Objective To study the methods and significance of motor and sensory areas mapping by optical intrinsic signal imaging (IOSI) and neuromonitoring (IOM) during the operation on the lesions near the central sulcus. Methods Intraoperative neuromonitoring were firstly used to map the central sulcus and motor cortex in 5 patients with glioma undergoing surgery. Then, intrinsic optical signals imaging were used to locate the postcentral gyrus. According to the results of mapping, microsurgical operation was chosen for the resection of glioma and postoperative functional results were evaluated. Results All the patients acquired accurate location of central sulcus, motor cortex and somatosensory cortex. The enhanced MRI performed within 24 hours postsurgery showed total resection in 5 cases. The motor and somatosensory function of 5 patients returned to normal after 3-12 months. Conclusion Intraoperative location of the somatosensory area and motor area by optical intrinsic signal imaging and neuromonitoring is a reliable and safe method.

Objective To observe the blood vessels distribution in iliac blood velles triangular area of the lumbosacral vertebrae and confirm the range of safety working area,so as to provide anatomic data for anterior lumbosacral interbody fusion.Methods CTA imaging da-ta of abdominal vessels were randomly collected from 32 adult patients.Observed the distribution and intersection features of lumbosacral ver-tebral ventral blood vessels.Measured the distance from the bifurcation or confluence to the L5 dise,level interval of iliaca vessels in the infe-rior boundary of L5 ,and width of L5 /S1 intervertebral space.And then computed the range of safety working area and conducted a preliminary classification.Results The lumbosacral vertebral ventral operation space is mainly (87.4%)composed of left iliac vein and right common iliac artery.In this study,patients of type A accounted for 87.4%,vascular clearance of the L5 dise was (3.8 ±1.1)cm,safety working area was (5.2 ±1.2)cm2 ,and the display ratio of L5 /S1 was 73.2%.Patients of type B accounted for 6.3%,vascular clearance of the L5 dise was (4.2 ±0.5)cm,safety working area was (7.1 ±0.2)cm2 ,and the display ratio of L5 /S1 was 81.0%.Patients of type C accounted for 6.3%,vascular clearance of the L5 dise was (1.0 ±0.7)cm,safety working area was (1.3 ±0.7)cm2 ,and the display ratio of L5 /S1 was 31.2%.The differences of anatomical parameters among the three types were statistically significant (P <0.05).Conclusion The study showed that most ordinary people have enough operation space in the lumbosacral vertebral ventral,which is suitable for anterior lumbosacral interbody fusion,but it is necessary to take preoperative imaging screening.

Objective To investigate the related index of early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.Methods 13 cases of the acute-on-chronic liver failure caused by chronic hepatitis B were collected in our department,39 cases of chronic hepatitis B were randomly paired to analyze the difference index.ROC curve analysis was conducted for the different data,then to choose the data whose AUC (area under the curve)is >0.8 to accumulate points,while the cutoff value in the light of Youden index was indentified.Each accu-mulating points data would score 1 point if it is≥cutoff value,otherwise,it would score 0 points.ROC curve analysis was conducted for the total accumulating points,the cutoff value of the total accumulating points according to Youden index was indentified,the sensitivity and specificity were calculated.Results The data of which AUC are >0.8 include glutamic-pyruvic transaminase (ALT)/Upper Limit Of Normal (ULN),neutrophil count (N),alkaline phosphatase (AKP)/ULN,glutamic-oxalacetic transaminease(AST)/ULN,direct bilirubin/total bilirubin(Dbil/Tbil),total bile acid(TBA),whose AUC were respectively 0.869,0.874,0.897,0.917,0.919 and 0.978,while their cutoff value were respectively 18.57,3.1 ×109/L,0.99,22.21,44.41%and 140.20μmol/L.The cutoff value of total accumula-ting points of the six data was 4 points,AUC was 0.987,Youden index was 0.949,and their sensitivity for ealier diag-nosis for the acute -on -chronic liver failure caused by chronic hepatitis B was 100%,specificity was 94.87%. Conclusion The accumulating points of the six data aboved (ALT/ULN,N,AKP/ULN,AST/ULN,Dbil/Tbil,TBA) will help the early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.

