Hemophagocytic lymphohistiocytosis (HLH)is a severe syndrome characterised by fever,splenomegaly,cytopenia,hyperferritinemia,hypertriglyceridemia and hypofibrinogennemia.HLH includes primary and secondary HLH.Secondary HLH can be encountered in.association with a variety of underlying condtions.Infectious triggers are most commonly due to viral infections,especially EBV infection.This review mainly introduces clinical characteration of several viral infections associated HLH.

Objective To review recent neuroimaging studies of aggressive/violent behaviors in schizophrenia and related the neural circuits of aggressive behaviors,tocusing on structure magnetic resonance imaging (MRI) method,published from 2000 to 2014.Methods A systematic literature search was conducted using articles from PsycINFO,Embase,Pubmed and Cnki pnblished between 2000 and 2014,we usedaggressive, violent, schizophrenia, structure M RI as the key words,to explore the relationship between schizophrenia of aggressive/violent behaviors and the related neural circuits.Results Of the 18 studies included in the analysis,mostly were case-control studies,two were written in Chinese.The neuroimaging literature on aggression in schizophrenia revealed the related grey matter volume of brain areas which contained the frontal lobe,temporal lobe,amygdala,hippocampus,cerebelum and caudate nucleus.Conclusion Findings from the current reviews suggest that the occurrence of violent/aggressive behaviors of schizophrenia were related with serval neural circuits as the frontal-temporal cognitive circuit,Papez circuit,cerebellum advaneed cognitive circuit and caudate nucleus-reward seeking cireuits.However,the precise violent/aggressive neural mechanism has vet to be studied further.

OBJECTIVE: Analysis of multislice CT (MSCT) on the misdiagnosis reasons of children bronchial foreign body, avoid missed diagnosis, to achieve reasonable application. METHOD: Fourteen cases of misdiagnosed cases of data were retrospectively analyzed in our department of suspicious in children with bronchial foreign body, and discuss the misdiagnosis reasons. RESULT: Fourteen cases of misdiagnosis of children with 9 cases by MSCT examination showed no obvious foreign matter. Through bronchoscopy intraoperative found foreign body, 5 cases by multislice CT (MSCT) to found foreign body, 4 cases of phlegm scabs, 1 case is inflammatory granulation, all recovered after treatment. Reasons of misdiagnosis were threshold selection error, scanning level from the inception glottis, imaging error, etc. CONCLUSION MSCT is a very valuable diagnostic on airway foreign body check method, but there are certain limitations, we should improve the understanding of misdiagnosis and reduce the occurrence of this phenomenon.
Bronchi ; Child, Preschool ; Diagnostic Errors ; Female ; Foreign Bodies ; diagnostic imaging ; Humans ; Infant ; Male ; Retrospective Studies ; Tomography, Spiral Computed ; methods

Objective To compare the postoperative analgesic effect of the single dose of oxycodone and dezocine in patients who underwent gynecological laparoscopic operation. Methods Sixty patients who underwent elective gynecological laparoscopic operation were randomly divided into two groups (n=30): oxycodone group (group O) and dezocine group (group D). Fifteen minutes before the end of surgery, oxycodone 0.1 mg/kg was given in O group, and dezocine 5 mg was given to D group. Twenty minutes before the end of surgery, tropisetron 5 mg was given to both groups. Analgesia was maintained by propofol-remifentanil with TCI. The mean arterial pressure (MAP) and heart rate (HR) of T1, T2, T3 and T4 were recorded respectively in both two groups. After the operation, pain of visual analogue scale (VAS) was assessed in 2 h ,4 h , 6 h and 24 h, respectively. Results There were no significant differences in MAP and HR between two groups at T1, T2, T3 and T4 (P＞0.05). The VAS score was significantly lower in group O than that of group D (P＜0.05). There was significant difference in the incidence of nausea between the two groups (P＜0.05). Conclusion Single dose of oxycodone 0.1 mg/kg can be used for postoperative analgesia after gynecological laparoscopic operation, and which has better analgesia than that of dezocine, except for the adverse reaction of nausea.

