Cardiopulmonary arrest is one of the most critical situations,posing a serious threat to life.With the development of medical technology, the rate of return of spontaneous circulation after cardiac arrest has been improved.However, many children suffer from multiple organ dysfunction because of the long hypoxia time from cardioplumonary arrest, so the rate of long-term survival is relatively low and the long-term outcome is still not satisfactory.Therefore, how to make cardiopulmonary resuscitation more effective is the focus of current research.This article reviews the related factors that affect the outcome of resuscitation, providing references for the treatment of cardiopulmonary arrest in children.

Background One of the important machanisms of all trans retinoic acid (ATRA) is to regulate the expression of connexin (Cx) gene.ATRA inhibits the proliferation and differentiation of retinoblastoma (RB) cells,which is related to Cx43.However,the control site of ATRA and its effect on RB tumor in vivo have not been identified.Objective This study was to investigate the effect of ATRA on Cx43 expression in RB cells and its approach mechanisms.Methods ATRA solution of 1 × 10 2 mol/L was prepared with ethanol and formulated into 1×10 5,1×10-6and 1 × 10 7 mol/L of solution with culture medium further.Human RB cell line (HXO-RB44) was cultured and treated with different concentrations of ATRA for 2,4 and 6 days,respectively.The expressions of Cx43 protein and mRNA in RB cells were detected by Western blot and reverse transcription PCR (RT-PCR),respectively.RB models were established by injecting HXO-RB44 cell suspension into anterior chamber in the right eyes of 15 athymic mice.Eleven successful models were divided into the blank control group,negative control group and 1 × 10-5 mol/L ATRA group,and 0.5％ normal saline solution with athymic or 1 ×10-5 mol/L ATRA solution was injected into the anterior chamber in the negative control group and 1 × 10-5 mol/L ATRA group in the 3-day interval for 3 weeks.The model eyes were examined under the slit lamp microscope.The eyeballs were extracted at the end of the experiment for hematoxylin and eosin staining.Results Western blot assay showed that the absorbance values of Cx43 protein (ACx43/AGAPDH) were increased gradually as time lapse of ATRA treatment among the groups (Ftime =71.31,P =0.00; Fgroup =7.66,P =0.00).The expressions of Cx43 protein were significantly higher in the 1 × 10 5 mol/L ATRA group after 2 days,1 × 10-6 mol/L ATRA group after 4 days,1 × 10-7 mol/L ATRA group after 6 days than those in the blank control group at various time points (t =3.34,P＜0.01 ;t =2.33,P＜0.05;t =3.12,P＜ 0.01).RT-PCR showed that the absorbance values of Cx43 mRNA (ACx43mRXA/Aβ-actin) were significantly enhanced as the prolong of treatment time of ATRT among the groups (Ftime =90.90,P =0.00 ; Fgroup =6.86,P =0.00).The expressions of Cx43 mRNA were significantly higher in the 1 × 10-5 mol/L ATRA group after 2 days,1 × 10 6 mol/L ATRA group and 1 ×10-7 mol/L ATRA group after 4 days than those in the blank control group at various time points (t=3.57,P＜0.01 ;t=6.31,P＜0.01 ;t=2.22,P＜0.05).RB models were successfully created in 11 eyes on the 6-9 days following the intrachamber injection of RB cell suspension.The RB cells were filled with chamber in the blank control group 20 days after injection,and RB only occupied half of the anterior chamber in the 1 × 10-5 mol/L ATRA group.Histopathological examination exhibited that the RB cells were seen in the anterior and posterior chamber as well as vitreous in the blank control group,however,the cells were only found in the anterior chamber in the 1 × 10 5 mol/L ATRA group.Conclusions ATRA can inhibit the growth of RB in vitro and in vivo by inducing the expression of Cx43 gene in transcription process.

Objective To develop a nursing pathway outlined the reasonable timing for care of paraplegia patients at rehabilitation stage. Methods Literature and patient records were reviewed to draw up a clinical nursing pathway. It was modified and finalized after 2 rounds of Delphi's expert-consultation. Results and Conclusion The draft was responded by 100% of the experts, with a specialist authoritative coefficient of 0.87. The text for the clinical nursing pathway was then completed.

Objective To investigate the level of sex hormone in serum and blood clotting parameters in patients with acute cerebral infarction(ACI).Methods The level of estradiol(E 2),testosterone(Te),E 2/Te,antithrombin Ⅲ(AT Ⅲ) and fibrinogen(FIB) in the serum of 116 old patients with ACI and 78 healthy subjects were measured by ELISA, Enzyme colorimetric method.Results The concentration of E 2? E 2/Te?FIB in the male patients with ACI were higher than that of control group ( P 0.05). The concentration of FBI was higher than that of control group( P

Programmed cell death 1 (PD-1) is an important negative costimulatory molecule discovered in recent years, which is expressed on the surface of T and B cells and plays an important role in the regulation of cellular immune response and immune tolerance.After the combination of PD-1 and its receptor programmed cell death 1 ligand 1 (PD-L1), negative regulatory signals are transmitted to suppress the immune response.Under the activation of stimulating factors, PD-1 and PD-L1 are combined to weaken the conduction of downstream signaling pathways such as PI3K/Akt and ERK through recruitment of phosphorylated SHP2, thereby inhibiting the proliferation of T cells and the production of cytokines, inhibiting the immune response and participating in the occurrence and development of a large number of inflammatory diseases.PD-1 in the field of ophthalmology research is still in its infancy.As far as we know, PD-1 participates in ocular inflammatory diseases such as uveitis, sympathetic ophthalmia, allergic conjunctivitis, also is involved in corneal transplant rejection, optic nerve crush injury and optic myelitis, diabetic retinopathy, thyroid related ophthalmopathy, melanoma and other diseases, thus preventing the interactions between PD-1 and its receptor PD-L1 may become a new potential target for the treatment of ocular tumor, inflammation, autoimmune and neurodegeneration disease.In this article, the latest research progress of PD-1 and its receptor PD-L1 in the pathogenesis of ocular diseases were reviewed.

