Objective To explore the effect of hyperbaric oxygen combined with progressively controlled decompression on the prognosis of patients with emergency craniocerebral trauma.Methods Ninety-six patients with emergency craniocerebral trauma were selected as study subjects,and they were divided into observation group (n =50) and control group(n =46) according to the random number table.The observation group was treated by progressively controlled decompression combined with hyperbaric oxygen,while the control group was treated by standard large trauma craniotomy combined with hyperbaric oxygen.The incidence of perioperative complications,prognosis (evaluated by GOS) and activities of daily living(evaluated by ADL) were compared between the two groups.Results In the observation group,the incidence rates of perioperative acute encephalocele,delayed hematoma and postoperative cerebral infarction were 6.0％,10.0％,6.0％,respectively,which were lower than 19.6％,26.1％,21.7％ of the control group(x2 =4.031,4.255,5.069,all P ＜ 0.05).The good prognosis rate in the observation group was 62.0％,which was significantly higher than 39.1％ in the control group (x2 =5.014,P ＜ 0.05).There was no significant difference in ADL score between the two groups before treatment (t =0.347,P ＞ 0.05).After treatment,the ADL scores of the two groups were increased (t =5.673,8.223,all P ＜ 0.05).Meanwhile,the ADL score of the observation group was higher than that of the control group (t =2.920,P ＜ 0.05).Conclusion The application of progressively controlled decompression combined with hyperbaric oxygen in patients with emergency craniocerebral trauma is conductive to reduce acute encephalocele,bone window brain tissue incarceration,delayed hematoma,postoperative cerebral infarction and other complications.Besides,it can repair the damaged nerve cells,and eventually improve activities of daily living of patients and reduce morbidity and mortality,and the prognosis is better.

OBJECTIVE:To discuss the management tactics and developmental prospects of fair-price drug stores in China.METHODS:To analyze the advantages and disadvantages of fair-price drug stores and countermeasure.RESULTS&CONCLUSION:Development of fair-price drug stores need not only support of governments but also the improvement of drug and service quality by strengthening physical distributions,renewing management methods and bringing up specialists.

Objective To study the echocardiographic characteristics and its diagnosis value on congenital supravalvular aortic stenosis (SVAS) in children. Methods Thirty-one patients with SVAS diagnosed by multiplane echocardiography were enrolled in the study. Their echocardiographic characteristics were compared with cardiac catheterization, operation, and gene detection results. Echocardiographic changes were mainly observed in aortic valve, supravalve, descending aortic arch, pulmonary artery valve, main pulmonary artery and its branches,and coronary artery. Results Of the 31 patients,26 had hourglass type SVAS,4 hypoplastic type,and 1 membranous type; 2 patients had extremely mild stenosis (defined as a Doppler gradient <25 mm Hg) ,20 mild (25～49 mm Hg) ,5 moderate (50～75 mm Hg) ,and 4 severe C>75 mm Hg) ones. Nineteen patients were diagnosed with Williams syndrome by gene detection. Three patients were associated with aortic valve stenosis including one missed at the initial diagnosis; 10(32.26%) patients with pulmonary stenosis, including pulmonary valve stenosis in 6, left and right pulmonary artery stenosis in 3 ,and branch stenosis in 1:6 patients with coronary stenosis. Conclusions The sternal border and five chamber apical views are the best to detect SVAS. Williams syndrome patients are prone to SVAS.Pulmonary stenosis echocardiography forms a great proportion of the SVAS patients. Routine examination is necessary for coronary stenosis in cases of SVAS.

BACKGROUND: Numerous studies have shown that nuclear factor-KB (NF-kB) was positively correlated with vascular endothelial growth factor (VEGF) in the cerebral hypoxia region. Thus, we assumed whether NF-kB in the pathway of hypoxia-inducible factor-1 α (HIF-1α) upregulating VEGF and plays a bridge effect.OBJECTIVE: To study the effects of NF-kB in HIF-1α pathway of increasing expression of VEGF using HIF-1α-modified neural stem cells (NSCs) as vectors.DESIGN, TIME AND SETTING: In vitro observation of cytology was conducted at the Neuroscience Institute, Jiamusi University from March to December 2008.MATERIALS: Wistar rats aged less than 24 hours of both genders were used.METHODS: NSCs were transfected after amplification of adenovirus vector HIF-1α (AdHIF-ia)-green fluorescent protein (GFP).Fluorescence detection was used to determine HIF-1α-GFP and blank vector Ad-GFP expression in NSCs. Protein was extracted from transfected NSCs, blank vector NSCs and normal NSCs, separately. Subsequently, NF-kB specific inhibitor pyrrolidine dithiocarbamate (PDTC) (50,150, 300 μmol/L) was added in HIF-1α-modified NSCs. Western blot analysis was used to determine changes in VEGF expression.MAIN OUTCOME MEASURES: The following parameters were measured: expression of HIF-1α, VEGF and NF-kB in NSCs in each group; VEGF expression in NSCs following treatment of NF-kB specific inhibitor.RESULTS: Gene expression was associated with MOI and transfected time following AdHIF-1α-GFP transfected with NSCs. After transfected AdHIF-1α-GFP in NSCs, HIF-1α, VEGF and NF-kB expression was positively correlated. Expression of VEGF was reduced in AdHIF-1α-GFP-modified NSCs following treatment of NF-kB inhibitor PDTC in a concentration-dependent fashion.There were significant differences in VEGF expression between each concentration group (P < 0.05-0.01).CONCLUSION: NF-kB in signaling pathway of HIF-1α-upregulated VEGF expression and played a bridging effect.

