During the fetal-neonatal transition, the body must undergo many important physiological changes to adapt the extrauterine environment. After birth, the blood and energy supply through placenta is stopped with clamping of the umbilical cord and, meanwhile, the pulmonary ventilation function is established when exposure to the air, which results in a series of changes in the respiratory, circulatory and endocrine systems and energy metabolisms, etc. The physiological transition can be relfected in heart rate, blood pressure, oxygen saturation, temperature, and other physiological indicators. The changes of these indicators can be used as references for prevention, diagnosis and treatment of neonatal diseases. This review provides an overview of physiological changes and implications in the lung function, circulatory and endocrine systems, and energy metabolism during the transition at birth as well as intervention measures for abnormal fetal-neonatal transition.

Objective To analyze the best methods for diagnostic scanning and image processing of multi-slice spiral CT (MSCT) in the detection of renal malformations (RM). Methods From June 2008 to Februany 2012, one hundred and four patients with kidney malformation received 64-slice MSCT assay were enrolled in our Hospital. Related materials of the patients were used for retrospective analysis. Diagnostic accuracy of urinary malformation were calculated on the image of axial and MPR, Curve, MIP, VR by MSCT unenhangced scanning, enhangced cortical phase scanning, enhangced parenchymal phase scanning and enhangced excretory phase scanning. Results One hundred and four patients with kidney abnormalities received the MSCT unhangced scan axial and MPR, Curve film, enhangced cortical phase scanning, enhangced parenchymal phase scanning, enhangced excretory phase scanning and MPR, MIP, VR film, respectively. The diagnostic accuracy were as follws: renal dysplasia (72.73%, 81.82%, 81.82%, 72.73%), renal hypoplasia (83.33%, 91.67%, 95.83%, 100%), solitary kidney (100%, 100%, 100%, 100%), ectopic kidney (76.92%, 100%, 100%, 100%), horseshoe kidney (100%, 100%, 100%, 100%),misplaced renal lobe (0%,100%). Conclusion The MSCT with image post-processing techniques in the diagnosis of RM has its unique advantages, MSCT can be preferred as a method for renal malformation examination.

Objective To evaluate the risk factors for intracranial hemorrhage in premature infants. Methods Cochrane Library, PubMed, ScienceDirect, Chinese Academic Literature Main Database, Chinese Science and Technology Periodi-cal Database, Wanfang Periodicals and Dissertation Database were searched for articles published from January 2000 to December 2012 on the risk factors of intracranial hemorrhage in premature infants, with retrospective retrieval and manual retrieval as supplement. RavMan5.2 provided by Cochrane was used for meta-analysis. Fixed-or random-effects models were selected according to the results of heterogeneity test. Results Nine studies were conifrmed to be eligible. Odds ratio (OR) and 95%conifdence interval (CI) of the risk factors were as follows:gestation age≤32 weeks (OR=3.29, 95%CI=2.76-3.91), birth weight≤1 500g (OR=2.68, 95% CI=2.24-3.20), maternal complications (OR=1.59, 95% CI=1.23-2.06), intrauterine distress or birth asphyxia (OR=2.42, 95% CI=2.06-2.84), mechanical ventilation (OR=3.23, 95% CI=2.55-4.09), metabolic acidosis (OR=2.88, 95%CI=2.04-4.05), use of high concentration of oxygen (OR=2.98, 95%CI=1.63-5.44), prenatal use of dexametha-sone (OR=0.69, 95%CI=0.55-0.86), respiratory distress syndrome (OR=1.57, 95%CI=1.04-2.39). Those differences were all statistically signiifcant. There was no difference in caesarean section (OR=0.99, 95%CI=0.84-1.17), multiparity (OR=1.05, 95%CI=0.79-1.40) and gender (OR=1.25, 95%CI=0.97-1.59). Conclusions The risk factors for intracranial hemorrhage in premature infants are gestation age≤32 weeks, birth weight≤1 500 g, maternal complications, intrauterine distress or birth asphyxia, mechanical ventilation, metabolic acidosis, use of high concentration of oxygen, respiratory distress syndrome, but prenatal use of dexamethasone can reduce the incidence of intracranial hemorrhage in premature infants.

