Objective To investigate the outcome of microsurgical treatment and its influencing factors in patients with aneurysmal subarachnoid hemorrhage.Methods The consecutive patients with aneurysmal subarachnoid hemorrhage treated with the early or ultra-early microsurgery were enrolled retrospectively.The Glasgow outcome scale (GOS) was used to assess the outcomes of patients at discharge.GOS 4-5 was defined as good outcome,and GOS 1-3 was defined as poor outcome.Results A total of 147 patients with aneurysmal subaraclnoid hemorrhage were enrolled.One hundred and twelve patients (76.2％) had good outcomes.There were significant differences in the proportions of preoperative Glasgow Coma Scale (GCS) scores (12.8 ± 2.8 vs.7.5 ± 3.8;t =7.525,P ＜0.001),low Hunt-Hess grade (83.0％ vs.31.4％;x2 =34.318,P ＜ 0.001),size of aneurysm (x2 =9.531,P =0.009),preoperative rebleeding (6.3％ vs.25.7％;x2 =8.506,P =0.003),preoperative brain herniation (4.5％ vs.40.0％;x2 =26.846,P ＜ 0.001),initial CT scan showing intracerebral hemorrhage (19.6％ vs.48.6％;x2 =11.449,P =0.002),and intraventricular hemorrhage (8.9％ vs.40.0％;x2 =18.846,P ＜0.001) between the good outcome group and the poor outcome group.Multivariate logistic regression analysis showed that the larger aneurysm (odds ratio [OR] 3.194,95％ confidence interval [CI] 1.458-6.999;P =0.004),older age (OR 1.054,95％ CI 1.013-1.097;P=0.010),lower preoperative GCS score (OR 0.539,95％ CI 0.410-0.724;P ＜ 0.001),and preoperative brain herniation (OR 3.633,95％ CI 1.039-12.700;P =0.043) were the independent risk factors for poor outcomes.Conclusions After active surgical treatment,most of the patients with aneurysmal subarachnoid hemorrhage have good outcomes,however,patients with older age,larger aneurysms,lower preoperative GCS scores,and preoperative brain herniation usually have poor outcomes.

OBJECTIVE To provide a practical action plan which can prevent and control the similar occurrence through studying the epidemiological characteristics of a norovirus-induced diarrhea outbreak in the wards of our hospital. METHODS To obtain the information about the epidemic situation of norovirus involving 15 patients in the two wards of our hospital, during the period from Nov 12 to 15, 2006. RESULTS It was a norovirus gastroenteritis outbreak in the 8 cases among 15 patients and there were other 7 sporadic cases. The consummate monitoring system on nosocomial infection could gain the information of disease, and be very helpful to control its transmission. Beijing Municipal Center for Quality Control and Improvement of the Management of Nosocomial Infection was known the information and shared it among different kinds of hospitals. Thus an unnecessary panic was avoided in Beijing at that time. CONCLUSIONS The social factor, senile situation and immunocompromise are the causes of this norovirus outbreak. The effective control measures and the information exchange in time could prevent the spread of infection. It is shown that the nosocomial infection monitoring network could catch the epidemic tendency of nosocomial infection sensitively, so to strengthen the monitoring network is the key.

Objective To investigate the application value of spiral CT spinal cord and intervertebral disk 3D recontruction in vertebra trauma.Methods 78 patients with vertebra trauma were examined by CT axial, the primal date of each were retrospectively inserted and reconstructed, all the cases use 3D,SSD and sagittal MPR, compared with routine 2DCT.Results Spinal cord was normal in 23 cases.Spinal cord was pressed in 39 cases.Spinal cord was transected in 16 cases.Intervertebral disk was damaged in 38 cases.Conclusion Spiral CT can do spinal cord and intervertebral disk 3D reconstruction , it can show vertebra trauma and display intervertebral disk damage intuitionistically,which has instruction in making reasonable cure project and judging cure effect.

