Objective To explore the construction and application effects of extended care form for children with epilepsy based on Omaha System.Methods Based on Omaha System,the form was established by referring medical records,literature review and three rounds of focus group discussion.From February to June,2016,48 children with epilepsy were selected as the observation group and received routine care as well as management using the form based on Omaha System;from August to December,2015,48 children with epilepsy were selected as the control group and received routine care and follow-up.The effects of intervention and scores of Family Management Measure were compared between two groups.Results Nursing issues in all domains for the observation group 3 months after intervention were lower than those during hospitalization except financial situation (P＜0.05);there was statistically significant difference in scores of knowledge-behavior-status of main nursing issues before and after intervention except cognition and mental health items (P＜0.05).Duration of hospitalization,expenditure,readmission rate,EEG results and scores of FAMM in the observation group were better than those in the control group (P＜0.05).Conclusion The construction and application of the form based on Omaha System can provide references for longterm management for children.

Objective To analyze the clinical characteristics and treatment Methods of severe com?plications after percutaneous tracheotomy( PDT) in neurosurgery patients,and to provide reference for the treat?ment and rescue of these patients. Methods A retrospective analysis of 578 cases after PDT was performed in Neurosurgery Intensive Care Unit ( NSICU ) of Xuanwu Hospital of Capital Medical University from 2005 to 2015. The types of complications,treatment method and prognosis were analyzed. Follow?up was 3 months to 1 year. Results Eighteen cases with severe complications,including bleeding,wound infection,asphyxia caused by tracheal mucosa suffocation,airway stenosis caused by granulation tissue,subcutaneous emphysema and neu?momediastinum,etc. After treatment and active rescue,most patients recovered,no patients die directly associated with surgery. Conclusion PDT plays an important role in the treatment of patients in NSICU,but it is still pos?sible to have serious complications,so physicians must understand and be prepared for complications,and pay more attention to prevent poor prognosis.

Objective To identify the metabolic levels in prefrontal lobe in patients with post-concussion syndrome by proton magnetic resonance spectroscopy (1H-MRS), and to explore the relationship between metabolic levels and executive function. Methods The study was conducted in 40 patients with post-concussion syndrome and 20 normal controls. 1H-MRS on prefrontal lobe was performed in patients and controls, the NAA, Cho and Cr were measured and the ratios of NAA/Cr, Cho/Cr and NAA/(Cho + Cr) were determined. They were also evaluated executive functions by verbal fluency test (animal), Wisconsin Card Sorting Test (WSCT) and Tower of Hanoi (TOH). Results Compared with normal controls, the patients with post-concussion syndrome were significantly lower NAA/Cr and NAA/(Cho+Cr) ratios in left prefrontal lobe (P < 0.05). The NAA/Cr ratio in left prefrontal was significantly positive correlated with total scores of verbal fluency (r = 0.66, P < 0.05), categories of WSCT (r = 0.54,P < 0.05) and total score of TOH(r = 0.58, P < 0.05). The NAA/Cr ratio was significantly negative correlated with total errors (r = -0.53, P < 0.05) and persistent errors (r = -0.47, P < 0.05) of WSCT and mean executive time of TOH(r = -0.67, P < 0.05). Conclusions The metabolic levels of NAA in left prefrontal lobe in patients with post-concussion syndrome is significantly decreased , it is one cause of impaired executive functions.

Objective To evaluate the efficacy of decompression craniotomy for the treatment of patients with malignant cerebral venous thrombosis. Methods The clinical characteristics,treatment process and follow - up results of 9 patients with malignant cerebral venous thrombosis treated with decom-pression craniotomy in Beijing Xuanwu Hospital,Capital Medical University from February 2010 to August 2015 were analyzed retrospectively. Results The preoperative Glasgow coma scale (GCS)score of 9 patients was < 9,7 survived and 2 died. The conditions of 6 patients (preoperative GCS 8 in 1 case, GCS 6 in 3cases,GCS 4 in 1case,and GCS3 in 1case)were improved in combination with other control intrac ranial pressure treatment after craniotomy decompression surgery. They recovered well (Glasgow outcome scale, GOS 4 -5). One patient (preoperative GCS 4)had severe disability (GOS 3)after procedure;1 (preoperative GCS 3)was in deep comatose state at the time of discharge and died of complications after 1 month;1 patient with bilateral mydriasis (GCS 5)was treated with craniotomy decompression,and his pupils did not return,he had circulatory failure,gave up the treatment,and died. All patients did not have the complications directly related to the surgery. Seven patients survived and continued to use warfarin anticoagulation therapy for at least 6 moths after discharge. The controlled international normalized ratio (INR)was 2 -3. They were followed up for 3 months to 5 years. The head MRI re-examination did not reveal the recurrence of venous sinus thrombosis. The modified Rankin scales (mRS)score was 0 to 2 in 6 cases after 3 months. The other one (preoperative GCS 4)had ipsilateral cerebral hemorrhage on surgical site at 4 months after discharge. He was improved after withdrawing anticoagulation and using conservative treatment for 20 d (mRS score 4). Conclusions For patients with malignant cerebral venous thrombosis,when the patients have acute cerebral hernia or hernia tendency,the emergency craniotomy decompression surgery may save lives and enable patients to achieve a better quality of life.

