Through analyzing the children's pre-hospital transport,emergency medicine,intensive care medicine,nursing,professional training and research,we reviewed the current status of construction and issues of pediatric emergency and critical care system,then put forward recommendations of its development.

The intakes of Al, Ca, Mg, Zn, Fe or P in the diet of college students were determined with chemical methods and the effects of Al on several elements were observed. The results showed that the mean intake of Al was 4.59 mg/d for students and the mean daily intakes of Ca, Zn, Fe were 40.1%, 81.8%, 191.1% of RDA, respectively. Higher intake of Al (33.88mg/ person/d) did not apparently influence the serum Al, Ca, Mg, Zn and Fe levels in short time. The multiple stepwise regression analysis found that there was a positive correlation between the serum Al content and P intake and a negative correlation between the serum Al content and Mg intake. Further studies were needed for the effects of Al on Ca, Mg, Zn, Fe and P metabolism.

Objective To discuss the clinical application of simplified neonatal critical illness score (sNCTS)in comparison with original neonatal critical illness score(oNCIS)published in 2001.Method A total of 705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009 were prospectively studied with control.The patients were scored by oNCIS on admission day,3rd,7th days after admission and on the day of discharge or dead.At the first scoring on admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and the remaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUN were scored out from 8 items and the still remained 5 items were used for the subsequent 3 scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illness score.The simplified NCIS was evaluated by comparing the patients'condition that was assessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over 80%.Results There were 8 items were used to evaluate the severity of disease on admission, and the consistence rate was 86.7%with the original NCIS.The 5 items selected from the original NCIS were used on the 3rd,the 7th days and the day of discharge or death.the consistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed between the original NCIS and simplified NCIS(P<0.01).There were significant differences in mortality rates of the non-serious,serious and extremely serious groups between original NCIS and simplifled NCIS used for the first and the last seorings(P<0.01).Within a cohort of neonates with the same general condition,the assessments of mortality rates were not significantly different between these two methods (P>0.05).Conclusions Compared with the original NCIS.the simplified NCIS is consistent to a large extent in disease assessment,which is a concise way to evaluate the critical ill neonates objectively and can be easily applied to clinical practice.

BACKGROUND: Studieshave shown that long time of warm ischemia or cold preservation would injury the biliary tract in liver transplantation. However, whether relative warm ischemia (RWI) of biliary tract would result in bile component changes is unclearly. OBJECTIVE: To establish auto-liver transplantation bile ducts RWI models, observe the effects of RWI on the bile salts and phospholipid concentration secreted by the donor liver, and to study the correlation between the total bile salt/phosphoUpid ratio (TBA, PL ratio) and billary tract injury. METHODS: A total of 32 SD rats were selected for auto-liver transplantation models with bile ducts RWI, and the rats were randomly divided into 4 groups (n=8). In Group Ⅰ (sham operation group), rats only received liver dissociation without any cold reperfusion. The RWI time of Group Ⅱ,Ⅲ, and Ⅳ were 0 minutes, 30 minutes and 60 minutes, respectively. The concentration of TBA in bile was measured with enzymatic cycling assay, andPL with enzymic colorimetric. Pathological observation with light microscope and ultrastructural observation with transmission electron microscope were performed on the hilar bile duct. The endothelial cell apoptosis was detected with TUNEL assay. The correlation between TBA, PL ratio and biliary injury was analyzed. RESULTS AND CONCLUSION: One rat died, the other 31 rats were included in the final analysis. RWI could change the composition of bile secreted by donor liver, raise the TBA/PL ratio, and increase the bile toxicity. These changes had a positive correlation to RWI time, and the changes were obviously with time prolonged. In addition, the changes are closely related to the biliary tract injury. This study shows an important mechanism of the biliary tract injury caused by RWI-injury.

