Pulse arrival time: Measurement and clinical applications

Pulse arrival time is the time elapsed between the R-wave of electrocardiogram and systolic peak in peripheral pulse obtained by any of the plethysmographic methods. Similarly, differential pulse arrival time, also known as pulse transit time, is the time elapsed between systolic peaks of proximal and distal peripheral pulse recordings in an extremity. Distance between the proximal and distal site in the extremity (in meters) divided by differential pulse arrival time (in seconds) gives arterial pulse wave velocity in the limb segment. Differential pulse arrival time has been used to discriminate between an aortic or arterial block from generalized atherosclerosis in aortic and arterial occlusive diseases for nearly four decades. All along there have been efforts to monitor beat-to-beat blood pressure with the help of these time intervals and other pulse parameters. Encouraging correlation has been observed with that obtained by Finapres. Recently pulse arrival time has been explored for the prompt detection of sudden hypertensive episodes during laryngeal microsurgery, for detection of mental stress, monitoring of baroreflex sensitivity, and real-time monitoring of blood pressure. This paper briefly describes the measurement technique of pulse arrival time and an overview of its clinical applications.

Analysis on "the essence of tuina, arrival of qi ensuring curative effect" / 中国针灸

In reference with the systematic review of the thought of deqi (arrival of qi) put forward in Huangdi Neijing (Internal Classic of Yellow Emperor) and other classic books of traditional Chinese medicine, in view of detecting qi and identifying qi before treatment, as well as the prerequisites of deqi in tuina, meaning the accurate syndrome differentiation and manipulations, the importance of deqi in treatment with tuina is expounded. In association with clinical experience, the specific manifestations of deqi in patients during tuina are summarized, e.g. soreness, distention, pain, numbness, warm feeling and slight sweating, local changes in intestinal sound and skin color, as well as mind regulation. It is anticipated that deqi of tuina may be drawn the attention in clinical practice, and the relevant study be expanded.

Socio-demographics and clinical characteristics affecting pre-hospital delays in acute stroke patients: A 6-year registry study from a Malaysian stroke hospital

@#Background and objectives: The cumulative time spent without medical intervention in acute stroke patients may affect clinical outcomes. As the onset-to-arrival time to the hospital is crucial for effective treatment interventions, this study aimed to explore the factors associated with pre-hospital delays amongst acute stroke patients. Methods: We explored 932 patients data retrieved from the National Neurology Registry of Seberang Jaya Hospital between January 2013 and December 2018. Data on patient demographics and stroke manifestations were analysed using descriptive, univariate and multivariate logistic regressions. Results: Most patients were men (62.9%) with an average age of 62 years old. In the final multivariate regression model, pre-hospital delay was significantly lower among Chinese patients (aOR=0.6, 95% CI 0.4–0.9, p=0.016) and those using hospital ambulance (aOR=0.4, 95% CI 0.3–0.7, p<0.001), but higher among patients with lacunar infarcts (aOR=2.5, 95% CI 1.4–3.3; p<0.001). Conclusions: Demographic characteristic (ethnicity) and stroke manifestations, particularly stroke subtypes, and mode of transport were mainly associated with pre-hospital delays among acute stroke patients.

Arrival time parametric imaging of contrast enhanced ultrasound for differential diagnosis of gallbladder lesions / 中国医学影像技术

Objective: To explore the value of arrival time parametric imaging (ATPI) of contrast-enhanced ultrasonography (CEUS) for differential diagnosis of gallbladder lesions. Methods: Data of 25 patients with gallbladder carcinoma and 22 with benign gallbladder lesions who received CEUS and cholecystectomy were reviewed. ATPI system was used to analyze CEUS imaging. The artery patterns of the lesions on ATPI in artery phase were evaluated. Then quantitative parameters, including arrival time of gallbladder lesions, arrival time of surrounding liver as well as the time difference (△T) were analyzed. Results: The artery patterns were different between benign and malignant gallbladder lesions in artery phase (P0.05). However, △T (the arrival time difference of lesions and the surrounding liver) of benign (-0.21±1.37)s and malignant (-2.69±1.37)s lesions were statistically significant (P<0.001).Taken -1.05 s as the cut off value of △T, the sensitivity, specificity, positive predictive value, negative predictive and value accuracy in differentiating gallbladder carcinoma from benign lesions was 81.80%, 92.00%, 85.20%, 90.00% and 87.20%, respectively. Conclusion: Artery patterns and parameters of ATPI of CEUS are helpful to differential diagnosis of benign and malignant gallbladder lesions.

