Advances in resuscitation and intensive care have led to high rates of survival among neonates with life -threatening conditions such as asphyxia,prematurity and congenital malformations.The sequelae of neurologic con-ditions arises in the neonatal period include lifelong disabilities such as cerebral palsy,epilepsy,intellectual and beha-vioral disabilities.There is an increasing demand for resource -intense strategies for acute neurological care within neo-natal intensive care unit.Neonatal neurocritical care is a multidisciplinary subspecialty that combines expertise in neo-natology,pediatric neurology,radiology,rehabilitation,surgery,and has led to improved outcomes in newborn that have critical illnesses.Neonatal neurocritical care focus the needs of the developing newborn brain,including attention to physiology to help prevent secondary brain injury,a protocol -driven approach for common conditions such as hypoxic -ischemic encephalopathy and seizures,education of specialized teams that use brain monitoring and imaging to evaluate the effect of critical illness on brain function.

10.3969/j.issn.1000-3606.2013.06.024

Objective:To investigate the correlation between ankle-brachial index(ABI)and intracranial atherosclerosis in patients with ischemic stroke.MetlaTds:qhe ABI of 73 patients with ischemic stroke were detected using vascular Doppler ultrasound;head magnetic resonance angiography(MkA)was performed using a 1.5 T magnetic resonance imahing system,and the extent of intracranial artery stenosis was graded.The correlation between ABI and the grade of intracranial artery stenosis in patieras with ischemic stroke was analyzed.Results:The ABI in patients without intracranial artery stenosis(n=38)was significantly higher than those with intracranial artery stenosis(n=35)(0.975±0.114 vs 0.837±0.096,P<0.001).The ABI was significantly negatively correlated with the extent of intracranial artery stenosis(r=-0.736,P=0.001).Conclusions:The ABI was negatively correlated with the extent of intracranial artery stcnosis.It can he used as a preliminary screening means of intracranial atherosclerosis.

Objective-To-explore-the-feasibility-and-safety-of-endoscopic-total-thyroidectomy-via-chest-wall-approach-.-Methods-Endoscopic-total-thyroidectomy-via-chest-wall-approach-was-performed-in-20-patients-with-nodular-goiter-from-January-2008-to-December-2012.Subcutaneous-operative-space-was-created-through-an-unilateral-areola-incision-,-through-which-laparoscope-and-surgical-instruments-were-introduced-.The-neck-suture-suspension-technique-was-used-to-reveal-the-thyroid-gland-.By-using-an-ultrasonic-scalpel-,-the-thyroid-was-separated-and-removed-completely-.-Results-All-the-operations-were-successfully-completed-without-conversions-to-open-surgery-.The-operation-time-was-90-180-min-(mean,-120-min).The-blood-loss-was-15-40-ml-(mean,-20-ml).The-postoperative-hospital-stay-ranged-from-4-to-7-days-(mean,-5.8-days).There-was-1-case-of-temporary-hoarseness.No-severe-hemorrhage-,-wound-infection-,-or-subcutaneous-effusion-was-found-.-Conclusion-Endoscopic-total-thyroidectomy-via-chest-wall-approach-is-a-safe-and-feasible-procedure-.

Objective To evaluate the value of amplitude-integrated EEG(aEEG)as a quantitative predictor of neurodevelopment outcome of full-term infants with hypoxic-ischemic encephalopathy(HIE).Method EMBASE,Ovid,PubMed,Cochrane Library,Springer Database,CNKI,CSJD and Wanfang Database were searched from when the database was founded to June 30,2010 for studies about aEEG as a predictor of neurodevelopment outcome in full-term infants with HIE.Characteristic information of each articles was extracted and QUADAS items were used to evaluate the qualities of included studies.Meta-disc software 1.4 was used to perform the metaanalysis.All included studies were combined with weighted quantity; sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and their 95 ％ CI were calculated.Results Eleven studies were eligible for the primary meta-analysis and totally 717 subjects were included.There was an overall sensitivity of 86％(95％ CI:81％-89％),specificity of 90％(95％ CI:86％-93％),positive likelihood ratio of 7.70(95％ CI:5.69-10.43),negative likelihood ratio of 0.17(95％ CI:0.13-0.22)and the area under the curve(AUC)of summary receiver operating characteristic curve was 0.95 for aEEG tracings to accurately predict poor outcome of HIE in full term neonates.Conclusion aEEG is a valuable bedside tool for predicting long-term neurodevelopment outcome in term infants with HIE.

Objective To investigate the clinical efficacy of new-type patent endotracheal tube in difficult endotrachea intubation patients.Methods Seventy-three patients with the abnormal airways were selected as our subjects.Patients were given the traditional endotracheal tube by mouth after anesthesia.The successes patients in terms of endotracheal intubation were as group Ⅰ (n =73).The failed patients were asgroup Ⅱ (n =63),who performed the secondary endotracheal intubation with new type patent endotracheal tube.Analyze the success rate of intubation of the two groups when on use the tube core.Results The first time intubation success rate and intubation success rate was (2.7％ (2/73),13.7％ (10/73) respectively) in Ⅰ group,and 73.02％ (46/63) and 98.41％ (62/63) respectively in the group Ⅱ,and there was the significant difference between two groups (x2 =36.01,31.08 respectively,P ＜ 0.01).Conclusion The new type endotracheal tube was proved with three advamage of good plasticity,without need of auxiliary core intubation with trachealtube and give full play to lead the soft cannula guide tubes leading role.Therefore,the new type patent endotracheal tube has more efficacy over traditional tube.

