BACKGROUND:In this study, we intend to retrospectively analyze the clinical data of postoperative neuroblastoma children, including the results of follow-up examinations and laboratory tests, to explore the clinical value of combined serum Carbohydrate antigen 125 (CA125), neuron-specific enolase (NSE) and 24-hour urine vanillylmandelic acid (VMA) levels at baseline for the prediction of recurrence in children with neuroblastoma.METHODS:265 children with neuroblastoma were successfully followed up, including 163 cases without recurrence (non-recurrence group) and 102 cases with recurrence (recurrence group). The levels of 24-hour urine VMA were determined using spectrophotometric methods. Additionally, the serum levels of CA125 and NSE were measured using electrochemiluminescence immunoassay.RESULTS:The serum CA125, NSE and 24-hour urine VMA levels were significantly higher in the recurrence group than in the non-recurrence group. It demonstrated a significant positive correlation between the levels of serum CA125, NSE, and 24-hour urine VMA in all children with neuroblastoma. All children in stage IV of neuroblastoma had the highest level of serum CA125, NSE and 24-hour urine VMA and vice versa. The combined CA125, NSE and VMA had significantly better sensitivity and specificity than an individual marker.CONCLUSIONS:Combined serum CA125, NSE and 24-hour urine VMA had the potential to predict neuroblastoma recurrence more effectively.

Objective:To evaluate the role of transient receptor potential vanillic acid 4 (TRPV4) in dexmedetomidine-induced improvement in cognitive function in mice with mechanical ventilator-caused brain injury.Methods:Ninety clean-grade healthy male C57BL6 mice, weighing 20-25 g, aged 8-12 weeks, were divided into 5 groups ( n=18 each) using a random number table method: control group (group C), mechanical ventilation group (group V), HC-067047 group (group H), dexmedetomidine group (group D), and dexmedetomidine+ GSK1016790A group (group DG). In group C, the animals breathed air spontaneously for 6 h without mechanical ventilation. In group V, the animals were mechanically ventilated for 6 h. In group H, TRPV4 blocker HC-067047 10 mmol was injected into the cerebral ventricle at 3 and 6 h of mechanical ventilation. In D and DG groups, dexmedetomidine 50 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation. In group DG, TRPV4 agonist GSK1016790A 5 μmol was injected into the cerebral ventricle at 60 min before mechanical ventilation. Morris water maze test was performed on 6 mice in each group at 1 day before mechanical ventilation and 3 and 7 days after mechanical ventilation. Six mice in each group were randomly selected and sacrificed at 1 day after mechanical ventilation, and the brain tissue was taken for determination of the neuronal apoptosis in hippocampal CA1 area by TUNEL method, and the apoptosis index was calculated. Six mice in each group were randomly selected and sacrificed at 1 day after mechanical ventilation, and the hippocampal tissues were taken for determination of the expression of TRPV4, serine-threonine protein kinase (Akt), phosphorylated Akt (p-Akt), Bcl-2, Bax and caspase-3 by Western blot. Results:Compared with group C, the escape latency was significantly prolonged and the number of crossing the original platform was reduced at 3 and 7 days after mechanical ventilation, the expression of TRPV4 and caspase-3 was up-regulated, the ratio of Bcl-2/Bax was decreased, and the apoptosis index of neurons was increased in group V and group DG ( P<0.05). Compared with group V, the escape latency was significantly shortened and the number of crossing the original platform was increased at 3 and 7 days after mechanical ventilation, the expression of TRPV4 and caspase-3 was down-regulated, the expression of p-Akt was up-regulated, the ratio of Bcl-2/Bax was increased, and the apoptosis index of neurons was decreased in group D and group H ( P<0.05). Compared with group D, the escape latency was significantly prolonged at 3 and 7 days after mechanical ventilation, the number of crossing the original platform was reduced, the expression of TRPV4 and caspase-3 was up-regulated, the expression of p-Akt was down-regulated, the ratio of Bcl-2/Bax was decreased, and the apoptosis index of neurons was increased in group DG ( P<0.05). Conclusions:TRPV 4 is involved in dexmedetomidine-induced improvement in cognitive function, which is related to up-regulation of p-Akt expression and inhibition of apoptosis in hippocampal neurons in mice with mechanical ventilation-caused brain injury.

