OBJECTIVE To study the risk factors and preventive therapeutic strategies of neurosurgical postoperative intracranial infection.METHODS Totally 1613 patients who had a neurosurgical operation from Jan 2005 to Jun 2008 in our department were chosen(64 cases with intracranial infection).The infection rate was 3.97%.The risk factors were studied retrospectively,?2 test was selected to analyze the factors which might cause infection.RESULTS The analysis of 1613 cases revealed that infection rate was closely related to ventricular drainage,long indwelling drainage,emergency subsequent surgery postcraniotomy,CSF leakage,the approach to the post fossa,surgical microscopy,operation time above 4 h and polluted operation;while had no significonce of sex,age,the season,application of antibiotics before the operation and emergency operation.CONCLUSIONS To decrease the infection rate,the suture should be complete to prevent CSF leakage,polluted region be cleaned effectively,strict asepticly technique be measured,the operation be finished as soon as possible,drainage be prevented from pollution carefully and the duration of the drainage be controlled strictly,especially to the ventricular drainage.

Objective To investigate the effects of permissive hypercapnia (PHC) strategy used in ventilated newborn swine with respiratory failure on cerebral blood flow (CBF) and tissue metabolism. Method Eighteen newborn swine were randomly (random number) divided into 3 groups (n = 6): PHC, normocapnia (NC) and normal control groups. In PHC (PaCO2 50～60 mmHg) and NC (PaCO2 35 ～ 45 mmHg) groups, newborn swine were ventilated for treating respiratory failure induced by meconium aspiration. CBF was measured by using colored microsphere tracking technique. Cerebral oxygen metabolism rate (CMRO2), cerebral glucose metabolism rate (CMRGlu), and cerebral lactate production (CLP) were measured. Results After ventilation for 6 hours and 12hours, CBF in NC group decreased more significantly than those did in control group, and CMRGlu and CLP increased more significantly than those did in control group. In NC group, CMRO2 decreased more prominently than it did in control group 12 hours later. The CBF/CMRGlu and CBF/CLP ratios in NC group were lower than those in control(P＜0.05). There was no significant difference in CBF/CMRO2 ratio between NC and control groups. After ventilation for 6 hours, CBF in PHC group was lower than those in control group. But after ventilation for 12hours, CBF in PHC group increased and there was no significant difference in CBF between PHC group and control group (P＞O.05). There were no significant differences in CMRGlu, CLP and CMRO2 between PHC group and control group. The CBF/CMRGlu and CBF/CLP ratios in PHC group were lower than those in control, but higher then those in NC group (P＜0.05). There was no significant difference in CBF/CMRO2 ratio between PHC and control groups. Conclusions The reduction of cerebral blood flow and the disturbance of CBF autoregulation disturbance occur in ventilated newborn swine with hypoxemia respiratory failure. PHC may attenuate the reduction in CBF and the disturbance of CBF autoregulation.

Objective To investigate the therapeutic effect of three-dimensional interactive reduction of femoral neck and shaft in treatment of irreducible femoral neck fracture.Methods The study enrolled 40 patients with irreducible femoral neck fractures treated by three-dimensional interactive reduction of femoral neck/shaft and internal fixation with three cannulated screws from June 2011 to July 2013 (study group).Frontal and lateral X-ray films were taken after operation.Garden index was used to evaluate the fracture reduction quality and Harris hip score was recorded.Meanwhile,a retrospective analysis was performed on 32 patients with irreducible femoral neck fractures treated by open reduction and internal fixation with cannulated screws between January 2008 and December 2010 (control group).Results Patients in study group obtained satisfactory reduction by minimally traumatic closed reduction.According to the Garden index,fracture reduction quality was level 1 in 24 patients and level 2 in 16 patients.Thirty-two patients were followed up for 12-28 months (mean,21 months),which showed fracture healing.At the final follow-up,Harris hip score was 87 points (range,61-100 points) and 4 patients had femoral head avascular necrosis.By contrast,6 patients in control group showed fracture nonunion.At the final follow-up,Harris hip score was 60 points (range,20-100 points) and 8 patients had femoral head avascular necrosis.Conclusion Three-dimensional interactive reduction of femoral neck and shaft provides good hip function recovery and decreased incidence of femoral head avascular necrosis and fracture disunion compared with the open reduction and internal fixation.

