In light of modern management theories and the actual situation in the hospital, a post and performance based hospital compensation system was designed. The chief features of the design include: ① Compensation consists mainly of post salary and performance salary while giving expression to the principle of stability and gradual transition, with the fixed part (accounting for about 60%) of the original file salary being retained; ②Post salaries fall under a hospital wide unified grade compensation framework, with grade evaluations based on a hospital wide unified system of indexes and weight, and they go up or down within the salary width each year according to the results of performance assessment; ③ Performance salaries are closely linked with post grades and performance assessment, with a hospital wide unified model of post and performance contracts being the basis for assessment; ④ The entire compensation design is based on scientific and standard post surveys, post appraisals and post specifications.

Objective To investigate the difficulty, safety and clinical efficacy of the pterional approach from the side of open A2 plane vs the approach from the side of closed A2 plane for anterosuperior-pointing anterior communicat?ing artery aneurysms (ACoAA). Methods Forty-two patients with anterosuperior-pointing ACoAA treated by microsurgi?cal clipping were divided into two groups of the approach from the side of open A2 plane (n=22) and the approach from the side of closed A2 plane (n=20). Primary objective endpoints were rates of gyrus rectus aspiration, displacement of the ipsilateral A2 and surgical-related complications, clipping results, incidence of cognitive function impairment and Glasgow Outcome Scale (GOS) at 6 months after treatment. Results The incidence of gyrus rectus aspiration and dis?placement of the ipsilateral A2, cognitive impairment at 6 months after treatment and the surgical-related complications was also significant lower in the approach from the side of open A2 plane than in the approach from the side of closed A2 plane [4(18.2%) cases vs. 11(55.0%) cases, χ2=6.185, P<0.05;4(18.2%) cases vs. 10(50.0%) cases, χ2=4.773, P<0.05;1 (4.5%) case vs. 7(35.0%) cases, χ2=4.481 P<0.05]. There were no significant differences in postoperative clipping results and GOS at 6 months after treatment between two approaches (P>0.05). Conclusions The pterional approach from the side of open A2 plane in patients with anterosuperior-pointing ACoAA allows the aneurysmal necks to be secured safely, decreases operation difficulty and prevents surgical-related complications.

Objective To investigate the risk factors for intracranial infection after external ventricular drainage and provide basis for preventing and controlling the drainage-associated intracranial infection. Metheds the clinical data from three hundred sixty-seven cases of ventricular hemorrhage patients were retrospectively analyzed, using Logis?tic regression to screen risk factors of intracranial infection after external ventricular drainage. Results There were 29 cases with intracranial infection and infection rate was 8.19%, 8.04% and 7.32% at ventricle drainage tube indwelling 1-week group, 2-week group and 3 week-group, respectively. Glasgow coma score (GCS) [OR= 2. 569 CI (1.792 3.378) %, P< 0.05), urokinase perfusion (OR= 2.897, 95%CI (1.297 5.061), P< 0.05), cerebrospinal fluid sampling (OR= 3.399, 95%CI (2.705 4.175), P< 0.01] and comorbidities [OR= 3.751, 95%CI (2.032 5.371), P< 0.01] were risk factors for ventricle drainage operation. Conclusion Ventricle drainage tube indwelling 3 weeks is safe. Less use of urokinase perfusion and cerebrospinal fluid sampling and active treatment of comorbidities diseases can reduce the intra?cranial infection incidence of external ventricular drainage after Intraventricular hemorrhage .

ObjectiveTo evaluate the efficacy of epidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of intravenous extract from rabbit skin inflamed by vaccinia virus (ERSVV) for severe herpetic neuralgia.MethodsForty-eight patients of both sexes with severe herpetic neuralgia aged 45-92 yr were randomly divided into 2 groups (n =24 each):control group (group C) and test group( group T).Both groups received intravenous ERSVV 6 ml/d.Group C received oral amitriptyline and gabapentin,while the group T received epidural infusion of 100 ml of a mixture of 0.075％ bupivacaine,fentanyl 2 μg/ml and dexamethasone 50 μg/ml in normal saline at 2-5 ml/h,once a day for 10 days and VAS score was maintained≤4.Epidural puncture was performed at the spinal segments severely affected by herpes virus.Intensity of pain was assessed with VAS (0 =no pain,10 =worst pain).In group C when VAS ＞ 4 oral amitriptyline 12.5 mg (once/d) and gabapenti 0.1 g (3 times/d) were given as rescue analgesics.Adverse effects of epidural infusion and incidence of post-herpetic neuralgia were recorded.ResultsThe incidence of urinary retention and incidence of post-herpetic neuralgia were lower in group T than in group C.No other adverse effects were found in group T.ConclusionEpidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of ERSVV can effectively reduce severe herpetic neuralgia and prevent development of post-herpetic neuralgia safely.

