Objective To study the normal anatomy and pathologic CT findings of HDL and compare the HDL dimension of two conditions.Methods 160 consecutive CT scans of the normal upper abdomen were reviewed and 19 cases of cadavers were used.Results There was no statistics differences between the cadavers and normal subjects on HDL.Conclusion The real dimension of HDL can be replaced by the measurement on CT image,CT is a accurate means of measuring HDL in vival of human being.

OBJECTIVE: To observe the therapeutic effect of scalp acupuncture on cognitive dysfunction of traumatic brain injury. METHODS: Seventy patients with cognitive dysfunction of traumatic brain injury were randomly divided into an observation group and a control group, 35 cases in each group. After treatment, 5 cases dropped off in each group. The patients in the control group were treated with cognitive training; the patients in the observation group were treated with cognitive training and scalp acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Zhisanzhen and Niesanzhen, and the needles were retained for 6 h. The two groups were treated once a day, 6 times a week; one-month treatment was taken as one course, and 3 continuous courses were given. The scores of mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), activity of daily living (ADL) and functional independence measure (FIM) were compared between the two groups before and after treatment. RESULTS: Compared before treatment, the MMSE and MoCA scores in the observation group, and ADL and FIM scores in the two groups were significantly increased after treatment ( CONCLUSION Scalp acupuncture could improve cognitive function and self-care ability of daily life in patients with traumatic brain injury.
Acupuncture Points ; Acupuncture Therapy ; Brain Injuries, Traumatic/therapy* ; Cognition ; Humans ; Scalp ; Self Care

Objective To investigate the clinical features and risk factors in children with symptomatic central venous catheter-related deep vein thrombosis,and to provide guidence for clinical therapy.Methods The clinical data of 105 children with central venous catheter were retrospectively analyzed.According to the thrombosis or not,these children were classified into two groups:thrombosis group and non-thrombosis group.The risk factors influencing symptomatic central venous catheter-related deep vein thrombosis forming were identified by Logistic regression analysis.Results Among the 105 cases with central venous catheter,the male to female ratio was 68:37;age ranged from 8.5 months to 13 years old with average age(5.5 ±4.0) years old.There were 98 cases in non-thrombosis group and 7 cases in thrombosis group.Factors such as age[(5.7 ±4.1)years old vs.(2.5 ± 1.8) years old],central venous catheter dwell time[(6.1 ±2.3)d vs.(8.9 ± 2.1) d],more than 7 days parenteral nutrition application (11/98 cases vs.5/7 cases) and more than 7 days intravenous application of mannitol(7/98 cases vs.4/7 cases)were found significantly different between the thrombosis group and non-thrombosis group(P ＜ 0.05).Multivariate Logistic regression analysis showed that more than 7 days parenteral nutrition application and intravenous mannitol were the risk factors of symptomatic central venous catheter-related deep vein thrombosis [OR =50.703 (95 ％ CI 3.258-789.056),OR =15.590 (95 ％ CI 1.196-203.146),P ＜ 0.05].Conclusion Symptomatic central venous catheter-related deep vein thrombosis is a common complication of deep venous catheterization.It cause acute pulmonary embolism and some critical diseases,and influence the prognosis and prolong hospital stay.Application of intravenous nutrition more than 7 days and intravenous mannitol more than 7 days are the risk factors of symptomatic central venous catheter-related deep vein thrombosis.

