Objective To evaluate surgical performance of reconstruction of the cistern magna for the treatment of Chiari Ⅰ malformation associated with syringomyelia.Methods Suboccipital craniotomy and laminectomy of C1 segment were performed.The superior edge of bone window was limited to the inferior nuchal line.The dura mater and arachnoid were opened Y-shaped.The cerebellar tonsils were removed by electrocoagulation or subpially.A communication of cerebrospinal fluid between the fourth ventricle and subarachnoid space was achieved.The pseduomembrane,which is a very thin membrane over the opening of the central canal,should be cut away,with fascia grafting.Then a new enlarged cistern magna was established.Results The procedure was successfully completed in all the 36 patients with Chiari Ⅰ malformation and syringomyelia.The pseduomembrane was found in 30 patients.Postoperative follow-up checkups for 3 months ~ 5 years showed various degrees of recovery of sensation and muscle strength.Re-examinations with MRI revealed that the spinal cord cavity disappeared in 6 patients and decreased in size in 30 patients.Conclusions The decompression of the posterior cranial fossa,the communication of cerebrospinal fluid between the fourth ventricle and subarachnoid space,and the removal of pseduomembrane are key processes for treating Chiari Ⅰ malformation associated with syringomyelia.

Objective To study the mechanism and prevention for complications associated with postoperative T-Tube cholangiography.Method The study reviewed the data of six patients with complications following postoperative T-Tube cholangiography.Results Minor adverse reactions occurred in 4 cases, severe in 2.The severe reactions were related to cholangiovenous reflux resulted from the increase in intrabiliary pressure during postoperative T-Tube cholangiography.Conclusion Limitation of high intrabiliary pressure during the perfor mance of postoperative T-Tube cholangiography is the most important measure to prevent such reactions.

Objective To investigate the clinical efficacy of the titanium clip in endoscopic treatment of the transverse colon pol‐yps and discuss the incidence of postoperative complications .Methods A retrospective analysis of 47 patients with the diameter of the transverse colon polyps with the diameter of 1 .0 cm above for EMR treatment .47 patients divided into titanium clip group (EMR preoperative using the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution ,n=21) and no titanium clip group (EMR preoperative no using the titanium clip ,n=26) .Analysis one‐time complete resection ,intraoperative blood loss and the hemorrhage after 7 days of two groups .Results There were one‐time removal of the tumor in the titanium clip group ,and no one‐time removal of the tumor in the no titanium clip group due to the large blood loss with poor visibility ,three cases can not be a one‐time complete resection ,the two groups were significantly different (P< 0 .05);the average amount of bleeding (20 .0 ± 5 .6)mL in titanium clip group ,that was (80 .0 ± 8 .2)mL in the on titanium clip group ;compared with the two groups , there was statistically significant (P<0 .01) .There was not complication of hemorrhage after 7 days ,but three cases were that in no titanium clip group ,the difference was significant (P<0 .05) .Conclusion EMR preoperative use the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution in trement of benign tumor of the transverse colon ,which can signifi‐cantly improve the clinical efficacy of EM R technique ,and significantly reduced the intraoperative and postoperative bleeding occur‐rence ,thus it's worthy of promotion .

OBJECTIVE To explore the source resulting in nosocomial infection and main component elements managing and controlling nosocomial infection in order to enhance the administration of nosocomial infection and to raise proposition on standardized administration.METHODS Main component elements resulting in nosocomial infection were investigated by reviewing literature and clinical data,and analyzing hierarchy process of administration.RESULTS Emphasis on the administrative measures of main component elements resulting in nosocomial infection might achieve the aim of preventing and reducing nosocomial infection.CONCLUSIONS Reconstruction of administrative links on nosocomial infection can reduce medical risk and cost.

[Objective] To discuss the effect of intestine-dredging and Qi-benefiting method and its corresponding prescription in managing systemic inflammatory response and preventing multiple organ dysfunction syndrome (MODS). [Methods] Eighty. SD rats were randomized to control, model, low-dosage (LD) and high-dosage (HD) groups. One day before modeling, HD and LD groups were administered the preparation based on intestine-dredging and Qi-benefiting method by 60g/kg and 30 g/kg for 2 times, and control and model groups were given equal amounts of normal saline. On the 2nd day after the administration, 3 groups except the control group were modeled on the given reference. Twelve hours after modeling, the content of TNF-? and NO in serum was examined and histopathological examination of the main organs was conducted. [Results] Compared with the control group, the level of TNF-? and NO significantly increased (P

The wild type cells of human stomach glandular carcinoma, cell line BGC 823, were treated firstly by a chemical carcinogen (MNNG) for the induction of mutagenesis, then the cells were selected in medium with gradually increasing amount of 8-AG (8-azaguanine) from 1-20?g/ml. It was found that the mutant cells could grow vigorously in the medium containing 20?g/ml of 8-AG but not in HAT medium. The HGPRT assay showed an obvious quantitative difference between the wild type and HGPRT mutant cells of BGC 823.

