Objective To evaluate retrospectively the efficacy of cistema magna plastic repair in the treatment of Chiari malformation complicated with syringomyelia Methods Fifty-one patients suffered from Chiari malformation complicated with syringomyelia were treated in our department from May 2004 to October 2009. Seventeen patients received cistema magna plastic repairment (the decompression of posterior cranial fossa, duraplastic repair,resection of hernia below cerebellar tonsil and separation of adherence of arachnoid membrane). Results Clinical symptoms disappeared or improved in 15 cases (effective rate of 90%). MRI showed tonsillar herniation disappeared,syringomyelia narrow. MRI showed cistema magna plastic repair, syringomyelia disappeared or significantly thinned and spinal cord subarachnoid space widened. Effective treatment obtained in 12 cases (effective rate 70%). Conclusions The efficiency of Cistern magna plastic repair treating Chiari malformation with syringomyelia is satisfied.

Objective To investigate the effect of budesonide atomization on tracheal extubation in children.Methods A total of 85 patients with tracheal intubation in Tianjin Children's Hospital from May 2013 to September 2016 were selected in this study.Patients were randomly divided into budesonide group (n=44) and dexamethasone group (n=41).The budesonide group was given 1 mg of budesonide for inhalation 30 min before extubation,and 1 mg of budesonide inhalation immediately after extubation.Then every 8 hours for 0.5-1.0 mg budesonide inhalation for 4 days.The dexamethasone group was given dexamethasone 0.2-0.3 mg/kg intravenously 30 min before extubation,and dexamethasone 2.5-5.0 mg inhalation immediately after extubation.Then dexamethasone 2.5-5.0 mg inhalation was given every 8 hours for 4 days.The incidence of laryngeal edema (stridor,hoarseness),the time of extinction,the expression of hypoxia,reintubation rate within 24 hours and secondary infection rate after extubation were compared between the two groups.Results There were no significant differences in the mission success rate,the incidence of laryngeal edema,the time of extinction,the incidence of hypoxia and re-intubation rate between the two groups (P ＞ 0.05).Two patients were found secondary infection after extubation in dexamethasone group.Conclusion Both budesonide and dexamethasone show curative effects on the prevention and treatment of laryngeal edema after extubation.Budesonide atomization can replace systemic corticosteroids,thus reducing the adverse reactions of glucocorticoids.We recommend the use of budesonide in treating adverse events after extubation.

[Objective]Discussion on clinical experience and academic ideas of Professor FU Weimin in treatment of viral encephalitis sequela.[ Method] From the etiology and pathogenesis, and the treatment method to expound the clinical experience and academic viewpoints of Prpfessor FU Weimin, summarize his law of characteristic medication and diagnosis thought,and put an example to exemplify that. [Results] Professor FU Weimin is good at treating this disease from phlegm and blood. He believes that the real standard based on six exogenous pathogenic factors or plague pathogen and other than evil not clear, long into the blood collaterals, phlegm heat and blood stasis obstruction, disturbing the brain orifices, are the symptoms of disease;and the virtual caused by the empty brains, heart and kidney failure and the losed senses and deities, are the causative organism. The pathological features are mainly composed of real or virtual inclusions.Treatment with the kaiqiao huatan tongyu methods are the basic principles, combined with tonifying the kidney and marrow, trafficing heart and kidney, which embodies the compatibility characteristics of eliminating pathogen without forgetting the acual. [Conclusion] Professor FU Weimin 's treatment of viral encephalitis sequela is effective, and can effectively control the disease, reduce the recurrence rate and improve patients ' self-care ability and quality of life.It's worthy of our study and promotion.

