Objective To investigate the causes and influencing factors of dead on arrival (DOA) in children.Methods The clinic data from 66 children with DOA admitted in the emergency department of Hunan Children's Hospital from Jan 2010 to Apr 2012 were analyzed retrospectively.Results All of the 66 cases had cardiac respiratory arrest when admission.Fourteen cases had arrest for 10 minutes,12 cases for 30 minutes to an hour,40 cases had no details.Forty-four (68.2％) cases were carried by parents,22(31.8％)cases were transferred by medical professionals.The main causes of DOA were severe pneumonia with respiratory failure and (or) heart failure,intracranial infection,neonatal diseases.All cases were taken to resuscitation room by triage immediately.Tracheal intubations were completed in 48 cases and intravenous access with injection of epinephrine and other resuscitative drugs were established in all cases,but all cases were dead due to breathing and heartbeat stopped for a long time.Conclusion DOA is one of the important reasons for pediatric high-risk.The key of reduction of DOA incidence and improvement of survival rate is to improve pediatric emergency medical service system,strengthen the health education for the parents,to carry out training and establish homogenization service in emergency ICU.

Objective Via observing concentration changes of interleukin(IL)-1β, IL-6 and IL-18 in hippocampus of pilocarpine treated rats after intranasal delivery of transforming growth factor-β1(TGF-β1), to explore the possi-ble anti-epileptogenic and neuro-protective role of TGF-β1 in the epiletogenesis progression. Methods Three hours after pilocarpine induced status epilepticus, rats were treated with recombinant human TGF-β1 or the same volume of PBS by intranasal administration. Animals were executed, harvested at 24, 48, 72 h after SE individual-ly. Using the methods of the enzyme-linked immunosorbent assay (ELISA) and immunohistochemisty (IHC), the concentrations and distribution of IL-1β, IL-6, IL-18 were detected in hippocampus. Results TGF-β1 could re-duce the expression of IL-1β and IL-6 in the hippocampus of pilocarpine treated rats effectively (P<0.05 or P<0.01), however, TGF-β1 did not affect the expression of IL-18 significantly( P >0.05). Conclusion By the supplementation of intranasal TGF-β1, classical pro-inflammatory cytokine ( IL-1β, IL-6) are remarkably sup-pressed, TGF-β1 may exert antiepileptogenic and neuropretective effects.

Objective To introduce the technique and efficacy of the treatment of avulsion fracture at tibial insertion of anterior cruciate ligament(ACL) in children through internal fixation by hollow cancellous bone screw under arthroscope.Methods December 2002 ～December 2007,internal fixation using percutaneous reduction by leverage was conducted in 68 children with avulsion fracture at tibial insertion of ACL in our hospital.In 68 children,there were 29 females and 39 males,aged 6～15 years(average age of 12 years),including 22 cases of typeⅡ(with limited knee extension)and 46 cases of type Ⅲ.The fracture was fixed by hollow titanium cancellous bone screw.Results Sixty eight cases were followed up for an average of 18 months(12～36 months).The muscle tension(mea sured by KT-2000) in injured side was recovered close to the uninjured side.Excellent reduction,solid inter nal fixation,complete healing,stable knee joint and negative Lachman and drawer tests were shown in this clinical setting.No swelling,pain and knee dysfunction were found.Impingement sign at intercondylar fossa disappeared.The patients were satisfied with their functional recovery.There was no abnormal angulation and shortness.Conclusion Treatment of avulsion fracture(type Ⅱ with limited knee extension or type Ⅲ) at tibial insertion of ACL by arthroscopic internal fixation with hollow titanium alloy cancellous bone screw could obtain accurate and reliable reduction,and avoide epiphysis injury with satisfactory functional recovery.