Objective To analyze implementation outcomes and obstacles of “treatment before payment” reform seen by medical institutions' managers,along with an optimal strategy proposed.Methods Quantitative survey and qualitative interviews were called into play,and the data so acquired are subject to evaluation of the radar chart and fishbone diagram analysis to learn the implementation outcomes and obstacles.Results The reform proves workable at hospitals of county and lower levels,achieving win-win for the people,hospitals and government.Obstacles found include poor allocation of designated funds for risk coverage,insufficient circulating funds in advance,poor risk aversion mechanism,and poor preparation for tertiary hospitals.Conclusion It is recommended to promote awareness of the reform,enhance inter-department cooperation,improve hospital information systems,clarify the screening standards of “purposely evasion offenders”,standardize the issuance and use of the NRCMS certificates,and better build the credit system of the society.

A polymer film of vitamin B1 was obtained at a graphite carbon electrode by cyclic voltammetric method in phosphate buffer solution (PBS). Cyclic voltammograms of the film electrode in PBS (pH 5) exhibited one pair redox waves, Epa=350　mV，Epc=325　mV，different from monomer vitamin　B1. The peak currents of poly-VB1 films was proportional to (scan rate)1/2, which showed that the charge transfer was controlled by diffusion in the polymer film. The Poly-VB1 modified electrode showed a good catalytic ability to dopamine and epinephrine. At the modified electrod, the peak potential for oxidation of dopamine occurred at 250 mV and 200 mV for epinephrine, while they were shifted towards the negative direction 100 mV and 300 mV respectively at the bare glassy carbon electrode . And their peak current had a linear relationship to the concentrations in the range of 8.0×10-7～1.0×10-4　mol/L for dopamine and 1.0×10-6～1.0×10-4　mol/L for epinephrine.

The aim of the study is to evaluate the feasibility and safety of Bispectral index (BIS) monitoring in pediatric radio frequency catheter ablation. One hundred and six children aged 0. 6-12 years, scheduled for radio frequency catheter ablation, were randomly divided into two groups. In group A patients received BIS monitoring during the operation (n = 50), and the group B received modified Observer's Assessment of Alertness/Sedation (OAA/S) scaling (n = 56). The anesthesia was maintained with propofol target-controlled infusion. The intraoperative propefol target concentration was adjusted to maintain the BIS values between 55-65 in group A and OAA/S scale about 1 in group B respectively, The heart rate (HR), mean arterial pressure (MAP) and pulse oximetric saturation (SpO2) were measured before anesthetic induction, 1 min after induction, catheter puncturing and the end of operation respectively. The requirements of propofol, the times of supporting ventilation and recovery, the respiratory depression, nausea and vomiting postoperatively were also recorded. The intraoperative HR, MAP and SpO2 showed no differences between two groups, but the requirements of pmpofol, the times of supporting ventilation and recovery were less in group A than that of group B (P<0.05). All children didn't have nausea, vomiting and respiratory depression. The results suggest that in pediatric radio frequency catheter ablation, BIS monitoring has the advantages of timely adjustment of anesthetic depth, reducing anesthetic requirements, shortening the time of recovery, so as the perioperative safety can be improved.

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.

Objective We discussed the influence of diary therapy for out-of-hospital rehabilitation of schizophrenia patients with first hospitalization. Methods Ninety schizophrenia patients with first hospitaliza-tion and who were during rehabilitation period were randomized into the intervention group and the control group with 45 cases in each group.The two groups both received systemic antipsychotics medication.The control group adopted general health education while the intervention group got diary therapy based upon general health education.The treatment effect was evaluated by medical and nursing staff with abundant experience using the self-medication compliance questionnaire,the brief psychiatric rating scale(BPRS)and social disability screening schedule(SDSS)at the first day,6th month and first year after intervention. Results The total score of BPRS,SDSS,medication compliance and relapse rate in the intervention group was statistically better than those of the control group. Conclusions Diary therapy could facilitate the recovery of racial function,improve the medica-tion compliance,reduce the relapse rate and increase life quality for schizophrenia patients.

Objective To develop the quality standard for evaluating Huangdi cataplasm. Methods Thin layer chromatography (TLC) was used to qualitatively identify Astragalus membranaceus (Fisch.) Bunge,Rheum palmatum Linn,Rhizoma Chuanxiong,Angelica sinensis and Resina Draconis in Huangdi cataplasm.HPLC method was used to determine astragaloside A and loureirin B in Huangdi cataplasm. Results The Astragalus membranaceus (Fisch.) Bunge,Rheum palmatum Linn,Rhizoma Chuanxiong,Angelica sinensis and Resina Draconis were well separated by TLC without interference in the negative control.content of Astragaloside A and loureirin B showed good liner relationships with respective peak area within the range of 6.96-23.2 μg,and 0.072-0.648 μg,with r = 0.999 5,r = 0.999 9, respectively;and the average recovery was 97.18%,and 96.93%,RSD was 1.21%(n= 6),1.53% (n = 6 ), respectively. Conclusion The established qualitative and quantitative detection method is simple, specific, reproducible, accurate and reliable, which can be used for quality control of Huangdi cataplasm.