correlation with cross-sectional area and negative correlation with bucking ratio. The effect of fat mass on hip geometric parameters at the three regions was inconsistent. (3) Fat mass and percentage of body fat ( Fat%) showed negative correlation with cross-sectional area and average cortical thickness and positive correlation with bucking ratio in young group. However, the negative contribution produced by fat mass and Fat% to hip geometric structure became weaker gradually in middle-aged and older groups. ( 4 ) Limb lean mass yielded the largest positive contribution to cross-sectional area and average cortical thickness at all three regions in young group. However, the contribution produced by trunk lean mass became the largest positive contribution to cross-sectional area and average cortical thickness in older group. Conclusions Among all the body composition parameters, hip BMD has showed the most marked correlation with hip geometric structure. Lean mass is ranked the second in the correlation. The impacts of fat mass and lean mass on hip geometry are changing with aging and their different tissue distributions.

Objective This study aims to investigate the sex difference in the hippocampus and parahippocampus in patients with bipolar disorder. Methods We acquired T1－weighted structural MRI from 133 bipolar type I patients (60 males) and 144 normal controls (81 males). The General Linear Model was used to examine the relationship between sex and brain volumes of the hippocampus and parahippocampus, with age and intracranial volume as covariates. Results Patients showed significantly smaller volumes of the bilateral hippocampus and parahippocampus (P＜0.01). There were sex－by－diagnosis interactions in the left parahippocampus gyrus (F=6.534, P=0.044). Male patients had significant smaller volumes of the left parahippocampus gyrus compared to the male normal controls (P＜0.001) whereas the volumes were not significantly different between female patients and female normal controls (P＞0.05). Conclusion The results suggest sex difference in the left parahippocampus gyrus volume in patients with bipolar type I disorder, which deserves further investigation in the future bipolar imaging researches.

Objective To evaluated the clinical efficacy of transurethral en bloc resection of bladder tumor with 2 μm laser in the high-risk elderly patients with bladder cancer under local anesthesia. Methods All of 64 high-risk elderly patients having underwent surgical treatment from April 2015 to October 2016 were divided into 2 groups,2 μm laser group(30 patients)and transurethral resection of bladder tumor(TURBT)group(34 group)according to surgical methods.The area and degree of pain was observed and recorded using visual analogue scales(VAS)during the 2 μm laser operation. The operation time,bladder irrigation time,catheter indwelling time,hospital stay,complications and 1-year cumulative recurrence rate were compared between 2 groups. Results The ASA grade in 2 μm laser group was higher than that in TURBT group and there was significant difference(P<0.05).During the 2 μm laser operation,the urethra pain was 53.33%(16/30),bladder pain was 20.00%(6/30), both urethra and bladder pain was 26.67%(8/30).The VAS scores were(2.50 ± 1.38)points,all the patients tolerated the pain in the 2 μm laser group.There was no significant difference in operation time between 2 groups(P>0.05).The bladder irrigation time,catheter indwelling time and hospital stay were shorter in 2 μm laser group than those in TURBT group:(40.00 ± 19.06)h vs.(56.47 ± 14.55)h,(4.33 ± 1.40)d vs. (5.65 ± 0.93) d,(4.13 ± 1.51) d vs. (6.24 ± 0.75) d,P<0.05 or<0.01. The overall incidence of complications was lower in 2 μm laser group than that in TURBT group:13.33%(4/30) vs. 64.71% (22/34),χ2=8.719,P=0.003.Compared with that of pre-treatment,the quality of life was higher after treatment in two groups,but there were no significant differences between the two groups.There were no significant differences in 1-year cumulative recurrence rate between the two groups after treatment (χ2= 0.496,P = 0.481). Conclusions Transurethral 2 μm laser treatment in bladder cancer under urethral surface anesthesia is safe and reliable for the high-risk elderly patients and complications are fewer than TURBT.The recent curative effect is satisfied.