Objective To evaluate the value of reducing radiation dose with decreased size of ECG-pulsing windows and influence on image quality in dual-source CT coronary angiography. Methods 120 patients with stable heart rate(HR) were divided into four groups according to HR and the rang of ECG-pulsing windows in dual-source CT coronary angiography: HR ＜ 70 bpm and 61% ～ 77% R-R interval of ECG-pulsing windows, HR ＜ 70 bpm and 25% ～ 80% R-R interval of ECG-pulsing windows,HR ＞ 80 bpm and 31% ～47% R-R interval of ECG-pulsing windows, and HR ＞ 80 bpm and 25% ～ 80%R-R interval of ECG-pulsing windows was employed, respectively. The radiation dose parameters were recorded and image quality scores were performed. The image quality and radiation dose between two slow HR groups and between two fast HR groups were compared respectively. Result The effective doses were (7.06 ± 2. 13 ), ( 11.34 ± 3.65 ), ( 6. 67 ± 1.97 ) and ( 9. 92 ± 3. 15 ) mSy for four groups, respectively.The effective dose was decreased by 37.74% for slow HR and by 32. 76% for fast HR using narrow ECG-pulsing windows. There was no difference on image quality between two slow HR groups and two fast HR grouvs. Concluslons The proper application of narrow ECG-pulsing windows can reduce radiation exposure significantly to stable slow or fast HR patients in dual-source CT coronary angiography withont sacrificing the image quality.

Objective To discuss the incidence, clinical features, diagnostic methods, treatment and prognostic factors of Hodgkin lymphoma of breast. Methods The clinical data, diagnosis, treatment and prognosis of one male patient diagnosed as Hodgkin lymphoma of breast were retrospectively analyzed, and literatures were reviewed. Results The 71-year-old male patient had a main physical sign of a local painless lump in breast. The lump increased progressively, associated with generalized lymphadenopathy, skin itching and sweats. Pathologic results showed the diagnosis of classical Hodgkin lymphoma (Ann Arbor stage: ⅢEB). The patient eventually died after 7 months following the combined chemotherapy. Conclusions Hodgkin lymphoma of breast is a rare disease lacking in specific clinical manifestations. It is difficult to clarify the diagnosis before operation, and its definite diagnosis largely depends on pathological and immunohistochemical examination. The combination of chemotherapy with radiotherapy may have a favorable efficacy, with the poor diagnosis.

[Objective]The oxidative injury of retinal pigment epithelium(RPE)plays a key role in the pathogenesis of age-related macular degeneration(ARMD). This study is to investigate the effects of endoplasmic reticulum stress and the vital transcriptional factor X-box binding protein 1(XBP1)in acrolein-induced oxidative damage of RPE.[Methods]RPE cells were treated with acrolein (75μmol/L)for 2~24 h,expression of glucose regulated protein 78(GRP78)and XBP1 was determined by Western blot analysis. After being transfected with XBP1 siRNA with 24 h,the expression of XBP1 was knocked-down in RPE cells. Protein level of Nrf2 and SOD2 was then determined by Western blot analysis and intracellular Reactive Oxygen Species(ROS)generation was determined by DCF staining. Acrolein was added for 8 h after being transfected with XBP1 siRNA or control siRNA for 24 h. Apoptosis was detected by TUNEL assay before and after the treatment. Subretinal injection of Cre or GFP adenovirus was performed in XBP 1flox mice. After 1 week the mice were sacrificed. Total RNA was extracted from mice eyecups using TRIzol and real-time RT-PCR was performed to determine the two XBP1 down-stream genes,ERdj4 and p58IPK. Cryosectioning and immunofluorescent staining were performed to look at the expression of XBP1,Nrf2 and SOD2 in mice RPE.[Results]Protein level of GRP78 was significantly un-regulated after exposure to acrolein for 2 and 4 h. XBP1 was activated after acrolein treatment for 6 h. Knock-down of XBP1 by siRNA down-regu?lates anti-oxidant genes expression and increased ROS generation in RPE cells. Loss of XBP1 exacerbates acrolein-induced cell apoptosis. XBP1 was knocked-down in the RPE of XBP1flox mice after subretinal injection of Cre adenovirus. Decreased mRNA level of ERdj4 and p58IPK,and decreased Nrf2 and SOD2 expression were seen in the Cre-injected group.[Conclusions]Acrolein induces ER stress and activates XBP1 in RPE cells. Knock-down of XBP1 down-regulates anti-oxidant genes expression ,increases ROS generation,and exacerbates acrolein-induced cell apoptosis. XBP1 plays a role in the anti-oxidant defense in the RPE cells.

