrichment were carried out in DAVID database. The ClueGO plug-in of Cytoscape was used to visually analyze the function and metabolic pathway of ferroptosis-related differential genes. Results:　Compared with the control group, TG (1.19±0.09), TC (2.31±0.15), LDL-C (0.29±0.05), HDL-C (1.68±0.06), the levels of TG (1.75±0.08), TC (38.80±4.03), LDL-C (36.27±3.80) in the model group significantly increased (P=0.000, 0.000, 0.000), and the level of HDL-C (1.26±0.05) significantly decreased (P=0.000) . The results of HE staining showed that compared with the control group, the swelling and degeneration of hepatocytes in the model group was obvious and accompanied by a large number of fat vacuoles. Three differential genes of ferroptosis, IREB2 (iron-responsive element-binding protein 2), FTL (ferritin light chain), and FTH1 (ferritin heavy chain 1), were screened by liver transcriptome analysis and calibrated in liver differential genes by PPI network analysis. A total of 23 ferroptosis related genes were screened, including6up-regulatedgenesand20down-regulated genes. Network relationship analysis showed that ferroptosis-related differential gene proteins were interrelated and regulated with each other. Through DAVID database, 36 biological processes and 5 signaling pathways participating in ferroptosis were screened out. Conclusion:　It is revealed that ferroptosis in liver tissue can regulate hyperlipidemia through multi-processes and multi-pathways, and high fat can promote the occurrence of ferroptosis, which provides a reference basis for revealing the pathogenesis of hyperlipidemia at the transcriptional level.

Abstract:Objective:　To investigate the effect of circular RNA hsa_circ_0002185 on cell viability and invasion of breast cancer cells and its mechanism of action. Methods:　Totally 20 pairs of breast cancer tissues and adjacent tissues were collected from the patients who were treated by radical operation in General Hospital of Ningxia Medical University from January 2018 to January 2020, and the mRNA expression levels of hsa_circ_0002185 and hsa-miR-1248 in human mammary epithelial cells (MCF10A) and human breast cancer cells (MCF-7, T47D, BT-474 and SK-BR-3) were detected by qRT-PCR. The T47D siCirc (hsa_circ_0002185 silencing) and T47D-NC (empty vector control) cell lines were constructed by lentivirus infection. The expression of hsa_circ_0002185 mRNA was detected by qRT-PCR with T47D as blank control. CCK-8 cell viability test, scratch test and Transwell test were used to detect the proliferation, migration and invasion ability of hsa_circ_0002185 to T47D cells. Immunofluorescence assay was used to detect the expression of E-cadherin and Vimentin. Bioinformatics website Circular RNA Interactome was used to predict the complementary miRNA of hsa_circ_0002185, and then the corresponding miRNA targeted binding genes were predicted according to Targetscan website. The expression of MAPK/ERK signal protein and E-cadherin and Vimentin was detected by Western blot. The recovery ex periment was carried out by down-regulation of hsa-miR-1248 to verify the effect of hsa_circ_0002185 on T47D cells. Results:　The expression of hsa_circ_0002185 in four kinds of human breast cancer cells was higher than that in MCF10A cells, and the mRNA expression level in breast cancer tissues was higher than that in normal tissues. The expression level of hsa-miR-1248 was opposite. Compared with the blank control cell line and T47D-NC cell line, T47D-siCirc cell line significantly decreased cell viability, migration and invasion ability, increased E-cadherin expression and decreased Vimentin (P<0.05) . The results of Circular RNA Interactome website prediction showed that hsa_circ_0002185 could combine with hsa-miR-1248, and Targetscan website prediction analysis showed that hsa-miR-1248 and Raf1 had targeted binding sites. Western blot analysis showed that the expression of hsa-miR-1248 in T47D-siCirc group were significantly higher than that in blank control group and T47D-NC group, and Raf1, P-MEK1/2, MEK1/2, P-ERK1/2 and ERK1/2 in T47D-siCirc group were significantly lower than those in blank control group and T47D-NC group (P<0.05) . There was no significant difference in above indexes between the blank control group and T47D-NC group (P>0.05) . The reversion experiment showed that down-regulation of hsa-miR-1248 could reverse the effect of hsa_circ_0002185 silence on T47D cells. Conclusion:　Circular RNA hsa_circ_0002185 is highly expressed in breast cancer. Overexpression of hsa_circ_0002185 may up-regulate Raf1 level by regulating hsa-miR-1248, thus activating MAPK/ERK signaling pathway and promoting the process of epithelial mesenchymal transition.