Discussion on the issues of time recorded in / 中国针灸

(the Chapter 76 of ) states the running course and time of the defensive circulation, as well as the needling techniques of acupuncture for waiting for arrival. However, because of the conflicts on the time system of acupuncture in the record, it is hard to be adopted in clinical practice in the later generations. In comparison of the 28-lunar-mansion time system with the clepsydra time system, it is known that the 28-lunar-mansion time system is much more rational because the clepsydra system is the tool for counting rather than timing. Hence, in compliance with the original meaning recorded in , the method for estimating the circulation of defensive is re-collected so as to provide a new approach to the study on the needling techniques of acupuncture for waiting for arrival.

Relationship between acupuncture sensations of and different organizational structures of acupoint area / 中国针灸

Acupuncture sensation, as one of the essential signs of (arrival of ), is closely associated with curative effect. With systematically reviewing the literature regarding relationship between acupuncture sensations of and different organizational structures of acupoint area (skin, connective tissue, muscles, nerves and blood vessels), it is believed that acupuncture sensation of is the product of various organizational structures in acupoint area, which is closely related to the nervous system. The sensations sensed by the hands of acupuncturists, which is called sense of needle stagnation, maybe caused by the contraction of muscles in the acupoint area during the process of needle manipulation. By system review, this paper puts forward a new research idea to explore the role of different manipulations of needling in generating the sense of -generating needle based on different acupoint structure and brain function response system, which could provide some reference for clarifying the scientific mechanism and clinical application of acupuncture sensations of .

Retardo En La Llegada De Pacientes Con Ictus Isquémico A Un Hospital Terciario De Ecuador / Delay In The Arrival Of Ischemic Stroke Patients At A Tertiary Hospital In Ecuador

Resumen Introducción: El tratamiento del ictus isquémico con trombolisis farmacológica en el entorno de una unidad de ictus se asocia a una mejor recuperación. El objetivo de este estudio es identificar variables que pudieran relacionarse con un retardo en la llegada al hospital. Métodos: Se realizó un estudio prospectivo, longitudinal, en los pacientes con diagnóstico de ictus isquémico que ingresaron en la Unidad de Ictus del Hospital de especialidades Eugenio Espejo de la ciudad de Quito, Ecuador, en el periodo comprendido entre noviembre de 2016 a julio de 2017. Se compararon los pacientes que fueron tratados con r-Tpa con los que llegaron después de las 4,5 horas. Resultados: Se estudiaron un total de 61 pacientes: 51 de ellos arribaron al hospital después de las 4,5 horas, y 10 (16,4 %) fueron sometidos a trombolisis en periodo de ventana terapéutica. Ninguna de las variables sociodemográficas y clínicas excepto el antecedente de fibrilación auricular se relacionó con el arribo precoz. En el grupo que recibió r-Tpa el porcentaje de pacientes que buscó atención médica en el hospital como primera opción fue significativamente mayor respecto a los que llegaron después del periodo de ventana (90 vs 49 %, p 0,0170). El mayor impacto de la remisión precoz y la trombolisis fue sobre la diferencia de puntaje entre la evaluación inicial y al alta en la escala del NIHSS. Conclusiones: Los resultados apuntan a que existe desconocimiento acerca del ictus y qué conducta asumir. El tratamiento con r-Tpa demuestra beneficios en nuestro medio.

