Objective To investigate the effect of combined application of mannitol and monosialoganglioside on neurological function and its efficacy in brain edema after intracerebral hemorrhage. Methods 92 cases of cerebral edema in patients with cerebral hemorrhage in our hospital, were randomly divided into groups, each group of 46 cases, the control group on the basis of the treatment of mannitol (125mL per times, once per 8h) treatment, the study group on the basic of control group received monosialogangliosides (20mg per times, once daily), 10d for a course of treatment, determination of serum indexes, neurological functions were recorded. Results The effective rate of control group was 71.74%, which was lower than 91.30% of the study group, there was significant difference (P < 0.05); compared with control group after treatment , in study group the intracranial pressure, intracranial hematoma, edema decreased, the urine volume increased, National Institutes of Health Stroke Scale (NIHSS) and quality of life score decreased, interleukin (IL-1β), high sensitive C reaction protein (Hs-CRP), IL-6 and IL-8 levels decreased, Na+-K+-ATP enzyme increased, the ratio of cerebrospinal fluid albumin and serum albumin, matrix metalloproteinase (MMP-2) and MMP-9 decreased, there were significant differences (P < 0.05). Conclusion The effect of the combined application of mannitol and monosialoganglioside on cerebral edema after cerebral hemorrhage is exact and could improve neurologic function.

[Objective]To evaluate the value of distraction osteogenesis for treatment of deformity of spine during development.Distraction osteogenesis could be used for patients with campylorrhachia,dwarfism eccyliosis of spine or those combined with thoracocyllosis and obliquity pelvis.[Method]According to the principle of Halo-pelvic distraction apparatus which was divided into two parts of halo and pelvic,the halo was 4-nail fixation and the pelvic was 2-nail fixation.The halo and pelvic were connected by 4 standing pillar.Through the daily extending of 4 standing pillar the curved spine was extended and stretched gradually.As a result,action of 3D correction of deformity of spine was achieved.[Result]Ten patients of this group were treated by this methods.The action of 3D correction and automatic correction of deformity were showed in 70~120 days distraction that the wedge-shaped vertebra changed into squareness,curved spine was stretched and rotatory vertebra was reduced.[Conclusion]Distraction osteogenesis is a minimally invasive surgery instead of internal fixation of spine for the treatment of deformity of spine during development.

Objective: To investigate the effect and mechanism of brain-derived neurotrophic factor (BDNF) pretreatment for reducing myocardial ischemia/reperfusion (I/R) injury in experiment rats.
Methods: Rat’s myocardial I/R model was established by left anterior descending artery ligation for 30min followed-by reperfusion for 180 min. The rats were divided into 5 groups:Sham operation group, I/R group and IR with BDNF pretreatment (1, 10, 100) nmol/(kg·ml) groups respectively. The LVSP, LVEDP, ±dp/dtmax were recorded after I/R;serum levels of LDH, CK and the cardiac tissue levels of MDA, SOD were examined;the ratios of left ventricular myocardial infarction area in different groups were observed by by Evans blue staining;cell apoptosis rates were evaluated by Tunel staining;the total-TrkB and p-TrkB in myocardium were detected by Western-blot analysis.
Result: Compared with I/R group, in 3 IR with BDNF pretreatment groups, LVSP, ±dp/dtmax were gradually increasing and LVEDP were gradually decreasing, all P<0.05;the leaking levels of LDH, CK and the content of MDA were gradually decreasing and the SOD activity was gradually increasing, all P<0.05;the average ratios of MI area/ischemic area were decreased from (47.54 ± 6.35)%to (28.68 ± 4.56)%, the apoptosis rates decreased from (37.89 ± 5.46)%to (10.24 ± 3.05)%, the level of p-trkB/Total-TrkB increased from (0.16 ± 0.03) to (0.42 ± 0.03), P<0.05.
Conclusion: BDNF pretreatment could maintain the cardiac function in experiment rats after I/R injury, it may reduce MI area, decrease oxidative damage and apoptosis, therefore, protect myocardial cells for reducing IR injury.

