Objective:To investigate the efficacy of sequential mechanical ventilation based on pulmonary infection control window in the treatment of severe pneumonia complicated by respiratory failure in children.Methods:A total of 300 children with pneumonia complicated with respiratory failure who received mechanical ventilation in Jiande Second People's Hospital from January 2016 to December 2017 were included in this study. They were assigned to receive either conventional continuous invasive mechanical ventilation (control group, n = 150) or invasive- noninvasive sequential mechanical ventilation based on pulmonary infection control window (observation group, n = 150) according to the order of admission. Invasive ventilation time, intensive care unit stay, expiratory time, inspiratory time and time to peak tidal expiratory flow, blood gas analysis indexes, incidence of ventilator-associated pneumonia, pulmonary hemorrhage and pneumothorax were compared between the two groups. Results:After treatment, PaO 2 value [(97.31 ± 6.39) mmHg vs. (86.24 ± 10.92) mmHg], PaO 2/FiO 2 [(280.78 ± 40.12) mmHg vs. (210.75 ± 40.11) mmHg], pH value [(7.44 ± 0.01) vs. (7.27 ± 0.04)], expiratory time [(1.18 ± 0.12) s vs. (0.89 ± 0.11) s], inspiratory time [(0.79 ± 0.09) s vs. (0.39 ± 0.09) s], time to peak tidal expiratory flow [(0.41 ± 0.02) s vs. (0.21 ± 0.03) s] and the rate of successful weaning (96.67% vs. 78.67%) in the observation were significantly higher than those in the control group ( t = 13.287, 130.381, 9.231, 6.353, 9.793, 10.131, χ2 = 22.475, all P < 0.001). After treatment, PaCO 2 value [(39.76 ± 5.49) mmHg vs. (46.72 ± 7.51) mmHg], invasive ventilation time [(8.11 ± 3.21) d vs. (17.24 ± 4.52) d], intensive care unit stay [(15.03 ± 2.94) d vs. (21.94 ± 4.29) d], the proportion of children having ventilator-associated pneumonia (1.33% vs. 6.67%), the proportion of children having pulmonary hemorrhage (0.00% vs. 2.67%) and the proportion of children having pneumothorax (2.67% vs. 8.00%) in the observation group were significantly higher than those in the control group ( t = 14.798, 10.136, 9.962, χ2 = 5.556, 4.054, 4.225, all P < 0.05). Conclusion:Sequential mechanical ventilation based on pulmonary infection control window for the treatment of severe pneumonia complicated by respiratory failure in children can achieve good curative effects through greatly improving blood gas index and is highly safe.

BACKGROUND:Osteoblasts occupy an important role in osteogenesis, which mainly come from bone marrow mesenchymal cels, and some transcription factors or local factors may promote the osteogenic differentiation of bone marrow stromal cels.
OBJECTIVE: To study the role of Osx and Satb2 in C2C12cels in the repair process of osteoporosis.
METHODS: Twenty wild-type Sprague-Dawley rats were assigned into normal control group (n=10), sham group (n=5) and osteoporosis group (model group,n=5). Another 10 Osx-KO rats were enroled in the study. Osteoporosis models were established by removal of both ovaries in the model group and Osx-KO group. In the sham group, bilateral ovaries were exposed but not removed. Changes in body mass and femoral bone density were detected in the four groups post operation. C2C12 cels were culturedin vitro, and siRNA-Satb2 and siRNA-Osx were designed. Expressions of Osx and Satb2 and their effects on osteoporosis were observed using cel experiments, gene silencing and western blot assay.
RESULTS AND CONCLUSION:After 12 weeks, the body mass in the model and Osx-KO groups was significantly increased compared with the normal control and sham groups (P< 0.01); the bone density in the model and Osx-KO group was significantly decreased compared with the normal control and sham groups (P < 0.01). Satb2 and Osx were expressed in al the wild-type rats, but their expressions were decreased significantly in the Osx-KO rats (P < 0.001). Additionally, there was no difference in the Runx2 mRNA expression between the two kinds of rats. After silencing, the mRNA expressions of Satb2, Osx, Runx2 and ALP were al inhibited. These findings indicate that in the pathogenesis of osteoporosis, Osx and Satb2 may be protective molecules that have a regulatory role in the osteogenic differentiation, bone formation and repair.

