《头儿，一切正常!》

在这本可爱的漫画书中，作者用敏锐的观察、尖刻犀利的文笔和不加修饰的幽默抨击了公司生活。他的漫画是如此的赏心悦目。在书的序言里，一位漫画迷把麦斯耐尔的漫画当作治疗头疼的良药。

Long-term Follow-up Study on Perthes Disease

Objective: To analyze the efficacy of various therapies on Perthes diseaseand summarize a systematic treatment strategy. Methods: One hundred and sixty-five cases merelong-term followed. The advantages and disadvantages of various therapies were compared. Results:Each method had its advantage and disadvantage; the effects were correlated with the stages andtypes of the patients and the therapy they were given. Simple treatment is recommended for type Ⅰcases . For type Ⅱ , simple procedures can be used in stage Ⅰ of the patients and surgery wasusually contraindicated for stage Ⅲ cases . For type Ⅲ, vascularized fibula grafting may beconsidered for cases of stage Ⅰ , Ⅱ and Ⅲ. For type Ⅳ cases, combined therapies should beenconsidered. Conclusion: The therapy should be individualized to patient.

Pressure from the lips and the tongue in children with class III malocclusion

Objective： To discuss possible relationships between class In malocclusion and perioral forces by measuring the pressure from the lips and the tongue of children with class nI malocclusion. Methods： Thirty-one children with class In malocclusion were investigated and their perioral forces were measured at rest and during swallowing under natural head position by a custom-made miniperioral force computer measuring system. Results： The resting pressures exerted on the labial side and palatine side of the upper lett incisor, as well as the labial side and lingual side of the lower lett incisor, were 0 g/cm^2, 0 g/cm^2, 0.57 g/cm^2 and 0.23 g/cm^2, respectively. Correspondingly, the swallowing forces were 2.87 g/cm^2, 5.97 g/cm^2, 4.09 g/cm^2 and 7.89 g/cm^2, respectively. No statistical difference between muscular pressure and gender existed. During swallowing, the lingual forces were significantly higher than the labial forces （P〈0.01）, however, at rest there was no significantly different force between these two sides. Compared to the normal occlusion patients, children with class Ⅲ malocclusion had lower pedoral forces. The upper labial resting forces （P〈0.01）, the lower labial resting forces （P〈0.05） and all the swallowing pressures from the lips and the tongue （P〈0.01） showed statistical differences between the two different occlusion conditions. Meanwhile, no significant difference was found for the resting pressure from the tongue between class Ⅲ malocclusion and normal occlusion. Conclusion： Patients with class Ⅲ malocclusion have lower perioral forces and this muscle hypofunction may be secondary to the spatial relations of the jaws. The findings support the spatial matrix hypothesis.

ILLUSTRATIVE CASES TREATED BY THE APPLICATION OF THE EXTRA POINT SISHENCONG

The president of our hospital, Dr. Chen Daoyi, has rich experience in the clinical us age of Sishencong (Extra 6). Having learnt from him, now Ⅰ present a few cases, in which the patients have been treated with this extra point.

Treatment for severe craniocerebral trauma combined with transtentorial hernia in children

Objective: To explore the treating method for severe craniocerebral trauma combined with transtentorial hernia in children.Methods: We treated 58 children with severe craniocerebral trauma combined with transtentorial hernia through evacuating the hematomas, incising the tentorium but preserving the floating bone flap between January 1996 and January 2002.Results: GCS was 3-5 in 17 cases and 6-8 in 41 cases. After treatment, 46 patients ((79.30)%) recovered well, 6 ((10.30)%) suffered from mild disability, 1 ((1.72)%) suffered from severe disability, 1 ((1.72)%) was in vegetative state, and 4 ((6.90)%) died.Conclusions: Evacuating hematomas and incising tentorium can effectively treat the child patients with severe craniocerebral trauma combined with transtentorial hernia, which can decrease the disability and mortality rates greatly, preserve the skull, exempt reoperation for cranioplasty and relieve the psychologic and physiologic burden of the child patients.

A seven-year study on head injuries in infants, Iran——the changing pattern

Objective： Head injury （HI） is the leading cause of mortality and life-long disability in infants. Infants have different anatomical and pathophysiological brain structures from other age groups. The aim of this study was to survey infant HI patients admitted to Shahid Behest Hospital in Kashan, Iran from 2004 to 2010, and to identify the causes of His in this age group. Methods： In this retrospective study, all HI patients under the age of two who were hospitalized for more than 24 hours between January 2004 and January 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed. Results： Infants comprised 20.8% of all children （under 15 years old） with His and 65.1% of the injuries occurred in the home. Falls were the most common cause of injury （63.4%）. In hospital mortality was 6.6 per 100 000 infants. A decreasing trend was seen in home events, but His caused by traffic accidents were increasing during the study period. The amount of HI infants resulting from car accidents has tripled from the years 2004 to 2010. Conclusion： Although home events and falling are the main causes of infant His and need attention, our study showed an increase of His caused by road traffic accidents, especially by car accidents, thus legislation for the implementation of protective equipment such as child safety seats and programs is urgently needed.