Objective To investigate the selection and efficacy of operative medality for pancreatic transec-tion with major duct injury. Methods The clinical data were retrospectively analyzed in 21 patients with pancreatic disruption. They were treated in our hospital from Jan. 1995 to Feb. 2009. There were 14 males and 7 females in these cases with a mean age of 26 years (range 9-53 years). The trauma causes of them were blunt injuries in 13 and patent injuries in 8 cases. The injury grade (according to American Association for the Surgery of Trauma) distribution for these patients was grade Ⅲin 8 cases, grade Ⅳ in 8 cases, and grade V in 3. The early emergency operation was performed in eighteen within 12 hours, and delayed opera-tion was in three cases. Of these operative medalities, Roux-en-Y distal panereatojejunostomy was in 10 ca-ses, pancreatoduodenectomy was in 3, modified duodenal diverticulizatian was in 2, distal pancreatectomy was in 3, tube installing in major duct and external drainage, and suture of pancreatic section was in 2, su-ture of two broken sides in 1 (Roux-en-Y distal pancreatojejunostomy in second time). Results Twenty patients were cured, and one was died after a procedure of pancreatoduodenectomy. The postoperative pan-creatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusions For improving the outcome of pancreatic transection, the earlier exploratory laparotomy and carrying out concept of "Damage Control Surgery" are critical. The individual operative modality based on the grade should be a-dopted in the surgical procedure.

ObjectiveControl study on the clinical efficiency and costs of fast track surgery(FTS) and traditional method was carried out in colorectal cancer patients. Methodsone hundred colorectal cancer patients were randomLy selected, 50 cases treated with conventional therapy as control group and 50 cases treated with FTS programme. The postoperative initial venting time, the incidence of complications, the hospital stay and cost index were compared between the two groups. ResultsThe postoperative initial venting time was in advance and postoperative stay was obviously shortened in FTS group. Hospitalization expenditure in FTS group was lower than that in control group. Patients recovered quickly, the result was satisfactory. The complication was not significantly different between the two groups (P ＞ 0.05 ) . ConclusionsFTS treatment can accelerate postoperative rehabilitation and elevate clinical efficiency in colorectal cancer patients during operation period. FTS treatment is a safe and effective method.

Objective:Based on the survey of qualitative and quantitative on rural doctors in 6 provinces and cities in China , this paper aimed to compare the present situation of construction of rural doctors under the new health care reform and explore the impact of the new health care reform as well as to propose some suggestions . Methods:Based on the survey of questionnaire and in -depth interviews on rural doctors in 6 provinces and cities in China .Results:The problems existed for rural doctors in China such as insufficient number of personnel , ag-ing, lack of young rural doctors supplement , low level the requirements and situation of professionalism , etc.Con-clusion:It should accelerate the process of the cultivation of rural doctors , promote the education level of rural doc-tors, gradually ease the current situation of the rural doctor shortage .

This paper summed up the medical professionalism as taking patients'interests first , reshaping the medical good faith , improving business ability and promoting social justice .Also proposed that in order to have rea-sonable human resource allocation , ensure the construction of rural health personnel team and stability , the follow-ings are necessary:medical staff at villages and towns setting up the medical ethics , strengthening the altruism spir-it;changing the traditional model of the doctor -patient relationship , adhering to the principle of patient autonomy;cultivating professional sense of responsibility , building moral education;intensive training and striving to improve the level of medical technology;increasing the doctor -patient communication , restoring patients'interests first , re-shaping medical doctor -patient trust integrity , improving business ability and promoting social justice as well as fully exerting the social , moral and cultural supporting factors etc .