Objective To evaluate the feasibility and accuracy of performing dose calculation on megavoltage cone-beam CT(MVCBCT) in the head and neck. Methods MiniCTQC phantom was imaged using MVCBCT scanner, and the MVCBCT value density calibration curve was established. Conventional CT and MVCBCT image of phantom and nasopharyngeal carcinoma(NPC) patient were acquired respectively. Two kinds of single field plan were designed for conventional CT image of phantom,and IMRT plan was used for conventional CT image of a NPC patient. The conventional CT plans were copied to MVCBCT image. The dose distribution was calculated for targets and normal tissues using the MVCBCT value density calibration curve,and compared with that of conventional CT. Results For all the cases,the differences between the calculated dose distributions using MVCBCT and CT were less than 3% and 3 mm in single field plan. In IMRT plan, DVHs of conventional CT and MVCBCT were in excellent agreement. The biggest difference between conventional CT and MVCBCT was 95 cGy with the error of 1.4%. On the isocenter plane,the passing rate was 95.5% ,99.4% ,93.8% ,98.7%, 100% ,94.5% ,97.3% ,95.6% ,99.3% and 99.4% for the beam angle of 0°,45°,90°,120°,160°,200°,240°,280° and 320°. Conclusions Performing dose calculation using MVCBCT in head-and-neck region was feasible, and the dose distributions on the conventional CT and MVCBCT were in excellent agreement.

Objective To investigate whether the macromolecular materials could enter cerebrospinal fluid and brain tissues in craniotomy with incision or non-incision of dura and arachnoid. Methods Adult male SD rats were randomly divided into three groups according to the random number table. The dura and arachnoid of rats in group A were cut open during craniotomy after general anesthesia; epidural craniotomy was done in rats in group B after general anesthesia; rats in group C (control group) were only generally anesthetized. All the rats were injected with Evans blue, a tracer used to detect the results, half an hour before each time point (1,3, 6, 12, 24, 72 hours and 1 week) via vein. The rats were executed at each time point to obtain the specimens of brain. The content of Evans blue in brain tissue was measured by fluorescence spectrophotometer for statistical analysis. The water content in the brain tissue was measured in a part of rats selected in groups A and B preoperatively and at postoperative 3 and 27 hours. Results It was found that some regions of the brain tissue were stained light blue in group A at 1,3, 6 and 24 hours. The blue was much lighter in brain tissue obtained at 72 hours in group A, and no blue stained at 1 week in group A . The contents of Evans blue in the brain tissues of rats in group A at 1,3, 6, 12, 24, 72 hours and 1 week were (18.07±1.25) μg/ml, (36.21±0.78) μg/ml, (25.73±1.14) μg/ml, (16.53±0.84) μg/ml, (23.34±1.91) μg/ml, (43.34±2.25) μg/ml and (25.27±1.88)μg/ml respectively, which were significantly higher than (3.15±0.45)μg/ml, (3.36±0.33)μg/ml, (2.98±0.54)μg/ml, (3.47±0.55)μg/ml, (3.54±0.37) μg/ml, (2.88± 0.42) μg/ml and (2.85±0.22) μg/ml respectively in group B and (2.97±0.37)μg/ml in group C (P<0.01). There was no significant difference in water content in brain tissue before and after operation (P>0.05). Conclusion After craniotomy with incision of dura and arachnoid, some macromolecular materials can enter the subarachnoid space and the brain parenehyma through blood-brain barrier of the wound of the scalp if the dura is sutured loosely.

Objective To describe our experience in laparoscopic radical prostatectomy (LRP)for incidental prostate cancer after TURP. Methods From April 2007 to July 2010, 5 patients with incidental prostate cancer after TURP were treated with a mean age of 73 years. The patients underwent LRP (2.8± 1.1) months after TURP. Results The five cases of LRP were performed successfully, with 1 case of transperitoneal approach and 4 cases of extraperitoneal approach. Mean operation time was (227.6±38.4) min, mean blood loss was (130±152.5) ml, and the mean follow-up was (16.1 ± 15.9) months. All five patients survived, and their urinary function was good without any incontinence. Conclusions Previous TURP represents a technical challenge when performing LRP, but highly skilled surgeons trained to perform LRPs can handle it.

Objective To explore the three ultrasonic technologies of two -dimensional ultrasound(2D -US),ultrasonic elastography(UE) and contrast -enhanced ultrasound(CEUS) for the measurement error in breast cancer and the correlation with the expression of ER,PR,VEGF.Methods 50 patients with breast cancer were meas-ured by 2D -US,UE,CEUS preoperatively,and the pathological specimen were measured postoperatively.Then used the immunohistochemistry to detect the expression of ER,PR,VEGF in tumor,and analyzed the correlation with the measurement errors.Results The results of differences between 2D -US,UE,CEUS and pathology were respectively as follows:( -0.59 ±-0.34)cm,( -0.20 ±-0.14)cm,( -0.40 ±-0.31)cm,and the differences were statistically significant(F =20.497,P <0.001).The positive expression rate of ER and PR was high if the difference between UE and 2D -US was less than or equal to 0.44cm.And the positive expression rate of VEGF was low if the difference between CEUS and 2D -US was less than or equal to 0.19cm.Three ultrasonic technologies in the measurement of breast cancer were different,the trend of difference between UE and 2D -US was smaller if the ER and PR were positively expression,and the trend of difference between CEUS and 2D -US was bigger if the VEGF was positively expression.Conclusion There is correlation between different immunohistochemical expression of breast cancer with measurement error in three different ultrasonic imaging technologies.The results suggest that the molecular pathology difference of breast cancer can impact on ultrasonic imaging,which contributes to know the reason and regulation of measurement error in different ultrasonic imaging technology.

