Objective To evaluate surgical performance of reconstruction of the cistern magna for the treatment of Chiari Ⅰ malformation associated with syringomyelia.Methods Suboccipital craniotomy and laminectomy of C1 segment were performed.The superior edge of bone window was limited to the inferior nuchal line.The dura mater and arachnoid were opened Y-shaped.The cerebellar tonsils were removed by electrocoagulation or subpially.A communication of cerebrospinal fluid between the fourth ventricle and subarachnoid space was achieved.The pseduomembrane,which is a very thin membrane over the opening of the central canal,should be cut away,with fascia grafting.Then a new enlarged cistern magna was established.Results The procedure was successfully completed in all the 36 patients with Chiari Ⅰ malformation and syringomyelia.The pseduomembrane was found in 30 patients.Postoperative follow-up checkups for 3 months ~ 5 years showed various degrees of recovery of sensation and muscle strength.Re-examinations with MRI revealed that the spinal cord cavity disappeared in 6 patients and decreased in size in 30 patients.Conclusions The decompression of the posterior cranial fossa,the communication of cerebrospinal fluid between the fourth ventricle and subarachnoid space,and the removal of pseduomembrane are key processes for treating Chiari Ⅰ malformation associated with syringomyelia.

OBJECTIVE To explore the source resulting in nosocomial infection and main component elements managing and controlling nosocomial infection in order to enhance the administration of nosocomial infection and to raise proposition on standardized administration.METHODS Main component elements resulting in nosocomial infection were investigated by reviewing literature and clinical data,and analyzing hierarchy process of administration.RESULTS Emphasis on the administrative measures of main component elements resulting in nosocomial infection might achieve the aim of preventing and reducing nosocomial infection.CONCLUSIONS Reconstruction of administrative links on nosocomial infection can reduce medical risk and cost.

Objective To investigate the clinical efficacy of the titanium clip in endoscopic treatment of the transverse colon pol‐yps and discuss the incidence of postoperative complications .Methods A retrospective analysis of 47 patients with the diameter of the transverse colon polyps with the diameter of 1 .0 cm above for EMR treatment .47 patients divided into titanium clip group (EMR preoperative using the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution ,n=21) and no titanium clip group (EMR preoperative no using the titanium clip ,n=26) .Analysis one‐time complete resection ,intraoperative blood loss and the hemorrhage after 7 days of two groups .Results There were one‐time removal of the tumor in the titanium clip group ,and no one‐time removal of the tumor in the no titanium clip group due to the large blood loss with poor visibility ,three cases can not be a one‐time complete resection ,the two groups were significantly different (P< 0 .05);the average amount of bleeding (20 .0 ± 5 .6)mL in titanium clip group ,that was (80 .0 ± 8 .2)mL in the on titanium clip group ;compared with the two groups , there was statistically significant (P<0 .01) .There was not complication of hemorrhage after 7 days ,but three cases were that in no titanium clip group ,the difference was significant (P<0 .05) .Conclusion EMR preoperative use the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution in trement of benign tumor of the transverse colon ,which can signifi‐cantly improve the clinical efficacy of EM R technique ,and significantly reduced the intraoperative and postoperative bleeding occur‐rence ,thus it's worthy of promotion .

Objective To study the mechanism and prevention for complications associated with postoperative T-Tube cholangiography.Method The study reviewed the data of six patients with complications following postoperative T-Tube cholangiography.Results Minor adverse reactions occurred in 4 cases, severe in 2.The severe reactions were related to cholangiovenous reflux resulted from the increase in intrabiliary pressure during postoperative T-Tube cholangiography.Conclusion Limitation of high intrabiliary pressure during the perfor mance of postoperative T-Tube cholangiography is the most important measure to prevent such reactions.