Abstract:Objective:　To investigate the value of XRCC1 gene DNA methylation in predicting the efficacy of oxaliplatin-based adjuvant chemotherapy in patients with gastric cancer. Methods:　A total of 116 patients with gastric cancer received at least 6 cycles of combination chemotherapy of oxaliplatin and fluorouracil. Bisulfite sequencing was used to analyze the methylation of XRCC1 gene in gastric cancer surgical specimens, and the correlation with the efficacy of chemotherapy in patients with gastric cancer were also analyzed. Results:　There was no statistically significant difference in the average methylation rates of XRCC1 gene among gastric cancer patients with different gender, age, lymph node metastasis, tumor diameters, differentiation, and whether they received adjuvant chemotherapy (P>0.05) . The average survival time of gastric cancer patients receiving chemotherapy and not receiving chemotherapy were (42.82±3.57) months and (25.68±4.90) months, respectively. The survival time of gastric cancer patients receiving chemotherapy was longer (χ²=7.208, P=0.007) . The average methylation rate of chemotherapy effective group was 51.60%, and that of chemotherapy ineffective group was 38.31%, with significant differences between the two groups (P<0.05) . Conclusion:　The DNA methylation rate of XRCC1 gene is positively correlated with the sensitivity of oxaliplatin, which is a potential molecular marker to predict the efficacy and prognosis of chemotherapy in patients with gastric cancer.

Abstract:Objective:　To investigate the clinical value of single-wire suspension in laparoscopic pyeloplasty in children. Methods:　A total of 14 cases of laparoscopic pyeloplasty in children were collected from Huai'an Maternal and Child Health Care Hospital from January 2019 to June 2021, including 9 males and 5 females. Age ranged from 2 months and 13 days to 8 years and 7 months, with mean age of 2 years and 9 months. There were 11 cases on the left and 3 cases on the right. Preoperative routine examination of all the children showed no obvious abnormalities, and the diagnosis was confirmed by intravenous urography (IVU) and magnetic resonance urography (MRU) . During the operation, the renal pelvis and ureter were cut out by single-wire suspension method under laparoscope, and then fine pyelo-ureter tension-free anastomosis was performed. Combined with the results of urine examination and ultrasound examination, individualized follow-up plan was formulated. Results:　All the 14 cases had successful operation, and all underwent primary anastomosis. No case was transferred and opened, and no blood transfusion occurred. The operation time was 110-155 min, and the average operation time was 140 min. Intraoperative bleeding of 4-8 mL mainly occurred during the cutting of the renal pelvis and ureter. Abdominal drainage tube was removed 3-7 days after surgery, and catheter was removed 7-20 days after surgery. After 6-8 weeks, the double J tubes were removed under cystoscopy. After 6-12 months of follow-up, 14 patients showed progressive reduction of anterior and posterior renal pelvis diameter and gradual retraction of renal pelvis and calyces. No anastomotic stenosis, urine extravasation, recurrent hydronephrosis, urinary tract infection and other complications. Conclusion:　Laparoscopic pyeloplasty in children by single-wire suspension method is convenient for accurate anastomosis of renal pelvis and ureter. It is a simple, safe and effective surgical method, which is worthy of clinical promotion.

Abstract:Objective:　To investigate the effect of individualized pulmonary protective ventilation on general anesthesia pulmonary ventilation in patients undergoing craniocerebral surgery. Methods:　Fifty-four patients admitted to Huzhou Central Hospital for craniocerebral surgery from July 2018 to July 2019 were selected as the study objects. They were divided into the conventional group (n=27) and the individualized group (n=27) randomly. The conventional group was given traditional volumetric control mechanical ventilation, and the individualized group was given individualized pulmonary protective ventilation by positive end expiratory pressure (PEEP) . Blood gas analysis, mean arterial pressure, pulmonary dynamic compliance and airway platform pressure were detected and compared before anesthesia induction (T₀), after skin incision (T₁), mechanical ventilation for 1 h (T₂), for 2 h (T₃), and tracheal extubation for 30 min (T₄), and chest CT one day after surgery and the occurrence of pulmonary complications within seven days after surgery were recorded. Results:　Compared with the conventional group, the oxygenation index at T₁, T₂and T₃and the lung dynamic compliance in the individualized group were significantly higher (P<0.05) . At the same time, the airway platform pressure at T₁, T₂and T₃was significantly lower than that in the conventional group (P<0.05) . Conclusion:　Compared with conventional ventilation, individualized pulmonary protective ventilation can improve the intraoperative oxygenation index and dynamic compliance of lung, and reduce the airway platform pressure during mechanical ventilation, which is safe and effective.

