Cardiopulmonary arrest is one of the most critical situations,posing a serious threat to life.With the development of medical technology, the rate of return of spontaneous circulation after cardiac arrest has been improved.However, many children suffer from multiple organ dysfunction because of the long hypoxia time from cardioplumonary arrest, so the rate of long-term survival is relatively low and the long-term outcome is still not satisfactory.Therefore, how to make cardiopulmonary resuscitation more effective is the focus of current research.This article reviews the related factors that affect the outcome of resuscitation, providing references for the treatment of cardiopulmonary arrest in children.

Background One of the important machanisms of all trans retinoic acid (ATRA) is to regulate the expression of connexin (Cx) gene.ATRA inhibits the proliferation and differentiation of retinoblastoma (RB) cells,which is related to Cx43.However,the control site of ATRA and its effect on RB tumor in vivo have not been identified.Objective This study was to investigate the effect of ATRA on Cx43 expression in RB cells and its approach mechanisms.Methods ATRA solution of 1 × 10 2 mol/L was prepared with ethanol and formulated into 1×10 5,1×10-6and 1 × 10 7 mol/L of solution with culture medium further.Human RB cell line (HXO-RB44) was cultured and treated with different concentrations of ATRA for 2,4 and 6 days,respectively.The expressions of Cx43 protein and mRNA in RB cells were detected by Western blot and reverse transcription PCR (RT-PCR),respectively.RB models were established by injecting HXO-RB44 cell suspension into anterior chamber in the right eyes of 15 athymic mice.Eleven successful models were divided into the blank control group,negative control group and 1 × 10-5 mol/L ATRA group,and 0.5％ normal saline solution with athymic or 1 ×10-5 mol/L ATRA solution was injected into the anterior chamber in the negative control group and 1 × 10-5 mol/L ATRA group in the 3-day interval for 3 weeks.The model eyes were examined under the slit lamp microscope.The eyeballs were extracted at the end of the experiment for hematoxylin and eosin staining.Results Western blot assay showed that the absorbance values of Cx43 protein (ACx43/AGAPDH) were increased gradually as time lapse of ATRA treatment among the groups (Ftime =71.31,P =0.00; Fgroup =7.66,P =0.00).The expressions of Cx43 protein were significantly higher in the 1 × 10 5 mol/L ATRA group after 2 days,1 × 10-6 mol/L ATRA group after 4 days,1 × 10-7 mol/L ATRA group after 6 days than those in the blank control group at various time points (t =3.34,P＜0.01 ;t =2.33,P＜0.05;t =3.12,P＜ 0.01).RT-PCR showed that the absorbance values of Cx43 mRNA (ACx43mRXA/Aβ-actin) were significantly enhanced as the prolong of treatment time of ATRT among the groups (Ftime =90.90,P =0.00 ; Fgroup =6.86,P =0.00).The expressions of Cx43 mRNA were significantly higher in the 1 × 10-5 mol/L ATRA group after 2 days,1 × 10 6 mol/L ATRA group and 1 ×10-7 mol/L ATRA group after 4 days than those in the blank control group at various time points (t=3.57,P＜0.01 ;t=6.31,P＜0.01 ;t=2.22,P＜0.05).RB models were successfully created in 11 eyes on the 6-9 days following the intrachamber injection of RB cell suspension.The RB cells were filled with chamber in the blank control group 20 days after injection,and RB only occupied half of the anterior chamber in the 1 × 10-5 mol/L ATRA group.Histopathological examination exhibited that the RB cells were seen in the anterior and posterior chamber as well as vitreous in the blank control group,however,the cells were only found in the anterior chamber in the 1 × 10 5 mol/L ATRA group.Conclusions ATRA can inhibit the growth of RB in vitro and in vivo by inducing the expression of Cx43 gene in transcription process.