Objective:To investigate the effect of baicalin on cognitive function of mice with brain injury induced by mechanical ventilation and its mechanism.Methods:Seventy two C57BL6 mice, weighing 20-25 g, aged 8-12 weeks, were randomly divided into control group (group C), mechanical ventilation group (group V), baicalin group (group B), baicalin+ Akt inhibitor MK-2206 group (group BM) according to random number table method, with 18 in each group.Mice in group C did not have mechanical ventilation and breathed air independently for 6 hours.Mice in group V received mechanical ventilation for 6 hours.Mice in group B and group BM were intraperitoneally injected with baicalin 100 mg/kg 30 minutes before mechanical ventilation, and mice in group BM were injected intraventricular with Akt inhibitor MK-2206 300 μg/kg 60 minutes before mechanical ventilation.Six mice in each group were randomly selected to test their learning and memory abilities by Morris water maze test 1st day before mechanical ventilation and 3rd day and 7th day after mechanical ventilation.One day after mechanical ventilation, six mice in each group were killed, and the brain tissue was taken.TUNEL method was used to detect the neuronal apoptosis in hippocampal CA1 area, and the apoptosis index was calculated.One day after mechanical ventilation, six mice in each group were killed, and the hippocampus was taken, Western blot was used to detect the protein expressions of caspase-3, caspase-9, Akt, p-Akt, GSK-3β and p-GSK-3β.SPSS 22.0 software was used for statistical analysis of data, repeated measure ANOVA and one-way ANOVA were used for comparison between multiple groups.LSD- t test was used for further pairwise comparison. Results:The results of water maze test showed that the time and group interaction of the four groups were not significant ( F=1.14, P>0.05), the main effect of time and group were both significant ( F=47.36, 59.65, both P<0.05). At 3rd day and 7th day after mechanical ventilation, the escape latencies of mice in group V were higher than those in group C (both P<0.05), and the numbers of platform crossing were lower than those in group C (both P<0.05). And 3 days and 7 days after mechanical ventilation, the escape latencies of mice in group B were lower than those in group V (both P<0.05) and the numbers of platform crossing were higher than those in group V (both P<0.05). The escape latenies of mice in BM group on the 3rd and 7th day were higher than those in group B (both P<0.05), and the numbers of platform crossing were lower than those in group B on the 3rd day and 7th day after mechanical ventilation(both P<0.05). TUNEL and Western blot results showed that apoptosis index of hippocampal neurons and expression levels of apoptosis-related proteins caspase-3 and caspase-9 were significant different in the four groups ( F=51.42, 41.21, 40.19, all P<0.05). The apoptosis index of hippocampal neurons ((40.6±3.9)%), the expression levels of caspase-3 (4.93±0.92) and caspase-9 (4.81±0.88) in the hippocampus of mice in group V were higher than those in group C ((13.7±1.4)%, (1.87±0.27), (1.71±0.25), all P<0.05), the apoptosis index of hippocampal neurons ((15.6±1.6)%), the expression levels of caspase-3 (1.95±0.30) and caspase-9 (1.76±0.28) in group B were lower than those in group V ((40.6±3.9)%, (4.93±0.92), (4.81±0.88), all P<0.05), the apoptosis index of hippocampal neurons ((27.8±2.7)%), the expression levels of caspase-3 (3.58±0.61) and caspase-9 (3.49±0.57) in BM group were higher than those in group B ((15.6±1.6)%, (1.95±0.30), (1.76±0.28), all P<0.05). Expression level of p-Akt, p-GSK-3β in hippocampal tissues of the four group of mice were significantly different ( F=37.54, 43.23, both P<0.05). The expression level of p-Akt (0.51±0.06) and p-GSK-3β (0.47±0.05) of hippocampal tissues of mice in group V were lower than those of group C ((1.07±0.10), (1.11±0.12), both P<0.05), the expression level of p-Akt (0.99±0.10) and p-GSK-3β (1.08±0.09) of hippocampal tissues of mice in group B were higher than those of group V (both P<0.05), the expression level of p-Akt (0.83±0.08) and p-GSK-3β (0.81±0.07) of hippocampal tissues of mice in group BM were lower than those in group B (both P<0.05). Conclusion:Baicalin can improve the cognitive function of mice with brain injury induced by mechanical ventilation, which is related with activation of Akt/GSK-3β signaling pathway and inhibition of hippocampal neuron apoptosis.

