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 assess and compare the advantages and disadvantages of five fields of three dimensional conformal radiation therapy(3DCRT),three fields of 3DCRT and the simulator-guided radiation therapy for patients with esophageal carcinoma.Methods Twenty patients with esophageal carcinoma were treated by three dimensional conformal radiation therapy,at the same TPS,three Dimensional conformal radiation therapy target and normal tissue of three radiotherapies were simulated.The treatment planning was five days per week with 1.8～2.0 Gy per fraction。 5 fractions per week,5OGy per 5～6 weeks. Results Compared with simulator-guided radiation therapy,3DCRT planning has better dose distribution and protection of normal tissue. Conclusion Esophageal cancer conformal radiotherapy can reduce the radiation injury of the normal tissue and complications,and improve treatment of conformal radiotherapy and the target dose distribution.

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.

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.

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.

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 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.

Objective To compare the variations of serum cytokines before and after ozone injection with different dosages and between intra-articular injection of knee joint and autohemotransfusion injection in experimental rabbits,to make a further understanding of the biologic mechanism of ozone therapy on osteoarthritis(OA).Methods Thirty-six New Zealand white rabbits were equally and randomly divided into six groups:(1) normal group,(2) OA model group,receiving no treatment,(3) group L10,receiving 10 ?g/ml ozone per intra-articular injection,(4) group L30,receiving 30 ?g/ml ozone per intra-articular injection,(5) group S10,receiving autohemotransfusion with 10 ?g / ml of ozonized blood per injection and(6) group S30,receiving autohemotransfusion with 30 ?g/ml of ozonized blood per injection.OA models were prepared by injecting 0.5 ml of collagenase II solution into the knee joint space two times with an interval of three days.Blood samples of all groups were collected 4 weeks after the last ozone treatment for further analysis.Serum levels of NO,T-SOD,TNF-? and IL-1? were estimated.Results The serum levels of NO,T-SOD,TNF-? and IL-1? in the model group and all treated groups were significantly higher than that in normal group(P0.05).Conclusion(1) An increase in the serum levels of NO,T-SOD,TNF-? and IL-1? exists in rabbit OA models.(2) Ozone has no inhibitary effect on the serum levels of NO,T-SOD,TNF-? and IL-1?,regardless of what route of administration of ozone is adopted.(3) The effect of "oxidative preconditioning" is not local,but rather systemic.