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 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 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 study the chemical constituents in the leaves of Piper laetispicum.Methods Compounds were separated and purified by silica gel column and macroporous resin.Their structures were identified on the basis of spectral methods.Results Sixteen compounds were isolated and identified from the leaves of P.laetispicum:(2E,4E)-N-isobutyl-11-phenylundecadienamide(Ⅰ),(2E,4E)-N-isobutyl-15-phenylpentadecadienamide(Ⅱ),laetispicine(Ⅲ),(2E,4E)-N-isobutyl-7-(3',4'-methylene-dioxyphenyl)heptadienamide(Ⅳ),brachystamide A(Ⅴ),dihydropipercide(Ⅵ),pipermacramide A [(2E,4E)-N-isobutyleicosadienamide,Ⅶ],(+)-spathulenol(Ⅷ),d-sesamin(Ⅸ),piperitol(Ⅹ),vitexin(Ⅺ),vitexin-2″-O-?-D-glucoside(ⅩⅡ),N-p-coumaroyltyramine(ⅩⅢ),?-sitosterol(ⅩⅣ),stigmasterol(ⅩⅤ),and 1-dotriacontanol(ⅩⅥ).Conclusion Compounds Ⅰ and Ⅱ are isolated for the first time as natural substance,compounds Ⅴ,Ⅵ,and Ⅷ are first isolated from P.laetispicum,compounds Ⅺ,ⅩⅡ,and ⅩⅥ are obtained from the plants of Piper L.for the first time.

Objective To investigate the MR imaging findings of acute experimental allergic encephalomyelitis(EAE) in correlation with pathology. Methods An EAE model was induced by intradermal inoculation with guinea pig CNS homogenate in 6 female Lewis rats.Another 6 rats served as control.The clinical presentation and body weight of the animals were recorded daily. Routine MRI,Gd-enhanced MRI were performed when EAE animals showed the initial symptoms. Uhrasmall superparamagnetic iron oxide(USPIO) colloid solution was also administrated intravenously and MRI was performed again after 24 hours. The brain was removed instantly after the second MR imaging. The pathological exams including HE staining,myelin sheath staining and prussian staining were performed.The imaging findings were observed in correlation with pathological results. Results The EAE rats showed decrease of body weight on the 6th to 7th day after inoculation,and the clinical symptoms appeared on the 10th to 11th day after inoculation.Routine MRI did not show any definite abnormalities.The Gd-enhanced MRI found the diffuse thickening and enhancement of brain meninges.The USPIO-enhanced MRI showedareas of low signal intensity at white matter of medulla oblongata on T2WI,and high signal intensity was observed at the corresponding area on T1 WI. Gradient T2 * WI found more foci of low signal intensity in eerebellar white matter besides the lesions in the brain stem.The range of abnormal signal intensity was larger in animal with higher clinical scores than that with lower score.There were no abnormal findings in control animaL The pathological exam found "perivascular cuff" in the brain white matter in EAE animals,some accompanied with adjacent demyelinatian. The prussian staining found blue particles within the cytoplasm of the macrophages around the lesion,which corresponded to the area of low signal intensity on T2WI.Conclusion USPIO-enhanced MRI could reveal acute EAE lesions which were not capable of being shown on routine MRI and Gd-enhanced MRI.It can image the macrophages around the lesions in vivo.USPIO is important for future research and application in MS patients.

Objective To evaluate the role of μ-opioid receptor (MOR) in attenuation of bone cancer pain by anti-nerve growth factor (anti-NGF) in rats. Methods Part Ⅰ Sixty female SD rats weighing 200-220 g were randomly divided into 4 groups (n = 15 each): sham operation group (group S), sham operation + anti-NGF group (group SN), bone cancer pain group (group P) and bone cancer pain+ anti-NGF group (group PN) . Bonecancer was induced by intra-tibial inoculation of 1 × 105 Walker 256 breast cancer cells in group P and PN. Group S and SN received injection of PBS 10 μl. APE 10 catheter was inserted at L2,3 interspace into the epidural space 13 days after cancer cell inoculation. Three days after the catheter was successfully placed, group SN and PN received intrachecal (IT) injection of anti-NGF 10 μg (in normal saline (NS) 10 μl) and group S and P IT injection of NS 10 μl twice a day for 5 consecutive days. The number of spontaneous flinches (NSF), paw withdrawal latency (PWL) and paw withdrawal threshold (PWT) were measured before and 13, 16, 18, 21 day after cancer cell inoculation. The animals were sacrificed at 21 day after cancer cell inoculation and the spinal cord dorsal horn and dorsal root ganglion were removed for determination of MOR and MOR mRNA expression. Part Ⅱ Thirty female SD rats weighing 200-220 g were randomly divided into 2 groups (n = 15 each): bone cancer pain + anti-NGF group (group PN) and bone cancer pain + naloxone + anti-NGF group (group PNN). Bone cancer was induced by intratibial inoculation of 1 × 105 Walker 256 breast cancer cells. APE 10 catheter was inserted at L2-3 interspace into the epidural space 13 days after cancer cell inoculation. Three days after the catheter was successfully placed,group PN received IT injection of anti-NGF 10 μg (in NS 10 μl) and group PNN IT injection of naloxone 10μg (in NS 25 μl) and 0.5 h later IT injection of anti-NGF 10 μg (in NS 25μl) twice a day for 5 consecutive days. NSF,PWL and PWT were measured before and 13, 16, 18, 21 days after cancer cell inoculation. Results Part ⅠCompared with group S, no significant change was found in NSF, PWL and PWT in group SN, and in MOR and MOR mRNA expression in group SN and PN (P ＞ 0.05), NSF was significantly increased, PWL shortened, PWT decreased at 13-21 days after inoculation in group P and PN, and MOR and MOR mRNA expression was down-regulated in group P (P ＜ 0.05 or 0.01). Compared with group P, NSF was significantly decreased, PWL prolonged, PWT increased, MOR and MOR mRNA expression was up-regulated in group PN at 18-21 days after inoculation (P ＜ 0.05 or 0.01). Part Ⅱ Compared with group PN, NSF was significantly increased, PWL shortened, PWT decreased at 18-21 days after inoculation in group PNN (P ＜ 0.05 or 0. 01). Conclusion The mechanism by which anti-NGF attenuates bone cancer pain in rats is related to the activation of MOR.