Objective To explore the clinical curative effect of recombinant human endostatin injection combined with chemotherapy in the treatment of patients with advanced gastric cancer and malignant ascites,and its influence on the quality of life.Methods 62 patients with advanced gastric cancer from July 2012 to July 2015,were randomly divided into observation group (31 cases)and control group (31 cases).The control group was treated with FOLFOX6 chemotherapy,the observation group was given recombinant human endostatin injection on the basis of the treatment of the control group.The two groups were treated for 3 weeks.The curative effect,QOL score,Karnofsky score,the change of serum CEA and CA19 -9 levels and drug adverse reaction incidence before and after treatment were compared in the two groups.Results The RR of the observation group was higher than that of the control group (54.84 vs 29.03%,χ2 =4.239 3,P <0.05).The QOL score and Karnofsky score in the two groups were increased after treatment (P <0.05).The QOL score and Karnofsky score after treatment in the observation group were higher than the control group(t =6.512 7,5.669 0,all P <0.05).The serum CEA and CA19 -9 levels of the two groups decreased significantly after treatment (P <0.05).The serum CEA and CA19 -9 levels of the observation group were lower than the control group after treatment (t =5.276 0,6.310 8,all P <0.05).The leukopenia,thrombocytopenia, peripheral neurotoxicity,decreased hemoglobin,diarrhea,nausea and vomiting adverse reaction rate of the two groups had no significant differences (P >0.05).Conclusion The clinical efficacy of recombinant human endostatin injec-tion combined with malignant ascites in the treatment of patients with advanced gastric carcinoma is significant,and can significantly improve the quality of life of patients,has the important research value.

Objective To explore the value of echocardiography in the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in children.Methods The echocardiographic images of 14 patients with ALCAPA confirmed by operation and 18 patients with endocardial fibroelastosis (EFE) diagnosed by clinical were compared and analyzed.Results Both ALCAPA and EFE exhibited obvious dilated left ventricle,decreased left ventricular systolic function,thick endocardium and mitral regurgitation of different degree.The former additionally showed dilated right coronary artery(RCA) with normal origin,left coronary artery(LCA) emerging from the root or wall of the pulmonary artery(PA),the retrograde flow into PA in LCA and abundant collateral vessels in myocardium.However the later exhibited normal diameter of LCA and RCA and no collateral vessels.Conclusions Color Doppler echocardiography not only demonstrates left ventricular systolic function,endocardium,mitrial regurgitation and collateral vessels in myocardium,but also shows the origination and courses of LCA clearly,which provide exact informations to diagnose ALCAPA.The echocardiography can be used as a powerful tool of ALCAPA diagnosis and preoperative assessment.

Objective To study the risk factors for ventilator associated pneumonia (VAP) in ICU and pathogens antimicrobial resistance.Methods 220 patients were selected and divided into observation group (88 patients) and control group(132 patients) depending on whetherhe has VAP or not.The clinical data were reviewed to explore the risk factors.And the secretions of respiratory tract were investigated by the routine bacterial culture and drag-resistance methods to analysis the distribution of pathogens.Results The risk factors associated with VAP were COPD,mechanical ventilation,the extensive use of antibiotics,age ＞ 60 years,APACHEII score ＞ 30(P ＜ 0.01).157 bacterial were cultured,68.9％ of pathogens was Gram-negative bacteria in which Pseudomonas aeruginosa was rated as the top one,and 26.1％ of pathogens was Gram-positive bacteria in which MRSA was the majority.The results of the antibiotic resistance monitoring indicated that all Gram-positive and Gram-negative bacteria showed high drugresistance to common antibiotics.Conclusion We should control these risk factors which are closely related to VAP,and select suitable antibiotics on the basis of etiological analysis and drug-resistance.

Objective To investigate the effect of caffeine citrate in the treatment of neonatal apnea and the corresponding intervention measures. Methods A total of 88 children with apnea were enrolled in this study from December 2015 to February 2017, and were randomly divided into control group and study group, 44 cases in each group.The study group on the basis of conventional therapy plus caffeine citrate, the control group on the basis of conventional therapy plus aminophylline group, two newborns with apnea were duration of treatment should be 7 for 7 days, record the treatment effect and the incidence of adverse reactions. Results The total effective rate was 88.64％ in the study group and 72.73％ in the control group (P<0.05). The incidence of adverse reactions was 11.36％ in the study group and 40.91％ in the control group (P<0.05). Conclusion The application of caffeine citrate treatment of apnea with clinical efficacy and safety of the ideal of the newborn, in the course of treatment given targeted clinical nursing intervention is conducive to the protection of newborns with apnea of quality of life and life safety.