Objective To investigate the clinical manifestations ofi nfantile and late-onset glycogen sot rage diseaes type Ⅱ.Mte hods We analyzed the cliin calm anifestations and prognosiso f infantile and late-onset glcy ogen storage disease type Ⅱ with a retrospective analysis of five cases admitted in PICU of Shengjing Hospital of China Medical University from 2013 to 2014.Resulst Firsts ymptoms of three infan-tile cases were dyspnea,cardiac hypertrophy,hepatomegaly,skeletal muscle weakness and low concentration of α-glucosidase A.Two cases completed gene detection.One case had frameshift mutation and missense mu-tation,and the other had two missense mutatoi n.Three infantile csa es all showed arrhythmia performance. Two cases died of fat l arrhythmia.One caes received ne zyme replacement therapy and survived.The main symptoms of two al te-onset cases who had not get gene detection were dyspnea,low muscle strength,muscle hypotonia and low concentration of ca idα-gluco sidase.One case receivedm echanicla ventilation,complicated with multiple infections,severe pneumonia andv entilator dependence,finally gave up the treatment.The other died of cardiac arrhythmia.Concluis on Infantile cases have the major symptoms of myocardial hypert o-phy,hepatomegaly,low muscular tension with rapid progression,high mortality and fatal arrhythmia.Late-on-set cases have the clinical features of respiratory failure,proximal limb muscle weakness and be susceptible to ventilator dependence and multiple infections.Enzyme replacement therapy can improve the clinical symp-toms of infantile cases.

Objective To observe the clinical effect of plasma exchange(PE) combined with continuous veno-venous hemodialysis filtration(CVVHDF) in children with acute liver failure.Methods Thirty-nine cases with acute liver failure admitted to pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from August 2008 to January 2014 were treated with PE combined with CVVHDF.CVVHDF was performed after PE immediately,each PE + CVVHDF lasted 24 ～ 72 hours.Prothrombin time,blood ammonia,alanine transaminase,aspartate transaminase,serum total bilirubin,conjugated bilirubin were detected before and after PE + CVVHDF treatment.Glasgow Coma Scale were assessed before and after PE +CVVHDF in the thirty-five cases with hepatic encephalopathy.Results After the treatment of PE + CVVHDF,20 children were clinical recover,7 died,12 abandoned the treatment and the results of follow-up were death.PE + CVVHDF was effective in the treatment by decreasing serum total bilirubin,conjugated bilirubin,alanine transaminase,aspartate transaminase [(128.8 ± 82.6) μmol/L vs (73.2 ± 92.4) μmol/L; (90.2 ±71.5) μmol/L vs (55.1 ± 42.6) μmol/L; (3 024.1 ± 2 457.0) U/L vs (1 256.8 ± 757.8) U/L; (3 420.6 ±2 216.3) U/L v s (579.4 ± 338.6) U/L] (P ＜ 0.05),increasing Glasgow Coma Scale (9.5 ± 3.1 vs 12.1 ±2.9) (P ＜0.01),shortening prothrombin time[(40.4 ± 23.0) s vs (22.8 ±9.4) s] (P ＜0.01),in association with the improvement of hemorrhage tendency.Conclusion PE + CVVHDF significantly improves clinical symptoms and biochemical abnormalities in children with acute liver failure.Security of PE + CVVHDF is good and with no obvious adverse reactions.

