Objective To explore a new surgical approach for the renovation of laryngotracheal stenosis. Methods the anatomical structures of the anteroventral portion of the digastric muscle along with the blood supply, innervation and periosteal coverage of the mandibular were investigated by observing 23(46 sides) cadaver. Results The anteroventral portion of the digastric muscle rise from the fossae digastrica at the angle of 30.4°±3.5°. Its length was (4.8+0.7) cm and the periosteal coverage averaged (111.6+28.2) mm2. The puncta of rami digastricus stats (2.4+0.7) cm from the arteriae submentalis. Mylohyoid nerve together with rami digastricus enters the muscular tissue. Conclusion Designed with reference to sternocleidomastoid clavicular periosteal flap, the periosteal flap of the anterovent of the digastric muscle-mandible may offer a new way for largngotracheal renouation.

Objective To explore a new surgical approach for the renovation of laryngotracheal stenosis. Methods the anatomical structures of the anteroventral portion of the digastric muscle along with the blood supply, innervation and periosteal coverage of the mandibular were investigated by observing 23(46 sides) cadaver. Results The anteroventral portion of the digastric muscle rise from the fossae digastrica at the angle of 30.4°±3.5°. Its length was (4.8+0.7) cm and the periosteal coverage averaged (111.6+28.2) mm2. The puncta of rami digastricus stats (2.4+0.7) cm from the arteriae submentalis. Mylohyoid nerve together with rami digastricus enters the muscular tissue. Conclusion Designed with reference to sternocleidomastoid clavicular periosteal flap, the periosteal flap of the anterovent of the digastric muscle-mandible may offer a new way for largngotracheal renouation.

Objective To explore the feasibility and efficacy of posterior minimally invasive scoliosis surgery in Lenke 5C adolescent idiopathic scoliosis (AIS).Methods From November 2012 to March 2014,a total of 16 patients underwent posterior minimally invasive scoliosis surgery assisted by O-arm three-dimensional CT navigation were included.There were 14 female and 2 male,with an average age of (16.7± 1.6) years (ranged from 14 to 18 years).The mean Cobb angles of lumbar and thoracic curve were 48.7°±5.6°and 24.1°±5.4°,respectively.Results 16 patients were successfully completed the operation,the average operation time was (246±89) min,the average intraoperative blood loss was (192± 105) ml,and the fusion level was 4.9±0.5 on average.A total of 155 screws were inserted in the 16 patients,with a mean implant density of 98.9％±4.9％.All the patients were followed up for (26.4±3.9) months on average.The following radiographic parameters were evaluated before surgery,immediately after surgery and at the last follow-up:curve magnitude,apical vertebral translation (AVT),apical vertebral rotation (AVR),trunk shift,thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL) and sagittal vertical axis (SVA).The accuracy of pedicle screw placement was assessed according to postoperative CT scans.SRS-22 scores and complications were also recorded during the follow-up.Immediately after surgery,the correction rate of main lumbar curve was 80.1％±8.3％,and thoracic curve was 59.3％±8.7％,and a obvious improvement was noted in terms of AVT,AVR,trunk shift and TLK.At the last follow-up,except the increase of SVA from (-27.6± 19.5) mm to (-12.3±6.6) mm,no obvious changes of AVT,AVR,trunk shift,TK,TLK and LL were observed during the follow-up.According to CT evaluation,the satisfactory rate of pedicle screw placement was 94.2％,while the perforation rate was 5.8％ (9/155).Fusion across the facet joint were satisfactory.In SRS-22 assessment,the mean scores of functional,pain,self-image,mental state and satisfaction were (4.3 ± 0.5) points,(4.7 ± 0.6) points,(4.2 ± 0.7) points,(4.2 ± 0.5)points and (4.4 ± 0.6) points.No wound infection,implant failure and neurologic complications were found after surgery.Conclusion Wiltse approach assisted by O-arm three-dimensional CT navigation has the characteristics of small injury,less bleeding,high accuracy placement of pedicle screws and high self-satisfaction of patients.It is a feasible,safe and effective way to treat Lenke 5C AIS.