BACKGROUND: More and more researches prove that cell apoptosis could be induced by glutamine, also there are more researches on studying the indirect and direct nervous-protective effects of insulin, but the nervous-protective effects of insulin on impairment induced by glutamine, as well as its mechanism still need further investigation.OBJECTIVE: To investigate the nervous-protective effects of insulin on impairment induced by glutamine in PC12 cells, and to explore its molecular mechanism.DESIGN: A prospective controlled study based on cells.SETTING: Department of Neurology, Zhejiang Hospital; Department of Neurology of Sun Yat-wen University Hospital.MATERIALS: The study was carried out at the Laboratory of the Third Affiliated Hospital and the Experimental Animal Center of Sun Yat-sen University from March 2002 to March 2003. PC12 cells were purchased from the same animal center.METHODS: Traumatic models were made in PC 12 cells by treated with 0.5 mmol/L glutamine for 20 minutes, and the insulin of different concentration were used for protection, after 24 hours, protective effects of insulin were assessed with MTT method, Hoechst33258 fluorescence staining, DNA agar gelatin electrophoresis, meanwhile the expression of PKB/Akt protein were also detected./Akt protein in experimental group.RESULTS: The A value of50 mU/L, 100 mU/L, 200 mU/L, 400 mU/L insulin groups were 0. 214 ±0. 062, 0. 234 ±0. 067, 0. 260 ±0. 076 and 0. 265 ± 0. 069, respectively, but the value of single glutamine group was 0. 201 ± 0. 079, statistical analysis indicated that compared with single glutamine group, there were no significant difference in 50 mU/L, 100 mU/L insulin groups( P > 0.05), but 200 mU/L, 400 mU/L insulin groups were found statistically different from single glutamine group(t=-2.398,-2. 716, P < 0.05); "DNA Ladder" could not be observed in 400 mU/L insulin group by electrophoresis;It was proved that Insulin could enhance the expression of PKB/Akt protein.CONCLUSION: Insulin has nervous-protective effects on impairment induced by glutamine in PC12 cells, furthermore it also has property of anti-apoptosis, and its protective mechanism might be associated with enhancement of the expression of PKB/Akt protein.

Objective To determine relationships between daily activities measured as modified version of Pulmonary Functional status and Dyspnea Questionaire (PFSDQ-M) and functional capacity and symptoms experienced in patients with chronic obstructive pulmonary disease (COPD). Methods Convenience sample of 94 COPD patients with stable condition were assessed by interview with PFSDQ-M Chinese version and modified Medical Research council dyspnea scale (MMRC) respectively. Pulmonary function test (PFT) and 6-minute walking test (6MWT) were undergone on the same day or within one week as interview. PFSDQ-M has three subscales,i.e.,change experienced by patient with activities (CA),dyspnea with activities (DA) and fatigue with activities (FA). Results Scores of CA,DA and FA correlated to 6-minute walking distancer= (-0.37)- (-0.42),FEV_1 r=(-0.27)-(-0.32),FEV_1/FVC r= (-0.27)- (-0.32),dyspnea rated by MMRC (r=0.55-0.60) and BODE index (r=0.35-0.40),respectively (all P<0.01). dyspnea explained 26% of the variance in changes of activities. Conclusions Physical activities moderately changed in patients with stable COPD;Dyspnea is the best predictor of limitation of daily activities.

Objective To retrospectively review the mortality and morbidity after orthopedic surgery for aged patients with reference to orthopedic version physiological and operative severity score for the enumeration of mortality and morbidity (O-POSSUM) and Portsmouth POSSUM (P-POSSUM) and validate the score' s accuracy in operative risk prediction.Methods O-POSSUM and P-POSSUM for mortality and morbidity were applied to 839 aged patients who had undergone orthopedic surgery between January 2008 and December 2011.Observed mortality and morbidity were compared with the expected values.Results O-POSSUM predicted 230 morbidities,but the observed value was 182 (x2 =2.718,P ＞ 0.05).O-POSSUM predicted 46 deaths,higher than the observed 3 deaths (x2 =38.870,P＜0.01).P-POSSUM predicted 16 deaths,higher than the observed 3 deaths (x2 =8.997,P ＜ 0.01).Conclusions O-POSSUM accurately predicts postoperative morbidity in aged orthopedic patients.However,O-POSSUM and P-POSSUM overpredicts the mortality and should be used with caution.