Abstract Introduction: In an Stroke unit, the ischemic stroke treatment with a pharmacological thrombolysis is associated with a better recovery. The aim of this study is to identify the variables having a significant impact in the delay of the arrival of patients at a tertiary hospital. Methods: A prospective and longitudinal study was undertaken in patients with an ischemic stroke diagnosis, who were admitted to the Stroke Unit of Eugenio Espejo Hospital of Quito city in Ecuador in the time period from November 2016 to July 2017. Patients treated with r-Tpa were compared to those who arrived 4,5 hours later. Results: A total of 61 patients were analyzed: of those, 51 arrived 4,5 hours after first symptoms at the hospital, and 10 (16,4%) were thrombolysed in the period of therapeutic window. None of the social, demographic and clinical variables were related to the early arrival, except the history of an atrial fibrillation. In the group of patients who received r-Tpa, a significantly higher percent sought for medical care as a first option compared with those arriving after the 4,5 hours (90 vs 49%, p 0,0170). The greatest impact of the early referral and the thrombolysis concerned the difference of score between the initial medical evaluation and the hospital discharge in the NIHSS scale. Conclusions: The results of this study point out to the unawareness of the stroke and the behavior to follow. The r-Tpa treatment shows clear benefits to the patients in our environment.

Progress of fMRI-based research in recent 10 years / 中国针灸

<p><b>OBJECTIVE</b>The research regarding the central mechanism of acupuncture (arrival of ) based on functional magnetic resonance imaging (fMRI) in recent 10 years was analyzed to summarize existing research achievements and experience.</p><p><b>METHODS</b>The literature regarding fMRI-based research published from January of 2007 through December of 2016 in CNKI and PubMed databases was collected. The research content and methods, including research design, inclusion criteria, acupoint selection and evaluation, were analyzed.</p><p><b>RESULTS</b>Totally 18 articles regarding the central mechanism of acupuncture based on fMRI was included. According to research content, the literature was divided into two categories: research and sensation research. In research, the differences of and not on brain functional activity were compared to summarize the central response pattern of ; in sensation research, the differences of different sensations and intensities of on central response were compared to explore the effects of different sensations and intensities of on brain functional activity. In recent 10 years, the number of research gradually increased, and the type of design was various, mainly RCT and paired design. The majority of participants was healthy people, and single acupoint was the focus of researches, including Zusanli (ST 36), Waiguan (TE 5), Hegu (LI 4), etc. The evaluation of was based on visual analogue scale (VAS). The research contents were mainly the effects of and not and different sensations on brain function activities. The present studies confirmed that and not as well as different sensations had different impacts on brain functional effects, and different acupoints had specific activated brain areas. There was a positive correlation between the degree of and the intensity of the activation of brain regions. Furthermore, tingling sensation was not included to sensations.</p><p><b>CONCLUSION</b>The number and quality of fMRI-based research need to be improved; the research content is simple, and research method is in exploratory stage. The results obtained in the literature are the phenomena of in the central level, and it is imperative to summarize the essential link between and the central effect through these phenomena to reveal the mechanism of . The specific impact of for brain function needs more clinical exploration.</p>

Analysis of contrast enhanced ultrasound in differential diagnosis of focal organizing pneumonia and primary lung cancer / 中华超声影像学杂志

Objective To invesitigate the application of contrast enhanced ultrasound in differentiating focal organizing pneumonia( FOP) and primary lung cancer . Methods The imaging data of 23 cases with FOP ( FOP group) and 75 cases with primary lung cancer ( primary lung cancer group) on conventional ultrasound and contrast enhanced ultrasound were retrospectively analyzed . The size and arrival time( AT) of the contrast agent and the enhanced pattern of the two groups were compared . ROC curve was created to determine the most accurate AT for differential diagnosis . Results There was no significant difference in the gender and the size of nodule between the two groups ( P > 0 .05) . The age of FOP group was younger than that of primary lung cancer group ( P = 0 .013) . The AT of FOP group was much earlier than that of primary lung cancer group [ ( 6 .9 ± 2 .4) s vs ( 11 .4 ± 4 .3) s , P = 0 .000] . In FOP group ,20 patients ( 87 .0％ ) showed centrifugal enhancement , 2 patients ( 8 . 7％ ) showed centripetal enhancement and 1 patient ( 4 .3％ ) showed diffuse homogeneous enhancement ,respectively .In primary lung cancer group , 12 patients ( 16 .0％ ) showed centrifugal enhancement , 58 patients ( 77 .3％ ) showed centripetal enhancement ,2 patients ( 2 .7％ ) showed diffuse homogeneous enhancement and 3 patients ( 4 .0％ ) showed diffuse heterogeneous enhancement ,respectively . There was significant difference in the enhanced pattern between the two groups ( P = 0 .000) . Meanwhile ,8 patients in FOP group ( 34 .8％ ) and 31 patients in primary lung cancer group ( 41 .3％ ) had unenhanced region in the nodule ( P = 0 .574) . ROC analysis demonstrated that AT of 8 .5 s was the best cut-off value for the differential diagnosis . When AT earlier than 8 .5 was taken as diagnostic criterion for FOP ,the diagnositc sensitivity ,specificity were 74 .7％and 82 .6％ ,respectively . Conclusions Contrast-enhanced ultrasound can provide evidence in differentiating FOP from primary lung cancer .