Objective To explore the effectiveness of monitoring for developmental delay (DD) and the feasibility of firsthand data reporting among 0~3 years old children. Methods A study population consisted of a cluster sample of 20907 children aged 0~3 years, from 22 communities in 5 districts in Beijing, was monitored for 1 year using questionnaires and data reports. The results were compared against the non-project communities. Results The screening rate of DD was 62.18%, higher than the non-project groups, and the rate of 0 year old group was significantly higher than the other groups. 268 children were positive screening, referral of 253 children, the referral rate was 94.4%; 97 children were diagnosed as DD with the prevalence rate of 7.46 ‰; 43.28% of the children received intervention and rehabilitation training. Conclusion The surveillance means of DD for 0~3-year-old children are effective and the firsthand data report is feasible

Objective To determine relationships between daily activities measured as modified version of Pulmonary Functional status and Dyspnea Questionaire (PFSDQ-M) and functional capacity and symptoms experienced in patients with chronic obstructive pulmonary disease (COPD). Methods Convenience sample of 94 COPD patients with stable condition were assessed by interview with PFSDQ-M Chinese version and modified Medical Research council dyspnea scale (MMRC) respectively. Pulmonary function test (PFT) and 6-minute walking test (6MWT) were undergone on the same day or within one week as interview. PFSDQ-M has three subscales,i.e.,change experienced by patient with activities (CA),dyspnea with activities (DA) and fatigue with activities (FA). Results Scores of CA,DA and FA correlated to 6-minute walking distancer= (-0.37)- (-0.42),FEV_1 r=(-0.27)-(-0.32),FEV_1/FVC r= (-0.27)- (-0.32),dyspnea rated by MMRC (r=0.55-0.60) and BODE index (r=0.35-0.40),respectively (all P<0.01). dyspnea explained 26% of the variance in changes of activities. Conclusions Physical activities moderately changed in patients with stable COPD;Dyspnea is the best predictor of limitation of daily activities.

BACKGROUND: More and more researches prove that cell apoptosis could be induced by glutamine, also there are more researches on studying the indirect and direct nervous-protective effects of insulin, but the nervous-protective effects of insulin on impairment induced by glutamine, as well as its mechanism still need further investigation.OBJECTIVE: To investigate the nervous-protective effects of insulin on impairment induced by glutamine in PC12 cells, and to explore its molecular mechanism.DESIGN: A prospective controlled study based on cells.SETTING: Department of Neurology, Zhejiang Hospital; Department of Neurology of Sun Yat-wen University Hospital.MATERIALS: The study was carried out at the Laboratory of the Third Affiliated Hospital and the Experimental Animal Center of Sun Yat-sen University from March 2002 to March 2003. PC12 cells were purchased from the same animal center.METHODS: Traumatic models were made in PC 12 cells by treated with 0.5 mmol/L glutamine for 20 minutes, and the insulin of different concentration were used for protection, after 24 hours, protective effects of insulin were assessed with MTT method, Hoechst33258 fluorescence staining, DNA agar gelatin electrophoresis, meanwhile the expression of PKB/Akt protein were also detected./Akt protein in experimental group.RESULTS: The A value of50 mU/L, 100 mU/L, 200 mU/L, 400 mU/L insulin groups were 0. 214 ±0. 062, 0. 234 ±0. 067, 0. 260 ±0. 076 and 0. 265 ± 0. 069, respectively, but the value of single glutamine group was 0. 201 ± 0. 079, statistical analysis indicated that compared with single glutamine group, there were no significant difference in 50 mU/L, 100 mU/L insulin groups( P > 0.05), but 200 mU/L, 400 mU/L insulin groups were found statistically different from single glutamine group(t=-2.398,-2. 716, P < 0.05); "DNA Ladder" could not be observed in 400 mU/L insulin group by electrophoresis;It was proved that Insulin could enhance the expression of PKB/Akt protein.CONCLUSION: Insulin has nervous-protective effects on impairment induced by glutamine in PC12 cells, furthermore it also has property of anti-apoptosis, and its protective mechanism might be associated with enhancement of the expression of PKB/Akt protein.

Objective To retrospectively review the mortality and morbidity after orthopedic surgery for aged patients with reference to orthopedic version physiological and operative severity score for the enumeration of mortality and morbidity (O-POSSUM) and Portsmouth POSSUM (P-POSSUM) and validate the score' s accuracy in operative risk prediction.Methods O-POSSUM and P-POSSUM for mortality and morbidity were applied to 839 aged patients who had undergone orthopedic surgery between January 2008 and December 2011.Observed mortality and morbidity were compared with the expected values.Results O-POSSUM predicted 230 morbidities,but the observed value was 182 (x2 =2.718,P ＞ 0.05).O-POSSUM predicted 46 deaths,higher than the observed 3 deaths (x2 =38.870,P＜0.01).P-POSSUM predicted 16 deaths,higher than the observed 3 deaths (x2 =8.997,P ＜ 0.01).Conclusions O-POSSUM accurately predicts postoperative morbidity in aged orthopedic patients.However,O-POSSUM and P-POSSUM overpredicts the mortality and should be used with caution.