Objective The metabolomics methods were applied to discover the serum differences metabolites in patients with lupus nephritis (LN),and to establish the diagnostic model and study the metabolic pathways change due to the interference of LN and explore the pathogenesis of LN.Methods Positive and negative ions mode of ultra high performance liquid chromatography-high resolution mass spectrometry (HPLS-HRMS) were used to analyze the serum samples of 38 LN patients and 35 healthy controls,respectively.Both univariate and multivariate data analysis were performed with SPSS software (V17.0,Chicago,USA) and SIMCA-P+ package (V12.0,Umetrics,Sweden),respectively.A supervised pattern recognition method,orthogonal partial least squares-discriminant analysis (OPLS-DA),was employed to study the metabolomics differences between control group and LN patients group.The metabolic pathways were analyzed by Metabo Analyst 3.0.Results LN patients and healthy controls could be well separated by OPLS-DA model Q2 of 0.583.Eighteen compounds (theophylline,oxidized glutathione,capric acid,norvaline,hippuric acid,sphingosine,sorbitol,cortisol,pyrrole-2-carboxylic acid,deoxycholic acid,tryptamine,5-aminolevulinic acid,glucose 6-phosphate,riboflavin,cortisone,taurine,creatinine,glycerophosphocholine) were initially identified as potential serum metabolic markers to distinguish LN patients from healthy people.Alternated metabolism pathways included citrate metabolism,pyrimidine metabolism and amino acid metabolism.Conclusion Through analysis of the metabolic pathways of different metabolites,the significant impact of LN on citrate metabolism,pyrimidine metabolism and amino acid metabolism pathways are identified.Some of the different metabolites are involved in the process of immunization.These results will benefit the early intervention and treatment of LN and the research of the mechanism of pathogenesis.

Objective To investigate the clinical characteristics of childhood intracranial tumor.Methods The age and sex distribution,location of tumor,clinical manifestation,imaging examination and pathological examination,diagnosis and treatment of 98 children under 14 years old admitted into Children′s Hospital of Chongqing Medical University from Jun.2003 to Sep.2008 were analyzed.Results There were 63 male and 35 female in the study.The gender ratio(male to female) was 1.8:1.The age range was 4 months to 14 years old,75 cases(76.5%) visited a doctor in the course of disease from 1 to 90 days.The tumors of 60 cases(61.2%) were located in posterior cranial fossa,while 14 cases(14.3%) in cerebral hemisphere.The most common intracranial tumors were medulloblastom(30 cases,30.6%),astrocytic tumor(26 cases,26.5%),ependymal tumor(17 cases,17.3%),craniopharyngioma(10 cases,10.2%) and germ cell tumor(4 cases,4.1%).The main clinical manifestations were vomiting(61 cases,62.2%),headache(58 cases,59.2%),instability of gait or incoordination(38 cases,38.8%),29 cases(29.6%) of the tumors were misdiagnosed.Obstructive hydrencephalus was found in 78 cases(79.6%) by imaging examination,positive rate of tumor′s diagnosis was 95.9% and 100% by brain CT and MRI scaning,respectively.Conclusions Intracranial tumors in childhood are mostly located in posterior cranial fossa with atypical clinical manifestations and short course of diseases.It is common to be misdiagnosed at early stage.Brain CT and MRI examinations are helpful for early diagnosis,which should be considered for the children when unreasonable increased intracranial pressure and localizing neurological sings exist.

Graduation Paper is a key to achieve the objective of cultivating undergraduates majoring in laboratory medicine.To improve the quality of graduation papers,the paper focuses on establishing a system of quality monitoring of graduation papers by students major in laboratory medicine and the difficulties of sustainable developments in graduation papers.

Objective To investigate the clinical value of simultaneous assessment of cardiac troponin I,Btype natriuretic peptide,and C-reactive protein in prediction of long-term cardiac outcome after cardiac surgery.Methods 224 patients undergoing cardiac surgery were included and followed up within 12 months after surgery.Serial blood samples were drawn in all patients the day before surgery,at the end of surgery,and 6,24,and 120h after surgery.Major adverse cardiac events within 12 months after surgery were chosen as study endpoints and were defined as malignant ventricular arrhythmia,myccardial infarction,congestive heart failure,the need for myocardial revascularization,and/or death from cardiac cause.Predictive ability of each cardiac biomarker was assessed using logistic regression.Results Accuracies of C-reactive protein,cardiac troponin I,and B-type natriuretic peptide,considered as continuous variables to predict the occurrence of major adverse cardiac events were limited(area under receiver operating characteristic curve:0..54[0.47 ～0.60],P =0.42,0.62[0.55 ～0,68],P =0.01,and 0.68[0.61 ～0.74],P ＜0,001,respectively).When biomarkers were considered as 75％ specificity dichotomized variables,evaluated C-reactive protein(＞ 180mg/L),cardiac troponin I(＞ 3.5ng/ml),and B-type natriuretic peptide (＞ 880pg/ml)were independent predictors of major adverse cardiac events(odds ratio:2.14[1.03 ～4.49],P =0.043,2.37 [1.25 ～ 5.64],P =0.011,and 2.65 [1.16 ～ 4.85],P =0.018,respectively) in a multivariate model including the European System for Cardiac Operative Risk Evaluation score.Conclusion Simultaneous measurement of cardiac troponin I,B-type natriuretic peptide,and C-reactive protein improves the risk assessment of long-term adverse cardiac outcome after cardiac surgery.