To management of syncope in children and adolescents,the primary objectives are etiological diag-nosis and risk stratification.The possible causes for syncope ranging from relatively benign conditions to potentially life -threatening events.The efficient methods of diagnosis and risk stratification are vital important to identify those syncope patients who are at short -term or long -term risk of life -threatening events,avoiding unnecessary hospitali-zation of low -risk patients.In recent years,there came up with a multitude of quantitative methods in diagnosis and risk stratification,according to clinical history and physical exam and 1 2 -lead electrocardiograph.These methods can assit front -line physicians do an optimal decision -making,especially providing valuable guidance to make a well -in-formed choice between hospitalization and outpatient referral.Nevertheless,these existing methods can not replace criti-cal assessment by an experienced physician.

Objective To study the feasibility and the efficacy of total extraperitoneal repair (TEP) under two laparoscopes.Methods Clinical data of 51 patients with inguinal hernia who underwent TEP under two laparoscopes from July 2015 to March 2016 in our hospital were analyzed retrospectively.During TEP,we added a 5-mm laparoscope for monitoring and exploration in the abdominal cavity.Results All the operations of TEP under two laparoscopes were successful.The operation time lasted 42-176 min with a mean of (74 ±27) min.The intraoperative blood loss was 5-30 ml with a mean of (12.8 ±5.9) ml.The length of postoperative hospital stay was 2-7 days with a mean of (4.0 ± 1.1) days.The percentage of postoperative complications was 11.8％ (6/51),including inguinal area seroma which accounted for 2.0％ (1/51),inguinal region pain accounting for 3.9％ (2/51),and postoperative urinary retention for 5.9％ (3/51).No infection was found.The follow-up period ranged from 3 to 11 months (mean,7 months),no recurrence was observed during this period.Conclusions TEP under two laparoscopes can treat inguinal hernia precisely.It is also helpful to find compound inguinal hernia and occult inguinal hernia.

Objective To discuss the main reason of re -pregnant patients'delivery mode selection after cesarean delivery and to guide the future clinical work.Methods Retrospectively analyzed the 181 cases of re -pregnancy after cesarean delivery and compare the clinical data of 140 cases of reselecting cesarean delivery with 41 cases of selecting vaginal trial production.Results Calculated the risks of vaginal trial production and cesarean delivery of scarred uterus by Smith formula.There was no statistically significant difference in two groups (P >0.05). Reselection of cesarean delivery accounted for 77.0% among the cases of re -pregnancy after cesarean delivery.In the investigation on the reason for re -pregnant patients reselecting cesarean delivery,38 patients chose cesarean delivery for the first time owing to social factors,accounted for 27.1%,taking the first place.While in the investiga-tion on the reason for re -pregnant patients selecting vaginal trial production,10 patients were operated on cesarean section for the first time due to fetal distress,accounted for 24.4%,coming first.Conclusion In the investigation on the reason for re -pregnant patients reselecting cesarean delivery,the result shows that the high possibility of reselect-ing cesarean delivery lies on those who chose cesarean delivery for the first time owing to social factors.While those who were transferred to cesarean section due to abnormal fetal heart rate during the first vaginal trial production,may have high possibility to select vaginal trial production when re -pregnancy.As a result,the key is to decrease the rate of cesarean delivery for the first time.

Objective To investigate the effect of cognitive intervention on language function and quality of life (QOL) in elderly patients with post-stroke aphasia.Methods Fifty-five elderly patients with post-stroke aphasia were randomly divided into the control group (n =27) and the experimental group (n=28).The control group received comprehensive treatment including speech-language therapy (SLT),while the experimental group was subjected to additional cognitive intervention.All patients were enrolled in an eight-week rehabilitation program.The mini-mental state examination (MMSE) was used to assess cognitive function,a device for diagnosis and treatment of language disorders,ZM 2.1,was used to evaluate language function,and the 36-item short-form health survey (SF-36) (Chinese version) was used to assess quality of life (QOL),before and after treatment.Results After treatment,MMSE scores,language function scores in all categories and QOL scores in all dimensions improved in both groups (P＜0.05 for both).Furthermore,after treatment,there were significant differences between the two groups in MMSE scores of orientation,recall,attention and calculation,and in scores of overall language ability and the individual categories (P＜0.05 for all).Scores of the experimental group vs.the control group for the individual categories of language function were as follows:simple instructions (76.6 ± 14.1 vs.67.4± 19.3),complex instructions (66.1±12.8 vs.58.2±14.9),yes or no (72.5±12.1 vs.63.0±14.1),naming (55.0 19.5 vs.43.3±22.2),simple comprehension (67.5±21.4 vs.55.620.6),complex comprehension (44.8±17.0 vs.35.0±18.9),listening and reading words (65.4±16.7 vs.53.7±19.3),calculation (39.3±25.8 vs.25.9±19.2),memory (36.4±18.7 vs.26.3±17.8),matching (75.9±18.6 vs.65.3±17.1),simple general knowledge (68.3±18.2 vs.58.0±19.5),complex general knowledge (58.7±17.4 vs.50.0±13.3),orientation (70.7±19.6 vs.60.5±17.2) and comparison (59.9± 14.6 vs.50.2±17.5) (P＜0.05 for all).There were significant differences between the two groups in emotional function (66.7±18.2 vs.53.1±21.2),general health (67.2±12.6 vs.60.7±9.8),mental health (71.0±5.6 vs.63.1±4.2),social functioning (64.7±9.0 vs.59.3±10.2) and vitality (55.4±14.8 vs.46.9±15.6) (P＜0.05 for all).Conclusions Cognitive intervention combined with SLT can contribute to the recovery of language function and the improvement of QOL in elderly patients with post-stroke aphasia.