OBJECTIVE To investigate the incidence rate of nasal septum fracture and it's influence on the effect of nasal bone reduction. METHODS Retrospective analysis of 212 cases of nasal fracture compared with nasal septum deviation were carried out. Among these cases 112 treated with nasal bone reduction only was called group A; the other cases were treated with nasal reduction concomitantly with septoplasty. Among them 58 cases were diagnosed with nasal septum fracture, it was called group B; 42 cases were diagnosed with nasal septum deviation, it was called group C. The postoperative nasal deformity rate was assessed, and the intraoperative findings of nasal septum contrast with preoperative CT diagnosis was analysed. RESULTS Three months after the operation, 27 cases (24.1%) of nasal deformity were found in group A; 9(9.0%) cases of nasal deformity were found in group B+C; septum fracture was found in 58 cases (100%) in group B and 30(71.8%) cases in group C introperatively. The diagnosis rate of nasal septum fracture by CT was 58.0%, while it's incidence rate was 88.0%. CONCLUSION More nasal septum fractures were observed introperatively than CT findings, and septoplasty concomitantly with nasal bone reduction can obviously reduce the rate of nasal deformity.

Objective To explore the MRI T 1WI features of the hyperacute intracerebral hematoma by super-low-field MR.Methods 160 patients with hyperacute intracerebral hematoma were examined by using MR unit of 0.04T magnetic(WDLMW-400) and PS3D T 1WI(TR=125 ms,TE=25 ms).Results Hematomas located in basal ganglia(140 cases),cerebral lobe(13 cases),cerebellum(5 cases) and brain stem ( 2 cases) respectively.All of the hyperacute hematomas showed short T 1 signal intensity in PS3D T 1WI;the mass effects and perihematoma edema also can be found in all of the 160 cases.Conclusion This study shows that the super-low-field MRI is superior to medium and high field MRI in diagnosis of hyperacute intracerebral hematoma.

OBJECTIVE: To report the experience of canalplasty in treatment of stenosis or atresia of the external auditory canal. METHOD: A retrospective review was performed on 10 patients (10 ears) that underwent canalplasty. The lesions located in bony segment in 1 case, cartilaginous segment in 3 cases, both in cartilaginous and bony segments in 6 cases, in which 4 cases accompanied with the middle ear diseases. All patients received the canalplasty surgery, and tympanoplasty was applied simultaneously if the patient had otitis media. RESULT: Follow-up was conducted for 8-50 months respectively, 8 of the external auditory canal was wide and tympanic membrane gained a good shape, 2 case had stenosis or atresia reoccurrence after the operation. CONCLUSION Appropriate approach and elimination of the lesions thoroughly are key points for the canalplasty.
Adult ; Aged ; Constriction, Pathologic ; surgery ; Ear Canal ; abnormalities ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Objective To investigate the effects of a recombinant antisense adeno virus for epidermal growth factor receptor (EGFR) combined with irradiation on b reast cancer cells.Methods Human EGFR cDNA fragment was subcloned in the oppos ite orientation to the cytomegaloviral promoter and inserted into a E1/E3-delet e d type 5 adenoviral vector to obtain AdE5 construct which expresses EGFR antisen se RNA. Combined with ?-ray irradiation, its effects on clonogenicity and cell cycle phase distribution were studied in a human breast cancer line MDA-MB-231 . Results EGFR protein expression was dramatically inhibited in MDA-MB-231 cell s after AdE5 infection. The post-irradiation clonogenicity was reduced by AdE5 in a viral and irradiation dose-dependent manner. Further cytometric analysis show e d that AdE5 infection at a?MOI of 300?pfu/cell induced a cell cycle progre ssion from radio-resistant G 0+G 1 phases to radiosensitive G 2+M phases, resultin g in a synergistic effect after combination of these two treatments. Conclusions The t ransduction of EGFR antisense RNA by adenoviral vector is effective for antisens e strategy targeting EGFR, and increases the cell-killing effect of ionizing radiation on breast cancer cells.

Objective To study the initial application of 3.0T high field intensity intraoperative magnetic resonance(iMR)for cranial tumors.Methods Forty-three patients with cranial tumors including 23 glioma cases,12 pituitary tumor cases,3 brain stem cavernous hemangioma cases,2 meningioma cases,2metastatic tumor cases,1 neurilemmoma case,received operation examined with GE Signa HDX 3.0T iMR system.The operation process and influence of iMR were reviewed.Results In 43 patients,average iMR examination was 1.3(1-3)times.In 16 patients the first iMR examination revealed tumor remnants,and in 13 of them continued surgical interventions and complete resection.The rate of complete resection was increased from 63％(27/43)to 93％(40/43).No complications related to iMR occurred.Conclusion 3.0T high field intensity iMR can provide accurate positioning and real-time navigation for the surgery,increase the rate of complete resection,improve the accuracy and safety of cranial tumor resection,and decrease complications.

