Infantile hemangiomas are the most common benign vascular tumors,accounting for 10％ of the incidence of benign tumors.Most hemangiomas may involute spontaneously,without any medical intervention.But partly because of the special parts of its growth,such as pediatric airway (subglottic),potentially it has fatality.So it is essential to give prompt diagnosis and appropriate treatment.Although there are multiple literatures have reported about the management of the subglottic hemangioma,there is no unified conclusion.This article summarizes a variety of methods on the diagnosis and treatment of infantile subglottic hemangioma.And the advantages and disadvantages of various treatments with the cases and the literature were assessed,so as to provide individualized treatment options for infantile.

Objective To analyze the common causes and clinical features associated with hoarseness in children of different ages.Methods The data of 2 500 children suffering from hoarseness were analyzed with electronic laryngofiberscopy retrospectively.Results There were 1 746 males and 754 females. The top 5 causes of hoarseness were vocal cord nodules(44.2%,1 105 cases),vocal hypertrophy (38.2%,955cases),acute and subacute laryngitis(6.5%,163cases),the paralysis of vocal cord(6.82%,141cases),and laryngeal papilloma(1.6%,40cases). These five diseases were common in children with hoarseness with 2 404 out of 2 500. 37.12% of the children were under school ages as the largest age group and the ratio of male and female was 2.32:1. The top five diseases were statistically distributed in different age groups (P

Objective To study the clinical efficacy and safety of esophageal pacing in termination of old patients with paroxysmal supraventricular tachycardia heartbeat.Methods A total of 68 elderly cases with paroxysmal supraventricular tachycardia heartbeat were given the esophageal pacing termination of therapy,who were treated with overdrive suppression method and a burst termination,and the clinical curative effect and adverse reaction in the two groups were observed.Results 34 cases were given overdrive suppression method,19 cases were successful,the success rate was 55.9％,the direct restoration of sinus rhythm includes 14 cases after the termination,accounting for 73.6％,heartbeat bradycardia occurred in 3 cases after termination,heart rate less than 50 beats per minute,and then disappeared.With a burst of 34 cases,31 cases were successful,the success rate was 91.2％,the direct restoration of sinus rhythm includes 25 cases after the termination,accounting for 80.6％,heartbeat bradycardia occurred in 4 cases after termination,heart rate less than 50 beats per minute,and then disappeared.Conclusion Esophageal pacing is an electrophysiological examination and treatment method with noninvasive,safe and effective advantages,the termination of PSVT has higher success rate,and it can distinguish between different types of PSVT.Compared with overdrive suppression method,burst terminate PSVT pulse method has higher success rate,it is worthy application in clinical.

Objective To investigate the hemostasis effect of alginate dressing for puncture point bleeding after peripherally inserted central catheter (PICC) by ultrasound-guided modified Seldinger technique (MST).Methods Between November 2013 and May 2016, 538 cases of cancer in our department underwent PICC, including 270 cases from November 2013 to February 2015 selected as control group (after PICC was successfully placed, sterile gauze and 3M transparent film were used to fix the puncture point) and 268 cases from March 2015 to May 2016 selected as observation group (after PICC was successfully placed, alginate dressing, sterile gauze and 3M transparent film were used to fix the puncture point).The patients in both groups were given 20 minutes of pressure for puncture point and elastic bandage compression fixation for 24 h.The degree of puncture point bleeding and times of dressing change in 24 h and 24-72 h between the two groups were compared.Results In the observation group, mild, moderate, and severe bleeding was seen in 232 cases, 34 cases, and 2 cases within 24 h, and in 242 cases, 25 cases, and 1 case between 24-72 h, respectively.In the control group, mild, moderate, and severe bleeding was seen in 12 cases, 196 cases, and 62 cases within 24 h, and in 21 cases, 212 cases, and 37 cases between 24-72 h, respectively, with significant differences (Z=-18.647, P=0.000;Z=-18.768, P=0.000).In the observation group, there were zero, once, twice, and ≥3 times of puncture point dressing change in 232 cases, 33 cases, 3 cases, and 0 case within 24 h and in 242 cases, 25 cases, 1 case, and 0 case between 24-72 h, respectively.In the control group, there were zero, once, twice, and ≥3 times of puncture point dressing change in 12 cases, 196 cases, 51 cases, and 11 cases within 24 h and in 21 cases, 209 cases, 37 cases, and 3 cases between 24-72 h, respectively, with significant differences (Z=-18.560, P=0.000;Z=-18.755, P=0.000).Conclusion The hemostasis effect of alginate dressing for puncture point bleeding after ultrasound-guided PICC by MST is satisfactory.