Objective: To investigate the effects of folic acid (FA), vitamin B6 (VB6) and B12 (VB12) on plasma homocysteine (Hcy) and antioxidative activities in focal cerebral ischemia rats. Method: Rats were randomly divided into four groups including sham operation (Sham), middle cerebral artery occlusion model (MCAO), MCAO+FA and MCAO+FA +VB6+VB12(MCAO+CV). MCAO model was induced by operation. Plasma Hcy, serum and brain SOD and GSH-Px activities and MDA content in rats were measured before and 28 d after supplementation and 24 h after ischemia or only after ischemia. Results: Plasma Hcy in MCAO+FA and MCAO+CV group were significantly lower than those in Sham and MCAO groups after supplementation and ischemia, and the MCAO+CV group lower than MCAO+FA group. Serum and brain SOD and GSH-Px activities were significantly higher, and MDA contents lower in MCAO+FA and MCAO+CV groups than those in MCAO group. Conclusion: Supplementing FA, VB6 and VB12 can reduce plasma Hcy, improve antioxidative abilities and decrease the injury by oxidative stress following cerebral ischemia.

Objective To investigate the effects of genistein(GEN) on the expression of collagen I and transforming growth factor-?1(TGF-?1 ) of osteoblast.Method The secondary generation of skull osteoblast of newborn SD rat was incubated with GEN.The cells were divided into six groups:control group,different dose of GEN(10-8,10-7,10-6,10-5mol/L,respectively) groups and E2 group( 10-10mol/L).MTT(OD),the contents of cell protein,the activity of alkaline phosphatase(ALP),the expression of collagen I and the content of TGF-?1 were detected.Results After 48h and 72h,the MTT(OD) of all GEN group and E2 group were significantly higher than those in control group.The MTT(OD) of control group and 10-8,10-7,10-6mol/L GEN groups in 72h were significantly higher than those in 48 h.The protein of 10-5,10-6 mol/L GEN group and E2 group were significantly higher than those in control group.The ALP activity of all GEN groups and E2 group were significantly higher than those in control group.The level of above indices were correlated with the dose of GEN.The expression of collagen I and the content of TGF-?1 in 10-7,10-6,10-5mol/L GEN group and E2 groups were higher than those in control group.They werecorrelated with the dose of GEN and TGF-?1.Conclusion GEN could stimulate proliferation and differentiation of osteoblast,and enhance the expression of collagen I and content of TGF?-1.Compared with E2,,there were similar effects with the higher dosage of GEN.

Objective To evaluate the narrow-band imaging (NBI) in differential diagnosis of colo-rectal proliferative lesions. Methods Suspected lesions in colon were examined with white light and NBI colonoscopy, respectively. The ensitivity and specificity in diagnosing colorectal inflammatory hyperplasia, adenoma, early cancer and advanced cancer were compared between NBI and conventional colonoscopy with reference to pathology as gold standard. The pit patterns and the surface microvessels of the lesions were also determined and scored with NBI combined with magnifying endoscopy, and were compared with pathological diagnosis. Results (1) A total of 368 lesions were detected in 280 patients with conventional colonoscopy and NBI. The sensitivity and specificity of NBI in differential diagnosis of colorectal lesions were superior to those of conventional colonoscopy. (2) The pit patterns of colorectal inflammatory hyperplasia were mainly type Ⅰ and Ⅱ , while in adenomas were mainly type Ⅱ and Ⅲ (94. 2%). The pit patterns of early cancer were type Ⅲ (18. 8%), Ⅳ (56. 3%) and Ⅴ (25.0%), and those of advanced cancer were mainly type Ⅴ (94. 0%). (3) The average scores of surface microvesseis of colorectal inflammatory hyperplasia, ade-noma, early cancer and advanced cancer were 1.35 ± 0. 72, 3. 86 ±1.07, 6. 52±2. 59 and 11.42 ± 3.59, respectively. Scores over 6. 5 was a strong indicator of malignant lesions. Conclusion NBI is superior to conventional eolonoscopy in differential diagnosis of colorectal lesions. Observing pit patterns and microves-sels of the lesion with combination of NBI and magnifying endoscopy is helpful in diagnosis.