Programmed cell death 1 (PD-1) is an important negative costimulatory molecule discovered in recent years, which is expressed on the surface of T and B cells and plays an important role in the regulation of cellular immune response and immune tolerance.After the combination of PD-1 and its receptor programmed cell death 1 ligand 1 (PD-L1), negative regulatory signals are transmitted to suppress the immune response.Under the activation of stimulating factors, PD-1 and PD-L1 are combined to weaken the conduction of downstream signaling pathways such as PI3K/Akt and ERK through recruitment of phosphorylated SHP2, thereby inhibiting the proliferation of T cells and the production of cytokines, inhibiting the immune response and participating in the occurrence and development of a large number of inflammatory diseases.PD-1 in the field of ophthalmology research is still in its infancy.As far as we know, PD-1 participates in ocular inflammatory diseases such as uveitis, sympathetic ophthalmia, allergic conjunctivitis, also is involved in corneal transplant rejection, optic nerve crush injury and optic myelitis, diabetic retinopathy, thyroid related ophthalmopathy, melanoma and other diseases, thus preventing the interactions between PD-1 and its receptor PD-L1 may become a new potential target for the treatment of ocular tumor, inflammation, autoimmune and neurodegeneration disease.In this article, the latest research progress of PD-1 and its receptor PD-L1 in the pathogenesis of ocular diseases were reviewed.

Objective The metabolomics methods were applied to discover the serum differences metabolites in patients with lupus nephritis (LN),and to establish the diagnostic model and study the metabolic pathways change due to the interference of LN and explore the pathogenesis of LN.Methods Positive and negative ions mode of ultra high performance liquid chromatography-high resolution mass spectrometry (HPLS-HRMS) were used to analyze the serum samples of 38 LN patients and 35 healthy controls,respectively.Both univariate and multivariate data analysis were performed with SPSS software (V17.0,Chicago,USA) and SIMCA-P+ package (V12.0,Umetrics,Sweden),respectively.A supervised pattern recognition method,orthogonal partial least squares-discriminant analysis (OPLS-DA),was employed to study the metabolomics differences between control group and LN patients group.The metabolic pathways were analyzed by Metabo Analyst 3.0.Results LN patients and healthy controls could be well separated by OPLS-DA model Q2 of 0.583.Eighteen compounds (theophylline,oxidized glutathione,capric acid,norvaline,hippuric acid,sphingosine,sorbitol,cortisol,pyrrole-2-carboxylic acid,deoxycholic acid,tryptamine,5-aminolevulinic acid,glucose 6-phosphate,riboflavin,cortisone,taurine,creatinine,glycerophosphocholine) were initially identified as potential serum metabolic markers to distinguish LN patients from healthy people.Alternated metabolism pathways included citrate metabolism,pyrimidine metabolism and amino acid metabolism.Conclusion Through analysis of the metabolic pathways of different metabolites,the significant impact of LN on citrate metabolism,pyrimidine metabolism and amino acid metabolism pathways are identified.Some of the different metabolites are involved in the process of immunization.These results will benefit the early intervention and treatment of LN and the research of the mechanism of pathogenesis.

Objective To investigate the level of sex hormone in serum and blood clotting parameters in patients with acute cerebral infarction(ACI).Methods The level of estradiol(E 2),testosterone(Te),E 2/Te,antithrombin Ⅲ(AT Ⅲ) and fibrinogen(FIB) in the serum of 116 old patients with ACI and 78 healthy subjects were measured by ELISA, Enzyme colorimetric method.Results The concentration of E 2? E 2/Te?FIB in the male patients with ACI were higher than that of control group ( P 0.05). The concentration of FBI was higher than that of control group( P

Objective To investigate the clinical characteristics of childhood intracranial tumor.Methods The age and sex distribution,location of tumor,clinical manifestation,imaging examination and pathological examination,diagnosis and treatment of 98 children under 14 years old admitted into Children′s Hospital of Chongqing Medical University from Jun.2003 to Sep.2008 were analyzed.Results There were 63 male and 35 female in the study.The gender ratio(male to female) was 1.8:1.The age range was 4 months to 14 years old,75 cases(76.5%) visited a doctor in the course of disease from 1 to 90 days.The tumors of 60 cases(61.2%) were located in posterior cranial fossa,while 14 cases(14.3%) in cerebral hemisphere.The most common intracranial tumors were medulloblastom(30 cases,30.6%),astrocytic tumor(26 cases,26.5%),ependymal tumor(17 cases,17.3%),craniopharyngioma(10 cases,10.2%) and germ cell tumor(4 cases,4.1%).The main clinical manifestations were vomiting(61 cases,62.2%),headache(58 cases,59.2%),instability of gait or incoordination(38 cases,38.8%),29 cases(29.6%) of the tumors were misdiagnosed.Obstructive hydrencephalus was found in 78 cases(79.6%) by imaging examination,positive rate of tumor′s diagnosis was 95.9% and 100% by brain CT and MRI scaning,respectively.Conclusions Intracranial tumors in childhood are mostly located in posterior cranial fossa with atypical clinical manifestations and short course of diseases.It is common to be misdiagnosed at early stage.Brain CT and MRI examinations are helpful for early diagnosis,which should be considered for the children when unreasonable increased intracranial pressure and localizing neurological sings exist.