Development and initial evaluation of sensation scale of heat-sensitive moxibustion / 中国针灸

Based on heat-sensitive moxibustion (HSM) theory, a widely applicable scale was developed to reflect the (arrival of ) sensation of HSM. By documentary method and interviewing method, the items of describing sensation of HSM were collected to establish the pool of candidate items. With expert questionnaire, patient questionnaire and core expert discussion, the items were screened and quantified by method of subjective evaluation to develop the initial draft of the scale. A total of 121 patients were pre-surveyed with the initial draft, and the structural validity of the scale was examined by exploratory factor analysis (principal component) and its internal consistency was assessed by Cronbach's coefficient. As a result, the items in the scale was reduced from 36 to 9; 110 effective questionnaires were reclaimed for statistical analysis. Finally, the scale (Version 1.0) contained 9 items and 4 dimensions, of which, 3 items highlighted the comfort emotional experience, 3 items highlighted autonomic response, 2 items highlighted heat sensation, and 1 item highlighted non-heat sensation. In conclusion, the sensation scale of HSM containes 9 items, which has fair content and structure validity. It is in line with the current clinical understanding of sensation of HSM and has strong clinical operability and wide adaptability.

Influência das condições térmicas do galpão de espera climatizado na mortalidade pré-abate de frangos de corte / The influence of thermal conditions from an environmentally controlled preslaughter lairage on mortality of broiler chickens

Avaliou-se o efeito das condições ambientais da espera pré-abate na mortalidade de frangos de corte, mantidos em galpão climatizado em um abatedouro comercial. Foram avaliados 215 caminhões de transporte de um abatedouro comercial quanto ao número de aves mortas durante as operações pré-abate e à temperatura retal dos animais em condição de espera no abatedouro. Os dados foram obtidos no galpão de espera climatizado por meio de ventiladores e nebulizadores, em diferentes períodos: manhã, tarde e noite. As variáveis térmicas, distância, tempo de espera e densidade de aves por caixa foram consideradas na análise. Destacaram-se os efeitos da temperatura, da umidade relativa e do tempo de espera na variação tanto do número de aves mortas por caminhão quanto da temperatura retal dos animais. Com relação à interação entre temperatura e umidade relativa interna do galpão de espera, houve eficiência do ambiente climatizado no abatedouro quanto à diminuição do número de aves mortas. A climatização foi mais expressiva na redução do número de aves mortas e da temperatura retal quando a temperatura do galpão de espera estava entre 21 e 24°C, principalmente em condições de umidade relativa interna em torno de 70%. Nessas condições climatizadas, o tempo de espera acima de duas horas proporcionou maior conforto às aves.

