Circadian rhythm abnormality and time therapy of bipolar disorder / 中华行为医学与脑科学杂志

Bipolar disorder is a common, highly disabling psychiatric disorder characterized by early onset, frequent episodes, high suicide risk, and chronic outcomes, and is associated with severe social dysfunction. The pathogenesis of bipolar disorder is still unclear, and current studies mainly focus on circadian rhythm abnormalities, including rhythm gene mutation, polymorphism, abnormal kinase expression, and rhythm abnormalities in neurotransmitter secretion and transport. It has been found that at any stage of bipolar disorder, whether prodrome, episode, or remission, patients exhibit circadian rhythm disruptions, including disrupted sleep-wake cycles, hormonal phase abnormalities, and irregular social rhythms. Based on this mechanism, the time therapy, such as light therapy, dark therapy, sleep deprivation and behavioral intervention, can rapidly improve the circadian rhythm of patients with bipolar disorder, achieve the goal of rapid relief of symptoms, with fewer side effects, low risk of switching to manic. In this paper, circadian rhythm mechanism, clinical manifestations and chronotherapy of bipolar disorder are reviewed to provide a basis for clinical diagnosis and treatment.

Effect of early involvement in clinical practice in improving comprehensive abilities and occupational cognition in medical students / 中华医学教育探索杂志

Objective To investigate the effect of early involvement in clinical practice in improving comprehensive abilities of medical students and strengthening their occupational cognition. Methods The students in the 5-year class of 2014 of pediatrics in our university were enrolled as subjects, among whom 78 students who received early involvement in clinical practice and teaching were enrolled as experimental group and 81 students who did not receive such teaching were enrolled as control group. A questionnaire survey was performed for the students participating in the teaching, including basic information, pre-training quality evaluation, development of personal knowledge and abilities, and comments or suggestions. The two groups were compared in terms of the score of the theoretical course of pediatric surgery, so as to explore whether"early involvement in clinical practice"could improve the theoretical study of students. Finally, the performance of students in clinical practice was evaluated and compared between the two groups to assess the role of "early involvement in clinical practice" in improving comprehensive abilities and occupational cognition. Results More than 90％of the students were satisfied with early involvement in clinical practice and they thought this activity helped them to improve clinical thinking, strengthen occupational cognition, enhance learning interests, improve communication skills, and promote the combination of basic and clinical knowledge. In addition, the follow-up analysis found that compared with the control group, the experimental group had a significantly higher average score [(74.59 ±0.50) vs. (68.89 ±0.67)] and a significantly higher proportion of students with a score of >70, and no students failed. As for the score of clinical practice, the experimental group had significantly better clinical work proficiency, clinical thinking, operational ability,and doctor-patient communication ability than the control group. Conclusion Early involvement in clinical practice among medical students can improve their comprehensive abilities and help to cultivate clinical thinking and doctor-patient communication skills and strengthen their occupational cognition, which lays a good foundation for cultivating high-quality talents through medical education.

Imaging and prognostic analysis in different molecular subtypes medulloblastoma / 临床儿科杂志

Objective To detect molecular subtypes of medulloblastoma, and its correlation with prognosis. Methods Surgically treated 32 cases of primary medulloblastoma from 2010-2013 were collected, the molecular subtypes were determined by immunohistochemical detection of GAB1 and YAP1 protein in the sample. Clinical characteristics, imaging features and survival condition of different molecular subtypes were analyzed. Results Molecular typing of the 32 cases (21 males and 11 females) shows 4 (12.5%) cases of SHH, 7 (21.9%) cases of WNT and 21 (65.6%) cases of non-SHH. There was no significant correlation of molecular subtypes with age, gender and pathological classification. Three-year progression free survival rate in SHH, WNT and non-SHH/WNT subtypes were 75%, 57.1% and 38.1%, respectively. Three-year progression free survival rate was significantly higher in patients under 3 years old group than that in patients over 3 years old group in non SHH/WNT (P=0.047). Conclusions The prognosis of SHH was better than WNT, WNT was better than non-SHH/WNT type, prognosis in patients under 3 years old group of non-SHH/WNT was better than that in patients over 3 years old group.

A quantitative study on evaluation of child diffuse axonal injury severity by using MR diffusion tensor imaging / 重庆医学

