Objective To investigate the diagnostic value of ST segment elevation in acute myocardial infarction (AMI) occurred in patients after resuscitation.Methods The relevant articles about coronary angiography performed in an emergency for all the post-resuscitation patients without obvious noncardiac cause,regardless of the representation of the electrocardiography were searched in the databases of Pubmed,Ovid medline,EBSCO,CBM,Wanfang and VIP of Chongqing.The meta-analysis was carried out with the data from the included articles using the meta-disc 1.4 software.Results Five articles about retrospective analysis of consecutive patients were included.The meta-analysis of pooled statistics showed the sensitivity 0.59,the specificity 0.86,the positive likelihood ratio (LR) 4.4,the negative LR 0.39,the diagnostic odds ratio (OR) 12.28 and the area under the curve (AUC) 0.85.Conclusions Although the high specificity is in favor of making diagnosis of AMI in post-resuscitation patients,the low sensitivity makes the integrative diagnostic value of using sole ST-segment elevation of ECG relatively low.

Pediatric acute liver failure is a severe and sudden onset of hepatocyte dysfunction,leading to synthetic and detoxification failure,which could progress to multi-organ failure and death.Mortality is predominantly high due to the raised intracranial pressure,infections and multi-organ failure.The mainstay of management is supportive care in an intensive care unit.The intensive care managements include immediate measures,etiology,management of complications and liver assist device,liver transplantation.Liver transplantation is an important life saving procedure for children with acute liver failure.

Objective To explore the role of LGR5 positive intestinal stem cells in repairing damage of intestinal mucosa resulting from endotoxemia and to determine whether the damaged intestinal mucosa can be repaired by regulating the proliferation and differentiation of intestinal stem cells.Methods Wistar rats were randomly divided into control group,lipopolysaccharide(LPS) group,and glucagon-like peptides 2(GLP-2) group.LPS was injected interaperitoneally into rats of the LPS group and GLP-2 group at a dose of 5 mg/kg(1 ml/kg) ; saline(1 ml/kg) was injected into the rats of control group.GLP-2 250 μg/kg(1 ml/kg) was rnjected into the rats of GLP-2 group 1 hour after the LPS injection.The terminal ilea were collected from 8 rats in each group at 6 h,24 h,and 72 h post-LPS injection.Structrral changes in the intestinal epthelium of every group were observed under the light microscope and electron microscope.The expression of LGR5 in intestinal stem cell was detected by immunohistochemical method and RT-PCR.Results In general,intestinal edema and hyperemia was observed in both LPS and GLP-2 groups at 6 h.Fracture and lodging of villi,infiltration of inflammatory cells,and visible exudate within the cavity were observed under light microscopy.The inflammatory injury was less severe in the GLP-2 group than in the LPS group at 6 h.The injury of intestina mucosa gradually repaired between 24 h and 72 h after injection of LPS in both LPS group and GLP-2 group.Importantly,samples taken from GLP-2 group and LPS group at the same time point indicated that the GLP-2 group recovered significantly better than the LPS group.And expressions of LGR5 mRNA in GLP-2 group at 6h,24h,72 h(0.13 ±0.05,0.16±0.05,0.16±0.04) were significantly higher than those in LPS group respectively (0.52 ±0.09,0.73 ±0.14,0.48 ±0.24),as shown by RT-PCR,and than that in control group(0.12 ±0.03) (P ＜ 0.05).Conclusion Exogenous GLP-2 may facilitate intestinal stem cell proliferation,thereby promoting the recovery of intestinal mucosa damaged by endotoxemia.GLP-2 appears to promote stem cell proliferation,differentiation,and gradual migration of stem cells from the intestinal crypts to the damaged mucosa.

Nuclear factor-?B (NF-?B) is a nuclear transcription factor that regulates the expressions of multiple genes. It can be activated during cerebral ischemia; it is closely correlated with the inflammatory reaction and apoptosis during cerebral ischemia. NF-?B inhibitor ? (I?B?), an important inhibitor factor of NF-?B, can regulate the survival and death of neuron in the ischemia penumbra. Therefore, the inhibition of the degradation of I?B? and the prevention of the activation of NF-?B with drugs or molecular biological methods has become an important approach in study of the effect of NF-?B at present. Recent studies have indicated that I?B? itself may also participate in the regulation of apoptosis.

Acute kidney injury(AKI)is a syndrome with many different causes and can occur at different stages throughout critical illness.Renal Doppler ultrasonography is the most appropriate imaging test in the evaluation of AKI and has the highest level of recommendation: (1)assessment of intrinsic causes of AKI, (2)distinguishing acute from chronic kidney diseases, (3)detection of the causes of obstruction.The resistive index in patients with AKI will be reviewed with attention to its use for predicting the development and prognosis of AKI.Meanwhile, combined application of cardiopulmonary ultrasound and evaluation of hemodynamics are helpful to evaluate the etiology, supervision and guiding treatment of AKI.