Background:Neuroblastoma (NB) is a common extracranial malignancy in children and accounts for 15% of all cancer-related deaths in children, with the 5-year survival of patients in an advanced stage being lower than 40%. Preoperative adjuvant chemotherapy has been reported to facilitate surgical resection and improve the 2-year survival of patients. Objective:To analyze the efficacy of surgery plus different chemotherapy on children with NB and to investigate the correlation of matrix metalloproteinase-9 (MMP-9) and tissue inhibitors of metalloproteinase-1 (TIMP-1) with chemotherapy efficacy. Methods:From April 2005 to May 2017, a total of 92 cases of NB treated in our hospital were assessed for eligibility and recruited. They were assigned at a ratio of 1: 1 to receive either CAV (cyclophosphamide + vincristine + adriamycin) (group A) and EP (etoposide + cisplatin) alternately or TOPO (topotecan) + CTX (cytoxan) + CiE (etoposide + cisplatin) + CPV (cyclophosphamide + pirarubicin + vincristine) (group B). The outcome measures include chemotherapy efficacy, surgical resection rates, complications, 2-year recurrence, and 2-year survival. The levels of NK cells, CD4+/CD8+ cells, MMP-9, TIMP-1, and urine catecholamine (VMA) in peripheral blood of patients before and after initial chemotherapy were determined to analyze the correlation of MMP-9, TIMP-1, and VMA with the efficacy of chemotherapy. Results:The two groups had similar efficacy (84.00% vs. 95.24%) and surgical resection rates (60.00% vs. 61.90%) after the initial chemotherapy (P > 0.05). Surgery for all eligible patients was successful after second chemotherapy. All eligible patients showed myelosuppression after chemotherapy, including 48 cases with stages I-II (52.17%) and 44 cases with stages III-IV (47.83%). The ratio of CD4+/CD8+ cells, MMP-9, TIMP-1, and VMA expression levels in peripheral blood of patients decreased (P < 0.05) after chemotherapy, and the ratio of CD4+/CD8+ cells was further reduced after surgery (P < 0.05), while natural killer (NK) cells levels increased (P < 0.05). However, intergroup differences were absent in the incidence of myelosuppression, CD4+/CD8+ cell ratio, NK cells, MMP-9, TIMP-1, and VMA expression levels (P > 0.05). MMP-9 and TIMP-1 were positively correlated with VMA (P < 0.05), and the expression levels of MMP-9 and TIMP-1 and VMA after chemotherapy were negatively correlated with chemotherapy efficiency (P < 0.05). Patients with high expressions of MMP-9, TIMP-1, and VMA were associated with lower 2-year survival versus those with low expressions (P < 0.05). Conclusion:Surgery plus chemotherapy for children with NB yields a promising clinical efficacy and a favorable surgical resection outcome. MMP-9 and TIMP-1 may be the potential biological indicators for chemotherapy efficiency and have a reference value for following surgical treatment of patients.

Background: Renal cancer is a common malignant tumor with an increasing incidence rate.Methods: In this study, based on the gene expression profiles, we analyzed the compositions of tumor-infiltrating immune cells (TIICs) in renal cancer and paracancerous samples using CIBERSORT. The proportions of 22 TIICs subsets in 122 paired renal carcinoma and paracancerous samples, and 224 Wilms tumor (WT) samples varied between intragroup and intergroup. Results: After analyzed the difference of TIICs composition between renal cancer and paired paracancerous samples, we found that M0 macrophages and CD8 T cells were significantly elevated, while naive B cells were significantly decreased in renal cancer samples compared with paracancerous samples. Survival analysis showed that high overall TIICs proportion , the low proportion of resting mast cells and the high proportion of activated memory CD4 T cells were associated with poor prognosis of renal cancer patients. In addition, 3 clusters were identified by hierarchical clustering analysis, and they presented a distinct prognosis. Cluster 1 had superior survival outcomes, while cluster 2 had an inferior survival outcome.Conclusions: Our study indicated that overall TIICs proportion, certain TIICs subset proportion, including resting mast cells and activated memory CD4 T cells, and distinct cluster patterns were associated with the prognosis of renal cancer, which was significant for the clinical surveillance and treatment of renal cancer.

目的:探讨小儿神经母细胞瘤的临床特点及手术治疗效果.方法:回顾性分析我院进行手术的37例小儿神经母细胞瘤患者临床资料,22例先进行手术切除病灶,然后进行化疗,其余15例发生转移的患儿进行术前化疗,术前化疗结束后手术切除瘤灶,术后再次行化疗,根据患者体质及耐受性决定化疗剂量及周期数.结果:根据国际神经母细胞瘤分期系统(INSS)分期,Ⅰ期7例(占18.9％),Ⅱ期8例(占21.6％),Ⅲ期7例(占18.9％),Ⅳ期14例(占37.8％),Ⅳs期1例(占2.7％).33例(占89.2％)完全切除瘤灶,剩余4例(占10.8％)进行姑息性肿瘤切除.手术并发症包括粘连性肠梗阻2例(占5.4％),腔静脉损伤1例(占2.7％).1年无瘤生存率为(31/37,83.8％),2年无瘤生存率为(28/37,75.7％),3年无瘤生存率为(24/37,64.9％).结论:小儿神经母细胞瘤手术效果良好,对于不能手术的患儿可先进行术前化疗,早诊断早治疗有利于提高预后水平.