Objective To compare the value of fractional anisotropy(FA)of MR diffusion tensor imaging(DTI) and Glasgow coma scale(GCS) at admission for judging the injury severity and prognosis of diffuse axonal injury (DAI). Methods Thirty-four patients with DAI adopted the GCS score to evaluate the conscious disturbance levels at admission and conducted the DTI examination within 2 weeks. Twenty-three individuals undergoing healthy physical examination conducted the DTI examination. The FA values of visuality lesion area in various sites,healthy side symmetric site and cerebral midline site were measured. The reduction degree of mean FA value at midline site and visuality lesions were measured. The correlation between GCS score,mean FA value reduction degree in visuality lesions and mean FA value at cerebral midline site with consciousness disorder time and recovery degree in half a year after injury was analyzed. Results The reduction degree of mean FA value at cerebral midline site was significantly correlated with consciousness disorder time and recovery degree in half a year after injury(r= 0. 519,P=0. 002; r= 0. 669, P=0. 000) ;the mean FA value reduction degree in visuality lesions and GCS score had low or weak correlation with consciousness dis order time and recovery degree in half a year after injury(r=0. 285,P=0. 103;r=0. 487,P=0. 003;r= -0. 241,P=0. 169;r=-0. 229,P=0. 192). The correlation between mean FA reduction degree in cerebral midline site and mean FA value reduction degree in visuality lesions with the recovery degree in a half years after injury was higher than that in GCS score. Conclusion DTI is a sensitive sequence for diagnosing DAI and has much more value for judging the injury degree and prognosis than the GCS score generally adopted by clinic.

Applied exploration of formative evaluation in teaching of pediatric surgery / 中华医学教育探索杂志

To explore the promotion of formative assessment for teaching, the surgery teaching and research section of Institute of Pediatric has carried out formative assessment in theory teaching of pediatric medicine pediatric surgery for seven-year program for two consecutive years , and the teaching effects and assessment results have been made detalled analysis. The results shows that for-mative assessment combining with summative assessment can guide the students to adjust learning method in time and improve teaching methods effectively. Compared with the pure summative evalua-tion, formative assessment has enhanced the students' learning initiative, and improved their abilityof learning and solving problems. Formative assessment can comprehensively measure the overall quality of students.

Imaging findings and typing of skull eosinophilic granuloma in children / 局解手术学杂志

Objective To explore the imaging typing of skull eosinophilic granuloma( SEG) in children,and the clinical significance of this typing system was determined. Methods The clinical and radiological data of 32 cases of SEG confirmed by pathology in the past six years were retrospectively reviewed. According to the imaging findings,which included the size and shape of the granuloma,and the degree of skull destruction,SEGs were divided into four types:typeⅠ( subtle granumoma) ,typeⅡ( exteriorly convex granuloma) ,typeⅢ( biconvex granuloma) and typeⅣ(multiple granulomas and destructions). The imaging features of different types of SEG were analyzed,and the signif-icance of imaging typing was explored combining with the clinical manifestations,treatment programs and prognosis. Results Three cases (9. 4%) were included in typeⅠ,in which,the granuloma was not obvious and the skull destruction was confined in the diploe and outer plate. In type Ⅱ (21 cases,65. 6%),the imaging features included an obvious exteriorly convex mass and complete skull destruction of in-side and outside panels. Granuloma remove and destructed skull repair were performed in all cases,in which 15 were followed up and no re-currence was found. The imaging features of type Ⅲ (5 cases,15. 6%) were biconvex mass which broke through the inner plate and op-pressed the dura and cerebral parenchyma. Therapy program included not only surgical excision of the lesion but also repair of skull and dura. Three cases were followed up and no recurrence was found. Type Ⅳ (3 cases,9. 4%) showed multiple skull destructions and granulomas of various sizes. Chemotherapy and surgery treatment,poor prognosis and ease recurrence were characterized by this type. Conclusion we put forward a imaging typing method for SEGs. This typing system is helpful in guiding clinical protocols and prognosis of SEGs in children.

Management of obstructive hydrocephalus before posterior fossa tumor resection in children / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the management of obstructive hydrocephalus caused by posterior fossa tumors before tumor resection in children.</p><p><b>METHODS</b>The clinical data were reviewed of 162 pediatric patients of posterior fossa tumors with obstructive hydrocephalus undergoing surgical tumor removal between January 2008 and June 2012. Ninety children received preoperative Ommaya external drainage (group A) and 72 underwent preoperative ventriculo-peritoneal shunting (V-Ps) (group B). The therapeutic effects were evaluated and compared between the two groups.</p><p><b>RESULTS</b>Postoperative complications found in a total of 67 cases including infection (27), shunt blockage (19), subdural hematoma or effusion (16), ventricle fissure syndrome (5), and tumor hernia (4). Significant differences were found in the incidences of shunt blockage (P=0.047) and subdural hematoma or effusion (P=0.039) but not in the incidences of intracranial infection (P=0.478) or tumor hernia (P=0.462) between the two groups.</p><p><b>CONCLUSION</b>Ommaya reservoir can produce good results through simple surgical procedures for treatment of acute hydrocephalus in children with posterior fossa tumors and is associated less trauma and complications.</p>

Clinical analysis of intracranial hemorrhage in children with hemophilia / 中华实用儿科临床杂志

Objective To discuss the risk factors,clinical characteristics,treatment protocol and prognosis of intracranial hemorrhage (ICH) in children with hemophilia.Methods Twenty-four hemophilic children with ICH,which were registered in hospital between Jan.2005 and Dec.2012,were reviewed retrospectively.Results (1) Fifteen patients were hemophilia A and 9 patients were hemophilia B,all boys.The mean age of ICH was 1 year and 7 months old.The 70.8％ of patients were less than 3 years old,among whom hemophilia was diagnosed after ICH in more than 88.9％.The 87.5％ of patients had moderate or severe disease,and 37.5％ had head trauma before ICH.(2) The clinical symptoms were high cranial pressure,anemia,disturbance of consciousness,seizure,hemiplegia.(3) ICH position:cerebral hemorrhage with subarachnoid hemorrhage (SAH) in 7 patients,ventricular hemorrhage 2 patients,subdural hemorrhage with SAH in 10 patients,extradural hemorrhage 5 patients.(4)All patients were given blood coagulation factor replacement therapy,5 patients by operation.(5)Thirteen patients had not sequelae,9 patients had sequelae and 2 patients died.Conclusions The risk factors of ICH in hemophilic children include ages less than 3 years old,moderate or severe disease.Some patients have no predispositions.The clinical symptoms of patients are similar with normal children suffering from ICH.The keys of treatment are early diagnosis,early treatment and adequate course of treatment.Surgical operation could be in treatment after coagulation function gets corrected back to normal.

Improvement of teaching methods of minimally invasive neurosurgery / 中华医学教育探索杂志

Minimally invasive neurosurgery techniques developing by leaps and bounds in the past few years,which is to be a great challenge for the clinical teaching of neurosurgery.Based on their own actual,neurosurgery department of the Children's hospital of Chongqing medical university enriched the teaching contents,improved teaching methods and trained microsurgical techniques for doctors at various levels,meanwhile,it strengthened participants'sterile awareness,set good team spirit,developed individualized assessment standards and achieved good results.

Practice of building multimedia teaching material library in pediatric surgery medicine teaching / 中华医学教育探索杂志

Multimedia is a widely-used teaching means in contemporary medical education.Establishing and improving the multimedia teaching material library is a strong guarantee for the smooth implementation of multimedia.The causes,significance and methods for establishment of pediatric surgery teaching multimedia material library according to the characteristics of pediatric surgery teaching are described in this article,with a view to provide a reference to other relevant professional institutions.

Treatment of acute traumatic subdural hematomas in infants / 中华创伤杂志

Objective To investigate the clinical features of acute traumatic subdural hematomas (SDH) in infants and discuss the treatment methods. Methods The clinical features of 48 infants under three years old with acute traumatic SDH admitted from 2002 to 2008 were retrospectively analyzed.Results There were 31 infants under one year old (65%). The most popular injury cause was accidental fall in 37 patients (77%). Of all patients, 12 patients (25%) had disturbance of consciousness,eight ( 17% ) had convulsion and eight ( 17% ) were combined with skull fractures. The treatment methods included craniotomy and evacuation of the blood clot in 18 patients ( including 13 patients underwent instant operation after admission ), burr hole craniotomy and external drainage of the chronic subdural hematoma in seven and conservative management in 23 with small subdural hematomas. All patients obtained good outcome except that two patients had motor dysfunction and one death. Conclusions The incidence of acute traumatic SDH in infants is high, especially in infants under one year old. It is easy to be disregarded at early stage and may deteriorate to chronic subdural hematoma or hydropsy. Early diagnosis and active surgical treatment may attain sound prognosis.

Clinical Application of Ultrasonography on Tethered Spinal Cord Syndrome / 实用儿科临床杂志

Objective To explore the clinical application of ultrasonography on tethered spinal cord syndrome (TCS).Methods Ultrasonic feature of 45 patients with TCS were analyzed retrospectively. Pre-and post-operative blood flow rates of cone were recorded by color doppler.Results Ultrasound was the same as computer tomography not only presented the image of anatomy and pathology of TCS,but also showed the lack of pulsatile motion of distal cord with TCS.Before the operation,blood flow rates of cone were( 0.047?0.012) m/s.After the operation,blood flow rates of cone were(0.158?0.029) m/s.There was significantly different(P

Changes of erythrocyte immunity function in rats with traumatic brain injury / 重庆医科大学学报

Objective:Toexplore the changes and mechanismofErythrocyte ImmunityFunction(EIF)in rats with Traumatic Brain Injury(TBI).Methods:HealthyWistar rat(sn=70)were divided intocontrol group(n=10)and TBI group(n=60),model ofTBI were prepared and divided into mild group(n=30)and moderate to severe group(n=30).Red Blood Cell-C3b Receptor Rate(RBC-C3bRR)and Red Blood Cell-Immune Complex Rate(RBC-ICR)of rats with TBI were measured by methed of yeast fungus and the content of serum ?-endophin(?-EP)was tested by radioimmunoassay.Results:Compared with the control group,RBC-C3bRR of rats with TBI decreased significantly while RBC-ICR and?-EP increased significantly(P

The make and application of multimedia courseware in pediatric surgery / 中华医学教育探索杂志

Pediatric surgery is the important part of the paediatrics,and the complicated content,limited time and many difficulties are the main problems of pediatric surgery teaching. The multimedia courseware is used in teaching of pediatric surgery,which is convenient for teachers'preparing lessons and teaching and is beneficial to students'review and summary. After the technique is used,the teaching efficiency and the quality are obviously improved.