The effect of environment conditions of preslaughter lairage on broiler mortality was assessed in the present study. Daily preslaughter data from 215 broiler flocks were recorded regarding the number of dead chickens during preslaughter operations and rectal temperature of broilers submitted to a lairage environment prior to slaughtering. A holding area at a slaughterhouse with environmental control was assessed. The thermal variables, distance between farms and slaughterhouse, lairage time and density of birds per cage was considered in this analysis. The effect of dry-bulb temperature, relative humidity and lairage time on death before arrival and rectal temperature was highlighted in this assessment. Regarding the interaction between temperature and inside relative humidity, a decrease in preslaughter mortality was observed due to exposure to a controlled environment. The environment control promoted an expressive reduction in dead birds and rectal temperature when the temperature inside the holding area was between 21 and 24 °C, mainly with inside relative humidity around 70%. In these environment control conditions lairage above 2 hours was necessary to reduce the thermal stress of birds.

Research Progress of the Modern Evaluation Methods of De Qi Sensation in Acupuncture and Moxibustion / 上海针灸杂志

Objective To introduce the research progress of the modern methods in evaluating de qi sensation in acupuncture and moxibustion, and to analyze the current research situation and major problems. Method The objective evaluation methods majorly used to estimate qi sensation were summarized. Result The currently used evaluation methods basically include scales and cerebral function imaging, while the rest methods are still in the beginning stage. Conclusion As a subjective feeling, de qi sensation is difficult to determine and quantify objectively, and there lacks an objective standard. The study on the mechanism of de qi sensation is relatively insufficient and superficial.

Effect of Acupuncture at Sanyinjiao (SP6) on the Infrared Temperature of Guanyuan (CV4) and Sanyinjiao in Dysmenorrhea Patients / 上海针灸杂志

Objective By using infrared thermal imager (Flir-SC620), to observe the effect of needling Sanyinjiao (SP6) on the skin temperature at Guanyuan (CV4) and Sanyinjiao in patients with primary dysmenorrhea (PD) of cold and dampness stagnation pattern, and to explore the probability of using infrared thermal imaging for diagnosis and as an objective index for evaluating the action and needling qi of acupuncture. Method Thirty-six subjects were recruited and divided into four group, a health control group (group A), a control group of PD of cold and dampness stagnation pattern (group B), a needling-qi-expected group (group C) and a needling-qi-unexpected group (group D). Group A and B were not given acupuncture treatment, while group C and D were treated with acupuncture at bilateral Sanyinjiao with needles retained for 30 min, and the needling sensations were recorded. The infrared thermal imager was used to detect the skin temperature at Guanyuan and bilateral Sanyinjiao for 40 min for each group, and the temperature was recorded every 10 min. The temperature during different periods of time, 0-10 min, 20-20 min, 20-30 min, 30-40 min, 0-30 min, and 0-40 min were then calculated. In group C, those obtained the needling qi sensation were further grouped into C-1 and those didn’t obtain the sensation were into C-2; in group D, those obtained needling qi sensation were further grouped into D-1 and those didn’t obtain the sensation were into D-2. SPSS 17.0 was adopted for data processing, and the data were analyzed by using MANOVA of repeated measuring. Result Compared to group A (6 cases), the temperature at Guanyuan in group B (6 cases) was significantly decreased during 0-30 min and 0-40 min (P<0.05), the temperature at the left Sanyinjiao during 0-40 min in group B was significantly decreased (P<0.05), and the temperatures at bilateral Sanyinjiao during 30-40 min in group B significantly dropped (P<0.05). Compared to group B, the temperatures at Guanyuan during 0-30 min and 0-40 min in group C1 (12 cases) and group D1 (11 cases) were significantly increased (P<0.05), the temperature at left Sanyinjiao during 0-40 min in group D1 was significantly increased (P<0.05), and the temperatures at bilateral Sanyinjiao during 30-40 min in group D1 were significantly increased (P<0.05). There was no case in group C2 and only 1 case in group D2, hence, the data were not enough for analysis. Conclusion Decrease of the infrared temperature at Guanyuan and Sanyinjiao can be taken as one of the diagnostic criteria for dysmenorrhea of cold stagnation pattern. Increase of the infrared temperature at Guanyuan can be regarded as one of the objective evidences for the along-meridian transmission characteristic in needling Sanyinjiao.