Correlation between BRAF^(V600E) mutation and clinicopathological features in pediatric papillary thyroid carcinoma

In adults, the presence of the BRAF^(V600E) mutation in papillary thyroid cancer(PTC) has been demonstrated to be strongly associated with aggressive cancer-cell characteristics and poor patient prognosis. In contrast, the frequency of this mutation in pediatric PTC has undergone limited study, and the few available estimates range from 0 to 63%. Furthermore, the role of the BRAF^(V600E) mutation in pediatric PTC is controversial; thus, the present study aimed to investigate the prevalence and role of the BRAF^(V600E) mutation in48 pediatric patients with PTC, aged 3–13 years. Of these patients, 41 were diagnosed with classic PTC, five were found to have a follicular variant of PTC, and two to exhibit a diffuse sclerosing PTC variant. The BRAF^(V600E) mutation was identified to be present in 35.4% of the 48 analyzed patients, and in 41.5% of the patients diagnosed with classical PTC. Furthermore, the presence of the BRAF^(V600E) mutation was found to be associated with a patient age at diagnosis of less than ten years(P=0.011), the performance of a thyroidectomy(P=0.03), exhibited tumor multifocality(P=0.02) and/or extra-thyroidal invasion(P=0.003), and both a low MACIS(Metastases, Age, Completeness of resection, Invasion, Size)(P=0.036) and AMES(Age, Metastasis, Extent of tumor,Size)(P=0.001)score. Together, these data suggest that the presence of the BRAF^(V600E) mutation may be negatively correlated with partial aggressive clinicopathological features of pediatric PTC.

Clinical observation on scalp acupuncture for diffusion tensor imaging in cerebral palsy children with periventricular leukomalacia

Objective： To observe the effect of Governor Vessel-unblocking and mind-refreshing needling technique on diffusion tensor imaging （DTI） in cerebral palsy （CP） children with periventricular leukomalacia （PVL） and investigate the underlying mechanism. Methods： A total of 18 CP children with PVL received modern rehabilitation training and scalp acupuncture. The before-after study was conducted to compare the fractional anisotropy （FA） of the white matter fiber tracts, gross motor function measure （GMFM） score, Gesell developmental scale and changes in muscle tone. Results： For the comparison before and after the first course of treatment, there were no statistical differences in DTI findings and FA values （both P〉0.05）; there were statistical differences in GMFM dimensions A and B （both P〈0.05） and no statistical differences in dimensions C, D and E （all P〉0.05）; and there were statistical differences in six items of Gesell development test （P〈0.01 or P〈0.05）. For the comparison before and after two courses of treatment, there were statistical differences in DTI findings and FA values in 8 cases between before and after 30 and 60 treatments （both P〈0.05）; there were statistical differences in GMFM dimensions A, B and C between before and after 30 and 60 treatments and between 30 and 60 treatments （all P〈0.05）; there were no statistical differences in GMFM dimensions D and E （all P〉0.05）; and there were statistical differences in six items of Gesell developmental test between before, after 30 and 60 treatments and between 30 and 60 treatments （P〈0.05 or P〈0.01）. Conclusion： The Governor Vessel-unblocking and mind-refreshing scalp acupuncture has no significant efficacy on the repair and regeneration of white matter fibers in children with PVL and CP in a short period of time; however, it gradually works along with the prolonged treatment time. In addition, it can improve the motor function and mental development and the efficacy is closely associated with the time of treatment.

Simple flaps for reconstruction of pediatric scalp defects after electrical burn

Objective： To analyze the management of high-voltage electrical burn injury of the scalp in our hospital. Methods： This study involved 10 patients who suf- fered from high-voltage electrical bum injury of the scalp. Scalp reconstruction was done by different modalities ac- cording to the size and location of the defect. Results： Complete flap viability was achieved in all the cases. We had one case of gapped wound which was managed only by dressing. Widening of the scar was found in 2 cases. Conclusion： Rotation, advancement and transposi- tion scalp flaps are used for reconstructing scalp defects caused by electrical bum. The choice of ideal flaps for re- construction depends upon the size and site of scalp defect.

Clinical observation on Governor Vessel-unblocking and brain-refreshing scalp acupuncture for cerebral palsy complicated with intellectual disabilities

Objective：To observe the clinical efficacy of Governor Vessel-unblocking and brain-refreshing scalp acupuncture for cerebral palsy （CP） complicated with intellectual disabilities. Methods：A total of 300 CP cases aged between 1 and 5 years were randomly allocated into a treatment group （n=150） and a control group （n=150）. Patients in the treatment group were treated with Governor Vessel-unblocking and brain- refreshing scalp acupuncture combined with rehabilitation training, whereas patients in the control group received rehabilitation training alone. The Beijing Gesell developmental （Gesell） scale and gross motor function measure （GMFM） scale were used to assess the motor and intellectual development before and 3 months after the treatment. In addition, the head CT/MRI examination was applied to assess the brain nerve repair before and after the treatment. Results：After the treatment, the total effective rate in the treatment group was 78.0%, versus 42.7% in the control group, showing a statistical significance （P〈0.05）. As for scores of five subscales in the Gesell scale, there were significant intra-group differences in the treatment group （allP〈0.05）; and the scores in the treatment group were significantly better than those in the control group （allP〈0.05）. As for scores of five dimensions in GMFM scale, there were significant intra-group differences in the treatment group （allP〈0.05）; and the scores in the treatment group were significantly better than those in the control group （allP〈0.05）. According to the head CT/MRI findings, the total effective rate was 73.3% in the treatment group, versus 62.0% in the control group, showing a statistical significance （P〈0.05）. Conclusion：When used in combination with rehabilitative training, Governor Vessel-unblocking and brain-refreshing scalp acupuncture can significantly improve the clinical efficacy for cerebral palsy complicated with intellectual disabilities. It can also improve the patients＆#39; motor function, intelligence and language ability.