Objective To explore the diffusion-weighted imaging(DWI) values in diagnosis and differential diagnosis in multiple system atrophy (MSA),progressive supranuclear palsy (PSP) and Parkinson's disease (PD).Methods Conventional MRI and DWI were performed in 24 clinically proved MSA patients,35 PD patients,12 PSP patients,and 32 age-matched normal controls (the control group).DWI was performed using a single shot-spin echo-echo planar imaging sequence,and ADC values were measured in the ROIs of different brain regions(including basal ganglia,thalamus,middle cerebellar peduncles and superior cerebellar peduncles).Then one way ANOVA test was used for statistical analysis.Results PSP group had the largest ADC values in putamen,globus pallidus,caudate,andsuperiorcerebellar peduncles[(0.75±0.43) ×10-3 mm2/s,(0.77±0.06)×10 3 mm2/s,(0.77±0.44)×10-3 mm2/s and (1.11±0.22)× 10-3 mm2/s].The ADC values of globus pallidus and caudate had statistically difference comparing with MSA [(0.73±0.04) × 10-3 mm2/s and (0.73±0.40) × 10-3 mm2/s],PD[(0.67±0.11) × 10-3 mm2/s and (0.73±0.04) × 10-3 mm2/s],and control group[(0.71±0.05) × 10-3 mm2/s and (0.72±0.04) × 10-3 mm2/s].MSA group had the largest ADC values in middle cerebellar peduncles[(0.95±0.16) × 10-3 mm2/s],and there was statistically significant difference,comparing with PSP,PD and control group[(0.74±0.49) × 10-3 mm2/s,(0.69±0.50) × 10-3 mm2/s and (0.68±0.31) × 10-3 mm2/s].The ADC values of PD group and control group had no statistically significant difference in putamen,globus pallidus,caudate,thalamus,middle cerebellar peduncles and superior cerebellar peduncles(P＞0.05).Conclusion ADC values in the basal ganglia,the middle cerebellar peduncles and superior cerebellar peduncles have very important significance in differential diagnosis in MSA,PSP and PD.

OBJECTIVETo investigate the expression of matrix metalloproteinase-9 (MMP-9) in the arachnoid membrane around posterior communicating artery aneurysms.

METHODSTwelve patients with posterior communicating artery aneurysms undergoing surgical intervention in our hospital between November, 2010 and November, 2011 were enrolled as the case group along with 6 concurrent patients with severely head trauma or epilepsy as controls. The expression of MMP-9 in the aneurysmal walls and the arachnoid membrane was examined in immunohistochemistry, and HE staining and Sirus red staining were performed to examine the pathological changes.

RESULTSThe perianeurysmal arachnoid membrane showed tissue destruction and disruption of the connections between the membrane and the artery wall with local detachment. Compared with that in the control group, the level of MMP-9 in the arachnoid membrane was significantly higher in the case group (P<0.05), but significantly lower than that in the aneurysm wall within the same sample (P<0.05). No differences were found in the levels of MMP-9 in the aneurysm patients with different ages or Hunt-Hess scale scores.

CONCLUSIONMMP-9 is closely related with the formation of posterior communicating artery aneurysms by causing degradation of extracellular matrix of the vascular wall and the arachnoid membrane.

Adult ; Arachnoid ; metabolism ; pathology ; Case-Control Studies ; Female ; Humans ; Intracranial Aneurysm ; metabolism ; pathology ; Male ; Matrix Metalloproteinase 9 ; metabolism ; Middle Aged

OBJECTIVETo explore the imaging features, diagnosis and treatment strategies of intracranial lageniform aneurysms.

METHODSThe clinical characteristics and therapeutic outcomes of 6 patients with intracranial lageniform aneurysms were retrospectively analyzed.

RESULTSAll the 6 aneurysms, including 5 anterior communicating artery aneurysms and 1 middle cerebral artery (MCA) aneurysm, were diagnosed by CT, DSA and (or) MRA. Pretreatment CT revealed subarachnoid hemorrhage and intracranial hematoma surrounding the ruptured aneurysm. Three dimensional DSA showed that all the lageniform aneurysms contained two parts, the larger false aneurysm and the smaller true aneurysms. All the 5 Acom aneurysms were coiled and the MCA aneurysm was clipped. Two patients with coiling developed serious brain edema, and acute decompressive craniectomy was performed to 1 of them. Pathological examination of the surgical specimens confirmed that pseudoaneurysm formed the larger part of the lageniform aneurysm. One patient died of brain hernia, and the other 5 patients were discharged with good GOS. All the patients showed stable neurological status during the 3-month follow-up.

CONCLUSIONLageniform aneurysm is a complex aneurysm consisting in larger part of false aneurysm and in smaller part of true aneurysm, and early intervention with individualized surgeries is recommended.

Adult ; Aneurysm, False ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Intracranial Aneurysm ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Radiography ; Retrospective Studies

OBJECTIVETo evaluate the feasibility, efficacy and safety of a new method for distant injection of Onyx for treatment of intracranial arteriovenous malformations (AVMs).

METHODSThe clinical data of 26 patients with AVMs receiving distant injection of Onyx using the new method were retrospectively analyzed. Onyx was injected by the surgeon in the control room through a pressure transmission system.

RESULTSThe 26 patients received a total of 31 embolization procedures, with an average estimated size reduction of AVMs of (61.48 ± 26.85)%. Total obliteration was achieved in 3 AVMs. In one case, Onyx leakage occurred during the operation resulting from a broken microcatheter, and the patient developed hemiparesis after the operation.

CONCLUSIONEndovascular treatment of intracranial AVMs with Onyx embolization using this new distant injection method is feasible, safe and effective. This method minimizes potential radiation exposure of the surgeons without increasing the risks of related complications.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; administration & dosage ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged ; Polyvinyls ; administration & dosage ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Young Adult