Objective To investigate the efficacy of super selective intra-arterial infusion of verapamil for the treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH).Methods From January 2013 to February 2016,the clinical data of 15 patients with subarachnoid hemorrhage (SAH) who had CVS after intracranial aneurysm clipping (n=8) or endovascular treatment (n=7) were analyzed retrospectively.All patients received whole brain digital subtraction angiography (DSA).Microcatheter super selection to spastic arteries was used and verapamil (11.1±3.4 mg) was infused.The findings of whole brain DSA before and after treatments were compared.The blood pressure and heart rate were collected during the treatment and the findings of transcranial Doppler ultrasonography were recorded.The patients were followed up for 6 months and the Glasgow outcome scale (GCS) scores were obtained.Results (1) A total of 20 intra-arterial infusion treatments were performed in 15 cases.They were compared before and after perfusion.CVS was improved on DSA in 14 cases,there was no significant change in on cases.(2) Transcranial Doppler ultrasonography showed that the mean blood flow velocity (mBFV) of the middle cerebral artery was decreased from 181±4 cm/s before the super selective intra-arterial infusion to 126±4 cm/s within 1 hour after treatment.There was significant difference (t=42.46,P<0.01).No complications associated with the use of microcatheters were observed.(3) The right upper arm blood pressure of the patients was monitored in the process of perfusion.The systolic pressure was 138±8 mmHg at the beginning of the perfusion,it was 135±10 mmHg at the end of the perfusion,and it was 137±7 mmHg at 1 h after the perfusion.The heart rate was 83±6/min at the beginning of the operation,it was 79±8/min at the end of the operation,and it was 80±5/min at 1 h after the operation.There were no significant differences (P>0.05).(4) All patients were followed up for 6 months.The GOS score at 6 months:good recovery in 9 cases,moderate disability but could take care of themselves in 3 cases,severe disability and could not take care of themselves in 3 cases,no persistent vegetative state or death.Conclusion Super selective intra-arterial infusion of verapamil can effectively improve the treatment of aneurysmal SAH caused CVS.At the same time,it has no obvious effect on blood pressure and heart rate.

Objective To study the recombination type of B/C genotype in hepatitis B virus.Methods The PCR was applied to amplifed the whole genes of HBV through the serums of four chronic HBV carriers who come from Jinghong distict,Yunnan province.The whole HBV genomes were ligated with pMD18-T vector and trasformed to E.coli JM109.After the positive colones were picked up,the HBV genotypes and recombinated sites were discoved through sequenced the acquired positive colones.Results All the acquired sixteen HBV sequences from the four HBV carriers were genotype B which were combinated with genotype C in some region.There are two ways of the combinations.For the first one,a 496 bp fragment from genotype C taked place the genotype B at the place of nt1825 to nt2320 of precore C/C region.For the second way,a 695 bp fragment of genotype B taked place at the both sites of nt822 to nt1020 of P gene region and nt1825 to nt2320 of precore C/C region.Conclusion A new recombination type of B/C genotype in hepatitis B virus was reported for the first time.The new Bj subgenotype was combinated with genotype C not only at the region of precore C/C but also at the place of P gene region.

Objective To observe the features of a rare Miao pedigree of Bardet-Biedl syndrome in Yunnan province and to reserve its gene. Methods Three patients of this pedigree were reported. Their clinical and biochemical features were compared with those of the other pedigree members. Lymphocytes from main members of this pedigree were collected and transformed with cyclosporine A methods. Immortalized B lymphocyte strains were checked by means of chromosome karyotype analysis. Results Patients of this pedigree demonstrated typical clinical characteristics of this syndrome with increased body weight, blood pressure, fasting glucose, and lipoprotein(a)as compared with the other pedigree members(P＜0. 05). The chromosome karyotype of the lymphocytes before and after transformation was kept consistent. Conclusions Patients of this Miao pedigree showed typical clinical characteristics of this syndrome as well as abnormal metabolic features. Immortalized B lymphocyte strains with their genetic information were set successfully.

Urinary excretion of prostaglandin E2. (PGE2) and thromboxane B2 (TXB2, a stable metabolite of TXA2), atrial natriuretic peptide (ANP) and arginine vasopressin (AVP) in plasma were determined with radioimmunoassay in 30 healthy normal controls (NC) and 53 cirrhotic patients without asoites (n = 18), with ascites (n = 25) and with hepatorenal syndrome (HRS, n=10). All of four vasoactive substances in the group of cirrhotic patients without ascites were significantly higher than that in NG (P