This study evaluated the change in regional left ventricular myocardial function in rats following acute occlusion of the left anterior descending coronary artery (LAD) by using two-dimensional speckle tracking imaging (2D-STI). Sixty Wistar rats were randomly divided into two groups, a myocardial infarction (MI) group, in which 50 rats were subjected to LAD occlusion for 30-45 min, and a sham-operated (SHAM) group that contained 10 rats serving as control. Echocardiography was performed at baseline and 1, 4 and 8 week(s) after the operation. High frequency two-dimensional images of left ventricular short axis at papillary muscle level were recorded. Peak systolic radial strain (PRS) and circumferential strain (PCS) were measured in the mid-ventricle in short-axis view by using EchoPAC workstation. Left ventricular internal diameter at diastole (LVIDd) and systole (LVIDs), fractional shortening (FS), ejection fraction (EF) and left ventricular mass (LVM) were measured by anatomical M-model echocardiography. Infarct size was measured using triphenyl tetrazolium chloride (TTC) staining 1 week and 8 weeks after the operation. Fibrosis of left ventricular myocardium was displayed using Van Gieson staining 1 week after the infarction. In terms of the TTC staining results, the left ventricle fell into three categories: infarcted, peri-infarcted and remote myocardial regions. Compared with those at baseline and in the SHAM group, (1) PRS and PCS in the infarcted, peri-infarcted and remote myocardial regions were significantly decreased in the MI group within 1 week after the operation (P<0.05) and the low levels lasted 8 weeks; (2) Compared with those at baseline, LVIDd, LVIDs, FS, EF and LVM in the MI group showed no significant difference 1 week after the operation (P>0.05). However, LVIDd, LVIDs and LVM were increased significantly 4 and 8 weeks after the operation (P<0.05), and FS and EF were decreased substantially (P<0.05). Van Gieson staining showed that fibrosis developed in all the three myocardial regions to varying degrees. It is concluded that 2D-STI is non-invasive and can be used to assess regional function of myocardium with different blood supply in rats following acute occlusion of the LAD, and can be used as a sensitive and reliable means to follow up the process of left ventricular remodeling.

Mechanical ventilation (MV) with large tidal volumes can increase lung alveolar permeability and initiate inflammatory responses,resulting in ventilator-induced lung injury (VILI).The mechanisms of the injurious effects of MV and the genetic susceptibility remain unclear.VILI-related genes such as cysteine-rich angiogenic inducer 61 (Cyr61)have been demonstrated to play a detrimental role in the aggressive ventilation strategies.In the present study,we investigated the involvement of Cyr61 in the VIM and the underlying mechanism.A549 cells were exposed to cyclic stretch of varying durations and then the mRNA and protein levels of Cyr61 were measured by real-time PCR and Western blotting,respectively.Additionally,after exposure ofA549 cells to cyclic stretch for 5 min to 1 h,the expression levels of nuclear factor kappaB (NF-κB) and IL-8 were detected by ELISA and Western blotting.Thereafter,Cyr61 expression was depressed in A549 cells with the siRNA pGenesill.1-Cyr61-3 before the cyclic stretch,and IL-8 secretion and the activation of NF-κB pathways were probed by ELISA and Western blotting,respectively.Moreover,a NF-κB inhibitor (PDTC) and an activator (TNF) were used before mechanical stretch.Realtime PCR and ELISA were performed to detect the mRNA and protein of IL-8,respectively.The results showed that the mechanical cyclic stretch led to increased Cyr61 expression at mRNA and protein levels in A549 cells.Additionally,cyclic stretch also mobilized NF-κB from the cytoplasm to the nucleus and increased IL-8 secretion in A549 cells.The inhibition of Cyr61 blocked the NF-κB activation and IL-8 secretion in response to cyclic stretch.Inhibition of NF-κB attenuated the mRNA and protein expression of IL-8 in A549 cells transfected with Cyr61 siRNA.It was suggested that Cyr61/NF-κB signaling pathway mediates the upregulation of IL-8 in response to cyclic stretch in A594 cells.These findings support the hypothesis that Cyr61 plays a critical role in acute lung inflammation triggered by mechanical strain.