Protein Kinase C (PKC) is an important messenger in intracellular signal transduction. So far, at least 11 members of PKC isoforms have been isolated and purified. The mutation of the non-synonymous SNP (1425G/A) of the η isoform of protein kinase C (PKC η), a protein kinase Cη gene (PRKCH) may result in the increased PKCη activity, which is considered as a new risk factor for lacunar infarction. In recent years, the studies about the role of PRKCH in cell differentiation and apoptosis and its relation with some signal transduction pathways have made some new advances, especially, PKCη participates in the regulation of some key enzyme activity that mitogen-activated protein kinase, inducible nitric oxide-synthase and matrix metalloproteinase are closely correlated with the process of atherosclerosis. It will provide a new way of thinking for the clinical intervention of cerebral infarction in the future.

Taking the medical education of UCLA Medical School as an example, this paper com-pares the differences of medical education between Chinese and the United States medical schools . US medical education features students from undergraduate students, the organ system-oriented curriculum, diversified teaching methods with emphasis on the PBL one and diversified academic assessment, under-graduate-based teachers' allocation and training objectives for excellent clinical physicians. From the expe-rience of American medical education, our country should focus on optimizing the teaching system, updat-ing the teaching ideas, diversifying the teaching methods, promoting students' initiative, strengthening clinical probation, strengthening students' clinical skills, improving the construction of teaching facilities and network, and enhancing the humanistic quality education and the overall quality of teachers.

Objective To analyze the correlation between serum interleukin-18(IL-18) level and changes of heart function in children with viral myocarditis(VM).Methods Seventy-two cases with VM were selected from Tianjin Children's Hospital.Control group were selected from the patients in surgery outpatient department.The patient group was divided into 3 groups which were named non-heart failure group,heart failure group and cardiogenic shock group.The Pillip Sonos 5500 type echocardiogram was applied to measured the left ventricular fractional shortening(LVFS),ejection fraction (EF),left atrium inner diameter(LAD),left ventricular end diastolic inner diameter (LVEDD)and left ventricular end systolic inner diameter(LVESD) in patient group,descripted function change of their heart.ELISA method was used to measure the content of IL-18 in 15 cases of control group and 36 cases of patient group.All data were analyzed by SPSS 11.5 software.Results 1.The LVESD in shock group were larger than that in non-heart failure group and heart failure group,abnormality probability of LVFS and EF step up from non-heart failure group to heart failure group and to shock group.2.The serum IL-18 level in patient group was higher than that in control group (P

Objective To study the different curative effect between r-tPA application and urokinase in the interventional therapy for acute and severe pulmonary embolism.Methods Analyzed the clinical date of 22 cases acute and severe pulmonary embolism patients,and classified them into two groups according to the application of r-tPA and urokinase to compare the changes of their blood pressure,heart rate,arterial partial pressure of oxygen,hemachrome and pulmonary arterial pressure before and after therapy,meanwhile,record the thrombolysis time that the two groups took.Results The thrombolysis effect time adopting urokinase was remarkably longer than that thrombolysis adopting r-tPA(P<0.05); The blood pressure,heart rate,arterial partial pressure of oxygen of the two groups gained remarkable improvement after therapy(P<0.05).The pulmonary arterial pressure of the urokinase group dropped obviously after operation(P<0.05),while the r-tPA group dropped not so significantly after operation.The hemachrome of the two groups did not dropped significantly after operation.Conclusion The r-tPA and urokinase are both effective to interventional therapy for acute and severe pulmonary embolism,while r-tPA can clearly shorten the time in thrombolysis and could reduce any bleeding risk.

Schwann cells (SCs) have potently neuroprotective and myelinization abilities. They are one of the earliest and the most frequently used cells that are applied to therapeutic studies in spinal cord injury. At present, SCs are usually used as a platform for therapeutic alliance to integrate various interventions. This review will mainly discuss the issues met in therapeutic alliances with SCs for spinal cord injuries, results of various therapeutic alliances with SCs, positive effects of co-transplantation with SCs on neural stem cells, survival, migration of SCs after transplantation and roles of endogenetic SCs in repairing spinal cord injury.

Biomarkers ; analysis ; Biopsy ; Child ; Female ; Fluid Therapy ; Humans ; Kidney Diseases ; etiology ; Rhabdomyolysis ; diagnosis ; etiology ; therapy ; Virus Diseases ; complications