Effect of Acupuncture at Neiguan (PC 6) with Different Inserting Methods on Short-form McGill Pain Questionnaire and Cardiovascular Function / 上海针灸杂志

Objective To observe the changes of cardiovascular function after acupuncture at Neiguan (PC 6) respectively with slowly twirling needling and tube needling in healthy subjects, and to objectively evaluate the pain intensity of the two needling methods.Method A hundred healthy young subjects were randomized into group A and group B, 50 cases in each group. Neiguan (PC 6) point was selected for acupuncture in both groups. In the first stage, group A received acupuncture by slowly twirling needling, while group B received acupuncture with tube needling; in the second stage (a week later), group A received acupuncture with tube needling, while group B by slowly twirling needling. The Short-form McGill Pain Questionnaire (SF-MPQ) was observed after acupuncture for each subject, and ZXG-E automatic cardiovascular function detector was adopted to evaluate the cardiovascular function before puncturing, 5 min after puncturing, and 30 min after puncturing.Result The Sensory Pain Rating Index (S-PRI) and total SF-MPQ scores of slowly twirling needling were significantly different from that of tube needling (P<0.01). The Affective Pain Rating Index (A-PRI), Visual Analogue Scale (VAS), and Present Pain Intensity (PPI) of slowly twirling needling method were significantly different from that of tube needling (P<0.01). At 5 min after needle insertion, the FEK and VER values of twirling needling were significantly different from that of tube needling (P<0.01).Conclusion The pain produced by slowly twirling needling is more variant and stronger than that by tube needling, and this pain variation can produce a positive effect on cardiovascular function.

Factors Associated with the Time form Myocardial Infarction Onset to Hospital Arrival in Southeastern Iran.

Background: Myocardial infarction (MI), is a fatal cardiovascular condition which results in various outcomes, considering time of treatment form symptoms onset. Despite of high importance of first hour after MI onset, a considerable proportion of patients arrive at hospital with delay. To assessing determinants of hospital arrival time in MI patients in southeastern Iran. Methods: A cross-sectional study was conducted. A validated and reliable questionnaire was designed and used for data collection. Patients with a confirmed diagnosis of acute myocardial infarction were interviewed after informed consent. Results: A total of 175 patients participated in this study. The most of them were male (76.6%, n=134). Median time to hospital arrival was 130 minutes. Its min and max were 15 and 1500 minutes, respectively. The most common reasons for delayed hospital arrival, were waiting for spontaneous recovery 45.70%, and then the distance to the hospital 35.40%. Conclusion: Lack of MI patients’ awareness of importance of times to hospital arrival could be the best underling reason for the delayed hospital arrival. Mass education about the symptoms of MI and importance of prompt care seeking may be effective intervention to reduce MI deaths and complications.

Factors Associated with Early Hospital Arrival in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Factors associated with early arrival may vary according to the characteristics of the hospital. We investigated the factors associated with early hospital arrival in two different stroke centers located in Korea and Japan. METHODS: Consecutive patients with ischemic stroke arrived hospital within 48 hours of onset between January 2011 and December 2012 were identified and the clinical and time variables were retrieved from the prospective stroke registries of Severance Hospital of Yonsei University Health System (YUHS; Seoul, Korea) and National Cerebral and Cardiovascular Center (NCVC; Osaka, Japan). Subjects were dichotomized into early (time from onset to arrival 4.5 hours) arrival groups. Univariate and multivariate analyses were performed to evaluate factors associated with early hospital arrival. RESULTS: A total of 1,966 subjects (992 from YUHS; 974 from NCVC) were included in this study. The median time from onset to arrival was 6.1 hours [interquartile range, 1.7-17.8 hours]. In multivariate analysis, the factors associated with early arrival were atrial fibrillation (Odds ratio [OR], 1.505; 95% confidence interval [CI], [1.168-1.939]), higher initial National Institute of Health Stroke Scale scores (OR, 1.037; 95% CI [1.023-1.051]), onset during daytime (OR, 2.799; 95% CI [2.173-3.605]), and transport by an emergency medical service (OR, 2.127; 95% CI [1.700-2.661]). These factors were consistently associated with early arrival in both hospitals. CONCLUSIONS: Despite differences between the hospitals, there were common factors related to early arrival. Efforts to identify and modify these factors may promote early hospital arrival and improve stroke outcome.