Objective To compare the diagnostic value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced helical CT (CECT) for various small focal nodular lesions (≤2 cm) in patients with liver cirrhosis. Methods Eighty-one small hepatic space-occupying lesions in 72 patients with liver cirrhosis were detected with CEUS and CECT, respectively. The diagnostic performance was calculated by histological results obtained from biopsy or surgery, which was considered as the gold standard, Results Fifty-three of the 81 small nodules were hepatocellular carcinoma, 26 were regenerative nodules and 2 were hemangioma. On CEUS, 51 (96.2%,51/53) HCC were hypervascular during arterial phase. On CECT, 41 (77.4%, 41/53) HCC were hypervascular (P < 0.01).Nodules which appeared by contrast enhancement during the arterial phase and contrast wash-out during the portal/late phase on CEUS or CECT were considered as HCC. The sensitivity, specificity and accuracy were 86.8% (46/53) ,82.1% (23/28) ,and 85.2 % (69/81) in CEUS, and 73.6% (39/53), 92.9 % (26/28), and 80.2 % (65/81) in CECT, respectively. Overall, there was no significant difference between CEUS and CECT in the diagnostic confidence for small hepatic nodules (P >0.05).Conclusions CEUS is superior to CECT in the detection of arterial vascularization for small hepatocellular carcinoma with a diameter ≤2 cm. The ability of CEUS in the characterization of focal nodular lesions in cirrhotic livers is similar to that of CECT.

Objective To study the feasibility and safety of limb remote ischemic preconditioning (RIPC) in infants and explore the protective effect on myecardium ischemia reperfusion injury for infants undergoing cardiac operation under cardiopulmonary bypass. Methods 60 infants weight less than 7 kilograms with ventricular septal defect were enrolled into the study. 30 of them (RIPC group) were ischemic preconditioned two times (24 hours and 1 hour preoperatively) by three cycles of iscbemia (5 minutes for each) and reperfusion on the left upper arm using a blood pressure cuff. Serum lactate dehydrogenase (LDH), creatine kinase (CK) and its isoenzyme (CK-MB), and tro-ponin I (TnI) ; malondialdehyde (MDA) and superoxide dismutase (SOD) was preoperatively detected. The expression of heat shock pro-tein 70 (HSP 70) in cardiomyocytes was determined by western blot analysis. The surgical outcome including limb movement and sensory function was also recorded. Results No limb disability or sensory disturbance or no other surgical complications was found in all infants. LDH, CK, TnI at the beginning of operation in RIPC group was higher than those in control group. After operation, leakage of heart enzymes were attenuated in RIPC group, and the serum concentration of enzymes were lower than those in the control group. The RIPC group had low coronary sinus venous concentration of MDA but high SOD. The expression of HSP70 was upregulated in cardiomyocytes of RIPC group. Conclusion The limb RIPC can be done easily and safety in infants, and BIPC can reduce the leakage of myocardial enzymes and upregu-late the expression of HSP, which possess protective effect on myocardial IRI.

Objective Toinvestigatetheimpactofthedifferentrupturepoints(sac,neck,andtop) of intraoperative aneurysm rupture (IAR)on the prognosis of patients in anterior circulation aneurysm clipping.Methods Theclinicaldataof135consecutivepatients(148aneurysms)acceptedmicrosurgical aneurysm clipping from May 2009 to March 2012 were analyzed retrospectively. The prognostic evaluation of the patients after procedure was assessed by using the Glasgow outcome scale (GOS). The different aneurysm rupture points of IAR were used as influencing factors,and the relationship between the different rupture pointsandtheprognosisofpatientswasanalyzed.Results Duringclippingof148aneurysmsin 135 patients,31 aneurysms in 30 patients had intraoperative rupture (20. 9% of the aneurysms, 22.2% of the patients). Nine rupture points occurred on the top of aneurysms,17 occurred on the sac,and 5 occurred on neck. The Glasgow outcome scale (GOS)scores 5,4,3,2 and 1 were in 17,8,2,1 and 2 patients,respectively. A total of 25 patients had good prognosis and 5 cases had poor prognosis. There were no significant differences in the impact of different rupture points of IAR on the prognosis in patients of IAR (OR,100. 00,95% confidence interval 6. 764-18. 344,P=0. 006). Of the 25 patients with aneurysm sac or top rupture,1 case had poor prognosis. Of the 5 patients with aneurysm neck rupture, 4caseshadpoorprognosis.Conclusion Inanteriorcirculationaneurysmclipping,thedifferent aneurysm rupture points may have significant impact on the prognosis of patients,the aneurysm neck rupture is a main factor for resulting in the poor prognosis of patients.