Objective To investigate the diagnostic value of plasma B-type natriuretic peptide(BNP) in left to right shunt congenital heart disease accompanied by heart failure in PICU.Methods We retrospectively reviewed the clinical data of 52 cases diagnosed left to right shunt congenital heart disease in the PICU of Shengjing Hospital of China Medical University from January 2012 to June 2014.The cases were divided into negative control group(n=18) and heart failure group(n=34) according to the criteria for the diagnosis of pediatric heart failure.We respectively compared plasma BNP,size of heart defects,left ventricular end-diastolic volume index(LVEDVI),ratio of left ventricular early diastolic filling blood flow velocity and left ventricular late diastolic filling blood flow velocity(E/A),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),and cardiothoracic ratio between the two groups.We analyzed the correlation between plasma BNP and the size of heart defects,LVEDVI,E/A,cardiothoracic ratio,LVEF,PASP.The receiver operating characteristic curve was used to determine the optimal cut-off value of plasma BNP to diagnose heart failure.Results Plasma BNP were 87.7(22.7,165.7)pg/ml in negative control group and 716.5(326.8,1813.0)pg/ml in heart failure group.The plasma BNP level of heart failure group was significantly higher than that of negative control group(Z=5.3,P<0.01).Size of heart defects were 5.0(3.0,6.8) mm in negative control group and 7.4(5.5,9.0)mm in heart failure group.Size of heart defects of heart failure group was significantly higher than that of negative control group(Z=3.5,P<0.01).LVEDVI were (44.6±18.3)ml/m3 in negative control group and (70.8±38.4)ml/m3 in heart failure group.LVEDVI of heart failure group was significantly higher than that of negative control group(t=2.7,P=0.01).E/A were 1.3±0.3 in negative control group and 1.1±0.3 in heart failure group.E/A of negative control group was significantly higher than that of heart failure group(t=2.2,P=0.04).Plasma BNP had a positive relation with cardiothoracic ratio(r=0.49,P=0.01) and a negative correlation with E/A(r=-0.28,P=0.04).The optimal cut-off value of plasma BNP was 181.8 pg/ml.The sensitivity of diagnosis of heart failure was 94% and the specificity was 88%.The area under the receiver operating characteristic curve was 0.951.Conclusion Plasma BNP may comprise a sensitive marker for heart failure of left to right shunt congenital heart disease.It is recommended that 181.8 pg/ml is the optimal cut-off value to diagnose heart failure of left to right shunt congenital heart disease.

Objective To investigate the clinical features of eleven cases of acute liver failure as the initial presentation of hemophagocytic syndrome(HPS),in order to improve the early diagnosis.Methods Eleven cases of acute liver failure as the initial presentation of HPS admitted in PICU of Shengjing Hospital affiliated to China Medical University from September 201 1 to February 2015 were investigated,the clinical manifestations,laboratory findings,therapy methods and prognosis were analyzed.Results Eleven cases of HPS had the initial symptom of acute liver failure accompanied by severe coagulation abnormalities,increase of alanine aminotransferase and aspartate aminotransferase,decrease of fibrinogen.All 1 1 cases with speno-megaly had more than 1 week thermal process.Glucocorticoid and gamma globulin were used to inhibit the activation of monocyte-macrophage cell system.Chemotherapy such as Etoposide were used as the basic treat-ment in the early stage.Plasma exchange and continuous hemodialysis and filtration were used in severe cases with bleeding tendency.One of these 11 children survived,4 cases died of multiple organ dysfunction syn-drome,and discharged six cases were followed up for mortality.Conclusion Unexplained acute liver failure, fever and cytopenias may suggest HPS,the mortality rate can be reduced by early diagnosis and treatment.

Objective: To observe the clinical effect of Guishao Liujunzi decoction combined with entecavir tablets in the treatment of liver cirrhosis with hepatitis B, and to provide reference for the clinical treatment. Methods: From May 2012 to January 2015, 80 patients with hepatitis B-induced liver cirrhosis treated in Dongyang Guangfu Hospital were selected, and they were divided into control group(n=40) and observation group(n=40) according to the different method.The control group was given entecavir tablets, while the observation group was given Guishao Liujunzi decoction on this basis.The TCM symptom scores and levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), gamma glutamyl transferase(GGT), total bilirubin(TBil), prothrombin time(PT), hepatitis B virus deoxyribonucleic acid(HBV-DNA) of the two groups before treatment and 3 months, 6 months and 12 months after treatment were compared. Results: The TCM symptom scores of the control group at 3 months, 6 months and 12 months after treatment were (12.68±1.82)points, (12.07±1.74)points, (11.38±1.63)points, respectively, which were higher than that before treatment[(14.30±1.48)points, t=4.368, 6.174, 8.388, all P<0.05]. The TCM symptom scores of the observation group at 3 months, 6 months and 12 months after treatment were (11.25±1.63)points, (10.40±1.82)points, (9.81±1.47)points, respectively, which were higher than before treatment[(14.59±1.61)points, t=9.137, 10.828, 13.780, all P<0.05]. The TCM symptom scores of the observation group at 3 months, 6 months and 12 months after treatment were significantly lower than those of the control group(t=3.589, 4.220, 4.359, all P<0.05). After treatment, the levels of ALT, AST, GGT and TBil in the observation group were (39.24±28.37)U/L, (45.18±34.35)U/L, (41.63±10.55)U/L, (20.94±9.15)μmol/L, respectively, which were lower than (85.18±27.22)U/L, (109.25±37.09)U/L, (50.71±9.62)U/L, (33.97±10.11)μmol/L in the control group(t=7.184, 7.818, 3.905, 5.898, all P<0.05). The levels of HBV-DNA in the control group at 6 months and 12 months after treatment were (3.18±1.13) copies/mL and (2.25±0.51) copies/mL, respectively, which were significantly lower than (3.65±1.19)copies/mL before treatment(t=1.811, 6.839; all P<0.05). The levels of HBV-DNA in the observation group at 6 months and 12 months after treatment were (2.96±0.97)copies/mL and (2.07±0.81)copies/mL, respectively, which were significantly lower than (3.70±1.13)copies/mL before treatment(t=3.143, 7.415, all P<0.05). Conclusion Guishao Liujunzi decoction combined with entecavir tablets in the treatment of liver cirrhosis with hepatitis B not only can significantly improve the clinical symptoms of patients, but also can help to strengthen the antiviral effect, improve the liver function of patients, which has important significance to the prognosis.