Objective To compare the short-term efficacies of laparoscopic intersphincteric resection (ISR) and laparotomy for ultra-low rectal cancers by Meta-analysis.Methods We searched case-control trials that compared clinical outcomes of laparoscopic ISR and laparotomy from PubMed, EMBase, Ovid, CNKI and Wanfang database.Relevant published and unpublished data and conference papers were also retrieved.Two reviewers independently assessed the qualities of the included studies.Meta-analysis was performed by using of RevMan5.2 software.Results A total of 5 trials with 552 cases were included.The results of Meta-analysis showed that in terms of blood loss of the operation [mean difference (MD) =-65.42, 95％ CI:-93.45--37.38, Z=4.57, P＜0.000 01], flatus passage time (MD=-0.96, 95％CI:-1.45--0.47, Z=3.83, P=0.000 1) and hospital stays (MD=-1.69,95％CI:-2.19--1.19, Z=6.63, P＜0.00001),laparoscopic ISR were significantly superior than those of laparotomy, with significant differences.In terms of operation time (MD =6.61,95 ％ CI:-21.29-34.51, Z =0.46, P =0.64), the positive rate of circumferential resection margin (OR =1.01, 95％ CI: 0.37-2.80, Z =0.02, P =0.98) and postoperative morbidity (0R=0.73, 95％ CI: 0.45-1.20, Z =1.23, P =0.22), there were no significant differences in the two groups.However, laparotomy may clean more numbers of lymph nodes than those of laparoscopic ISR (MD =-1.16, 95％CI:-2.14--0.18, Z =2.31, P =0.02), with significant difference.Conclusion The shortterm efficacy of laparoscopic ISR is superior than that of laparotomy in the treatment of ultra-low rectal cancer.

OBJECTIVE Toinvestigatetheantidepressantandantianxietyeffectofproanthocyani-dins(OPC)inchronicallystressedratsanditsunderlyingmechanism.METHODS Onemethodwas selected from 8 different stress methods each day,and the rats were treated with OPC (25,50 and 1 00 mg·kg -1 )1 h before the stress method.The chronically stressed model was established.After 21 d stress experi ment,the i mmobility ti me in force swi mming test,sucrose consu mption and the nu mber of marbles buried in the marble burying test were observed respectively each day.OPC (25,50 and 1 00 mg·kg -1 )was given 1 h before each test.In addition,Western blotting was used to analyze the expression of brain derived neurotrophic factor (BDNF) and phosphorylated cyclic AMP response element-bindingprotein(p-CREB)inthehippocampusandfrontalcortex.RESULTS Comparedwith the control group,the chronically stressed group showed obvious depressive-like and anxiety-like behav-ior,while the immobility time decreased from (90.57 ±4.27)s in chronically stressed group to (78.25 ± 2.53)s (P<0.05),(72.12 ±3.21 )s(P<0.05)and (60.77 ±3.41 )s (P<0.05)when ig given OPC 25,50 and 100 mg·kg -1 respectively,the ratio of sucrose preference increased from (42.80 ±4.92)%to (67.54 ±4.32)%(P<0.05)and (72.21 ±7.99)%(P<0.05)when ig given OPC 50 and 1 00 mg· kg -1 respectively,the number of buried marbles decreased from 1 .57 ±0.21 in chronically stressed group to 0.63 ±0.26 (P<0.05)and 0.44 ±0.1 8 (P<0.05)when ig given OPC 50 and 1 00 mg·kg -1 respectively.The expression of p-CREB in the hippocampus and frontal cortex distinctively increased in OPC group (25,50 and 100 mg·kg -1 )(P<0.05),so did the expression of BDNF in the hippocampus andfrontalcortexinOPCgroup(50and100mg·kg-1)(P<0.05).CONCLUSION OPCcanreverse the depressive-like and anxiety-like behavior in chronically stressed rats,which may be related to the cAMP-CREB-BDNF signal transduction cascades.

Objective To investigate the effects of controlled low central venous pressure (CLCVP) on cerebral oxygen metabolism during orthotopic liver transplantation (OLT),and study the safety of CLCVP in OLT.Method Forty-six patients subject to OLT were randomly divided into CLCVP group (CL group) and CVP group (C group).Blood samples were taken from radial artery and jugular simultaneously for blood gas analysis before operation (T1,baseline),immediately blocking inferior vena and portal vein (T2),30 min after anhepatic phase (T3),30 min after graft reperfusion (T4),2 h after graft reperfusion (T5),and 24 h after graft reperfusion (T6).Cerebral arterial oxygen content (CaO2),jugular oxygen content (CjvO2),cerebral arterial-venous oxygen content difference (Ca-jvO2),cerebral oxygen extraction rate (CERO2),and cerebral blood flow/ cerebral metabolic rate of oxygen (CBF/CMRO2) were calculated by the Fick formulae.Meanwhile,blood samples were taken from jugular simultaneously for serum creatinine (Cr) and urea nitrogen (BUN) a different time points.We also recorded the whole operation time,anhepatic phase time,volume of blood loss and transfusion,and urine volume.Results As compared with C group,CaO2,CjvO2,Ca-jvO2,SjvO2,CERO2 and CBF/CMRO2 in CL group were nearly not changed at different time pioints (P＞0.05),but in the same group,as compared with T1 and T2,the CaO2,CjvO2,Ca-jvO2 and CERO2 in T3,T4 and T5 were decreased significantly (P＜0.05),and the SjvO2 in T3,T4 and T5 was increased remarkably.The operation time and anhepatic phase time had no significant difference in both groups.As compared with C group,the volume of blood loss and transfusion in CL group were decreased (P＜0.05),and the urine volume in CL group CL was increased significantly (P＜0.05).Cr and BUN showed no significant difference in both groups and at the same time points of C group and CL group.Conclusion CLCVP can decrease volume of blood loss and transfusion,increase urine volume during OLT,and it does not change the cerebral oxygen metabolism during OLT.