Objective:To investigate the effects of dexmedetomidine on perioperative cardiac adverse events in elderly patients with coronary heart disease.Methods:Sixty elderly patients,who were diagnosed as coronary heart disease and underwent gastric cancer operation,were randomly divided into 2 groups (n=30):the dexmedetomidine group (Dex group) and the control group.In the Dex group,dexmedetomidine was administered intravenously at 0.5 μtg/(kg.h) after a bolus infusion at 0.5 μg/kg for 10 min before anesthesia induction.In the control group,equal volume of normal saline was infused instead of dexmedetomidine.The 2 groups received the same anesthesia treatment.The venous bloods were collected at the preoperative 0 h and postoperative 24 h.The concentrations of cardiac troponin (cTnⅠ),N-terminal pro-brain natriuretic peptide (NT-proBNP) and hypersensitive C-reactive protein (hs-CRP) were determined.The ECG was monitored at the above time and the postoperative incidence of cardiac adverse events was recorded.Results:The levels of cTnⅠ,NT-proBNP and hs-CRP in serum were elevated in the 2 groups after the operation.Compared with the control group,the levels of cTnⅠ,NT-proBNP and hs-CRP were significantly decreased in the Dex group (P＜0.05).Compared with the control group,the incidence ofbradycardia were significantly increased,while the myocardial ischemia and tachycardia were significantly decreased in the Dex group during the operation (P＜0.05);the incidence of silent myocardial ischemia and arrhythmia was significantly reduced at 3 days after operation in the Dex group (P＜0.05).Conclusion:Dexmedetomidine could decrease the incidence of cardiac adverse events in elderly patients with coronary heart disease.

Objective To explore the effect of health education improvement on promotion of timely vaccination among migrant children in community and to provide references for community health service center.Methods A total of 155 migrant children's parents were recruited from July 2015 to February 2016,and improved health education intervention was carried out on the basis of routine health education to promote parents' health belief on timely vaccination.The compliance of parents' participation in health education activities,the health belief of parents themselves on timely vaccination at different stages of intervention and parents' satisfaction,and the rate of timely vaccination of migrant children before and after intervention were evaluated.Results Regarding the compliance of health education activities for parents in 12 weeks,the first 3 weeks was 85％ ～ 91％,the last 4 weeks were 95％ and above.Six months after intervention,the score of parents' health belief on timely vaccination was higher than that after 3 months of intervention and before intervention,and the difference was statistically significant (P＜0.05).The timely vaccination rates in the study group for migrant children was higher than that in the historical groups (P＜0.05).After intervention,the satisfaction rate for parents was 95.484％.Conclusion Health education improvement could effectively promote parents' health belief on timely vaccination,satisfaction rate and rate of timely vaccination among migrant children.

Objective To investigate the effect of volume therapy with 6％ hydroxyethyl starch (HES) 130/0.4 on mesenteric microcirculation in a rabbit model of hypovolemia.Methods Sixty-four adult male rabbits,weighing 2.0-2.3 kg,were randomly divided into 4 groups( n =16 each):control group (group C),hypovolemia group (group HM),Ringer's solution group (group RS) and 6％ HES 130/0.4 group (group HES).The animals were anesthetized with sodiun pentobarbital 3.0-3.5 mg/kg.Femoral artery,femoral vein and right internal jugular vein were cannulated for MAP monitoring,blood withdrawing and fluid adminstration.Hypovolemia was induced by withdrawing blood from femoral vein of 30％ blood volume in 30 min in groups HM,RS and HES.In group C,no blood was withdrawed.In group RS,Ringer's solution 3 times of the volume of blood withdrawn was infused,while 6％ HES 130/0.4 equal volume of blood withdrawn was infused via right internal jugular vein immediately at the end of blood withdrawing.MAP and HR were recorded and femoral artery and femoral vein blood samples were taken before blood withdrawing (T0),immediately at the end of blood withdrawing(T1 ),immediately at the end of volume therapy(T2 ) and 30 min after volume therapy(T3 ).DO2,VO2 and ERO2 were calculated.Diameter and blood flow speed of microvessel were determined.Results Compared with group C,HR was significantly increased,MAP decreased,diameter and blood flow speed of microvessel were decreased at T1～3,DO2 was increased　at T1 in group HM.Compared with group HM,MAP was significantly increased at T2,HR decreased at T2,3,DO2and VO2 were increased at T1～3,diameter of arteriole was increased at T2 whlie decreased at T3,diameter of veinule　and blood flow speed of microvessel were increased at T2,3 in group RS,MAP was significantly increased at T2,HR　was decreased whlie DO2 and VO2 were decreased,VO2,ERO2,diameter and blood flow speed of microvessel were　increased at T2,3 in group HES.Compared with group RS,DO2,VO2 and ERO2 were significantly decreased at T3　in group HES.Conclusion Volume therapy with 6％ HES 130/0.4 can improve mesenteric microcirculation,organ perfusion and oxygen metabolic in a rabbit model of hypovolemia.