Objective To evaluate the accuracy of systolic pressure variation (SPV) in monitoring blood volume in patients.Methods Twenty-two ASA Ⅱ or Ⅲ patients (17 male,5 female),aged 49-79 yr,with body height 153-173 cm,weighing 55-89 kg,scheduled for elective coronary artery bypass grafting under cardiopulmonary bypass,were studied.Stroke volume variation (SVV) was monitored based on the arterial pressure wave and SPV measured based on the invasive arterial pressure wave after changing the title.After the chest was closed,the volume load test was immediately carried out.6％ hydroxyethyl starch 130/0.4 50-80 ml/min was infused via the jugular vein until cardiac index (CI) increased by 10％.HR,mean arterial pressure (MAP),SPV,CI,SVV,stroke volume index (SVI),systemic vascular resistance index (SVRI),central venous pressure (CVP),and pulmonary capillary wedge pressure (PCWP) were recorded in supine position (T1),at 30° head-down tilt before skin incision (T1'),before (T2) and after opening the chest in supine position (T2'),before (T3) and after the volume load test in supine position after closing the chest (T3'),in supine position after skin closure (T4),and at 30° head-down tilt after skin closure (T4').The difference in SPV and SVV (△SPV and △SVV) was calculated.The receiver operator characteristic curve for △SVV and △ SPV in determining blood volume changes was plotted.Results MAP,CVP,PCWP,CI,and SVRI were significantly increased,while SVV and SPV were decreased at T1' compared with those at T1 (P ＜ 0.05).HR was significantly increased,while CVP was decreased at T2' compared with those at T2 (P ＜ 0.05).MAP,CVP,PCWP,and CI were significantly increased,while SVV and SPV were decreased at T3' compared with those at T3 (P ＜ 0.05).MAP,CVP,and PCWP were significantly increased,while SVV and SPV were decreased at T4' compared with those at T4 (P ＜ 0.05).The area under receive operator characteristic curve for △SVV and △SPV in determining blood volume changes was 0.603 and 0.616 respectively,and there was no significant difference (P ＞ 0.05).Conclusion SPV can accurately monitor the blood volume in patients.

Objective To investigate changes of family parenting styles after the reforn and opening in China and its influence on mental health.Methods On the base of stratified convenience sampling,a valid sample of 429 were recruited from Wuxi and Hefei city residents:1960s group 103 persons,1970s group 107 persons,1980s group 116 persons,and 1990s group 103 persons.Subjects' childhood parenting styles were surveyed with the family upbringing style questionnaire(FUSQ) and their current mental health status was rated with the psychological symptom inventory-100 (PSI-100).Results (1) Except understanding-blame,and expects-demanding,and mother respect-humiliation and mother warmth-wildness,there were significant age differences on other parenting styles (P＜ 0.05),their scores were gradually increased from 1960s group ((38.29± 6.30)-(44.99± 7.36)) to 1980s group ((40.96±6.05)-(48.53±7.91)),1990s group declined((40.13±7.27)-(46.97±6.61)).(2) Most parenting style dimensions were significantly negatively correlated with symptom total score (r=0.095-0.308) and mental symptom scores (r=0.090-0.330).(3) The family parenting styles had significantly effects on the symptom total score (explained variance of 20.3％) and mental symptom scores (explained variance of 12.4％-21.5％).Conclusion There have been some positive,open and scientific changes on the family parenting styles after the reform and opening in China,childhood family parenting styles have long-term effects on mental health of youth and adult.

Cartoons were used in teaching of medical decision-making analysis course to analyze and reveal the connotations in different decision-making models according the difficulties of students in understanding the teaching decision-making models.The cartoons could effectively improve the understanding of abstract analysis model and the meaning of teaching analysis model in students because they could directly show the iterative and optimizing computation process in decision-making analysis, thus laying a solid foundation for the accurate analysis and ra-tional explanation of the results.Teachers should make full use of the visual cognition potential of students, and fo-cus their attention on the knowledge transmission and information exchange between teachers and students when they design the cartoons in order to improve the classroom teaching effect of teaching decision-making model.

Objective To discuss the artery effects of enhanced external counterpulsation for the progressive stroke patients.Methods Ninety-two progressive stroke patients who were treated in the Fourth People's Hospital of Shenzhen from August 2010 to February 2015 were selected and equally divided into the treatment group and the control group based on the random number table.The control group were received conventional therapy,and the treatment group were added treated with enhanced extemal counterpulsation therapy.Results All patients were successfully completed treatment,the C-reactive protein (CRP) and Endothelin-1 (ET-1) were presented decreased significantly after treatment (P＜ 0.05),and the C RP and ET-1 values in the treatment group were (2.09±2.11) mg/L,(13.98±6.30) mg/L,significantly lower than those of the control group((8.12±2.46) mg/L,(46.09± 11.02) mg/L;t =15.309,14.985;P＜0.05).After treatment,the FMD and NMD values in the treatment group were significantly increased from (5.26±1.34)％ to (11.93 ±2.13) ％,and from (13.20±5.33)％ to (22.98±8.34)％,in the control groupand were from (5.27±1.33)％ to (8.10±1.43) ％,and from (13.67±4.10)％ to (16.09±5.12)％ (t=16.934,21.787,8.443,12.345;P ＜0.05),and the value of FMD and NMD in treatment group were significantly higher than in the control group(t =7.982,9.113;P ＜ 0.05).The cardio ankle vascular index (CAVI) and brachial ankle pulse wave velocity (baPWV) values in the treatment group were significantly reduced after treatment,the difference was significant (P＜0.05),and compared with the control group the difference was also statistically significant (t =4.281,8.456;P＜ 0.05).Conclusion Enhanced external counterpulsation for the progressive stroke patients can effectively inhibit the expression of endothelin and inflammatory factors,improve endothelium-dependent relaxation of blood vessels,improve arterial elasticity,and thus play more effective treatment.