Theexcretionofurinaryandplasmametabolitesofsalbutamolwasstudiedusingultrahigh performance liquid chromatography electrospray time-of-flight mass spectrometry, after a single intragastric gavaged dose administration with salbutamol. The software of Agilent MassHunter Metabolite ID was employed to find and identify the chemical structure of metabolites of salbutamol. Five metabolites from salbutamol were identified. Metabolites identified in swine urine included glucuronide conjugate salbutamol, N-oxide-salbutamol, hydroxyl-salbutamol, methoxyl-salbutamol and dehydrated hydroxyl-salbutamol. Whereas, only the parent drug, glucuronide conjugate salbutamol and dehydrated hydroxyl-salbutamol were observed in swine plasma.

Objective To detect the genomic copy number variations(CNVs) of mice embryonic neural tissue with neural tube defects (NTDs) induced by methotrexate (MTX),and investigate the molecular genetic mechanisms between folic acid metabolism disorders and NTDs pathogenesis.Methods C57BL/6J NTD mice model was induced by MTX on gestational day 7.5,and the maternal serum and NTD embryonic neural tissues were collected;the array-comparative genomic hybridization(array-CGH) assay was utilized to analyze the whole genomic CNVs in NTD embryonic neural tissues;reverse transcription polymerase chain reaction(RT-PCR) was used to confirm the positive results;the maternal serum concentrations of folic acid and related metabolites and dihydrofolate reductase (DHFR) activity were detected by liquid chromatography-tandem mass spectrometry and enzymatic methods,respectively.Results ArrayCGH and RT-PCR results showed the 3 high confidence CNVs on XqE3,XqA1.1-qA2 and XqA1.1 in the NTD embryonic neural tissues.The NTD maternal serum concentrations of 5-methyltetrahydrofolate,5-formyltetrahydrofolic acid,S-adenosyl methionine and DHFR activity were reduced significantly compared with the control group,and there were statistical differences(all P ＜0.05).Conclusions There are obvious CNVs in embryonic neural tissue of NTD mice induced by MTX and folic acid dysmetabolism might cause mice embryonic neural tube developmental disorders through CNVs.

Objective To investigate the clinical characteristics of the infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) for better prevention and treatment of CRPA infections. Methods A retrospective study was conducted to compare the features of CRPA infections (n=85) and carbapenem-susceptible P. aeruginosa (CSPA) infections (n=94) treated in Huashan Hospital from January 1, 2013 to December 31, 2013. Results? The?proportion?of?CRPA?infections?was?significantly?higher?than CSPA in Neurosurgery (40.0% versus 16.0%) and Intensive Care Unit (22.4%, 9.6%). Traumatic brain injury (30.6%) and vascular accidents (21.2%) were the main underlying diseases in CRPA patients, which was higher than in CSPA patients (11.7%and?8.5%,?respectively).?CRPA?infection?was?associated?with?significantly?higher?incidence?of?fever,?altered?mental?status,?and?severe hypoproteinemia than CSPA infection. Multiple bacterial infection was found in more CRPA patients (45.9%, 39/85) than in CSPA patients (24.5%, 23/94). Fewer CRPA patients showed positive treatment response (44.7%, 38/85) than CSPA patients (78.7%, 74/94). CRPA was associated with significantly more cases of disease progression (55.3%, 47/85) and more deaths (16.5%, 14/85) than CSPA (21.3% and 1.1%, respectively). Logistic regression analysis indicated that stay in Department of Neurosurgery, prior carbapenem use, peripherally inserted central catheter, nasal feeding, and mechanical ventilation were the risk factors for CRPA infection. Conclusions No specific clinical manifestation is associated with CRPA infection, which poses a therapeutic challenge and results in unfavorable prognosis. Rational use of antibacterial agents and appropriate supporting treatments are essential for control of CRPA in Huashan Hospital.