Objective To discuss the clinic characters of clear cell papillary renal cell carcinoma ( CCPRCC) and the efficacy of related laparoscopic surgery.Methods From October 2013 to December 2015, 4 cases were treated as CCPRCC including 3 male and 1 female.Their age ranged from 34 to 67 years old ( mean 53 years old) .The duration of illness ranged from 7 days to 3 months, which the average duration was 1.5 months.The location of tumor included left side in 2 cases and right side in other 2 cases.All tumors were found incidentally, without symptoms or positive sign.Ultrasound showed that 2 cases were solid, and the other 2 cases were cystic solid with low, high or mixed echo and rich blood flow signals.The tumors were enhanced in CT arterial phase, and calcification showed in one case.MRI showed heterogeneous signal.The mean size of tumor was 3.0 cm,ranging 2.3 to 4.5 cm.After preoperative examination, all cases underwent retroperitoneal laparoscopic partial nephrectomy.During the operation, 2 cases were confirmed as cystic solid tumors, and the other 2 cases were solid tumors.Renal artery and renal mass were dissociated , then the artery was blocked.The tumor was complete resected, and kidney was sutured. Results All surgery was performed successfully without conversion.The operation time was 137-191 min (average 157 min).The blood loss was 10-100 ml (average 45 ml) without blood transfusion.The warm ischemia time was 15-35 min ( mean 22 min) .The postoperative hospitalization time stay 6-8 d ( average 7 d).Pathologic report was CCPRCC, including 3 cases of WHO/ISUP grade 1, and 1 case of WHO/ISUP grade 2.2 cases were cystic solid tumor, and other 2 cases were solid tumor.Bland-appearing tubules and occasional small papillae, and uniform small nuclei are arranged in a linear manner away from the basal aspect of the tubules in microscope.Immunohistochemistry showed that CA IX, CK7, 34 E12 were positive, but CD10 , P504S and CD117 were negative.The mean duration of postoperative follow-up was 14 months, ranging 4 to 30 months.No recurrence was found in those patients.Patients were followed up for 4-30 months ( average 14 months) without recurrence or metastasis.Conclusions CCPRCC is a rare subtype of renal tumor, which mainly diagnosed by pathological diagnosis . Retroperitoneal laparoscopic partial nephrectomy is an effective method for the treatment with good prognosis.

Objective To investigate outpatients' cognition towards common cold and their habituated medication so as to provide evidence for future public healthcare education.Methods Patients who attended hospital for diagnosis and treatment of common cold at least within past three months were asked to fill a questionnaire independently so as to learn their cognition towards common cold and medication habit.Results Among the patients underwent survey,52.2 ％ had incorrect knowledge about common cold; 2.99％ didn't know about the hazards of common cold; 34.80％ couldn't distinguish common cold from influenza; 30.07％ considered common cold couldn't get relief without treatment; 68.24％ didn't know about the proper effects of influenza vaccination; 6.4％ often took oral medicine even intravenous injection when they caught a common cold; 59.77％ often took medication from drugstore without prescription by doctor,and a few asked doctors to prescribe medicine on their request; 9.42％ didn't know about the side effects of drug for cold treatment; and 9.72％ didn't know about the active ingredients of drug for cold treatment.There were significant differences in the common cold cognition among population of different ages and education background.The older or the higher education status patients had a better cognition ( P ＜0.0 ).Conclusion There exist a certain degree of wrong cognition towards common cold among patients of different literacy degree and different age. Public health education on common cold need to be further strengthened.

Objective Sperm screening is an essential step in IVF procedures. The swim-up method, an assay on sperm motility, is used clinically to select the ideal sperm for subsequent manipulation. However, additional parameters, including acrosome reaction capability, chemotaxis, and thermotaxis are also important indicators of mammalian sperm health. To monitor both sperm motility and chemotaxis simultaneously during sperm screening, we designed and constructed a microdevice comprising a straight channel connected with a bi-branch channel that mimics the mammalian female reproductive tract. Methods The width and length of the straight channel were optimized to select the motile sperm. Cumulus cells were selectively cultured in the bi-branch channel to generate a chemoattractant-forming chemical gradient. Sperm chemotaxis was represented by the ratio of the sperm swimming towards different branches. Results The percentage of motile sperm was improved from ( 58. 5 ± 3. 8 ) % to ( 82. 6±2.9)% by a straight channel 7 mm in length and 1 mm in width. About 10% of sperm were found chemotactically responsive in our experiment, which is consistent with previous studies. Conclusion The combined evaluation of both sperm motility and chemotaxis was achieved for the first time, and the motile and chemotactically responsive sperm can be easily enriched on a lab-on-a-chip device to improve IVF outcome.