Objective To investigate the clinical features,pathogenic distribution of children with in-fective endocarditis(IE)during the past 10 years.Methods Medical records of 30 children with IE admitted to Shengjing Hospital of China Medical University from October 2006 to October 2016 were retrospectively analyzed,including the clinical data and pathogenic characteristics.Results Among the 30 cases of IE,there were 18 males and 12 females,age ranged from 2 months to 13 years old.Fever was found as initial symp-toms in 21 cases(70.0%),respiratory symptoms in 4 cases(13.3%),neurological symptoms in 4 cases (13.3%),edema in 2 cases(6.7%),murmur in 1 case,precordial discomfort in 1 case,and peripheral blood cell reduction in 1 case. The most common underlying factor was congenital heart disease(17 cases, 56.7%).Surgery was performed in 6 children due to congenital heart disease before endocarditis.Vegetations were detected on echocardiography in all cases(100%).Blood cultures were positive in 50.0%,Staphylococ-cus aureus was the most common organism,accounting for 6 cases (40.0%).Other notable pathogens in-cluded Streptococcus pneumoniae(4 cases,26.7%),Enterococcus faecalis(2 cases,13.3%),Streptococcus suis(1 case),Streptococcus anginosus(1 case) and Staphylococcus epidermidis(1 case).C-reactive protein was raised in 25 cases(83.3%)at the time of admission.C-reactive protein was higher than 100 mg/L in 8 cases.Conclusion Early clinical manifestations of IE are atypical.Fever is the most common symptom. Congenital heart disease is the major risk factor of IE,Gram-positive cocci is the most common organism. Antibiotic treatment is not effective,then surgical treatment may be considered.

Objective To study the development characteristics of cavum sepit pellucidun (CSP)in prematures,neonates,infants and adults with MRI.Methods Brain MR images of different subjects including 141 prematures,106 neonates,171 infants and 35 046 adults were observed to determine the incidence and shape of CSP,and to measure its transverse diameter.Results CSP incidences were 100% (141/141)in prematures,97.17% (103/106)in neonates,2.26%(4/177)in infants and 0.82% (287/35 046)in adults respectively,and the CSP was cylinder (44.00%)or triangle in shape (56.00%)in prematures,triangle (76.40%)or fissure in shape (23.60%)in neonates.For infants or adults,each shape accounted for about a third of three kinds of shape respectively.Its mean transverse diameters were 5.7 mm in prematures,4.1 mm in neonates,13.3 mm in infants and 14.3 mm in adults respectivity.Conclusion CSP has different performances at development periods in human being brain.Most close after birth,while fewer remain in the whole life.