Fluorescent staining method is a sensitive cytochemical staining method, it can reflect minimal changes of biochemical components of cells. The 7690-Xu fluorescent staining solution prepared with thioflavine can show the heterogeneo- us fluorescence of cells in different stages of differentiation. The younger cells with low degree of differentiation show blue fluorescence, the lower the degree the deeper the color. Along with the differentiation of cells, the blue color of fluorescence deflects to the red color of spectrum gradually, the blue color of fluorescence of cytoplasm changes gradually to bluish, bluish-green, and finally yellow color. The blue color of fluorescence of nucleus changes through greyish- blue to orangeyellow or orange-red.The cytoplasm of cells in various organs with high degree of differentiation appears yellow, and the nucleus orange-yellow or orange-red in color.

Fetal atrioventricular block (AVB) is a type of fetal bradyarrhythmias. The reported incidence of fetal complete atrioventricular block (CAVB) and mortality of perinatal fetuses and neonates are signiifcantly higher in pregnancies of anti-SSA/Ro-positive mothers than that of anti-SSA/Ro-negative mothers. The auto-antibodies in maternal serum that can be transported into fetal circulation through placenta may damage fetal cardiac conductive system and eventually result in fetal AVB. There are evidences that early diagnosis and proper treatment can improve the prognosis and survival rate of affected fetuses. In this article, the pathogenesis, risk factors, prenatal diagnosis, treatment and prognosis of fetal immune mediated AVB is reviewed.

ObjectiveTo explore puncture point and angle of skin for unipedicular vertebroplasty by imaging measurement and combining clinical practice in order to pr vide reference for clinical work.MethodsCT images of thoracic and lumbar vertebrae of imaged with multislice helical CT were random chosen.From high to low position vertebrae of easy fracture T6 to -L5,its angle between vertebraI pedfcle stalk line and 1/3 of vertebraI body stalk line fore and median of point of intersection was measured.The angle of sternocostal joints route was also measured.At the same time the distance between site of skin puncture and spinous process was measured.ResultsThe angle between the thoracic vertebraI pedicle and sagittal section was (28.2 ± 3.8) °,the lateral distance of the spinous process was ( 31.6 ± 5.4) mm.The angle of thoracic vertebraI pedicle lateral route was (35 ± 3.4) °,the distance was ( 55.2 ± 5.3 ) mm.In the lumbar vertebrae pedicle route,the angle of L1 -L4 was (29.3 ± 5.6 ) °,the distance was (38.4 ± 4.5 )mm.Ls was (39.2 ± 3.3) °,the distance was ( 71.6 ± 6.2) mm.Combining clinical practice,the lateral distance of the spinous process in thoracic vertebraIpedicle route,the best puncture point was 30 mm,in thoracic vertebraI pedicle lateral route it was 40 mm,in L1-L4 it was 45 mm,in L5 it was 60 mm.ConclusionsThe unipedicular vertebroplasty can be performed rapidly,accurately and safely,and it reduces complications,cost and time.

Objective:To formulate the norm value of auditory verbal learning test(AVLT)in the normal aged in Chinese community.Methods:360 normal old people(55 to 85 years)in city proper of Shanghai were enrolled and evaluated by AVLT,MMSE test of words reading ability and executive ablity,memory self-evaluation and medical history related to cognitive impairment.Results:70% of the normal old people complained of hypomnesia;The age of 70 and 80 was the hinge points of auditory verbal memory decreasing.AVLT had a moderate relation to age,and a lower relation to educational level.Female did better in AVLT than Male.Furthermore,AVLT had a significant relation to MMSE score,a mild relation to memory self-evaluation,and only related to hypertension of all the medical history.The cut off score of short-term recall,long delayed term recall and total AVLT score(-1SD,-1.5SD and-2SD)was listed.Conclusion:Norm value of AVLT is an effective tool of testing memory impairment.