Pediatric acute liver failure is a severe and sudden onset of hepatocyte dysfunction,leading to synthetic and detoxification failure,which could progress to multi-organ failure and death.Mortality is predominantly high due to the raised intracranial pressure,infections and multi-organ failure.The mainstay of management is supportive care in an intensive care unit.The intensive care managements include immediate measures,etiology,management of complications and liver assist device,liver transplantation.Liver transplantation is an important life saving procedure for children with acute liver failure.

Nuclear factor-?B (NF-?B) is a nuclear transcription factor that regulates the expressions of multiple genes. It can be activated during cerebral ischemia; it is closely correlated with the inflammatory reaction and apoptosis during cerebral ischemia. NF-?B inhibitor ? (I?B?), an important inhibitor factor of NF-?B, can regulate the survival and death of neuron in the ischemia penumbra. Therefore, the inhibition of the degradation of I?B? and the prevention of the activation of NF-?B with drugs or molecular biological methods has become an important approach in study of the effect of NF-?B at present. Recent studies have indicated that I?B? itself may also participate in the regulation of apoptosis.

Objective To investigate the diagnostic value of ST segment elevation in acute myocardial infarction (AMI) occurred in patients after resuscitation.Methods The relevant articles about coronary angiography performed in an emergency for all the post-resuscitation patients without obvious noncardiac cause,regardless of the representation of the electrocardiography were searched in the databases of Pubmed,Ovid medline,EBSCO,CBM,Wanfang and VIP of Chongqing.The meta-analysis was carried out with the data from the included articles using the meta-disc 1.4 software.Results Five articles about retrospective analysis of consecutive patients were included.The meta-analysis of pooled statistics showed the sensitivity 0.59,the specificity 0.86,the positive likelihood ratio (LR) 4.4,the negative LR 0.39,the diagnostic odds ratio (OR) 12.28 and the area under the curve (AUC) 0.85.Conclusions Although the high specificity is in favor of making diagnosis of AMI in post-resuscitation patients,the low sensitivity makes the integrative diagnostic value of using sole ST-segment elevation of ECG relatively low.

Objective To explore the role of LGR5 positive intestinal stem cells in repairing damage of intestinal mucosa resulting from endotoxemia and to determine whether the damaged intestinal mucosa can be repaired by regulating the proliferation and differentiation of intestinal stem cells.Methods Wistar rats were randomly divided into control group,lipopolysaccharide(LPS) group,and glucagon-like peptides 2(GLP-2) group.LPS was injected interaperitoneally into rats of the LPS group and GLP-2 group at a dose of 5 mg/kg(1 ml/kg) ; saline(1 ml/kg) was injected into the rats of control group.GLP-2 250 μg/kg(1 ml/kg) was rnjected into the rats of GLP-2 group 1 hour after the LPS injection.The terminal ilea were collected from 8 rats in each group at 6 h,24 h,and 72 h post-LPS injection.Structrral changes in the intestinal epthelium of every group were observed under the light microscope and electron microscope.The expression of LGR5 in intestinal stem cell was detected by immunohistochemical method and RT-PCR.Results In general,intestinal edema and hyperemia was observed in both LPS and GLP-2 groups at 6 h.Fracture and lodging of villi,infiltration of inflammatory cells,and visible exudate within the cavity were observed under light microscopy.The inflammatory injury was less severe in the GLP-2 group than in the LPS group at 6 h.The injury of intestina mucosa gradually repaired between 24 h and 72 h after injection of LPS in both LPS group and GLP-2 group.Importantly,samples taken from GLP-2 group and LPS group at the same time point indicated that the GLP-2 group recovered significantly better than the LPS group.And expressions of LGR5 mRNA in GLP-2 group at 6h,24h,72 h(0.13 ±0.05,0.16±0.05,0.16±0.04) were significantly higher than those in LPS group respectively (0.52 ±0.09,0.73 ±0.14,0.48 ±0.24),as shown by RT-PCR,and than that in control group(0.12 ±0.03) (P ＜ 0.05).Conclusion Exogenous GLP-2 may facilitate intestinal stem cell proliferation,thereby promoting the recovery of intestinal mucosa damaged by endotoxemia.GLP-2 appears to promote stem cell proliferation,differentiation,and gradual migration of stem cells from the intestinal crypts to the damaged mucosa.

Acute kidney injury(AKI)is a syndrome with many different causes and can occur at different stages throughout critical illness.Renal Doppler ultrasonography is the most appropriate imaging test in the evaluation of AKI and has the highest level of recommendation: (1)assessment of intrinsic causes of AKI, (2)distinguishing acute from chronic kidney diseases, (3)detection of the causes of obstruction.The resistive index in patients with AKI will be reviewed with attention to its use for predicting the development and prognosis of AKI.Meanwhile, combined application of cardiopulmonary ultrasound and evaluation of hemodynamics are helpful to evaluate the etiology, supervision and guiding treatment of AKI.