Abstract:Objective:　To evaluate the incidence of malignant pericardial effusion (MPCE) and its prognostic risk factors at presentation in patients with small-cell lung cancer (SCLC) . Methods:　This study retrospectively analyzed the clinical data of SCLC patients from the SEER (Surveillance, Epidemiology, and End Results) database between 2004 and 2015. The Kaplan-Meier method and log-rank test were used to estimate the overall survival (OS) and the Cox proportional hazard model was used to assess whether MPCE was an independent risk factor for prognosis. Then we used univariate and multivariate analyses to explore the independent prognostic factors of SCLC with MPCE. Results:　Among the 74 125 patients with SCLC, MPCE was present in 1 694 (2.29%) cases. The probability of MPCE was higher in female patients with larger tumors and higher lymph node stages at presentation. Compared with patients without MPCE, the OS in patients with MPCE was significantly worse (median survival time: 3 months vs.7 months; estimated 1-year OS: 16.50% vs. 29.53%; 2-year OS: 7.67% vs.13.19%; P<0.001) . Multivariate analysis showed MPCE was also an independent factor for poor prognosis of SCLC (HR=1.41, 95% CI=1.34-1.48; P<0.001) . In 1 694 cases of SCLC with MPCE, multivariate analysis showed that age, gender, N stage, radiotherapy and chemotherapy were independent prognostic factors. Conclusion:　SCLC patients with MPCE are rare (2.29%) with poor OS, and the patients with younger age at diagnosis, female and lower N stage have a better prognosis. Radiotherapy and chemotherapy can significantly improve the prognosis of the patients.

Abstract:Objective:　To investigate the correlation between clinical basic blood biochemical results and endoscopic findings in children with Crohn's disease (CD), and to evaluate the predictive effect of the main positive blood biochemical results on endoscopic scores to guide clinical diagnosis, treatment and follow-up. Methods:　A retrospective analysis was conducted among 41 CD children diagnosed in Children's Hospital of Chongqing Medical University from January 2012 to April 2019. According to the pediatric Crohn's disease activity index (PCDAI) for clinical severity scoring, they were divided into mild activity group (mild group, n=17) and moderate-severe activity group (moderate-severe group, n=24) . The general conditions, major clinical manifestations, blood biochemical indicators, lesion locations, simplified endoscopic activity score for Crohn's disease (SES-CD) of the two groups of children, and typical endoscopic and pathological manifestations were analyzed, and through receiver operating characteristic (ROC) curve and related analysis, the main positive blood biochemical indicators were also analyzed for the predictive efficacy of SES-CD. Results:　Through the analysis of the major clinical manifestations, it was found that children in the moderate-severe group had a higher rate of weight loss than children in the mild group, and the difference was statistically significant (P=0.005) . Red blood cell (RBC), hemoglobin (Hb), albumin (ALB), platelet (PLT), erythrocyte sedimentation rate (ESR) and SES-CD were significantly different between the two groups (P<0.05) . In the moderate-severe group, RBC, Hb and ALB nutritional indicators were significantly lower than those in the mild group (3.91±0.15 vs.4.38±0.13, P=0.027; 91.33±3.67 vs.107.00±3.61, P=0.005; 33.00±1.27 vs.37.54±1.37, P=0.022, respectively), PLT and ESR system inflammation index were significantly higher than those in the mild group (492.80±27.10 vs.387.60±31.56, P=0.016; 78.38±7.39 vs.44.47±5.95, P=0.002), and the SES-CD score was significantly higher than that of the mild group (19.50±0.79 vs.11.71±1.09, P<0.001) . According to the analysis of lesion location, the proportion of lesions in the colon (21/24 vs.9/17, P=0.035) and rectum (23/24 vs.10/17, P=0.011) in the moderate-severe group was higher than that in the mild group; while in terms of the typical endoscopic performance of the two groups, the moderate-severe group had higher proportions of ulcerative performance (24/24 vs.15/17) and proliferative performance (17/24 vs.1/17) than the mild group. ROC curve diagnostic efficiency analysis found that the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PCDAI in predicting endoscopic activity reached up to 100%, the sensitivity and NPV of PLT in predicting SES-CD were 100% and 66.67% respectively, while ESR in predicting SES-CD specificity and PPV were 76.47% and 81.82%, respectively. Spearman correlation coefficient analysis showed that SES-CD had a moderate relationship with PCDAI and Hb, and a mild relationship with ESR, RBC and ALB. Conclusion:　ESR in the blood biochemical indexes of CD children have a certain correlation with SES-CD and the predictive efficiency of endoscopy, which should be paid more attention to in clinical follow-up and disease monitoring.