Objective To improve the arthroscopic posterior cruciate ligament (PCL) reconstruction using tibial Inlay technique. Methods The special arthroscopic device and related fixation technique were designed. Five cadaveric knees were used to simulate the process of arthroscopic posterior cruciate ligament reconstruction using tibial Inlay technique. The knees were cut open to observe whether the outlet of the tibial tunnel shape and location met the design requirements. Thirty normal MRI films were measured to identify tunnel angle and localizer angle. Results The inner outlet of tunnel was conical shape(14 mm×7 mm×15 mm) and the outer outlet was cylinder-shaped (a diameter of 7 mm). The tibial drill was designed into a split structure and could be assembled in vitro. According to the data obtained from MRI films, the angle between the plane of posterior cruciate ligament and horizontal place was 36°-47°, and the localizer was fixed at 50°.The achilles tendon was used as implant and the allogft bones were designed into conical shape to fit the inner outlet of tunnel. The other end of implant to the proximal tibia was fixed with button plate. All reconstruction operations were performed under arthroscopy. The outcomes of procedure were satisfactory. There were no vascular or peripheral nerve injuries in the cadaveric knees The tunnel position was accurate and the shape of tunnel had met the design requirements. Conclusion Our results imply that improved arthroscopic of posterior cruciate ligament using tibial Inlay technique is simple, accurate, rapid and stable fixation.

BACKGROUND: Soybean isoflavone has a variety of bioactivities and its antioxidation becomes a hot spot of research in recent years. At present,the research of soybean isoflavone places more emphasis on animal experiment and clinical observation,but lacks research on cellular level of human body.OBJECTIVE: To observe the influence of soybean isoflavone in vascular endothelial cells with oxidative damage.DESIGN: Controlled trial and observation.SETTING: Central Laboratory, Institute of Public Health,Tianjin Medical University.MATERIALS: The experiment was completed in the Central Laboratory,Institute of Public Health,Tianjin Medical University from January to July 2002.The experimental materials included vascular endothelial cell strain in human umbilical vein,low density lipoprotein,soybean isoflavone and vitamin E,etc.METHODS: The vascular endothelial cells were cultured in vitro.The experiment was divided into 6 groups: blank control group,oxidative damage control group (malondialdehyde content was 1 μmol/L),oxidative damage+vitamin E control group(vitamin E was 50 μmol/L) and oxidative damage+soybean isoflavone 10,50,100 μ mol/L control group. The endothelial cells,which were joined with vitamin E and soybean isoflavone of different concentrations in advance to be incubated for 24 hours,were affected by oxidized low density lipoproteins and then cultured continually for 24 hours.All the indexes of antioxidation were determined in both extra-cell and intra-cell.MAIN OUTCOME MEASURES: Malondialdehyde content,activity of superoxide dismutase and glutathione peroxidase,the release condition of lactate dehydrogenase and productive quantity of nitrogen monoxide inside and outside the endothelial cells of each group.RESULTS: ①Comparison of malondialdehyde content,the activity of superoxide dismutase and glutathione peroxidase in endothelial cells of each group: The malondialdehyde content was higher significantly in oxidative damage control group than in blank control group (P ＜ 0.01),but the activity of superoxide dismutase and glutathione peroxidase was lower significantly in oxidative damage control group than in blank control group(P ＜ 0.01).The malondialdehyde content was lower significantly in oxidative damage+vitamin E control group,oxidative damage+soybean isoflavone 10,50,100 μmol/L control group than in oxidative damage control group(P ＜ 0.01),but the activity of superoxide dismutase and glutathione peroxidase was higher significantly in oxidative damage+vitamin E control group,oxidative damage+soybean isoflavone 10,50,100 μ mol/L control group than in oxidative damage control group (P ＜ 0.01). ②Comparison of the release condition of lactate dehydrogenase and the productive quantity of nitrogen monoxide in endothelial cells of each group: The release percentage of lactate dehydrogenase was higher significantly in oxidative damage control group than in blank control group (P ＜ 0.01),but the productive quantity of nitrogen monoxide was lower significantly in oxidative damage control group than in blank control group(P ＜ 0.01).The release percentage of lactate dehydrogenase was lower significantly in oxidative damage+vitamin E control group,oxidative damage+soybean isoflavone 10,50,100 μmol/L control group than in oxidative damage control group (P ＜ 0.01),but the productive quantity of nitrogen monoxide was higher significantly in oxidative damage+vitamin E control group,oxidative damage+soybean isoflavone 10,50,100 μmol/L control group than in oxidative damage control group(P ＜ 0.01).CONCLUSION: Soybean isoflavone can alleviate the oxidative damage in vascular endothelial cells,caused by oxidized low density lipoprotein,possibly through such antioxidization indexes as malondialdehyde content,the activity of superoxide dismutase and glutathione peroxidase,the release condition of lactate dehydrogenase and the productive quantity of nitrogen monoxide,etc.