Cutaneous dyschromia is a common problem of plastic and cosmetic surgery. There are not good methods to resolve this problem in present. The mechanisms of skin pigmentation process are not well understood. It is now recognized the correlation between melanogenesis and alpha-melanocyte-stimulating hormone. Alpha-msh enhances activity and quantity of tyrosinase as well as stimulates melanogenesis, specifically to stimulate eumelanin synthesis by activating the melanocortin-1 receptor (MC-1R) on melanocytes. Alpha-msh stimulates melanocyte prolixferation, formation of dendricity, and transfer of melanosomes to keratinocytes, It also protects melanocytes from the damaging effects by immunomodulation. Also, alpha-msh interact with other factors to affect pigmentation indirectly. Agouti signaling protein(ASIP) is a endogeneous antagonist of alpha-msh can induces pheomelanin synthesis by competing with alpha-msh for binding to the MC-1R.Follwing better understood the mechanisms of skin pigmented process, it will provide effective methods to resolve acquired human cutaneous hyperpigmentation and hypopigmentation.

Impaired ability to undergo apoptosis in response to a wide range of external stimuli acquires melanomas a selective advantage for progression and metastasis as well as their notorious resistance to therapy. Changes at genomic, transcriptional and post-translational levels of G-proteins and protein kinases (Ras) , their transcription factor effectors (c-jun,ATF2, stat3 and NF-?B) and upregulator of antiapoptosis gene (Bcl-2、Bcl-X_L、survivin、ML-IAP)affects apoptosis-induced of TNF, Fas and TRAIL receptors, which play important roles in acquiring melanoma's resistance to apoptosis. The complexity of the molecular variants involved in signal transduction along apoptotic pathways suggests that the cell may have a variety of possibilities for regulating apoptosis and generating apoptosis deficiency.

Objective To investigate the present situation and outcome of cardiopulmonary resuscitation (CPR) for pediatric in-hospital cardiopulmonary arrest and to analyze the prognostic risk factors.Methods Data were collected from October 2008 till October 2011 using Ustein style.Patients older than 28 days who received CPR were evaluated.Returning of spontaneous circulation(ROSC) more than 24 hours was the primary outcome.Neurological outcome was assessed by pediatric cerebral performance categories half year after discharge.Results Of the 36 patients,15 (41.7％) achieved sustained ROSC.Seven (19.4％) patients survived to discharge.Single factor analysis indicated that the beginning heart rhythm,defibrillation and original disease were significantly different between the two groups(P ＜0.05).The beginning heart rote of the patient in ROSC ＞ 24 h group was mostly sinus bradycardia.Patients who need defibrillation had bad prognosis.Patients with heart disease had a lower rate of ROSC ＞ 24 h.At half year follow-up study,4 patients had 1 or 2 score,1 patient had 4 and 1 had 5 score in the pediatric cerebral performance categories scales.Condusion The successful rate of CPR in our hospital was the same as that in developed country.The beginning heart rhythm,defibrillation and original disease were associated with the outcome.Most of the patients who survived to discharge had a good neurological outcome.

A few of patients with lumbar disk herniation having a separation of clinical symptoms and signs and imaging features, can be found in clinic, but the traditional theory of direct mechanical compression of nerve roots by herniated nucleus pulposus can't be used to explain this abnormal protrusion of lumbar intervertebral disc. The clinical symptoms and signs of the atypical lumbar disk herniation are affected by multiple factors. The indirect mechanical compression and distraction effect of spinal nerve roots may play an important role in the occurrence of the separation, and the appearance of abnormal clinical symptoms and signs is closely related to the migration of herniated nucleus pulposus tissue, transmission of injury information in the nervous system, and the complex interactions among the nucleus pulposus, dural sac and nerve roots. Moreover,the changes of microcirculation and inflammation secondary to the herniated nucleus pulposus tissue, the hyperosteogeny in the corresponding segment of the lumbar vertebrae and the posture changes all results in a diversity of symptoms and signs in patients with lumbar intervertebral disc herniation. Besides, there exist congenital variation of lumbosacral nerve roots and vertebral bodies in some patients, and the misdiagnosis or missed diagnosis of imaging finding may occur in some cases. However, the appearance of a separation of clinical symptoms and signs and imaging examination in patients may be caused by a variety of reasons in clinic. The exact mechanism involved in the interaction among nucleus pulposus tissue, dural sac and nerve root, secondary changes of pathophysiology and biomechanics around the nucleus pulposus, the determination of lesioned responsible segments, and how to overcome the limitations of imaging all need the further researches.
Humans ; Intervertebral Disc Displacement ; complications ; diagnosis ; Lumbar Vertebrae ; Nerve Compression Syndromes ; etiology

Objective To explore effective nursing intervention through clinical analysis of middle ear function of children with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Tympanogram was obtained from both pre-operation and post-operation in 413 OSAHS cases(the OSAHS group).Audiogram was conducted if the tympanogram was abnormal.There were 279 cases of normal children in the control group.The incidence of middle ear function loss of two groups were compared.Results 288 cases(328 ears) had some degree of middle ear dysfunction,accounting for 69.73％.69 cases had some degree of hearing loss,accounting for 16.71％.The incidences of middle ear dysfunction and degree of hearing loss in the OSAHS group were higher than 7.53％ and 1.43％ of the control group.The hearing ability was gained after operation in both groups.Conclusions The incidence of middle ear dysfunction is higher in children with obstructive sleep apnea hypopnea syndrome.But the bad influence alleviated with age.Therefore,early detection,timely treatment and effective nursing can achieve good effect.