Objective To develop a nursing pathway outlined the reasonable timing for care of paraplegia patients at rehabilitation stage. Methods Literature and patient records were reviewed to draw up a clinical nursing pathway. It was modified and finalized after 2 rounds of Delphi's expert-consultation. Results and Conclusion The draft was responded by 100% of the experts, with a specialist authoritative coefficient of 0.87. The text for the clinical nursing pathway was then completed.

ObjectiveTo observe the effect of work simulated training for workers suffered from work-related injuries.Methods65 injured workers joined a 2.8-month (on average) training program by applying the BTE PRIMUS work simulated training system, with six-month follow up period after discharge.ResultsDuring the six-month follow up after discharge, 29(44.62%) workers returned to the same company with the same job,24(36.92%) workers returned to the same company but changed job,6 (9.22%)works changed company and changed job ,6(9.22%)works didn't return to work.ConclusionWork simulated training program can improve injured workers'working ability and help them return to work.

Objective To examine the academic emotions and its relationship with academic self-efficacy among secondary special school students. Methods 352 secondary special school students were collected as the subjects.All subjects were tested with academic emotions questionnaire and academic self-efficacy questionnaire and analyzed the result of the test by multivariate analysis of variance,correlation analysis and linear regression analysis. Results Scores on enjoyment,anxiety,anger,depression,total scores on positive-high arousal academic emotions and negative-high arousal academic emotions of secondary special school girls(27.88±3.84,24.77±5.03,18.03±3.37,18.14±3.65,59.33±7.98,57.48±10.49,respectively)were higher than those of boys(26.41±4.55,22.38±5.71,17.01±3.91,16.07±3.94,57.46±9.20,53.45±11.76,respectively),(P<0.05).The academic emotions' differences among different grades of secondary special school students were not significant(F-(1,348)=1.275,P=0.226).The interaction of gender and grade on academic emotions was not significant(F-(1,348)=1.057,P=0.397).Academic emotions and academic self-efficacy was interrelated(r=-0.513～0.685).The result of multiple regression analysis showed that each factor of academic self-efficacy played a significant predictor role on academic emotions(β=-0.631～0.462,P<0.01). Conclusion The academic emotions' differences between secondary special school boys and girls are significant. Academic self-efficacy is closely related to academic emotions.

Objective To evaluate left atrial function by velocity vector imaging (VVI) in patients with rheumatic mitral stenosis(RMS). Methods Thirty eight patients with RMS and 42 normal controls were studied with VVI analysis software. Peak systolic strain (S), systolic strain rate(SRs), early diastolic strain rate(SRe) and late diastolic strain rate(SRa) of each left atrial segments were measured,and also the SRa peak time delay(Td-SRa). Results Comparing to the controls group, the S, SRs and SRe of all segments were significantly lower(P<0.05). Except the base latero-aorta's SRa, the other segments' SRa were lower (P<0.05). In patients with atrial fibrillation(AF),56% segments had no SRa,and 18.6% had irregular low amplitude movement at late diastole, while 25.4% had discernible positive peak. The base and middle inferior SRa of patients with AF were lower (P<0.05 ) than those of the patients with sinus rhythm. While the Td-SRa of patients was longer than that of control group,especially what of the patients with AF. Conclusions The segmental and globe left atrial function of patients with RMS can be evaluated with VVI.