Abstract:Objective:　To discuss the effect of less invasive surfactant administration (LISA) and intubation surfactant exudation (INSURE) to inject pulmonary surfactant (PS) on respiratory distress syndrome in infants with very low birth weight. Methods:　A total of 110 cases of very low birth weight infants with respiratory distress syndrome admitted to NICU (neonatal intensive care unit) of Children's Hospital of Chongqing Medical University from February 2018 to March 2020 were selected as the research objects, and they were divided into control group and observation group according to the single and double numbers of hospitalization number. Among them, 56 cases in control group applied INSURE technique, and 54 cases in observation group applied LISA technique. The differences of one-time success of intubation, medication reflux, PS medication reuse rate, 72 h mechanical ventilation rate, mechanical ventilation time, continuous positive airway pressure (CPAP) duration, oxygen time, hospitalization time and hospitalization expenses between the two groups were analyzed retrospectively. Results:　In this technique operation, one-time success rate of intubation in the observation group was higher than that in the control group［98.15% (53/54) vs.85.71% (48/56), P=0.042］. In the course of treatment, the average of fraction of inspiration O₂ (FiO₂), incidence of bradycardia, and rate of re-tracheal intubation within 72 hours in observation group were lower than those in control group, with significant differences (P<0.05) . The utilization rate of mechanical ventilation in control group was higher than that in observation group ［30.36% (17/56) vs.12.96% (7/54), P=0.027］. The average hospitalization expenses in control group［ (99 720.23±37 356.95) yuan］were higher than those in observation group［ (85 630.83±34 110.20) yuan］, with significant differences (P=0.041) . Conclusion:　The LISA technique is superior to INSURE technique in the treatment of respiratory distress syndrome in very low weight infants.

Abstract:Objective:　To compare the effectiveness and safety of rigid and soft bronchoscope in the treatment of bronchial foreign bodies in children. Methods:　A total of 240 children with bronchial foreign bodies were admitted to the Children's Hospital of Chongqing Medical University from September 2019 to September 2021. They were divided into rigid bronchoscope group (140 cases) and soft bronchoscope group (100 cases), and the success rate, operation time, oxygen saturation during operation, anesthesia methods, anesthesia time, hospitalization time and adverse reactions were compared. Results:　Compared with rigid bronchoscopy, soft bronchoscopy had a shorter anesthesia time, higher oxygen saturation, but longer operation time (P<0.05) . There was no significant difference in the success rate, anesthesia methods, hospitalization time and total adverse reactions (P>0.05) . Conclusion:　Both rigid and soft bronchoscope can effectively remove bronchial foreign bodies in children, and both have their own advantages and disadvantages. The effectiveness and safety need to be further explored.

Abstract:Objective:　To evaluate peripheral blood cells count［white blood cell (WBC), lymphocyte absolute value, platelet (PLT) ］and their related ratios (i.e. neutrophil to lymphocyte ratio, NLR; lymphocyte to monocyte ratio, LMR; platelet to lymphocyte ratio, PLR; platelet count to mean platelet volume ratio, PLT/MPV) in predicting the severity of respiratory infections in patients with pertussis. Methods:　The data of 1 129 patients with pertussis were analyzed retrospectively, and the differences of WBC, PLT, NLR, PLR, LMR and PLT/MPV in peripheral blood were evaluated statistically in different respiratory tract infection groups. Results:　A total of 1 129 patients were included in the study. There were statistically significant differences in WBC count levels between the severe pneumonia group and the three non-severe pneumonia groups (the upper respiratory tract infection group, the bronchitis group, and the pneumonia group) (P=0.000, 0.041, 0.000) . The WBC count level in the severe pneumonia group was significantly higher than that in the three non-severe pneumonia groups. The higher the WBC count, the more likely it was to develop severe pneumonia, suggesting that the WBC count of peripheral blood cells can be used as an index to predict severe pneumonia and non-severe pneumonia. There were significant differences in NLR between the severe pneumonia group and the three non-severe pneumonia groups respectively (P=0.000, 0.014, 0.037), between the pneumonia group and the non-pneumonia group (P=0.043) . The NLR of the severe pneumonia group was significantly higher than that of the three non-severe pneumonia groups, and the NLR of the pneumonia group was significantly higher than that of the non-pneumonia group, indicating that the NLR increased with the severity increasing of respiratory tract infection. Especially when severe pneumonia occurred, NLR was significantly higher than the three non-severe pneumonia groups. NLR is an effective index to predict the severity of respiratory tract infection. The higher the NLR, the more severe the respiratory tract infection could be. LMR was statistically higher in the upper respiratory tract infection group than the other three groups (P=0.001, 0.000, 0.001) . The statistics found that the more severe the respiratory tract infection, the lower the LMR, which may be one of the indicators to predict the severity of respiratory tract infection. In addition to the above three indicators, the lymphocytes absolute value, PLT, and PLT/MPV had limited roles in predicting the severity of different respiratory tract infections. Conclusion:　WBC and NLR are good independent predictors of severe pneumonia. NLR has a role in predicting pneumonia. The larger the WBC or NLR, the higher the probability of predicting severe pneumonia and the more serious the respiratory infection being.