Objective To analyze the common causes and clinical features associated with hoarseness in chil-dren of different ages. Methods The data of 2 500 children suffering from hoarseness were analyzed with electronic [aryngofiberscopy retrospectively. Results There were 1 746 males and 754 females. The top 5 causes of hoarseness were vocal cord nodules(44.2%, 1 105 cases), vocal hypertrophy (38.2% ,955cases), acute and subacute laryngitis (6.5 %, 163cases), the paralysis of vocal cord(6.82 %, 141cases), and laryngeal papilloma(1.6 %, 40cases). These five diseases were common in children with hoarseness with 2 404 out of 2 500. 37.12% of the children were under school ages as the largest age group and the ratio of male and female was 2.32 : 1. The top five diseases were statisti-cally distributed in different age groups (P<0.01) . Conclusion The main causes of hoarseness were different in different age groups. The preschoolers made up the largest group (928/2 500), showing the greatest incidence of hoarseness in children . The incidence for male patients was higher than female and the vocal cord nodules was the top disease (1 105/2 500 cases,44.2%). Hoarseness in children was different from that of adults so that to under-stand the characteristics of this disorder in children will be beneficial to the proper diagnosis and effective treatment.

ObjectiveTo evaluate the efficacy of etanercept in the treatment of active ankylosing spondylitis ( AS) with enthesitis and explore an easy and accurate scoring method.MethodsWe designed this 12-week double-blind,placebo-controlled,randomized clinical study in active AS patients.The first part was a 6-week placebo-controlled period that patients received etanercept or placebo,followed by a 6-week open-label period that all patients received etanercept. At week 0,2,4,6,8,10,12,the scores of enthesitis were recorded.The primary efficacy endpoint was the Mander Index in the two groups. We compared the Maastricht AS Enthesis Score ( MASFS) index,Spondyloarthritis Research Consortium of Canada ( SPARCC) index,Berlin index and San Francisco index with the Mander Index. Results A total of 127 patients were included with 92 in the etanercept group and 35 in the placebo group.In etanercept group there were 25,41,47 patients without enthesitis at week 2,4,6 separately. At week 12,more than 70％ patients' enthesitis in two groups turned negative.The primary endpoint,as the Mander Index at week 6,was achieved by 0(0,2) score in the etanercept group compared with 1 (0,3) score in the placebo group (P =0.0286). Among the four Indexes.the San Francisco Index was the one most COrrelated with the Mander Index.Conclusion Etanercept can improve the symptoms of enthesitis fast and significantly. In clinics,the San Francisco Index is easier to operate and more accurate for assessment.

Objective To determine whether thalidomide can maintain remission after discontinuing the treatment of etanercept in ankylosing spondylitis (AS). Methods One hundred and five patients with active AS treated with etanercept 50 rag/week for 12 weeks and attained an ASAS20 response at week 12. They were randomly assigned to receive thalidomide 150mg/night, sulfasalazine (SASP) 2.0 g/d, or non-steroidal anti-inflammatory durgs (NSAIDs) only. All patients were followed monthly for BASDAI, BASFI, PGA and spinal pain VAS. A Kaplan-Meier survival analysis was used to calculate the probability of a relapse. Results One hundred patients completed the follow-up. Thirty patients were treated with thalidomide, 33 patients with SASP and 37 patients with NSAIDs only. The mean follow-up time was 5.1 months and the longest time was 12 months. At the end of the follow-up, the percentage of patients who maintained remission in the thalidomide group was 40%, much higher than SASP group (15%) and NSAIDs group 11% (P=0.0265 and 0.0053 respectively). No difference was found between the remission rate of SASP and NSAIDs only group (P=0.5881). Conclusion Thalidomide can successfully maintain remission of AS after discontinue etanercept treatment.