BACKGROUND: Vascular restenosis alter carotid endarteractomy (CEA) is an important factor affecting curative affect ofoperation.OBJECTIVE: To explore the role of matrix metalloproteinase-9 (MMP-9) mRNA dynamic expression in the development of early vascular restenosis after carotid endarterectomy.DESIGN, TIME AND SETTING: A random grouping contrast observation was completed in the General Hospital of Beijing Military Area Command of Chinese PLA from February 2006 to December 2007. MATERIALS: Forty-one healthy male New Zealand rabbit, weighing about 3.0 kg, with 36 ones used for preparing carotid atherosclerotic stenosis (CASS) models. experimental group, each 6 of the CASS rabbit models (n =36) were selected at the time points of hour 4, day 1, 3, 7, 30, and 90 following CEA respectively. Then they were fixed with 40 g/L polyoxymethylene perfusion and stained with hematoxylin-eosin to observe their morphologic changes.MAIN OUTCOME MEASURES: The expression changes of MMP-9 mRNA were observed dudng the development of early vascular restenosis by the quantitative real-time polymerase chain reaction technique preoperatively as well as at day 1, 3 and 7 following CEA.RESULTS: Several stages could be seen in the reparative process of neointima after CEA, including the thrombosis, the inflammatory reaction, the repair of endothelium, the proliferation of vascular smooth muscle call, the formation and accumulation of extracellular matrix. MMP-9 mRNA was expressed since day 1, reached a peak at day 3 and then decreased significantly at day 7 postoperatively.CONCLUSION: MMP-9 plays an important role in the proliferation, migration and reconstruction of vascular smooth muscle calls, the mediated reconstruction of local blood vessels, as well as the development of vascular restenosis.

Objective For decreasing the infected rate,the prevention and cure methods of intracranial infections following posterior fossa craniotomy were study. Methods Twenty-eight patients with the intracranial infections following posterior fossa craniotomy were examined by lumbar puncture,and analyzed cerebrospinal fluid with routine examination and reference to the bacteriological data and drug sensitive tests. All the patients were treated with high dosage sensitive antibiotics, and draining continually the infected cerebrospinal fluid by lumbar puncture catheterization and injected small dosages of antibiotics into intraspinal for most cases. Results Twenty-eight patients had intracranial hypertension by lumbar puncture examination, outcome of cerebrospinal fluid culture indicated that 17 cases had bacteria growth and 11 cases had no bacteria. The intracranial infection was controlled effectively,and 96.4%(27 cases) were cured, 1 case dead of systemic failure. Conclusions Strict aseptic techniques,reduce operative time,decrease intracranial place of foreign matters, such as gelfoam, hemostatic gauze and artificial implants, could reduce the possibilities of intracranial infections. Appropriate antibiotics selection,lumbar puncture catheterization and intraspinal administration of antibiotics can cure intracranial infections effectively.

[Objective]The purpose of this study was to describe mid report the result of the ulnar nerve transfer to biceps muscle to restore elbow flexion after acute and delayed upper brachial plexus injuries.[Methods]Two patients with acute brachial plexus injury (the time between the injury and the operation were six and eight months) and three patients with delayed brachial plexus injury(the time between the injury and the operation were from twevle to eighteen months) underwent nerve transfer using fascicles of the ulnar nerve to the motor branch of the biceis muscle. The average age of the patients was twenty eight and the mean follow-up periods were nine months after the surgery. Patients were evaluated with regard to reinnervation of the biceps, ulnar nerve function, elbow flexion strength, and grip strength.[Results]For the two acute patients, the first sign of biceps muscle contraction were observed within 1 week, the average time required for reinnervation of the biceps after nerve fascicle transfer was within six months. For the three delayed patients, the first sign of bicep muscle contraction was observed in about three month, and the average time required for reinnervation of the biceps was ten months.Hypoesthesia of the ulnar nerve was clinically abserved in three patients, but this symptom disappeared within month with no treatment.Compared with those delayed cases, the acute patients had faster and better recovery of their olbow flexion function.However, all patients achieved grade-3 or better elbow flexion strength according to the grading system of the Medical Research Council.[Conclusion]The author recommend this safe, simple and effective Oberlin procedure for brachial plexus injuries involving the C5、6 or C5~7 nerve roots.