Objective: To investigate the delayed effect of liver injury and metabolism of dimethylformamide (DMF) after high exposures in rats. Methods: A total of 12 rats were randomly divided into four groups and 3 rats were in each group. Rats in 1d DMF+2 d delayed group were dosed for 1 day and rested for 2 days, and sacrificed at the 4th day. Rats in 3 d DMF group were dosed for 3 days and sacrificed at the 4th day. Rats in 3 d DMF+3 d delayed group were dosed for 3 days and rested for 3 days, and sacrificed at the 7th day. Rats in control group were administrated with water for 3 days, sacrificed at the 7th day. The administrated dose was 1 000 mg/kg (body weight·d) DMF by oral. The daily observation and body weight were recorded during the study period. After the experiment, the blood biochemistry, including alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , lactic dehydrogenase (LDH) , alkaline phosphatase (ALP) , total bilirubin (TBIL) etc. were detected. Liver weight, kidney weight, liver/body ratio, kidney/body ratio and pathologic examination of liver and kidney were investigated. The concentrations of hemoglobin-adduct (NMHb) were detected. Results: During the period of 1~3 d, body weight growth rate of rats in each treated group had no significant difference with control rats. In the 4~6 th day of the period, rats in group 3 became thinner than before, and the body weight was negative growth (-4.22±3.29 g/d) and significant lower than that of control rats (10.33±3.21 g/d, F=30.07, P<0.05) . AST and LDH levels of 3 d DMF group were significant higher than control group (P<0.05) . Liver/body ratio in 3 d DMF+3 d delayed group were significant higher than control group (P<0.05) . The gross inspection showed 1 rat and 3 rats were observed liver injury in 3 d DMF group and 3 d DMF+3 d delayed group, respectively. Histopathological lesions of 1d DMF+2 d delayed group, 3 d DMF group and 3 d DMF+3 d delayed group were mainly spotty necrosis, focal necrosis and large necrosis of liver cells, respectively. Only NMHb level of control group was undetectable. NMHb levels in 3 d DMF+3 d delayed group were significantly higher than 3 d DMF group (F=135.46, P<0.05) . Conclusion The DMF-induced liver injury and DMF metabolism may be delayed after high DMF exposures in rats.

BACKGROUND: Preliminary study has prepared the three-dimensional silk fibroin/chitosan/nano-hydroxyapatite scaffold successfully.OBJECTIVE: To explore the mechanical properties, physical characteristics, chemical composition and antibiotic sustained-release ability of three-dimensional silk fibroin/chitosan/nano-hydroxyapatite scaffold loaded with levofloxacin. METHODS: Levofloxacin/chitosan (3:1) microspheres were constructed by emulsion settlement filter method. 5, 7.5 and 10 g of microspheres were added into 2％ of silk fibroin/chitosan/nano-hydroxyapatite mixed solution through freeze drying and chemical cross-linking to obtain the scaffolds loaded with antibiotics. The scaffolds loaded with antibiotics underwent scanning electron microscope observation, and chemical composition analysis. The sustained release, mechanical properties, porosity, water absorption expansion rate and hot water soluble loss rate were detected. RESULTS AND CONCLUSION: (1) Scanning electron microscope observed that there were drug microspheres at the inner wall of the scaffold, and the voidage was decreased with mass of microspheres increasing. (2) Energy spectrum analysis showed that the three kinds of scaffolds were rich in calcium and phosphonium ions. (3) The three kinds of scaffolds showed the same releasing trend, which presented with sudden-release effect at the former 3 days (release> 50％) , and then tended to be stable. The release rate was the slowest in the scaffold loaded with 10 g of microscopes, and the rapidest in the scaffold loaded with 5 g of microscopes. (4) With the mass of microspheres increasing, there was an increase in the compressive and tension abilities and hot water soluble loss rate, and a decrease in the porosity, mean pore size and water absorption expansion rate. (5) These results indicate that the three-dimensional tissue-engineered scaffold loaded with levofloxacin is constructed successfully by freeze drying and chemical cross-linking method, which holds good sustained-release effect and compressive ability, water absorption expansion rate and hot water soluble loss rate.

Objective:The purpose of this study is to establish the trajectory of targeted grafting for facial fat compartment based on anatomical research, and then bring it to clinical practice.Methods:The boundary of fat compartment and the relationship of adjacent vessel and nerve were clarified through autopsy. The recommended injection points and trajectory for targeted fat grafting were established on the anatomical findings. Retrospective clinical data of facial rejuvenation of 46 patients through targeted fat grafting were collected from June 2017 to June 2019 in Shanghai Ninth People’s Hospital. The result of 3D scanning were analyzed to evaluate the survival rate of fat grafts.Results:There were subcutaneous superficial fat compartments in the frontal region, and there were both deep and superficial fat compartments in the temporal and middle face. According to the anatomical characteristics, a targeted fat grafting technique was established with the frontal hairline and the oral commissure corner mucosa as the entry points. In the clinical study, 46 patients were evaluated by 3D scanning 6 months after the last fat grafting. The amount of fat grafts in the temporal region was (17.84±8.47) ml and (11.2±2.44) ml was left after operation, and the survival rate was 63%. The amount of fat grafts in mid-face was (26.81±10.36) ml and (16.09±4.48) ml was left after operation, and the survival rate was 60%. Overall satisfaction rate of patients was 93% (43/46).Conclusions:Compartment-based targeted fat grafting is an accurate injection method, which meets the requirement of physiological augmentation. The trajectory of targeted fat grafting will further improve the efficacy and safety of injection.