ObjectiveTo investigate the protective effect of tanshinoneⅡA on the expression of S100A1 protein after acute myocardial ischemia injury in rats.Methods Sixty Wistar rats were randomly divided into sham operation group, acute myocardial ischemia model group and tanshinoneⅡA pretreatment group by random number table. The acute myocardial ischemia model was established by thoracotomy and penetration of a thread and occlusion around the root part of the left anterior descending coronary artery, while the sham operation group was established only by thoracotomy and penetration of a thread around the root part of that artery but without occlusion; 3 days before the operation, in the tanshinoneⅡA pretreatment group, intraperitoneal injection of tanshinoneⅡA solution(at a dose of 1.5 mg/kg) was applied, while in the sham and acute myocardial ischemia groups, intraperitoneal injection of an equal volume of saline was given. Myocardial cell apoptosis was detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling(TUNEL), the levels of serum superoxide dismutase (SOD), malondialdehyde(MDA), creatine kinase(CK), lactate dehydrogenase(LDH) and S100A1 protein were examined and the level of expression of S100A1 protein in myocardial tissue was assayed by immunohistochemical staining and Western Blot.Results Compared with the sham operation group, the myocardial cell apoptosis rate, the contents of MDA, CK, LDH, S100A1 and the level of S100A1 expression in myocardial ischemia group and tanshinoneⅡA pretreated group were significantly increased, while SOD activity was decreased obviously; compared with the myocardial ischemia model group, the myocardial cell apoptosis rate, the contents of MDA, CK, LDH, S100A1 and the level of S100A1 protein expression were significantly reduced〔apoptosis rate:(32.1±4.2)% vs.(72.4±5.4)%, MDA(μmol/L): 9.1±2.2 vs. 17.3±5.2, CK(U/L): 83.3±12.2 vs. 107.5±12.4, LDH (μmol·s-1·L-1): 84.0±16.4 vs. 114.4±16.0, S100A1(μg/L): 37.6±6.0 vs. 78.4±8.6,P<0.05 orP<0.01〕, while the activity of SOD was increased markedly in tanshinoneⅡA pretreated group(kU/L:72.8±10.2 vs. 49.6±8.8,P<0.01). TUNEL staining showed that in the myocardial ischemia model group and tanshinoneⅡA pretreated group, the myocardial cells represented positive staining(brown-yellow in color), irregular in shape with nuclear pyknosis, cell detachment from the surrounding tissue and other characteristics. And in sham operation group,the staining of majority of cells was negative. The results of immunohistochemistry showed that S100A1 protein staining was relatively deep in the myocardial ischemia model group and tanshinoneⅡA pretreated group, and in the latter group, the color of S100A1 protein positive staining was not as deep as that in the former group. Western Blot showed that the S100A1 protein expression in myocardial ischemia model group was 2.8 folds of that of the sham operation group, while the S100A1 protein expression in tanshinoneⅡA pretreated group was significantly decreased compared with that of myocardial ischemia model group(bothP<0.05),which was 1.5 folds of that of the sham operation group.ConclusionTanshinoneⅡA may play a role in inhibiting the expression of S100A1 protein to protect against acute myocardial ischemia injury, suggesting that this agent have a potential effect for treatment of myocardial ischemia.