Abstract:Objective:　To analyze the cases who were given amikacin intravenously in the neonatal ward of Children's Hospital of Chongqing Medical University and to summarize the etiological basis, dose, efficacy, ototoxicity, and nephrotoxicity of amikacin for providing guidance for clinical medication of amikacin. Methods:　A retrospective study described the clinical features of 104 neonates with amikacin intravenously admitted to the Neonatal Ward of the Children's Hospital of Chongqing Medical University from January 2013 to December 2018, including general information, etiological examination results, main diagnosis, amikacin usage, renal function, and telephone follow-up of their hearing situation after discharge. Results:　Totally 104 neonates given amikacin intravenously were included in this study, with an average gestational age of (32±4) weeks, and a median birth weight of 1 395.00 (1 131.25, 2 190.00) g. Bloodstream infections, respiratory tract infections, intestinal infections, and intracranial infections were the main infection sites of patients treated with amikacin. Most of them had pathogenic evidence, including blood culture, sputum culture, urine culture, secretion culture, etc. The culture results were mainly multidrug-resistant Klebsiella pneumoniae and Escherichia coli. The average dose of amikacin was (14.97±1.94) mg/ (kg·d), and the average administration duration was (9.42±5.06) days. A total of 68 cases (65.4%) showed improvement in inflammation and clinical symptoms after treatment with amikacin. The renal function was monitored in use, and multivariate logistic regression analy sis was used. The results showed that there was no significant correlation between amikacin-related exposure variables and the occurrence of acute kidney injury. After discharge, the children's hearing situation was followed up. Only one case failed the hearing test and cochlear implantation was recommended. The remaining children had no abnormal hearing in life. Conclusion:　Amikacin is mostly used in neonatal wards for patients with multi-drug resistant gram-negative bacteria infection. The dosage using, duration and frequency of amikacin are different according to the disease situation of the neonates. The plasma concentration should be monitored to ensure that trough concentration and peak concentration are within the safe range. In addition, in terms of nephrotoxicity, there is no significant correlation between amikacin-related exposure variables and the occurrence of acute kidney injury.