Objective To analyse clinical features of 86 cases of intracranial arteriovenous malformation (AVM) and explore strategies and methods of the microsurgical treatment of intracranial arteriovenous malformations.Methods The clinical data of 86 intracranial arteriovenous malformation from January 2010 to January 2013 were retrospectively reviewed.For diagnosis,computed tomography (CT) with angiography (CTA),and DSA were used,which could provide real size,location,feeding arteries and draining veins of AVM,and apply NEPM to evaluate the nerve function,assess the qualitative and quantitative flow rate of AVM and surrounding blood vessels by Doppler ultrasonography and fluorescein angiography,and reveal opography of AVM.Operative techniques were used including embolization,feeding artery control.Results Eighty-six cases of AVM were resected successfully under mutitechnology.Following-up demonstrated excellent neurological outcomes in 70 cases,nine case had mild disability,five cases had severe disability,two dead cases.DSA shows resected completely,and long-term follow-up was still in progress,conclusion Multi-technology combined microsurgical techniques which can effective improve the outcomes of intracranial arteriovenous malformations.

Objective To investigate the clinical manifestation,pathological characteristics,neurological imaging,indications,operative approach and microsurgieal technique of surgery for brain stem tumor.Methods 17 cases of brain stem tumor treated by applying microsurgical skills were retrospectively analyzed from Jan.2002 to Dec.2007.Ten cases were operated via the suboccipito-retromastoid approach,among which 5 situated in pons,3 in medulla oblongata and 2 invoved both pens and medulla oblongata;4 cases were performed via the posteromedian-suboccipital approach,among which 2 located in pens,1 in medulla oblongata and 1 involved both midbrain and pens;3 lesions situated in varying sites of mesencephalon were operated by the suboceipito-supratentorial,infratemporal approach and pterional approach respectively.Results In the series of the patients,lesion was totally excised in 6 cases,subtotally in one,without surgical mortality.All patients were followed up for years ranging from 5 months to 4 years.During the follow-up period,seven patients resumed work and normal life;4 patients could perform physical labor;3 patients obtained self care capability;2 patients needed to be taken care of,1 patient died from pneumonia after discharge.Conclusion Fine therapeutic efficacy and low disability rate could be obtained while applying microsurgical techniques to resect brain stem tumors with correct indication,appropriate approach and elaborate microneurosurgical skills.

Objective To study the clinical effect of microsurgical treatment of craniopharyngioma by modified pterional approach.Methods Forty-one patients were carried out a retrospective case study with craniopharyngioma who underwent microsurgieal treatment via modified pterional approach at our department.Preoperative preparation mainly included hormone replacement therapy and prevention of epilepsy.The modified pterional approach was adopted.The patients' clinical indications were monitored postoperatively such as consciousness, blood pressure, in and out quantity of water, urine specific gravity, electrolytes, CT and MRI, and prompt prevention and treatment of the complications including diabetes insipidus and disorder of electrolytes were carried out after the surgery.Meanwhile, measures were taken to prevent postoperative epilepsy and low level of hormone.Results Thrrty-three patients had total craniopharyngioma resection, 5 had subtotal craniopharyngioma resection and 3 had partial craniopharyngioma resection, and all of them survived from the surgery.2 to 19 months postoperative follow-up showed that 32 patients could normally live,study and work, while 9 patients had to be assisted for normal lives.There was a recurrence of the tumor in 3 patients out of 8 patients that had subtotal and partial craniopharyngioma resection within 12 months postoperatively.Conclusion Adopting modified pterional approach plus efficient and effective perioperative management can reduce the damage rate of hypothalamus and improve the total resection rate of the craniopharyngioma, and achieve good results of the treatment.

Objective To approach the expression and significance of connection tissue growth factor(CTGF) in articular cartilage after full-thickness osteochondral defect on the medial femoral condyle in young and adult rabbits model.Methods Totally 25 young(at an age from 10 to 12 weeks) and 25 adult New Zealand white rabbits(at an age from 34 to 39 weeks) were randomly divided into 5 groups(n=5) ,control group,24-hour,1-week,4-week and 8-week after full-thickness cartilage injury groups.A rabbit model of spontaneous healing of full-thickness cartilage defect in the medial femoral condyle in both knees was reproduced.Macroscopic and histological morphous of repairs were observed in each age group during repair.mRNA and protein expression of CTGF were detected with RT-PCR and immunohistochemistry,respectively.Results The morphologically good repairs with hyaline-like cartilage appearance were observed in young rabbit,but formation of fibrous tissue in adult rabbit.The expression of CTGF mRNA was detected in all groups.Expression of CTGF mRNA was significantly higher in young rabbit than in adult rabbits(P