BACKGROUND:Severe acute respiratory syndrome (SARS),an acute infection with a mutant coronavirus,is characterized by acute pulmonary inflammatory injury accompanied by possible multiple organ injuries. Besides somatic symptoms,affective disorder constitutes an obvious neuropsychiatric symptom in SARS patients.OBJECTIVE:To analyze the clinical features of SARS with neuropsychiatric involvement.DESIGN:A retrospective case analysis.SETTING:Department of Neurology,Department of Respiratory Diseases and Department of Radiology of Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS:Totally 325 SARS patients treated in the Second Affiliated Hospital of Sun Yat-sen University and the 8th People's Hospital of Guangzhou from February 2003 to May 2003 were involved,including 173cases who developed neuropsychiatric symptoms.METHODS:The clinical data of 325 of SARS including 173 cases with neuropsychiatric symptoms were retrospectively analyzed.MAIN OUTCOME MEASURES:Clinical neuropsychiatric symptoms,ophthalmoscopic examination,and pathological findings in autopsy.RESULTS: ①The incidence of neuropsychiatric involvement was about 53.2% in SARS patients. The manifestations consisted mostly of headache (67.1%),dizziness(28.9%),conscious-ness disturbance(10.4%),mental disorder(4.6%), local orientational disorder(0.6%),seizures(1.2%),and affective disorders (30.6%);anxiety occurred in 20.2%,depression in 6.4%,suicidal tendency in 1.2%,and phobia in 7.5% of the patients with neuropsychiatric involvement. ②Among the 325 patients,56 were in critical condition of whom 47 had accompanying neuropsychiatric impairment,with significantly greater incidence than that in mild cases (P＜0.01). ③Ophthalmoscopic examination performed in 4 patients showed blurred margin of the optic disc with retinal venous congestion. ④Autopsy in 2 cases identified edema of the perivascular tissue and vascular wall of the small veins with mononuclear cell and lymphocyte infiltration,neuron degeneration and demyelination in focal brain tissues.CONCLUSION:The manifestations of neuropsychiatric involement can vary in association with the severity of SARS,and the typical pathological changes include edema,neuronal demyelination etc.in the brain.

Objective To observe before and after surgery plasma vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-β1) content changes in the children with congenital heart disease(CHD) combined severe pulmonary arterial hypertension(PAH),and to explore the relationship with the pulmonary artery pressure.Methods Sixty cases patients with CHD in the First Hospital of Hebei Medical University from June 2014 to January 2015 were selected,including 30 cases left to right shunt CHD with severe PHD,30 cases no PHD.The content of serum VEGF,TGF-β1,parallel echocardiographic estimates pulmonary artery mean pressure(PAMP) of all children were detected with preoperative and postoperative 24 h,7 d and 30d.Results PAMP of children with severe PAH before surgery was (60.29±8.48) mmHg and (48.36±5.25)mmHg of postoperative 24 h,(28.21±3.29) mmHg of 7 d after surgery,(25.21±2.09) mmHg of 30 d after surgery,the difference was statistically significant (F within the grouP=39.86,P＜0.001),and compared with no PHD group,the difference was significant ((14.26±1.78) mmHg,(14.30±1.92) mmHg,(13.31±1.02)mmHg;F between groups=46.01,P＜0.001).The levels of VEGF and TGF-β1 in severe PHD group were (808.90±41.37) ng/L and (1156.96±83.68) ng/L of before operation,(620.21±30.30) ng/L and (906.20±65.11) ng/L of postoperative 24 h,(454.49±21.48) ng/L and (826.23±35.11) ng/L of postoperative 7 d,(454.49±21.48) ng/L and (806.49±29.48) ng/L of postoperative 30 d,the differences were significant (Fwithin the grouP=43.73,P＜0.001;F within the grouP=65.41,P＜0.001),compared with no PHD group,the differences were significant (VEGF:(379.25±20.21) ng/L,(380.05±19.98) ng/L,(380.05±19.98) ng/L,F between groups =54.09,P＜0.001;TGF-β1:(728.56±29.93) ng/L,(728.11±25.26) ng/L,(727.05±24.99) ng/L,F between groups=83.05,P＜0.001).Conclusion Plasma VEGF and TGF-β1 level has correlation with pulmonary artery pressure,the severity evaluation of pulmonary hypertension and surgical curative effect has a certain significance.After surgery,severe PAH is still exist in a certain period in children with pulmonary hypertension,sufficient attention should be paid to strengthening treatment and follow-up.