Objective To determine the radiographic feasibility of oblique lumbar interbody fusion (OLIF) corridor to treat lumbar disease at each lumbar disc level,including the corridor's numerical value and the influence of diaphragmatic crura and aorta abdominalis.Methods A retrospective CT study was conducted on 110 patients (including 69 males and 41 females,average age 47.95 years,range 16-83 years) that continuously collected and analyzed in the PACS system.The oblique corridor was defined as the area between the left lateral border of the aorta abdominalis(or iliac artery) and the right lateral border of the left psoas.The distances and angles of L1-2,L2-3,L3-4 and L4-5 levels were measured.Whether the change of diaphragmatic crura and aorta abdominalis affected the building of the corridor was also observed.Results The mean distances of oblique corridor to the levels of L1-L5 discs were:L1-2 15.90 mm,L2-3 14.82 mm,L3-4 17.57 mm,L4-5 11.16 mm.At the levels of L1-2 and L3-4,all of the images could build the corridor.But there were only 97.27％ images allowing operation at both L2-3 and L4-5,and the other 3 cases couldn't build the corridor since the aorta abdominalis was very close to psoas,and the distance was almost 0 mm.The max mean distance was 36.79 mm at L3-4 level.The mean angles were:L1-2 36.98°;L2-3 37.76°;L3-4 40.96°;L4-5 37.85°.The significant difference was at L3-4,ranged from 13.09 to 61.93°.The level of the aortic bifurcation was from the lower third of the L3 vertebral body to the middle third of the L5 vertebral body.The levels of left diaphragmatic crura's ending point in the lumbar was divided into four groups:1) Group L1 vertebral body level:the level at L1 vertebral body and above,5 cases (4.55％);Group L1-2 disc to L2 vertebral body level:at L1-2 disc and L2 vertebral body,67 cases (60.91％);Group L2-3 disc to L3 vertebral body level:at L2-3 disc and L3 vertebral body,36 cases (32.72％);Group L3-4 disc to L4 vertebral body level:at L3-4 disc and L4 vertebral body,2 case (1.81％).Conclusion The OLIF corridor can be built successfully at L1-2 and L3-4.However,it may be difficult at L2-3 and L4-5 for some patients due to the aorta abdominalis which is too close to psoas.The angles of L1-L5 levels were similar.While the left diaphragmatic crura was mainly impact the corridor insertion at L1-2 and L2-3.And the level of the aortic bifurcation was mainly located at the upper endplate of L4 to the L4-5 disc (87％).

Objective: To assay the content and stability of vitamin C(VC) in serum by a simple, specific method. Methods: Serum samples were extracted by metaphosphoric acid, and analyzed on a column C 18 of HPLC with DAD detector at 234 nm. Mobile phase was 100 mmol/L KH 2PO 4, pH3.00. The flow rate was 1 ml/min. Results: Under this condition, the retention time of VC was 5.76 min. The within run and between run reproducibilities tests were 0.42% and 2.11% respectively, and the recovery rate ranged from 82% to 88.5%. Stored at -70 ℃ and compared to that of its metaphosphoric acid extract, serum VC content was stable only for two days, and then decreased rapidly, whereas it did not decrease in metaphosphoric acid extract until the fifth day. Conclusion: A simple, sensitive and reliable method of HPLC with DAD detector is established for measuring VC in either serum or fruit, such as orange juice. VC should be determined immediately or should be extracted with metaphosphoric acid as soon as possible, then the extracts are kept at -70 ℃, and analysed within 5 d.

Object To optimize the preparation procedure for WEI'AN GRANULES Methods The optimum conditions of WEI'AN GRANULES were selected with the active components: magnolol, polysacchride of Rhizoma Atractylodis Macrocephalae and berberine hydrochloride as mark by orthogonal test Results The optimum preparative procedure was as follow: Cortex Magnoliae officinalis and Fructus Aurantii Immaturus were extracted with water and precipitated with alcohol (adding 20 fold water as much as medicine, extracting three times, 0 5 h per time and precipitated with 95% alcohol to remove impurities); Rhizoma Coptidis was extracted with 95% alcohol by refluxing; Rhizoma Atracylodis Macrocephalae and other herbs were extracted with water (adding 24 fold water as much as medicine, extracting twice, 2 h per time, its granule size of Rhizorna Afracylodis Macrocephalae was 2 mm to 4 mm) Conclusion The optimum preparative procedure is reliable and the extracting ratio of active component is high