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 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 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 compare the effects of different doses of atorvastatin on blood lipid and endothelial function in patients with hypertension and carotid plaque.Methods:Ninety-two patients with hypertension and carotid plaque who received treatment from June 2019 to June 2020 were included in this study. They were assigned to receive treatment with either atorvastatin 20 mg (control group, n = 46) or atorvastatin 40 mg (study group, n = 46) for 3 months. Blood lipid level and endothelial function were compared between the two groups. Results:There were no significant differences in sex, age, course of disease, body mass index (BMI) and carotid plaque grading between the two groups (all P > 0.05). Before treatment, there were no significant differences in serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) between two groups (all P > 0.05). After treatment, serum levels of TC, TG and LDL-C in each group were significantly decreased compared with before treatment [study group: TC: (5.8 ± 2.3) mmol/L vs. (3.5 ± 1.3) mmol/L, t = 5.904; TG: (2.5 ± 0.8) mmol/L vs. (1.2 ± 0.5) mmol/L, t = 9.346; LDL-C: (5.0 ± 0.4) mmol/L vs. (3.3 ± 0.4) mmol/L, t = 20.382; control group: TC: (5.9 ± 1.8) mmol/L vs. (4.5 ± 1.5) mmol/L, t = 4.052; TG: (2.6 ± 0.3) mmol/L vs. (1.8 ± 0.7) mmol/L, t = 7.125; LDL-C: (4.9 ± 0.5) mmol/L vs. (4.2 ± 0.5) mmol/L, t = 6.714, all P < 0.01). After treatment, serum level of HDL-C in each group was significantly increased compared with before treatment [study group: (0.8 ± 0.5) mmol/L vs. (1.5 ± 0.3) mmol/L, t = 8.142; control group: (0.8 ± 0.4) mmol/L vs. (1.3 ± 0.2) mmol/ L, t = 7.583, both P < 0.01]. After treatment, serum levels of TC, TG and LDL-C in the study group were significantly lower than those in the control group ( tTC = 3.417, tTG = 4.731, tLDL-C = 9.533, all P < 0.01). After treatment, serum level of HDL-C in the study group was significantly higher than that in the control group ( tHDL-C = 3.762, P < 0.01). Before treatment, there were no significant differences in endothelium-dependent (flow mediated dilation, FMD) and endothelium-independent diastolic function (nitroglycerin- mediated dilatation, NMD) between the two groups (both P > 0.05). After treatment, FMD in each group was significantly enhanced compared with before treatment [study group: (7.5 ± 1.8) % vs. (10.9 ± 2.5) %, t = 7.486; control group: (7.7 ± 1.5) % vs. (8.9 ± 2.2) %, t = 3.057; both P < 0.05]. After treatment, FMD in the study group was significantly higher than that in the control group ( t = 4.073, P < 0.01). There was no significant difference in NMD between before and after treatment in the control group. After treatment, NMD in the study group was significantly increased compared with before treatment [(12.5 ± 2.3) % vs. (13.6 ± 2.5) %, t = 2.196, P = 0.031]. Conclusion:Atorvastatin 40 mg once a day can effectively regulate blood lipid level and improve endothelial function in patients with hypertension and carotid plaque, which exhibits superior effects to atorvastatin 20 mg once a day.

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.

Objective To analyze the Doppler indices of uterine artery at 11-16 weeks normal gestation. Methods Two hundred and ninty-seven normal pregnant women were consecutively recruited to take routine ultrasound examination at 11-16 weeks' gestation. According to gestational week, they were divided into 6 groups (11-11+6 weeks, 12-12+6 weeks, 13-13+6 weeks, 14-14+6 weeks, 15-15+6 weeks, 16-16+6 weeks). According to the location of placenta, they were divided into 3 groups (central placenta, right placenta, left placenta). Finally, the pregnant women were divided into 5 groups (RI<0.60 group, 0.60-0.69 group, 0.70-0.79 group, 0.80-0.85 group and ≥ 0.85 group) according to resistance index (RI). Doppler indices of uterine artery were measured in each case. Results (1) The PIm, RIm, S/Dm values (the mean PI, RI, S/D values of bilateral uterine artery) were decreased with the progress of pregnancy, but the difference of the RIm, S/Dm were not significant. Only the decrease of PIm after 15 weeks was significant (P<0.05). The mean PIm of each group was:11 weeks 1.96±0.39, 12 weeks 1.94±0.45, 13 weeks 1.79±0.43, 14 weeks 1.79±0.36, 15 weeks 1.51±0.43, 16 weeks 1.50±0.30. (2) The PI, RI, S/D values of uterine artery with placenta attached were lower than the other side. In the left placenta group, bilateral RI difference was-0.04 (t=-3.095, P=0.005), bilateral PI difference was -0.24 (t=-3.232, P=0.004), bilateral S/D difference was-1.00 (t=-2.965, P=0.007);in the right placenta group, bilateral RI difference was 0.04 (t=6.159, P=0.000), bilateral PI difference was 0.43 (t=6.614, P=0.000), bilateral S/D difference was 2.05 (t=6.378, P=0.000);in the middle placenta group, bilateral RI difference was 0.02 (t=4.150, P=0.000), bilateral PI difference was 0.14 (t=4.475, P=0.000), bilateral S/D differencewas 0.54 (t=4.376, P=0.000). (3) According to the RI, incidence rates ofα-notch detected:in<0.60 group both sides were 0;in 0.60-0.69 group, left uterine artery was 0.08, right uterine artery was 0.08;in 0.70-0.79 group, left uterine artery was 0.34, right uterine artery was 0.31;in 0.80-0.85 group, left uterine artery was 0.65, right uterine artery was 0.72;in≥0.85 group, left uterine artery was 0.81, right uterine artery was 0.87. Conclusion The uterine artery Doppler indices of 11-16 weeks maybe a reliable and non-invasive method for examining uteroplacental perfusion.

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.

Objective To evaluate the effect of the traditional Chinese medicine (TCM) knowledge and skills training on non TCM community physicians in Shanghai, and provide important basis and feedback for future adjustments and training improvement.Methods The current situation of the TCM knowledge and skills training on non TCM community physicians in Shanghai was reviewed. The community physicians participated in the training courses in 2014 in Jiading district were randomly selected for investigation. The TCM theory and skills scores of all the 65 trainees were compared before and after training, a self-made questionnaire survey on assessment of training was conducted after training, and the influencing factors of training effect were analyzed. Results After training,test results of TCM theory and skills were significantly higher than before(P<0.01). According to the survey of trainees after TCM training, 84.6% thought the training was necessary,95.4% liked the teaching form, 93.9% accredited training content difficulty level,92.3% thought the training was practical, 98.5% were willing to provide Chinese medicine services for community residents, 60.0% thought training to promote the general medical work was very helpful. The existing problems were short training periods(43.1%), only 10.8% could skilled TCM appropriate technologies and 60.0% were basically master. Conclusion The TCM knowledge and skills training on non TCM community physicians in Shanghai had achieved better effect. There still were some deficiencies, which require further exploration in order to better carry out future training.

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.