Objective:To evaluate the effect of dexmedetomidine on the extracellular signal-regulated kinase(ERK)/sodium-potassium ATPase(Na + -K + -ATPase)signaing pathway in lung tissues of rats with mechanical ventilation-induced lung injury (VILI). Methods:Forty-eighty clean-grade male Sprague-Dawley rats, weighing 270-320 g, aged 4-5 months, were divided into 4 groups ( n=12 each) using a random number table method: control group (group C), VILI (alpha2-adrenergic receptor antagonist) group (group V), dexmedetomidine group (group D), and dexmedetomidine plus yohimbine group (group DY). Group C underwent no mechanical ventilation and breathed air spontaneously for 4 h. Mechanical ventilation (respiratory rate 40 breaths/min, tidal volume 40 ml/kg, inspiratory/expiratory ratio 1∶1, PEEP 0, fraction of inspired oxygen 21%) lasted 4 h in group V. Dexmedetomidine was infused intravenously in a dose of 5.0 μg/kg at 20 min before ventilation followed by an infusion of 5.0 μg·kg -1· h -1 throughout ventilation in group D. In group DY, yohimbine 0.1 mg/kg was injected intravenously at 10 min before dexmedetomidine, and the other treatments were similar to these previously described in group D. Blood samples and lung tissues were taken at 4 h of mechanical ventilation to determine the wet/dry weight ratio (W/D ratio), lung permeability index (LPI), alveolar fluid clearance rate (AFC), and expression of extracellular signal-regulated kinase (ERK), phosphorylated extracellular signal-regulated kinase (p-ERK), and Na + -K + -ATPase in lung tissues (by Western blot) and to observe pathological changes of lung tissues. Results:Compared with group C, LPI and W/D ratio were significantly increased, AFC was decreased, p-ERK expression was up-regulated, and Na + -K + -ATPase expression was down-regulated in group V and group DY ( P<0.05), and no significant change was found in the incidence of the parameters mentioned above in group D ( P>0.05). Compared with group V, LPI and W/D ratio were significantly decreased, AFC was increased, p-ERK expression was down-regulated, Na + -K + -ATPase expression was up-regulated ( P<0.05), and the pathological changes of lung tissues were significantly attenuated in group D, and no significant change was found in the incidence of the parameters mentioned above in group DY ( P>0.05). Compared with group D, LPI and W/D ratio were significantly increased, AFC was decreased, p-ERK expression was up-regulated, Na + -K + -ATPase expression was down-regulated ( P<0.05), and the pathological changes of lung tissues were accentuated in group DY. Conclusion:The mechanism by which dexmedetomidine alleviates VILI may be related to activating alpha2-adrenergic receptors and inhibiting ERK/Na + -K + -ATPase signaling pathway in rats.

目的:观察探讨对小儿高位直肠肛门畸形使用腹腔镜下治疗的临床效果.方法:将2018年1月-2018年12月期间在我院治疗的高位直肠肛门畸形患儿选择48例作为实验的临床研究对象,随机将所有患儿平均分成观察和对照组,归入各组24例患儿,给予观察和对照组患儿腹腔镜下肛门直肠成形术和后矢状入路肛门成形术两种治疗方式,对两组患儿的直肠肛管测压结果进行总结.结果:观察组患儿的最大肛管静息压和静息非对称指数比较对照组后的结果差异显著,P<0.05;但是肛管高压带长度没有显著的对比差异,P>0.05.结论:对该病患儿使用腹腔镜下肛门直肠成形术的疗效显著,患儿的肛门功能得到有效改善,有比较重要的临床实践意义.

先天性巨结肠症是一种比较多见的肠道畸形,是由于远端肠壁黏膜下和肌间神经丛内神经节细胞缺如或发育不良导致的常见消化道发育畸形.伴随着诊断水平的提高,发现的病例数进一步上升,手术治疗的年龄也大大提前.自smith等应用腹腔镜成功地治疗1例2岁的先天性巨结肠患儿后,不断有腹腔镜巨结肠根治术的报道.我科自2016年9月以来,行腹腔镜巨结肠根治术治疗新生儿期先天性巨结肠8例,均获成功.现报告如下.