Objective:Deeper studies have been rarely reported on the characteristics and influencing factors of the psychological health of army nurses and on the measures for raising their ability of military stress management. To gain an insight into the psychological state of army nurses in the present military streamlining and to explore its countermeasures. Methods:We investigated the psychological state of 123 army nurses from 6 military hospitals by psychometrical methods and psychological interviews,and analyzed the results. Results:Of the total number of subjects,70.73% scored

Objective To evaluate the effect of dexmedetomidine on lung injury induced by renal ischemia/reperfusion (l/R) in rats.Methods Healthy male Sprague-Dawley rats,aged 4-5 months,weighing 250-300 g,were randomized into 4 groups (n =10 each) using a random number table:sham operation group (group S); group I/R; dexmedetomidine pretreatment group (group D1) and dexmedetomidine postconditioning group (group D2).Renal I/R was induced by right nephrectomy and occlusion of the left kidney for 45 min followed by reperfusion in animals anesthetized with intraperitoneal chloral hydrate.In group D1,dexmedetomidine was infused intravenously starting from 30 min before ischemia until beginning of ischemia.In group D2,starting from onset of reperfusion until 30 min of reperfusion,dexmedetomidine was infused intravenously for 10 min at a rate of 1 μg· kg-1 · h-1,and then infused for 20 min at 0.5 μg· kg-1 · h 1.Blood samples were collected at 6 h of reperfusion to determine serum creatinine,blood urea nitrogen,interleukin-1β (IL-1β),IL-6 and tumor necrosis factor-α (TNF-α) concentrations,and IL-1β,IL-6 and TNF-α concentrations in broncho-alveolar lavage fluid (BALF).Lungs were removed for microscopic examination and for determination of wet/dry lung weight ratio.Results Compared with group S,wet/dry lung weight ratio,serum creatinine and blood urea nitrogen concentrations,and IL-1β,TNF-α and IL-6 concentrations in serum and BALF were significantly increased in the other three groups (P ＜ 0.05).The parameters mentioned above were significantly lower in D1 and D2 groups than in I/R group (P ＜ 0.05).Microscopic examination showed that the pathological changes were significantly attenuated in D1 and D2 groups as compared with I/R group.Conclusion Both dexmedetomidine pretreatment and postconditioning can attenuate lung injury induced by renal I/R and inhibition of inflammatory responses is involved in the mechanism.

Objective To study the practicability of measurement of abdominal wall tension (AWT) for noninvasive monitoring of intra-abdominal pressure in ICU patients.Methods Patients with indwelling urethral catheter admitted to ICU from April 2011 to March 2013 were enrolled for a prospective study.Exclusion criteria were patients with muscular relaxants,abdominal operation in three months,acute peritonitis,abdominal mass,acute injury of urinary bladder,acute cystitis,neurogenic bladder,intrapelvis hematoma,and pelvic fracture.The AWT (N/mm) and urinary bladder pressure (UBP) (mm Hg) of all patients were measured.Statistical analysis was performed by SPSS 13.0 statistical software.The correlation of AWT and UBP were analyzed using linear regression analysis.The effects of respiration and body position on AWT were analyzed using the Paired-samples t test,and the effects of gender and body mass index (BMI) on basic level of AWT (IAP ＜ 12 mm Hg) were analyzed using the One-way ANOVA.Results A total of 51 patients were recruited in study.A significantly linear correlation between AWT and UBP were observed (R =0.986,P ＜ 0.01),the regression equation was Y =1.369 + 9.57X (P ＜ 0.01).Under the supine-flat positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.65 ± 0.52) N/mm and (1.45 ± 0.54) N/mm,respectively,and under body straight up 30° supine positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.25 ± 0.30) N/mm and (1.07 ± 0.35) N/mm,respectively.There were significant differences in intra-abdominal pressure between different respiratory phases and body positions (P ＜ 0.01).Basic levels of AWT in male and female were (1.09 ± 0.29) N/mm and (1.01 ± 0.34) N/mm.The basic levels of AWT in patients with BMI ＜ 18.5,18.5 ≤ BMI ≤25 and BMI ＞ 25 were (0.91 ± 0.30) N/mm,(1.02 ±0.35) N/mm and (1.16 ±0.28) N/mm respectively,but gender and BMI had no significant effects on basic level of AWT (P =0.457 and 0.313,respectively).Conclusions There was a significantly linear correlation between AWT and UBP,and respiratory phase and body position had significant effects on AWT,but gender and BMI had no significant impacts on basic level of AWT.AWT could be served as a simple,easy,and accurate method to monitor the IAP in critical ill patients.