Endometriosis ; therapy ; Female ; Humans ; Infertility, Female ; therapy ; Medicine, Chinese Traditional ; Phytotherapy ; methods

To combine current situation and existing problem of sanitation equipment packaging in military area, perfect organization, special funds and package research of military special useful can be given. The high level of standardization, informationization and containerization of packaging has great significance that improves the ability to protection and pro-motes the development of sanitation equipment packaging on troops.

Teacher student relationship is the most important part in educational activities.It’s quality and quantity have a significant impact on educational and teaching effectiveness.This article aims to analyze the exiting status of the relationship between the tutors and the postgraduates in Peking Union Medical College Hospital, focusing on the some main factors which affect the said relationship, including education environment factor, tutor factor, postgrad-uate factor and etc., and combining the characteristics of Medical Colleges’studying.On the basis of the concerned survey, this article initially discusses the key issues during the establishment of the harmony relationship between tutors and postgraduates.

Objective To investigate the features and its risk factors for cognitive impairment in patients with lacunar infarct (LI) and white matter lesion (WML).Methods The inpatients with LI and WML aged 65 to 75 years old were enrolled.Their demographic and clinical data were collected.LI and WML were diagnosed by magnetic resonance imaging (MRI).Montreal Cognitive Assessment Scale (MoCA) was used to evaluate cognitive function.Self-Rating Depression Scale and Hamilton Anxiety Scale were used to exclude patients with depression and anxiety.The patients were divided into either a cognitive impairment group or a normal cognitive function group.The demographic and clinical data of both groups were compared.Multivariate logistic regression analysis was used to analyze and determine the independent risk factors for cognitive impairment.The characteristics of cognitive impairment of LI and WML were compared.Results A total of 130 patients with LI or WML were enrolled,92 of them had cognitive impairment,and 38 had normal cognitive function; 85 had LI,and 45 had WML; 53 were males and 77 were females.Univariate analysis showed that years of education in the cognitive impairment group (7.54 ±4.65 years vs.11.29 ±3.17 years; t =4.286,P=0.001) was significantly lower than that of the normal cognitive function group,while the constituent ratios of hypertension (54.6％ vs.16.2％ ;x2 =4.477,P =0.018),hyperlipidemia (53.1％ vs.16.2％ ;x2 =5.263; P =0.044),diabetes mellitus (46.9％ vs.10.8％;x2 =3.827,P=0.017),as well as LI (43.8％ vs.21.5％;x2 =3.928,P=0.015) and WML (26.9％ vs.7.7％ ;x2 =4.072,P =0.009) were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that years of education (odds ratio [OR],1.305,95％confidence interval [CI] 1.104-7.975; P =0.001),diabetes mellitus (OR 1.328,95％ CI 1.292-3.422;P =0.015),hypertension (OR 1.978,95％ CI 1.034-5.443; P =0.028,LI (OR 1.224,95％ CI 1.004-2.007; P =0.013),and WML (OR 1.489,95％ CI 1.202-3.778; P =0.010) were the independent risk factors for cognitive impairment.The total MoCA score (21.61 ± 5.33 vs.19.19 ± 7.07; t =1.841,P =0.038) and cube copy (0.43 ± 0.50 vs.0.31 ± 0.47; t =1.104,P =0.010),clock drawing test (2.53 ±0.89 vs.2.04 ± 1.22; t =2.229,P =0.008),letters identification (0.85 ±0.36 vs.0.62 ±0.50; t =2.585,P==0.000),and 100 minus 7 consecutively (2.62 ±0.79 vs.2.19 ± 1.17; t =2.113; P=0.001) of the WML group were significantly lower than those of the LI group.Conclusions The patients with LI and WML often had cognitive impairment,and the cognitive impairment in patients with WML was more serious.Years of education,hypertension and diabetes were the independent risk factors for cognitive impairment in patients with LI and WML.Visuospatial executive function and attention damage in patients with WML were severer than those of the patients with LI.

Objective To analyze the prevalence of hospital acquired infection and the associated risk factors.Methods Nine hundred and three hospitalized preterm infants in our neonatal intensive care unit from August 2006 to October 2010 were retrospectively studied.Risk factors of hospital acquired infection were analyzed by single factor analysis and logistic regression analysis method.Site and pathogen of infection were also analyzed.Results One hundred and ten preterm infants developed 123 times of hospital acquired infection.The incidence of hospital acquired infection was 12.2％,and hospital acquired infection patient-day rates was 7.3‰.The mortality was 2.7％.Gestational age less than 32 weeks,birth weight less than 1500 gram,non-invasive ventilation,tracheal intubation,umbilical vein catheter(UVC),peripherally inserted central catheter(PICC),parenteral nutrition were the risk factors of hospital acquired infection.Logistic regression analysis showed mechanical ventilation,UVC and PICC were the main risk factors.The main sites of infection were sepsis(45.5％),low respiratory infection and conjunctivitis.Seventy positive culture samples were obtained.Bacteria were the main pathogen.Fifty percent was gram-staining positive,while 46％ was gram-staining negative.Conclusion It is very important to identify the high risk factors for hospital acquired infection.Standardized management of preterm infants,standardized usage of umbilical vein catheter and peripherally inserted central catheter,minimized usage of intubation would be conductive to reduce the incidence of hospital acquired infection.