Objective To determine the optimal dose of oxycodone for patient-controlled intravenous analgesia (PCIA) after gastrointestinal surgery when combined with dexmedetomidine in elderly patients.Methods Sixty patients of both sexes,aged 65-80 yr,weighing 50-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective open gastrointestinal surgery,were divided into 3 different doses of oxycodone groups (group O1,group O2 and group O3,n=20 each) using a random number table.At 15 min before the end of surgery,oxycodone 0.1 mg/kg was intravenously injected,and PCIA pump was connected simultaneously.In O1,O2 and O3 groups,the PCIA solution contained dexmedetomidine 2.0 μg/kg and oxycodone 0.3,0.5 and 0.7 mg/kg in 100 ml of 0.9％ normal saline,respectively.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Oxycodone 0.05 mg/kg was intravenously injected as a rescue analgesic after surgery,postoperative pain was assessed using a verbal rating scale,and the verbal rating scale score was maintained ≤4.The number of successfully delivered doses and requirement for rescue analgesics were recorded within 48 h after surgery,and the rate of rescue analgesia was calculated.The occurrence of adverse reactions such as nausea,vomiting,dizziness,respiratory depression,somnolence,bradycardia,hypotension and over-sedation was recorded.Patients' satisfaction with analgesia at postoperative 72 h and the length of postoperative hospital stay were also recorded.Results Compared with group O1,the rate of rescue analgesia after surgery and the number of successfully delivered doses were significantly decreased,and the degree of patients' satisfaction with analgesia was increased in O2 and O3 groups,and the incidence of nausea and somnolence was significantly increased in group O3 (P＜0.05).Compared with group O2,no significant change was found in the rate of rescue analgesia after surgery or the number of successfully delivered doses (P＞0.05),and the incidence of nausea and somnolence was increased in group O3 (P＜0.05).Conclusion When combined with dexmedetomidine 2.0 μg/kg,the optimal dose of oxycodone for PCIA is 0.5 mg/kg after gastrointestinal surgery in elderly patients.

Objective To investigate the analgesic effect and adverse reactions of patient-controlled intravenous analgesia (PCIA) in breast cancer patients with radical mastectomy.Methods A total of 210 breast cancer patients who underwent radical mastectomy was randomly divided into two groups,experimental (group A) and control (group B) groups (n =105 cases per group).Patients in group A was used PCIA for 48 hours analgesia,while group B weas applied routine intramuscular injections of pethidine.Visual analogue score (VAS) at 4,8,12,24,and 48 hours after operation were recorded.Pulse,respiration,and blood pressure were monitored and side effects e.g.existed skin itching,nausea,vomiting,and respiratory repression were observed.Results The VAS of group A patients on 4,8,12,24,and 48 hours were2.02 ± 1.47,1.73 ± 1.38,1.68 ± 0.91,1.44 ± 0.65,and 1.21 ± 0.61,respectively;and the VAS of group B patients were 6.95 ± 1.96,6.42 ± 1.57,5.63 ± 1.66,4.99 ± 1.62,and 3.72 ± 1.46,respectively.The VAS was significantly lower in group A patients than in group B (P ＜ 0.05).The incidence of skin itching,nausea,vomiting,and respiratory repression was also distinctly decreased in group A than in group B (P ＜0.05).The overall satisfaction of patients in group A (96.2％) was remarkably higher than in group B (67.6％) (P ＜0.01).Conclusions Patient-controlled intravenous analgesia pump can more effectively alleviate the degree of pain,reduce the incidence of skin itching,nausea,vomiting and respiratory repression,improve the satisfactory degree for analgesia in breast cancer patients with radical mastectomy compared to traditional intramuscular way.

Objective To evaluate the effect of obesity on the potency of propofol for sedation.Methods Sixty patients of both sexes, aged 35-55 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective operation under general anesthesia, were enrolled in the study.The patients were divided into 2 groups (n=30 each) according to the body mass index (BMI) : normal body weight (BMI ＜ 25 kg/m2) group (group C) and obesity (BMI 30-40 kg/m2) group (group O).No patients received premedication.Propofol was given by target-controlled infusion.The initial target plasma concentration of propofol was set at 1.2 μg/ml.After the target concentration was steadily maintained for 30 s, it was increased in 0.3 μg/ml increment until the patients lost consciousness (OAA/S score =1).The target plasma concentration of propofol was recorded during each period.The median effective concentration (EC50) and 95％ confidence interval of propofol for loss of consciousness was calculated using probit analysis.Results The EC50 and 95％ confidence interval of propofol for loss of consciousness were 3.82 (3.73-3.90) and 3.29 (3.20-3.37) μg/ml in group C and group O, respectively.Compared with group C, the EC50 was significantly decreased in group O (P＜0.05).Conclusion Obesity can enhance the potency of propofol for sedation.