ObjectiveTo explore the clinical effect of oral administration and external application of traditional Chinese medicine on early stage of osteofascial compartment syndrome. Methods56 early osteofascial compartment syndrome patients had assigned in two groups randomly, each group had 28 patients. The treatment group used topo-application Xiaoyu tincture,after aseptic gauze sodden by physic liquor,affected limb would coverd by the aseptic gauze and change of dressing every two hours,oral administration of Xingqihuayu decoction. The control group used 250ml of 20％ mannitol with dehydration therapy,two times everyday;654-2 bullet 10ml to intramuscular injection,three times every day. ResultsAfter the treatment,the results showed that the treatment group was much better than the control group at the time of ache abatement,swelling regression and disappear of all levels injury, arteriae dorsalis pedis changing. The difference had statistical significance( P ＜ 0.05). ConclusionTopo-application chinese drugs pharmaceutics of Xiaoyu tincture and oral administration of Xingqihuayu decoction was a available nonspecific treatment to early osteofascial compartment syndrome.

Objective To observe the correlation between heart rate turbulence (HRT) and heart rate variability in patients with essential hypertension.Methods 50 cases of essential hypertension were selected and 30 healthy subjects were taken as controls.Turbulence onset (TO) and turbulence slope (TS) were calculafed according to 24 h Holter results of the two groups.The correlation between TO,TS and SDNN of 24 h RR,every-5-min of 24 h RR and rMSDD of RR as well as the correlation between TO and TS Was studied.Results TO in essential hypertension group Was remarkably higher than in control group but TS Was lower.TO and TS were correlated with SDNN, SDANN and rMSDD (r=-0.587,r=0.679,r=0.423,r=0.513,r=0.336,r=0.417)(P<0.05 respectively). Conclusion Systolic HRT before ventricular period is weakened in patients with essential hypertension.TS can be an index in evaluating autonomic nerve function of primary hypertension.

Objective To study the clinial application value of MR dispersion arthrography in meniscus tear of knee.Methods The conventional MR scans of 24 knee joints in 24 patients who were considered to have meniscus tear were performed and followed by MR dispersion arthrography.All cases were approved by arthroscope or operation.The results of both convention MR scan and MR arthrography were compared with arthroscope and operation.The sensitivity and the specificity of plain MR scan and MR dispersion scan were evaluated respectively.Results The signal intensity in the area of meniscus tear was obiously highen on MR dispersion scan than that of MR plain scan.The sensitivity was improved from 74.2% to 94.3% ,and the specificity improved from 88% to 94.3%.Conclusion MR dispersion scan is superior to convention MR scan in image quality and sensitivity in detecting meniscus tear.

Objective To elucidate the role of the Wnt/-catenin signaling pathway in regulating the phenotypic transformation of aortic valvular myofibroblasts to osteoblast-like cells.Methods Cultured primary valvular myofibroblastes isolated from porcine aortic valve leaflets were treated with oxidized low-density lipoprotein (ox-LDL) for different lengths of time:24 h,48 h and 72 h.The Wnt signaling pathway inhibitor Dickkopf-1 (DDK-1) was co-incubated with ox-LDL for 72 h.After cells harvest,the expression of myofibroblastic or osteoblast-like phenotype related markers,a-smooth muscle actin (α-SMA),bone morphogenetic protein 2 (BMP2),alkaline phosphatase (ALP) and corebinding factora-1 (Cbfα 1),was detected by Western blotting.The expression and sub cellular localization of β3-catenin was assessed by immunocytochemistry.Changes of the Wnt/β-catenin signaling pathway and the transformation of aortic valvular myofibroblast to osteoblast-like cells were monitored.Results BMP2,ALP and Cbfa 1 protein expression was not or barely detectable in the control group.However,after ox-LDL treatment,the expression of α SMA,BMP2,ALP and Cbfa 1 increased significantly (each P＜0.01) in a time-dependent manner (each P＜0.05).Besides,ox-LDL was also able to up-regulate the protein expression of β-catenin in a time-dependent manner (P＜0.05) and promoted its nuclear translocation.After DKK-1 treatment,the protein expression of β3 catenin and osteogenesis related markers was down regulated (P＜0.05).Conclusions The Wnt/β-catenin signaling pathway may play a crucial role in regulating the transformation of aortic valvular myofibroblasts to an osteoblast like phenotype.