Clinical teaching and studying is suffering increasing hardship.This article analysises the present condition of clinical education problems and causes,and researches whether patients are obliged to coorperate clinical teaching and studying when they protect their rights.It also researches how to practice clinical teaching and studying in educational hospital and looks for effective pathway to go out of the clinical education problem.

Objective: To explore psychomotor ability of children wit h behavior problems Method: 133 children with behavior problems were screened out from a sample of 1225 pupils by tests with CBCL and CRT-C2 T he control group was selected from the other pupils matched by age and sex, the rate of case/control was 1:2 Jinyi Psychomotor test Battery (JPB) was applied to both groups Result: There were 93 valid pairs in all The study group was more impaired in selecting reaction time, digit symbol, trail ma king and JPB total score They had also larger standard deviation of selecting reaction time and higher rate of JPB abnormality than control Trail making was a protective factor for internalizing and externalizing problems Standard dev iation of selecting reaction time was a risk factor of externalizing problems Selecting reaction time, cancellation digit, digit symbol and JPB total score we re protective factors of mixed problems and JPB abnormality was the risk factor The rate of JPB abnormality of mixed problem group was significantly higher t han that of single problem groups There was significant negative correlation b etween CBCL total score and,digit symbol trail making T score and JPB total T sc ore Conclusion: Children with behavior problems perform poor i n psychomotor test, which suggests they have brain dysfunction, especially those with mixed problems

BACKGROUND: Presently used biological factors for inducing bone marrow mesenchymal stem cells (BMSCs) do not obtain mature chondrocytes. Cartilage tissue engineering using BMSCs as seeds does not collect tissue-engineered cartilage, which has value in the clinic. The obtained tissue is cartilage-like tissue. OBJECTIVE: To screen differentially expressed genes between rat BMSCs and chondrocytes by microarray. DESIGN, TIME AND SETTING: The cytology gene study was conducted at the Central Laboratory, First Affiliated Hospital, Dalian Medical University in July 2007. MATERIALS: A total of 8 healthy Sprague Dawley rats aged 2 months were obtained from Animal Experimental Center, Dalian Medical University. 27K Rat Genome Array chip was supplied by Bo’ao, Beijing, China. METHODS: Rat BMSCs and chondrocytes in the aural region were sterilely isolated and cultured in vitro. Total RNA was extracted and purified using Trizol one-step method, and transformed into double chain cDNA probe following reverse transcription. Cy5-dCTP and Cy3-dCTP were used to label BMSCs and chondrocytes, which were hybridized and washed. The fluorescent signals were scanned by a scanner. The values were analyzed and calculated by GenePix Pro 4.0 software. MAIN OUTCOME MEASURES: Gene expression spectrum chip hybridization results. RESULTS: Among the differentially expressed genes (2 times difference), BMSCs as controls, upregulated and downregulated genes were 1 226 and 888, respectively. There were many differential expression gene of BMSCs and chondrocytes. Cy5/Cy3 20 genes are defined as significant differential expression gene. Thus, two important cytokines were found: chondromodulin and connective tissue growth factor. CONCLUSION: The gene chip technique provides an ideal method for screening cytokines during study of tissue-engineered cartilage. Cartilage regulin and connective tissue growth factor highly express in chondrocytes, which indicated that the two have closely association with the differentiation of BMSCs into cartilage.

Objective To evaluate the safety and efficacy of thoracoscopic lobectomy for pulmonary benign diseases.Methods Between July 2002 and September 2007,35 cases with pulmonary benign diseases underwent thoracoscopic lobectomy in our hospital.Of the patients,video-assisted thoracoscopic lobectomy was performed on 12 cases,and totally endoscopic lobectomy was carried out in 23.Results The operation was completed in all of the cases except in one who was converted to open surgery because of massive hemorrhage.In this series,no peri-operational death occurred,however,complications occurred in 3 cases(morbidity rate: 8.6%),including 2 cases of persistent air leak and 1 case of pneumonia.The mean duration of chest tube drainage was 3.6 days(2 to 7 days),and average hospital stay after operation was 7.7 days(2 to 14 days).Postoperative pathological diagnosis included bronchiectasis in 15 patients,pulmonary inflammatory pseudo-tumor in 6,tuberculosis in 5,fungal infection in 5,pulmonary sequestration in 2,and bronchogenic cyst in 2.Conclusions Thoracoscopic lobectomy is safe and effective for pulmonary benign disease.

Endoplasmic reticulum(ER) is a locus where proteins are modified,folded and calcium stored.The accumulation of unfolded protein and disorder of calcium ion can lead to ER stress.Early ER stress will induce unfolded protein response(UPR)which may be protective to cells.On the contrary,long-time strong ER stress will induce cell apoptosis,even death.ER stress has been suggested to be involved in some human neurodegenerative diseases.However,the exact contributions of ER stress in the various disease processes are yet unknown.This review mainly summarizes recently reported discoveries concerning ER stress associated with neurodegenerative diseases and highlights current knowledge in this field that may reveal novel insight into disease mechanisms and help to design better therapies for these disorders.