目的 研究儿童晚期肝母细胞瘤伴肺转移52例的临床治疗疗效以及预后效果.方法 对2017年2月-2018年2月期间在河北省沧州市中心医院儿外科进行治疗的52例晚期肝母细胞瘤伴肺转移的患儿的临床资料进行回顾性分析,所有患儿均经过病理诊断确认患病,其中男性患儿30例、女性患儿22例,年龄区间2个月～14岁,平均年龄为(3.5±1.2)岁.对所有患儿的治疗疗效以及预后效果进行分析.结果 所有患儿在接受综合治疗后,完全缓解的共计20例,缓解率为38.5％;部分缓解的共计11例,治疗总有效的31例,治疗有效率为59.6％,13例患儿死亡,死亡率为25.0％.40例患儿为单纯边缘区肺转移瘤,其中12例为中心型肺转移瘤.结论 完全肝母细胞瘤肺转移较为容易出现在边缘区,并且根据观察数据显示晚期肝母细胞瘤并中心型肺转移瘤患儿的预后效果较差,早期确诊以及对患儿进行综合治疗,能够保证患儿的治疗疗效以及预后效果.

小儿急性脓胸的治疗一般为应用抗菌药物、加强营养支持、胸腔闭式引流和后期的纤维板剥脱术[1].作者于2011年2月至2012年2月应用胸腔镜治疗小儿急性脓胸8例,现报告如下. 临床资料 一、一般资料 8例患儿中,男5例,女3例.年龄0.8～5岁,体重7.2～17 kg.均继发于肺部感染.右侧6例,左侧2例.发病时间4～20 d.临床表现为咳嗽、发热、喘憋.患侧叩诊呈浊音或实音.听诊患侧呼吸音减弱或消失.胸部X线片和CT检查均提示大量胸腔积液、肺不张、肺炎、纵膈移位.术前均予感染、加强营养支持、纠正贫血和电解质平衡失调等处理.术前反复穿刺抽吸5例,3例在超声引导下穿刺置管引流,平均置管时间5 d.

<正>先天性巨结肠(hirschsprung′s disease,HD)是小儿消化道常见的畸形,手术治疗有多种方式,经肛门Soave术根治HD,因创伤小、出血少、恢复快等优点,近年来被多数学者接受并应用于临床[1-3]。河北医科大学附属沧州市中心医院应用Soave术治疗新生儿巨结肠,取得了较好的效果,现报道如下。一、资料与方法1.一般资料:本组男37例,女9例,年龄18~34d,平均27d。出生后均有便秘、腹胀及胎便排出延迟史。术前根据病史、体检、肛诊、立位腹部X线片、钡灌肠和直肠肛管测压等检查诊为HD,其中短段型16例,常见型27例,长段

患儿,男,28 d,主因发现右侧腹股沟及阴囊红肿伴呕吐、腹胀1 d,血便1次急诊入院.患儿足月顺产,生后无缺氧窒息史.既往无右侧腹股沟可复性肿物病史.体查:体温37.1 ℃,脉搏136次/分,呼吸41次/分,体重4.7 kg.精神欠佳,心肺检查未见异常.全腹膨隆,未见胃肠型及蠕动波,质稍硬,肝肋下2 cm可扪及,叩诊鼓音,移动性浊音阴性,肠鸣音弱.右侧腹股沟及阴囊部位明显红肿,水肿蔓延至阴茎及左侧阴囊.

患儿,男,3 d.因腹胀、呕吐1 d急诊入院.1 d前进食母乳后出现腹胀\呕吐,呕吐物为奶液,内含有咖啡样物.小便量及颜色正常.排黄色大便1次,无脓血.入院时立位腹平片显示:胄泡胀气,明显增大.小肠腔内含气减少.

目的分析应用腹腔镜治疗小儿膀胱结石的手术方法。方法对5例小儿膀胱结石应用腹腔镜成功取出。本组病例均采用两孔法,一孔观察,一孔操作。其中1例为膀胱横纹肌肉瘤术后者,取石后可清晰观察原手术区的情况。结果全部病例均一次取石成功,无并发症,术后随访均无残余结石影。结论应用膀胱镜治疗小儿膀胱结石方法简单、创伤小、时间短、并发症少,达到了微创的效果。

目的观察小儿腹腔镜精索静脉高位结扎术的疗效,探讨手术需要注意的关键问题。方法回顾分析40例小儿精索静脉曲张患者行腹腔镜下精索静脉高位结扎术的临床资料。结果手术时间24～50min,平均术后肠功能恢复时间13.5h,平均术后住院2.6d。术后1例(2.5%)出现同侧阴囊气肿,40例术后随访3～6个月,全部患者症状明显改善。结论腹腔镜下精索静脉高位结扎术具有创伤小、恢复快、并发症少等优点,对于双侧曲张更具优越性,因此更适合于小儿患者人群。