Objective To study the different effects on unilateral middle cerebral artery infarction with standard large trauma craniotomy and frontotemporal craniectomy and decompression treatment.Methods The clinical data of 56 patients with unilateral middle cerebral artery infarction were retrospectively analyzed.They were divided into the two groups according to the different operation methods,and compared the incidence of postoperative complications and GCS score after 1 week,GOS score after 1 month,and ADL score after 6 months and so on.Results The differences were significant between the two groups in incidence of postoperative complications [ incidence of rebleeding after the operation(A group 5 cases,B group 4 cases),showing of brain pools(A group 23 cases,B group 14 cases),lung infection(A group 7 cases,B group 13 cases),gastrointestinal bleeding(A group 8 cases,B group 17 cases),χ2 =0.579,4.703,8.606,7.081] and postoperative GCS score after a week[12 -15points(A group 5 cases,B group 2 cases),9-11points(A group 15 cases,B group 10 cases),5-8points(A group 6 cases,B group 8 cases),3-4points(A group 2 cases,B group 4 cases),death(A group 1 case,B group 3 cases),W value was 599.500,P=0.028] (all P<0.05).There was significant difference in postoperative GOS score and rate of brain tissue bulging after a month [ advantages ( A group 7 cases, B group 4 cases ) , good ( A group 15 cases, B group 8 cases),middle(A group 3 cases,B group 6 cases),poor(A group 2 cases,B group 4 cases),death(A group 1 case,B group 2 cases),encephalocele(A group 9 cases,B group 19 cases),W value was 492.000,P=0.007](all P<0.05).There was no difference in postoperative ADL score half of a year(P>0.05).Conclusion Standard large trauma craniotomy has features as decompression full,low early complication rate,and can improve the short-term efficacy of unilateral middle cerebral artery infarction in patients,and promote recovery.

Objective To explore the microsurgical treatment strategy of ruptured anterior communicating artery aneurysms.Methods From September 2009 to February 2013,thirty-three patients with ruptured anterior communicating artery aneurysms were treated with microsurgical clipping via modified pterion approach.The clinical and follow-up data were analyzed retrospectively.Results At 3 to 44 months period followed-up after microsurgical clipping of ruptured anterior communicating artery aneurysms were obtained in 32 patients.According to Glasgow Outcome Score,the curative effects score were 5 in 28 cases,four in 2 cases,three in 1 case and death in 1 case.Conclusion Microsurgical clipping of ruptured anterior communicating artery aneurysms via modified pterional approach was an effective method with sufficient exposure.It has less invasiveness to the brain tissue,reliable neck clipping and satisfactory results.Safety and effectiveness of this procedure are based on preoperative radiological evaluation of three-dimensional morphological specificity of aneurysms,identification of the parental arteries and its branches,as well as temporary proximal occlusion.

Objective To investigate the effects of fast-track surgery on postoperative rehabilitation of patients with liver cancer. Methods Forty-one patients with liver cancer who had been admitted to Zhongshan Hospital of Fudan University from 9 to 30 in July 2008 were randomly divided into fast-track surgery group (n =20) and routine treatment group (n =21) according to the random number table. Patients in fast-track surgery group were preoperatively educated in order to lessen their anxiety. Bowel preparation was not applied before operation, and they were orally administered with 1000 ml of enteral nutrition emulsion (1300 kcal), then they were fasted for 4 hours before operation. Urethral catheter and gastric tube were removed after operation. They were orally administered with 1000 ml of enteral nutrition emulsion on postoperative day 2, and were encouraged to partake in off-bed activity shortly after the operation. The off-bed time, anus exhaust time, postoperative complica-tions, hospitalization time, expense, nutritional and metabolic indexes on postoperative day 1, 3 and 5, hepatic and renal function, immune and stress indexes between the 2 groups were compared by t test and chi-square test. Results There were significant differences in off-bed time, anus exhaust time, patients' weight, expense, total bilirubin level on postoperative day 1, 3 and 5, and level of serum TNF-α on postoperative day 3 between the 2 groups (t =7.065, 5.483, 3.754, 2.291,2.289, 3.218, 3.192, 2.434, 2.089, P <0.05). Conclusions Fast-track surgery can accelerate the postoperative rehabilitation of patients with liver cancer.