Analysis of Mind-control and Qi-regulation:Tracing the Arrival of Qi Recorded by Nei Jing and Nan Jing / 上海针灸杂志

Objective To discuss the relationships between qi-arrival and mind-control, qi-arrival and qi-regulation, and to define qi-arrival by tracing the relevant records in Nei Jing (Classic of Internal Medicine) and Nan Jing (Classic of Difficult Issues). Method Thirty-seven relevant ancient books of the two classics were reviewed and the notes by WANG Bing, MA Shi, and YANG Shang-shan were referred. Result Mind-control requires the spirits of the practitioner, patient and environment, as well as observing and waiting for the arrival of qi. Regarding qi-regulation, theories involve that qi-arrival achieves same reinforcing and reducing effect as qi-regulation, qi-regulation is elucidated from the correct location of acupoint, proper needling depth and direction, and to regulate qi by observing the arrival of qi. Besides, the changes of internal and external environments also influence qi-arrival via qi-regulation and mind-control. Conclusion Qi-arrival is closely related to mind-control and qi-regulation in obtaining, differentiation, and adjustment. Mind-control and qi-regulation assist each other through the whole acupuncture process, which is the core of qi-arrival.

Regressão e crescimento do primogênito no processo de tornar-se irmão / Firstborn's regression and growth in the process of becoming a sibling

Investigaram-se indicadores de regressão e crescimento do primogênito no processo de tornar-se irmão. Participaram três primogênitos pré-escolares no terceiro trimestre de gestação, aos 12 e 24 meses do irmão. Foi aplicado o Teste das Fábulas e realizada análise qualitativa de conteúdo. Os resultados revelaram regressão do primogênito na gestação materna e crescimento, aos 12 e aos 24 meses de idade do irmão. A regressão foi uma forma de enfrentar a chegada do irmão, enquanto que o crescimento revelou capacidade para conquistas ou custos de ser mais velho. Tanto a regressão quanto o crescimento oportunizaram um ir e vir saudável, fundamental para o desenvolvimento rumo à independência. Esses achados têm implicações para a pesquisa e para a clínica.

Regression and growth indicators in the process of becoming a sibling were investigated. Three firstborns took part in the study during the first sibling's third trimester of pregnancy, and when the sibling was 12 and 24 months old, respectively. The Fables Test was used and a qualitative content analysis was carried out. Results revealed regression indicators during pregnancy. At 12 and 24 months there were growth indicators together with regression indicators. Regression was used by the firstborn for coping with the sibling's arrival while growth revealed the capacity for acquisitions or the costs of being an older sibling. Both regressive and growth manifestations enabled a healthy to and fro, which is fundamental for development towards independence. These findings have both research and clinical implications.

The analysis on 66 children with dead on arrival in emergency department / 中国小儿急救医学

Objective To investigate the causes and influencing factors of dead on arrival (DOA) in children.Methods The clinic data from 66 children with DOA admitted in the emergency department of Hunan Children's Hospital from Jan 2010 to Apr 2012 were analyzed retrospectively.Results All of the 66 cases had cardiac respiratory arrest when admission.Fourteen cases had arrest for 10 minutes,12 cases for 30 minutes to an hour,40 cases had no details.Forty-four (68.2％) cases were carried by parents,22(31.8％)cases were transferred by medical professionals.The main causes of DOA were severe pneumonia with respiratory failure and (or) heart failure,intracranial infection,neonatal diseases.All cases were taken to resuscitation room by triage immediately.Tracheal intubations were completed in 48 cases and intravenous access with injection of epinephrine and other resuscitative drugs were established in all cases,but all cases were dead due to breathing and heartbeat stopped for a long time.Conclusion DOA is one of the important reasons for pediatric high-risk.The key of reduction of DOA incidence and improvement of survival rate is to improve pediatric emergency medical service system,strengthen the health education for the parents,to carry out training and establish homogenization service in emergency ICU.