Clinical teaching and studying is suffering increasing hardship.This article analysises the present condition of clinical education problems and causes,and researches whether patients are obliged to coorperate clinical teaching and studying when they protect their rights.It also researches how to practice clinical teaching and studying in educational hospital and looks for effective pathway to go out of the clinical education problem.

Objective To explore the nursing of polycystic ovary syndrome treated by transvaginal ultrasound small follicular puncture.Methods The treatment and nursing of 58 cases with polycystic ovary syndrome treated by transvaginal ultrasound small follic~ar puncture were summarized.Results Among 58 cases of polycystic ovary syndrome treated by transvaginal ultrasound small follicular puncture,21 cases obtained postoperative pregnancy,the pregnancy rate was 36.20％.Conclusions According to the psychological characteristics of patients with polycystic ovary syndrome treated by transvaginal ultrasound small follicular puncture,good psychological nursing and sufficient preoperative preparation are helpful to reduce the patients' psychological pressure,cooperate with the operation smoothly,and obtain satisfactory clinical effect.

Naphazoline,Diphenoxylate, Over-the-counter (OTC) cough and cold medications, widely used for the symptomatic relief of nasal obstruction, diarrhea or common cold symptoms. But these medicines might cause poisoning even if utilized in recommended doses for treatment. The side effects of these medicines were neglected when they were used much more commonly. The clinical manifestation of these medicine poisoning were delitescence and children' s parents couldn't provide the whole history, so these medicine poisoning were often misdiagnosis, even lead to treatment failure. We explore the toxicities of these medicines ,discuss their mechanisms and clinical manifestation, and suggest why physicians should be more vigilant in specifically inquiring about them when evaluating an ill child.

Dexamethasone is a synthetic glucocorticoid that is widely used in clinical due to its multiple pharmacological effects. Recently, dexamethasone is increasingly utilized in anti-cancer therapy. It is frequently used to prevent side effects of chemotherapy such as nausea, vomiting and pain, as well as to increase the anti-tumor activity of the cancer chemotherapeutic agents as a chemosensitizer and to inhibit tumor growth as an anti-cancer agent in some certain cancers. Dexamethasone produces the effects in anti-inflammation, anti-angiogenesis, control of estrogen activity and so on, by binding to glucocorticoid receptor to regulate gene expression of some important bio-signal molecules. Those signal pathways could interfere with the transcription of various factors which can regulate proliferation, invasion and metastasis of tumors.

Objective To investigate the association of human papilloma virus (HPV) typing and p53 expression with radiosensitivity in patients with cervical cancer.Methods A total of 80 patients with cervical cancer from 2014 to 2016 were enrolled,and among these patients,40 had stage Ⅰ B+ Ⅱ A disease and 40 had stage Ⅱ B +ⅢA disease.HPV genotype was identified and p53 expression was measured.All the patients underwent external and internal pelvic irradiation alone,and the correlation between short-term therapeutic effect and HPV typing/p53 expression was analyzed.The chi-square test or the Fisher's exact test was used for statistical analysis,and Spearman rank correlation analysis was also performed.Results The radiotherapy-insensitive (stable disease+progressive disease) group had higher p53 positive rates than the radiotherapy-sensitive (complete response+partial response) group (stage Ⅰ B+ Ⅱ:100％ vs.80.0％,P=0.044;stage Ⅱ B+ⅢA:100％ vs.90.0％,P=0.013).The expression of p53 was negatively correlated with radiosensitivity (r =-0.427,P =0.000).In the radiotherapy-insensitive group of patients with stage I B + Ⅱ and Ⅱ B +Ⅲ A,the rate of HPV multiple infections was higher than that of single subtype infection (65.0％/95.0％ vs.35.0％/5.0％,P=0.004 and 0.003),while in the radiotherapy-sensitive group,the rate of single subtype infection was higher than that of multiple infections (85.0％/60.0％ vs.15.0％/40.0％,P=0.004 and 0.003).The highest detection rate of HPV16 was 66.3％ in all patients,and the highest detection rate of HPV18 was 60.0％ in the radiotherapy-insensitive group.Conclusions High expression of p53 is associated with radioresistance in patients with cervical cancer.Patients with HPV muhiple infections have poor radiosensitivity,and HPV16 is the most common subtype in dual infection.Among patients who do not achieve remission after radiotherapy,HPV multiple infections with HPV18 as the main pathogen has the highest detection rate.