Abstract:Objective:　To evaluate the variability index of internal jugular vena cava (VJVC) and variability index of inferior vena cava (VIVC) through ultrasound in predicting fluid responsiveness in adult petients with cardiosurgery. Methods:　Prospectively, 76 adult pa tients who had cardiosurgery in the Department of Cardiovascular Surgery, Chongqing General Hospital were collected in the study, and the passive leg raising (PLR) tests were carried out on them of intensive monitoring in the intensive care unit (ICU) ward. Patients with elevated cardiac output index≥10% after PLR were included in the fluid responders (FR) group, while patients with elevated cardiac output index<10% were included in the fluid unresponders (FN) group. Meanwhile, the hemodynamic parameters of heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure were all recorded before and after PLR tests in both groups. The N-terminal pro-brain natriuretic peptide (NT-proBNP), VJVC, and VIVC were recorded before PLR tests. Results:　After PLR tests, in FR group, there were no significant differences in central venous pressure［ (7.6±1.9) mmHg vs. (10.1±11.4) mmHg, P=0.154］; there were significant differences in heart rate［ (83.0±8.9) bpm vs. (75.3±7.5) bpm, P=0.000］, systolic blood pressure［ (91.1±9.4) mmHg vs. (94.9±9.1) mmHg, P=0.000］, diastolic blood pressure［ (52.8±9.8) mmHg vs. (58.9±8.2) mmHg, P=0.000］, and mean blood pressure［ (65.6±9.2) mmHg vs. (70.7±8.0) mmHg, P=0.000］. In FN group after PLR, there were no significant differences in systolic blood pressure［ (90.0±7.4) mmHg vs. (92.3±6.7) mmHg, P=0.076］, and there were significant differences in heart rate［ (83.5±9.1) bpm vs. (80.7±7.4) bpm, P=0.005］, diastolic blood pressure［ (50.0±7.1) mmHg vs. (55.2±5.7) mmHg, P=0.000］, mean blood pressure［ (63.3±6.8) mmHg vs. (67.6±5.0) mmHg, P=0.000］, and central venous pressure［ (7.9±1.6) mmHg vs. (10.2±1.4) mmHg, P=0.000］. There were no significant differences in heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure and central venous pressure between FR goup and FN group before PLR tests. After PLR, there were no significant differences in systolic pressure［ (94.9±9.1) mmHg vs. (92.3±6.7) mmHg, P=0.075］and central venous pressure［ (10.1±11.4) mmHg vs. (10.2±1.4) mmHg, P=0.474］between the two groups, and there were significant differences in heart rate［ (75.3±7.5) bpm vs. (80.7±7.4) bpm, P=0.001］, diastolic blood pressure［ (58.9±8.2) mmHg vs. (55.2±5.7) mmHg, P=0.014］, and mean blood pressure［ (70.7±8.0) mmHg vs. (67.6±5.0) mmHg, P=0.024］. In addition, There was no significant difference in plasma NT-proBNP between the two groups［ (1 144.6±992.1) pg/mL vs. (1 243.6±1095.0) pg/mL, P=0.335］, and there were significant differences in VIVC［ (15.2±3.9) % vs. (12.5±4.2) %, P=0.003］and VJVC［ (17.7±4.3) % vs. (13.9±4.0) %, P=0.000］. The cutoff value of VIVC diagnostic capacity was 11.5%, the sensitivity was 87.8%, and the specificity was 55% (AUC=0.7, 95% CI=0.575-0.826, P=0.003) . The cutoff value of VJVC diagnostic capacity was 15.5%, the sensitivity was 68.3%, and the specificity was 77.1% (AUC=0.764, 95% CI=0.654-0.874, P=0.000) . Conclusion:　VIVC and VJVC can easily predict the noninvasive parameter of fuid responsiveness in patients with cardiosurgery and accurately guide the clinical rehydration therapy. Moreover, the internal jugular vein is easier to measure than the inferior vena cava, its position is shallower and more constant, and it is not affected by the obesity of patients, abdominal pressure and drainage tube after cardiosurgery, so the repeatability is better. It is more recommended to use the VJVC to evaluate the fluid responsiveness after cardiosurgery in clinical work.

Abstract:Objective:　To describe the prevalence of diabetes in the Bai nationality of Heqing, Dali, and to analyze the influencing factors of diabetes. Methods:　A multistage and stratified cluster sampling method was used to obtain samples from all residents of aged 30-79 in Xintun Town and Caohai Town of Heqing County, Dali Bai Autonomous prefecture, and a total of 6 167 people were eventually included in the study. Questionnaire surveys, physical examinations and laboratory examinations were carried out on the study subjects. The prevalence of diabetes between different ages and genders was described and related influencing factors were analyzed. Results:　①The overall prevalence of diabetes in the natural population of Bai nationality in Dali, Yunnan, was 8.9%, 12.9% for men and 7.2% for women. The prevalence of diabetes in men was higher than that in women (P<0.001) . The prevalence of men and women increased with age.②The awareness rate of diabetes in the natural population of Bai nationality in Dali, Yunnan was 40.4%, the treatment rate was 35.3%, and the control rate was 44.6%. ③Multivariate logistic regression analysis showed that venerable age, high annual family income, high BMI, central obesity, and dyslipidemia were independent risk factors for diabetes, and women and diary fan consumption were protective factors. Conclusion:　The prevalence of diabetes in the natural population of Bai nationality in Dali is 8.9%, and the prevalence of diabetes in men is higher than that in women. In the study, the diabetes awareness rate of the population is only 40.4%, which is still low. It is still necessary to strengthen the popularization of diabetes knowledge. Obesity, central obesity, hypertension, hyperlipidemia, etc. are re lated influencing factors of diabetes, and attention to diet and weight control should be paid to.

Abstract: