Epidemiological investigation and risk factor analysis of infant dyschezia in Xi′an / 中华实用儿科临床杂志

Objective:To investigate the epidemiological characteristics of infant dyschezia in Xi′an city based on the Rome Ⅳ Criteria for Functional Gastrointestinal Disorders in Infants/Toddlers, and to analyze the related risk factors so as to provide epidemiological basis for clinical diagnosis and treatment.Methods:It was a cross-sectional survey conducted in the child health department of community health service center or hospital in Xi′an from October 2020 to October 2021 using the multi-stage cluster random sampling method.Infants aged 0-12 months were enrolled and their caregivers were interviewed by face-to-face electronic questionnaire.The prevalence and influencing factors of defecation difficulty in infants aged 0-9 months were analyzed according to the Rome Ⅳ Criteria for Functional Gastrointestinal Disorders in Infants/Toddlers.The prevalence of dyschezia in infants aged over 9 months was explored as well.The counting data were compared by Chi- square test.Univariable and multivariate Logistic regression analysis were performed to identify risk factors for dyschezia. Results:A total of 1 446 infants were collected, including 735 boys (50.8%) and 711 girls (49.2%), with an average age of (5.94±3.27) months.The prevalence of dyschezia aged 0-9 months in Xi′an was 3.46% (42/1 215), which gradually decreased with the increased age.Infants with dyschezia could defecate 2-3 times a day, or once a few days.Family history of defecation disorders ( OR=3.785, 95% CI: 1.912-7.494) was the risk factor for infant dyschezia, while complementary food ( OR=0.193, 95% CI: 0.075-0.495) was the protective factor for infant dyschezia ( P<0.05). Breastfeeding ( OR=8.126, 95% CI: 2.258-29.236) was the risk factor for dyschezia in infants who defecated less frequently ( P<0.05). Only 2 cases of 10-month-old infants had defecation-like symptoms, manifested as crying for a long time before defecation. Conclusions:The prevalence of dyschezia in infants aged 0-9 months in Xi′an is 3.46%.Dyschezia infants may also have a lower frequency of defecation.Timely addition of complementary food is beneficial to alleviate infant dyschezia, while infant who defecated less frequently are more likely to have dyschezia while breastfeeding.

Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome / 中华烧伤杂志

Objective: To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome. Methods: A retrospective observational study was conducted. From May 2012 to December 2021, the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected, including 8 males and 11 females, aged 28-71 (56±11) years, with 12 cases of infected acute wounds and 7 cases of infected chronic wounds. The lesions were located in the limbs, perianal, and sacrococcygeal regions, with original infection ranging from 9 cm×5 cm to 85 cm×45 cm. After admission, the patients were performed with multidisciplinary assisted diagnosis and treatment, and the wounds were treated with debridement and vacuum sealing drainage, according to the size, severity of infection, suture tension, and bone and tendon tissue exposure of wounds, direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair. The levels of cortisol and adrenocorticotropic hormone (ACTH) of patients at 8:00, 16:00, and 24:00 within 24 h after admission were counted. After admission, the number of operations, wound repair methods, and wound and skin/flap donor site healing of patients were recorded. During follow-up, the wounds were observed for recurrent infection. Results: The cortisol levels of 16 patients at 8:00, 16:00, and 24:00 within 24 h after admission were (130±54), (80±16), and (109±39) nmol/L, respectively, and ACTH levels were (7.2±2.8), (4.1±1.8), and (6.0±3.0) pg/mL, respectively; and the other 3 patients had no such statistical results. After admission, the number of surgical operation for patients was 3.4±0.9. The following methods were used for wound repair, including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases, of which 2 cases underwent stage Ⅱ autologous skin grafting after artificial dermis grafting in stage Ⅰ, and 6 cases had pedicled retrograde island flap+autologous skin grafting. The wound healing was observed, showing that all directly sutured wounds healed well; the wounds in 6 cases of autologous skin and/or artificial dermis grafting healed well, and the wounds in 3 cases also healed well after the secondary skin grafting; the flaps in 4 cases survived well with the wounds in 2 cases with distal perforators flap arteries circumfluence obstacle of posterior leg healed after stage Ⅱ debridement and autologous skin grafting. The healing status of skin/flap donor sites was followed showing that the donor sites of medium-thickness skin grafts in the thigh of 4 cases were well healed after transplanted with autologous split-thickness grafts from scalp; the donor sites of medium-thickness skin grafts in 3 cases did not undergo split-thickness skin grafting, of which 2 cases had poor healing but healed well after secondary skin grafting 2 weeks after surgery; the donor sites of split-thickness skin grafts in the head of 2 patients healed well; and all donor sites of flaps healed well after autologous skin grafting. During follow-up of more than half a year, 3 gout patients were hospitalized again for surgical treatment due to gout stone rupture, 4 patients were hospitalized again for surgical treatment due to infection, and no recurrent infection was found in the rest of patients. Conclusions: The infected wounds in patients with iatrogenic Cushing's syndrome have poor ability to regenerate and are prone to repeated infection. Local wound treatment together with multidisciplinary comprehensive treatment should be performed to control infection and close wounds in a timely manner, so as to maximize the benefits of patients.

Establishment of a three-dimensional coordinate system for measuring the recurrence rate after orthognathic surgery and evaluation and analysis of the degree of recurrence / 口腔疾病防治

Objective@# To establish a three-dimensional coordinate system that can accurately measure the recurrence rate after orthognathic surgery, and evaluate and analyze the degree of recurrence.@*Methods @#Data from patients who underwent orthognathic surgery in a hospital were selected to reconstruct three-dimensional images with spiral CT. The two researchers used the multiplane assisted positioning method to fix the points three times and screened them using intra-andintreclass correlation coefficients (ICC). Reproducible and accurate landmark points were drawn to establish different coordinate systems and calculate the facial asymmetry index (AI) to determine the coordinate system with the best mid-sagittal plane symmetry. This coordinate system and lateral radiographs were used to separately measure the recurrence rate, and evaluate and analyze the three-dimensional recurrence degree of orthognathic surgery.@*Results @#Ten landmark points that may be repeatedly fixed were obtained, including N (nasion), K (K point), ANS(anterior nasal spine), PNS (posterior nasal spine), Ptm(pterygomaxillary fissure), Gn (gnathion), IZ(IZ point), MZ (MZ point), Ms (mastoideale), Cor (coronion) and and Go (gonion). Three coordinate systems were established, and the most suitable coordinate system was the upper edge point of the left infraorbital foramen. The inner upper edge of the right infraorbital foramen and both sides of the midpoint of the ear points constituted the horizontal plane (HP), which passed through the outermost point of the left zygomatic frontal suture and the outermost point of the right zygomatic frontal suture and was perpendicular to the horizontal plane to constitute the coronal plane (CP). It was perpendicular to the two planes to form a sagittal plane (SP). Two-dimensional and three-dimensional measurements of recurrence were performed on 112 patients, and new three-dimensional recurrence evaluation results were obtained. Less than 40% had low recurrence, 40% to 61% had moderate recurrence, and greater than 61% had high recurrence.@*Conclusion@#This study established a three-dimensional coordinate system suitable for measuring the recurrence rate after orthognathic surgery, obtained a new three-dimensional recurrence evaluation result, and provided a clinical experimental basis for evaluating the effect of orthognathic surgery and improving stability.

Efficacy and Safety of Emricasan in Liver Cirrhosis and/or Fibrosis

This study aimed to perform a meta-analysis to determine the efficacy and safety of emricasan. Nine databases were searched for clinical trials investigating the efficacy of emricasan treatment in patients with liver cirrhosis or fibrosis. A manual search was conducted to identify the missing trials. The quality of the included studies was assessed using the revised Cochrane risk of bias tool. Efficacy of emricasan treatment was defined as a positive change in apoptosis-related parameters from baseline to the last follow-up visit. Overall, emricasan treatment is more effective in patients with liver cirrhosis or fibrosis than placebo (standardized mean difference [SMD] [95% confidence intervals (CI)]=0.28 [0.14; 0.41]). No significant change in model for end-stage liver disease (MELD) score between the emricasan and placebo groups was noted (SMD [95% CI]=0.18 [-0.01; 0.36]; p=0.058). A 50 mg dose of emricasan had the highest efficacy rate compared to placebo (SMD [95% CI]=0.28 [0.06; 0.50]; p=0.012), followed by the 5 mg dosing regimen (SMD [95% CI]=0.28 [0.06; 0.50]; p=0.012). Treatment with emricasan resulted in significant reductions in ALT (mean difference (MD) [95% CI]=-5.89 [-10.59; -1.20]; p=0.014) and caspase3/7 levels (MD [95%CI]=-1215.93 [-1238.53; -1193.33]; p<0.001), respectively. No significant increase in the rate of overall adverse events was noted (OR [95% CI]=1.52 [0.97; 2.37]; p=0.069). Treatment with emricasan is more effective in improving liver function and apoptosis parameters compared to placebo, with a well-tolerated safety profile. However, due to the poor quality of the analyzed studies, the small number of trials and patients, and the short follow-up periods, more robust trials are still warranted.

Clinical application of continuous glucose monitoring in children with diabetes mellitus / 国际儿科学杂志

Blood glucose control is not only the key issue of diabetes management, but also one of the goals of diabetes treatment.Pain associated with self-monitoring of blood glucose(SMBG)results in poor compliance with blood glucose testing.With the advent of continuous glucose monitoring(CGM), it is more convenient to detect blood glucose and realize dynamic glucose monitoring.Continuous glucose monitoring(CGM)is widely used in adults with diabetes, and the usage among children is also increasing.Many studies have conducted clinical trials on the use of CGM in children with diabetes, initially confirming the use of CGM in children with diabetes.However, some studies still have controversies on the use of CGM in children.In this paper, the clinical studies of CGM in children′s diabetes in recent years were summarized to further understand the application of CGM and its combined insulin pump in pediatrics.

Long-term follow-up of efficacy of insulin pump in the treatment of children with type 1 diabetes mellitus / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect of continuous subcutaneous insulin infusion (CSⅡ) versus multiple daily injection (MDI) on blood glucose control in children with type 1 diabetes mellitus (T1DM).@*METHODS@#A retrospective analysis was performed on the medical data of 91 children with T1DM who were treated with CSⅡ for more than 1 year and 75 children with T1DM who were treated with MDI. The two groups were compared in terms of glycosylated hemoglobin (HbA1C) and the recurrence of diabetic ketoacidosis (DKA) to evaluate the difference in the efficacy during the 3-year follow-up. A survey was conducted for the children in the CSⅡ group and their family members to investigate the degree of satisfaction with insulin pump.@*RESULTS@#There was no significant difference in age, sex, and course of diabetes between the CSⅡ and MDI groups at disease onset and in the first year, the second year, and the third year of follow-up (@*CONCLUSIONS@#Children with T1DM treated with CSⅡ have a better control of blood glucose than those treated with MDI, and children and their family members are satisfied with CSⅡ treatment. Therefore, it holds promise for clinical application.

Relationship between dexmedetomidine-induced reduction of sevoflurane-induced neurotoxicity and NKCC1/KCC2 in neonatal rats / 中华麻醉学杂志

Objective:To evaluate the relationship between dexmedetomidine-induced reduction of sevoflurane-induced neurotoxicity and cation-chloride cotransporters Na + -K + -2Cl --1 (NKCC1) /K + -2Cl --2 (KCC2) in neonatal rats. Methods:Eighty healthy male Sprague-Dawley rats at postnatal day 7 were divided into 4 groups ( n=20 each) using a random number table method: control group (group C), sevoflurane anesthesia group (group S), dexmedetomidine group (group D), and sevoflurane and dexmedetomidine group (group SD). Rats were exposed to 2.5% sevoflurane for 6 h to establish the model of sevoflurane anesthesia in group S. Dexmedetomidine 1.0 μg/kg was intraperitoneally injected, and then sevoflurane anesthesia was performed in group SD.The expression of cleaved caspase-3, NKCC1 and KCC2 was detected by Western blot at 24 h after the end of anesthesia.At 35 days after the end of anesthesia, the cognitive function was assessed using the Y maze test, and the neurons in the hippocampal CA1 area were counted using the Nissan staining method. Results:Compared with group C, the percentage of time spent in novel arm and the number of neurons in hippocampal CA1 area were significantly decreased, the expression of cleaved caspase-3 and NKCC1 was up-regulated, the expression of KCC2 was down-regulated, and the ratio of NKCC1/KCC2 was increased in S and SD groups ( P<0.05), and no change was found in the above indicators in group D ( P>0.05). Compared with group S, the percentage of time spent in novel arm and the number of neurons in hippocampal CA1 area were significantly increased, the expression of cleaved caspase-3 and NKCC1 was down-regulated, the expression of KCC2 was up-regulated, and the ratio of NKCC1/KCC2 was decreased in group SD ( P<0.05). Conclusion:The mechanism of dexmedetomidine attenuating sevoflurane-induced neurotoxicity may be related to maintaining the relatively stable expression of NKCC1/KCC2 in neonatal rats.

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China / 生物医学与环境科学（英文）

Objective@#Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.@*Methods@#A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( @*Results@#Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks.@*Conclusion@#Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.

Case report of Bainbridge-Ropers syndrome caused by ASXL3 mutation / 中华实用儿科临床杂志

The clinical data of a child with Bainbridge-Ropers syndrome in Qingdao Women and Children′s Hospital was retrospectively analyzed.A 26-day old female presented with no weight gain, more sleep, mild feeding difficulty and low muscle tension.A novel nonsense mutation (c.3464c > A) was found in ASXL3 gene through whole exon sequencing, namely a pathogenic mutation, and has not been reported at home and abroad.At the age of 6 months, special facial features were obvious, with claw-shaped hands and bilateral wrists deviated to ulnar side.Follow-up revealed that psychomotor development is retarded.

Long term follow-up and efficacy of continuous subcutaneous insulin infusion in the treatment of children with type 1 diabetes mellitus in Qingdao / 中华实用儿科临床杂志

Objective:To study the effect of continuous subcutaneous insulin infusion (CSII) in the long-term treatment of type 1 diabetes mellitus (T1DM) children, to analyze the factors influencing the efficacy, and to provide theoretical guidance for the application of CSII in long-term therapy and follow-up management.Method:A total of 60 T1DM children who were under 18 years old, lived in Qingdao for a long time, had CSII for more than 6 months, and visited the Outpatient Department of Endocrinology of Qingdao Women and Children′s Hospital for a long term from January 2019 to June 2019 were followed up with questionnaires to understand their general condition and treatment-related data.Result:After the CSII therapy, the hemoglobin A1c (HbA1c) of T1DM children significantly decreased from (9.58±2.08)% to (7.12±1.11)% ( t=7.315, P<0.05), the daily insulin dosage per unit weight significantly declined from 0.91(0.86, 0.94) IU to 0.80 (0.66, 0.88) IU ( Z=-5.514, P<0.05), and the frequency of both hypoglycemia and ketoacidosis was significantly reduced.Diet control, daily exercise time, the visit frequency and the self-monitoring frequency of blood glucose affected the curative effect of CSII therapy (all P<0.05). Conclusion:CSII therapy can effectively control the blood glucose of children with T1DM in Qingdao area, significantly lower HbA1c, and reduce the insulin dosage and the incidence of hypoglycemia and ketoacidosis.Good diet control, regular exercise, regular follow-up and a high frequency of blood glucose monitoring are associated with better glycemic control.

Impact of the Timing of Traditional Chinese Medicine Therapy on the Therapeutic Effect and Prognosis of Severe Coronavirus Disease 2019 / 中国医学科学院学报

To explore the optimal therapy time for the treatment of severe coronavirus disease 2019(COVID-19)by traditional Chinese medicine(TCM)and its influence on the therapeutic effect and prognosis. The clinical data,laboratory findings,and outcomes of 64 patients with severe COVID-19 treated with TCM and western medicine in Chongqing from January 20,2020, to March 11,2020 were retrospectively analyzed.Patients were divided into early intervention group[TCM was initiated within 3 days (including day 3) after the first diagnosis of severe type/critical type COVID-19]and late intervention group[TCM was initiated after 7 days (including day 7) after the first diagnosis of severe type /critical type COVID-19].The changes in clinical parameters during the course of disease were compared between the two groups. On day 14,the oxygenation index was 292.5(252.0,351.0)mmHg in the early intervention group,which was significantly higher than that in the late intervention group [246.0(170.0,292.5)mmHg](=0.005).The length of hospital stay [(18.56±1.11)d (24.87±1.64)d,=0.001],duration of ICU stay [(14.12±0.91)d (20.00±1.53)d,=0.000] and time to negativity [(16.77±1.04)d (22.48±1.66)d,=0.001] in the early intervention group were significantly shorter than those in the late intervention group.The intubation rate(7.3%)in the early intervention group was significantly lower than that in the late intervention group(30.4%)(=0.028). Early TCM therapy within three days after a diagnosis of severe COVID-19 can shorten the length of hospital stay,duration of ICU stay,and time to negativity and decrease intubation rate.

Novel Nonsense Mutation in ASXL3 causing Bainbridge-Ropers Syndrome

Background:Bainbridge-Ropers syndrome is a rare autosomal dominant genetic disorder.Case characteristics: A 26-day-old neonate presented with feeding difficulties, excessivesleeping, and hirsutism over forehead and lumbosacral skin. Outcome: Whole-exomesequencing identified a novel nonsensemutation. Message: We report a novel mutation ina Chinese neonate with Bainbridge-Ropers syndrome.

's experience and practice in treatment of stroke / 中国针灸

is the famous acupuncture scholar in modern times and he emphasizes the importance of moxibustion in the diagnosis and treatment of stroke. According to the different stages and types of stroke, the full-period moxibustion treatment is dominant, i.e. the moxibustion therapy for pacifying is used for stroke prevention, the moxibustion therapy for rescuing is for the emergency and the moxibustion therapy for warming and promoting meridian circulation is for the rehabilitation. Moxibustion is applicable in the full-period treatment of stroke. The corresponding treatment regimen and manipulation should be selected in terms of the individual stage and type of stroke.

Phase I total hip replacement for severe hip osteoarthritis with proximal femoral fractures / 中国骨伤

OBJECTIVE@#To investigate the effect and prognosis of stage I total hip replacement in the treatment of severe hip osteoarthritis with proximal femoral fracture.@*METHODS@#From July 2014 to October 2017, 8 patients with severe end-stage hip disease and proximal femoral fracture were treated with stage I total hip replacement including 6 males and 2 females, aged 59 to 72 years old with an average age of 65 years old, involving 4 femoral head necrosis with proximal femoral fracture in the right side, 3 femoral head necrosis with proximal femoral fracture in the left side, and 1 left acetabular dysplasia with proximal femoral fracture in the left side. The average time from injury to operation was 7 days. Eight patients were treated with biologically elongated hip prosthesis.@*RESULTS@#Eight patients with stage I total hip arthroplasty were followed up for 12 to 48 months with an average of 31 months. During the follow-up period, there was no loosening or subsidence of the prosthesis. Harris score increased from 33 points (22 to 42 points) preoperatively to 87 points(82 to 90 points) at the last follow-up. Among them, 3 cases were excellent and 5 cases were good. Abandoned abduction and walked 3 months after operation. X-ray films during 3-6 months after operation showed that fracture healing was good, hip pain and function were improved significantly, and the quality of life was greatly improved.@*CONCLUSIONS@#Phase I total hip arthroplasty for severe hip osteoarthritis patients with proximal femoral fracture has the advantages of shortening the treatment time, alleviating patients'pain, reducing hospitalization costs and good prognosis.

Effect of sevoflurane combined with propofol anesthesia on postoperative expression of hnRNPA2 in brain tissues of rats with mild cognitive impairment / 中华麻醉学杂志

Objective To evaluate the effect of sevoflurane combined with propofol anesthesia on the postoperative expression of nuclear heterogeneous ribonucleoprotein A2 (hnRNPA2) in brain tissues of rats with mild cognitive impairment (MCI).Methods Male Sprague-Dawley rats,aged 16-18 months,were anesthetized with pentobarbital sodium.MCI was induced by ligation of bilateral common carotid arteries after anesthesia.Forty-eight rats with MCI were divided into 4 groups (n =12 each) using a random number table method:sham operation group (SH group),sevoflurane anesthesia group (S group),propofol anesthesia group (P group),and sevoflurane combined with propofol anesthesia group (SP group).Group S inhaled 3％ sevoflurane.Propofol was intravenously infused at a rate of 40 mg · kg-1 · h-1 in group P.In group SP,1.7％ sevoflurane was inhaled,and propofol 20 mg· kg-1 · h-1 was intravenously infused.The anesthesia time was 3 h in the three groups.After disappearance of eyelash reflex,open reduction and internal fixation was performed after tibial fracture was induced.Y-maze test was performed at 7 days after operation,and the percentage of time of staying at novel arm was calculated.The open field test was performed,and the total activity distance and time of staying at the central region were recorded.Then the rats were sacrificed,and brain tissues were obtained for determination of the expression of hnRNAP2 and γ-aminobutyric acid receptor A1 subunit (GABAA-α1) in hippocampus by immunofluorescence and Western blot,respectively.Results Compared with SH group,the percentage of time of staying at novel arm was significantly decreased,the expression of hnRNPA2 in the hippocampus was up-regulated,and the expression of GABAA-α1 was down-regulated in S and P groups,and the expression of hnRNPA2 in the hippocampus was up-regulated (P＜0.05),and no significant change was found in the percentage of time of staying at novel ann or expression of GABAA-α1 in SP group (P＞ 0.05).Compared with S group or P group,the percentage of time of staying at novel arm was significantly increased,the expression of hnRN-PA2 in the hippocampus was down-regulated,and the expression of GABAA-α1 was up-regulated in SP group (P＜0.05).There was no significant difference in the total distance or time of staying at the central region among the four groups (P＞ 0.05).Conclusion The mechanism by which sevoflurane combined with propofol anesthesia does not aggravate the postoperative cognitive dysfunction may be related to up-regulating the expression of hnRNPA2 in brain tissues and maintaining GABAA-α1 stable in rats with MCI.

Clinical features of pituitary stalk interruption syndrome in neonates and infants / 中华实用儿科临床杂志

Pituitary stalk interruption syndrome (PSIS) is characterized by a thin or absent pituitary stalk,hypoplasia of the adenohypophysis,and ectopic neurohypophysis.The occurrence of PSIS is associated with perinatal abnormalities and congenital gene mutations.PSIS manifestations include a wide spectrum of clinical phenotypes and pituitary hormone deficiencies of variable degree and timing of onset.The phenotype in children and adolescents includes short stature and abnormal sexual development.However,the manifestations of PSIS in neonates and infants are not specific.The phenotype in the neonatal period includes hypoglycemia,hyponatremia,micropenis,cryptorchidism,malformations,jaundice,constipation and poor appetite.Great importance should be attached to the prognostic value of magnetic resonance imaging (MRI) in pituitary region,and the pituitary characteristics indicated by MRI are closely associated with the clinical phenotypes of PSIS.Once PSIS is diagnosed,hormone replacement therapy should be performed in early stage and subsequent long-term follow-up is demanded.

Effect of dexmedetomidine on expression of NR1 subunit-containing NMDA receptors and GluR2 subunit-containing AMPA receptors during hypoxic injury to rat hippocampal neurons / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on the expression of NR1 subunit-containing NMDA receptors and GIuR2 subunit-containing AMPA receptors during hypoxic injury to rat hippocampal neurons.Methods The hippocampal neurons were isolated from Wistar rats within 24 h after birth and divided into 3 groups (n=24 each) using a random number table:control group (group C),hypoxia group (group H) and dexmedetomidine group (group D).The cells were subjected to hypoxia for 6 h to establish the model of neuronal hypoxic injury in H and D groups.In group D,0.1 μmol/L dexmedetomidine was added at 6 h of hypoxia and neurons were incubated for 3 h,and then the culture medium was replaced with a normal medium and neurons were incubated for 24 h.The neuronal viability was measured by CCK-8 assay,the leakage of LDH was detected,and the leakage rate was calculated.The expression of NR1 subunits-containing NMDA receptors and GluR2 subunits-containing AMPA receptors was detected by Western blot.The concentration of calcium ion in cytoplasm was measured using Fluo-3AM.Results Compared with group C,the neuronal viability was significantly decreased,the LDH leakage rate was increased,the expression of NR1 subunits-containing NMDA receptors in the membrane was up-regulated,the expression of GluR2 subunits-containing AMPA receptors was down-regulated,and the concentration of calcium ion in cytoplasm was increased in H and D groups (P＜0.05).Compared with group H,the neuronal viability was significantly increased,the LDH leakage rate was decreased,the expression of NR1 subunits-containing NMDA receptors in the membrane was down-regulated,the expression of GluR2 subunitscontaining AMPA receptors was up-regulated,and the concentration of calcium ion in cytoplasm was decreased in group D (P＜0.05).Conclusion The mechanism by which dexmedetomidine reduces hypoxic injury to rat hippocampal neurons may be related to inhibiting up-regulation of the expression of NR1 subunits-containing NMDA receptors in the membrane and down-regulation of the expression of GluR2 subunitscontaining AMPA receptors.

Factors Associated with Trait Anger Level of Juvenile Offenders in Hubei Province: A Binary Logistic Regression Analysis / 华中科技大学学报（医学）（英德文版）

The risk factors of high trait anger of juvenile offenders were explored through question naire study in a youth correctional facility of Hubei province,China.A total of 1090 juvenile offenders in Hubei province were investigated by self-compiled social-demographic questionnaire,Childhood Trauma Questionnaire (CTQ),and State-Trait Anger Expression Inventory-Ⅱ (STAXI-Ⅱ).The risk factors were analyzed by chi-square tests,correlation analysis,and binary logistic regression analysis with SPSS 19.0.A total of 1082 copies of valid questionnaires were collected.High trait anger group (n=316) was defined as those who scored in the upper 27th percentile of STAXI-Ⅱ trait anger scale (TAS),and the rest were defined as low trait anger group (n=766).The risk factors associated with high level of trait anger included:childhood emotional abuse,childhood sexual abuse,step family,frequent drug abuse,and frequent internet using (P＜0.05 or P＜0.01).Birth sequence,number of sibling,ranking in the family,identity of the main care-taker,the education level of care-taker,educational style of care-taker,family income,relationship between parents,social atmosphere of local area,frequent drinking,and frequent smoking did not predict to high level of trait anger (P＞0.05).It was suggested that traumatic experience in childhood and unhealthy life style may significantly increase the level of trait anger in adulthood.The risk factors of high trait anger and their effects should be taken into consideration seriously.

Look into Hepatic Progenitor Cell Associated Trait: Histological Heterogeneity of Hepatitis B-Related Combined Hepatocellular-Cholangiocarcinoma / 华中科技大学学报（医学）（英德文版）

Combined hepatocellular-cholangiocarcinoma (CHC) is a mixed tumor containing elements of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).Its remarkable histological heterogeneity has been linked to putative hepatic progenitor cell (HPC) origin.However,detailed histological or phenotypic description is rarely documented.In the present study,we reassessed 68 cases previously diagnosed as hepatitis B-related CHCs by immunohistochemistry and double-fluorescence immunostaining,focusing on HPC associated phenotypic observation of intermediate area of the tumor.It was found that tumor cells showed remarkable heterogeneity in intermediate area.Tumor cells with intermediate morphology between hepatocytes and cholangiocytes were oval-shaped and small with scant cytoplasm and hyperchromatic nuclei,arranging in solid nests mostly.By Keratin 7 (K7) staining,it appeared that the nests of tumor cells represented a maturation process from the undifferentiated small cells to mature hepatocytes through the "transitional" cells.Then,these small cells were further confirmed with intermediate phenotype as HPC by exploring immature hepatocellular marker and HPC/biliary markers co-localization.In conclusion,the HPC associated trait in CHC can be interpreted by HPC origin or gain of"stemness" by dedifferentiation.It is still too soon to give a final word that it is innate or acquired signature of HPC associated trait in CHC.

Training and assessment of cardiopulmonary resuscitation skill among non-clinical medical staff / 实用医学杂志

Objective To explore better management of cardiopulmonary resuscitation(CPR)skill train-ing and assessment and to improve CPR skills of non-clinical medical staff. Methods We developed standard CPR process and produced operating video ,and CPR models were used to train and assess 385 non-clinical medi-cal staff then the results were analyzed. Results All the 385 non-clinical medical staff were qualified. The medi-an score was 86.0,and quartile spacing 9.5. Scoring rate and full mark rate were the lowest in assessing for breath-ing and pulse before and after rescue ,followed by chest compressions/rescue breathing and quality of CPR. Age had significant positive correlation with the score of step 12(assessing for breathing and pulse after rescue),(r=0.1,P < 0.05). Gender and different professional titles had no significant effect on the results of the assessment. Conclusions Non-clinical medical staff need to pay more attention to CPR skill. Sound system ,advanced and ef-fective training methods,repeated training and regular assessment are conducive to the improvement of CPR skill of young non-clinical medical staff.