BACKGROUND: Skeletal muscle-derived stem cells (MDSCs), another adult pluripotent stem cells, have become a hot topic in the field of gene therapy and cell-based tissue engineering. It has wide prospect in treating stress incontinence by periurethral injection of patients' MDSCs.OBJECTIVE: To investigate the method of culturing MDSCs in vitro so as to provide experimental basis for treating stress incotinence by injecting MDSCs.DESIGN: Repeated observation.SETTING: Department of Reproductive Medical Center and Department of Urology, Renmin Hospital of Wuhan University.MATERIALS: This experiment was conducted at the Laboratory of Department of Urology , Renmin Hospital , wuhan University from December 2003 to May 2004. Totally 20 female SD rats , aged 4 to 6 weeks , were involved . Type- Ⅺ pancreatin, collgenase , pancreatin ,polylysine (Sigma), dispase enzyme (Gibco) , chick embryo extract (self made).METHODS: ① Rats were anesthetized intraperitoneally with 10 g/Lpentobarbital sodium (30 g/kg). Under aspetic condition, gastroeneminus were isolated and immediately put into pre-cooled DMEM media (Gibco)containing antibiotics and then removed into the hood. After washed with D-hank's solution three times, muscle biopsies were removed of fascia,tendon, nerve and blood vessels and minced into small pieces about 1-3 mm3,and then transferred into a centrifugation tube. 0.2% collgenase-type Ⅺ(Sigma) and 0.1% pancreatin were added to the left tissue . Skeletal muscle cells of the rats were isolated with collagenase. ② Differential attachment was used to purify the skeletal muscle cells of the rats. After screened with cell screen cloth , cell suspension was transferred into a polylysine-coated flask and cultured at 37 ℃ in a humid atmosphere with 0.05 CO2 in air for 1 hour. All the cells that did not adhere to the flask were then transferred to another flask with new culture medium and cultured for approximately 1 hour at 37 ℃ .Again,the non-adhering cells were transferred to another flask and were incubated at 37 ℃ overnight.The technique was carried out for an additional 4-5 days. This operation was repeated every 24 hours until the fifth day. Those cells attached on days 5-6 were MDSCs.③ After they grew with 70% confluence , the cells were digested with trypsin and passaged at the ratio of 1:2. After digestion, the generative cells were inoculated to the culture plate with 6-well cover glass. Growing culture medium was added and cell slide was prepaared 24 hours later. The expression of specific protein antigen and stem cell antigen-1 of the cultured cells were identified with immunohistochemical staining.MAIN OUTCOME MEASURES: Morphology and identification of MDSCs.RESULTS: ① Morphology of MDSCs: Cells isolated from skeletal muscle tissue took the form of spheres and had high refraction. When subcultured,they began to adhere at the 12th hour, at that time they were still round,and complete their attachment at the 48th hour. Then they began to expand and ultimately became fusiform-shaped or spindle-shaped, having two poles and small size. As time going, they fused with each other to form mature poly-nuclear myotubes. ② Identification results of muscle-derived stem cells: MDSCs were desmin and stem cell antigen-1 (Sca-1) positive specific for some stem cells. Red fluorescence effluenced from cytoplasm was found under the fluorescence microscope and the positive rate reached 90%.CONCLUSION: MDSC belongs to adult stem cells and has the advantages of rich source, low immunogenicity and long survival after transplantation. High-purity muscle-derived stem cells can be obtained through primary culture , and immunohistochemical technique can identify muscle-derived and specific characteristics of stem cells, so it has a broad application perspective in tissue engineering and gene therapy.

Objective To report the clinical and imaging characteristics of 9 cases of gastric duplication in children,as well as to probe into all kinds of imaging examination methods,with an aim to improve preoperative diagnostic accuracy.Methods Nine cases of children with gastric duplication that received surgical resection and were pathologically confirmed in our hospital from January 2009 to November 2016 were retrospectively analyzed.The clinical manifestations,complications,complicated malformation and imaging findings of the cases were summarized.Three asymptomatic cases were carried out regular ultrasound examination follows-up preoperatively.Results Gastric duplication in children varied in terms of cliuical manifestations.All the 9 cases were performed ultrasonography preoperatively,and 5 of them were accurately diagnosed.Meanwhile,7 cases received preoperative CT examination,with 2 cases being confirmed.Three cases received magnetic resonance imaging (MRI) examination,with 2 cases being confirmed.And 2 cases had upper abdominal gastrointestinal imaging (GI) examination,but no definite diagnosis was made.Three cases of asymptomatic children with enlarged lesion can be seen in follow-up.Conclusions Gastric duplication is a rare congenital malformation,ultrasound allows to clearly display the capsule wall structure and the relation between gastric duplication with gastric wall,which is associated with high utilization rate and diagnosis rate,and it can be served as the preferred imaging examination method for gastric duplication in children.