Objective To investigate the role of endoplasmic reticulum stress (ERS) pathway involving protein kinase R-like ER kinase (PERK)-activating transcription factor 4 (ATF4)-CCAAT/enhancer binding protein homologous protein (CHOP) in apoptosis in lungs of rats with bronchopulmonary dysplasis (BPD).Methods Forty eight premature SD rats were divided into BPD group and control group according to random number table.Rats in BPD group were continually exposed to O2 with volumetric concentration factor of 850 mL/L,while rats in control group were exposed to air.Lung tissues in each group were obtained in 7,14 and 21 days respectively.The apoptosis in lung cells was evaluated by terminal dexynucleotifyl transferase-mediated dUTP nick end labeling (TUNEL) assay.The mRNA levels of glucose regulated protein 78 (GRP78),PERK,ATF4 and CHOP were detected by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR).The protein levels of GRP78,phosphorylated PERK (pho-PERK),ATF4 and CHOP were detected by using Western blot.Results Compared with control group,the lung cells of the rats in BPD group developed more serious apoptosis.Furthermore,the apoptosis index (AI) in lung cells of the rats increased rapidly with the hyperoxia exposure time.This had been statistically verified by comparison with the control group at different timing(7 d:15.50 ± 0.58 vs 1.25 ± 0.50,14 d:27.75 ± 1.71 vs 3.25 ± 0.96,21 d:50.50 ±3.70 vs 4.00 ± 1.15 ;t =57.00,20.58,25.16,all P ＜0.01).The mRNA levels of GRP78,PERK,ATF4 and CHOP in BPD group increased significantly compared to the control group [GRP78:7 d (33.88 ± 3.73) vs (11.65 ± 1.00),14 d (54.50 ±2.18)vs(12.84 ± 1.41),21 d (95.34 ± 7.61)vs(12.43 ±0.59) ;PERK:7 d (5.23 ±0.92)vs (1.45 ±0.46),14 d (7.60 ± 1.56)vs(2.18 ±0.97),21 d (16.55 ±0.50)vs(2.90 ± 1.18) ;ATF4:7 d (23.04 ± 2.45)vs(12.56 ±2.81),14 d (28.66 ±2.66)vs(15.18 ±2.92),21 d (36.63 ±2.99)vs(15.14 ±2.09) ;CHOP:7 d (2.21 ±0.19)vs(0.81 ±0.02),14 d (4.19 ±0.17)vs(0.90 ±0.08),21 d (6.08 ±0.38)vs(0.88 ±0.10) ;all P ＜ 0.05].The protein levels of GRP78,pho-PERK,ATF4 and CHOP in BPD group increased significantly as well [GRP78:7 d (1.33 ±0.03)vs(0.85 ±0.04),14 d (1.31 ±0.02)vs(0.92 ±0.01),21 d (1.82 ±0.28)vs(0.87 ± 0.01);pho-PERK:7 d (0.68±0.02)vs(0.54±0.01),14 d (1.04±0.01)vs(0.65±0.01),21 d (1.29± 0.02)vs(0.73 ±0.01) ;ATF4:7 d (1.26 ±0.01) vs(0.83 ±0.01),14 d (1.39 ±0.02) vs (0.87 ±0.02),21 d (1.67 ±0.02)vs(0.94 ±0.02) ;CHOP:7 d (1.37 ±0.01)vs(0.47 ±0.06),14 d (1.50 ±0.04)vs(0.74 ±0.05),21 d (1.61 ± 0.03) vs (0.55 ± 0.02) ; all P ＜ 0.05].Positive correlation was demonstrated between the expression levels of CHOP protein and AI,PERK,ATF4 in the BPD group (r =0.87,0,92,0.93 respectively,all P ＜ 0.05).Conclusion PERK-ATF4-CHOP mediated ERS may participate in and contribute to the apoptosis mechanism in lungs of rats with BPD.