Objective To observe the clinical results that application improvement lumbar-puncture.Methods (1)Puncture point was always fixed;(2)To keep "perpendicular" concept,and emphasize the action coherent;(3)To reduce to cause the puncture-direction and puncture-point to be partial to move as far as possible of action;(4)To increment enters needle to the complement with "the feeling of obstruct",making the judgment standard by "end up in nothing feeling" not only;(5)To reduce anesthetic dosage.Results Among the 100 patients with the new method to be lumbar puncture,the success rate was 87%.Of the 100 patients with the traditional method,the number was 67%.Conclusion The method of the lumbar puncture techrique can raise success rate indeed,deserving expansion.

Objective To explore the reasons and the treatment counter-measures for secondary intracranial hemorrhage happens in the intracranial tumor craniotomy. Methods Retrospectively analyzed the clinical data of 15 patients with intracranial tumor who suffered secondary intracranial hemorrhage intraoperation. Summarized the tumor characteristics and the situation of corresponding vessels confined by second operation. Results In these 15 cases,the rank of course of disease was 6.5 months to 2 years, mean 1.2 years. The size of the tumor was big with diameter 4.62 ～5. 82cm,mean 5. 12cm,and the tumor was deep surrounding by large range edema,which led to intracranial hypertension. The emissary vein,bridging vein and cortical draining vein were considered as the corresponding vessels for ' secondary intracranial hemorrhage during the second operation carried out for all 15 cases. There wsa no death cases in this research and all patients recovered the nomal ability for self-caring after 3 months following up. Conclusion Sudden drawdown of intracranial pressure and perfusion pressure breakthrough of local vessels had relationship with secondary intracranial hemorrhage during craniotomy for intracranial tumor. Accurate judgement for the occurrence of secondary intracranial hemorrhage intra-operation and quickly taking the effective corresponding measures was the important strategy for prognosis improving for these patients.

Objective To explore hematoma piercing attract joint hematoma clearance to bone valves decompression technique in hematoma volume,skull,pressure high blood pressure brain hemorrhage treatment,and to further explore hypertension brain hemorrhage of reasonable surgery. Methods Hematoma in relatively large quantities of high intracranial pressure in hypertensive cerebral hemorrhage patients were randomly divided into experimental group and control group,and patients in the experimental group were implemented early hematoma puncture to attract a joint hematoma decompressive craniectomy treatment,and the control group were implemented the traditional hematoma de-compressive craniectomy treatment. The prognosis of the two groups were compared. Results The two groups were followed up for 6 months,and evaluated by ADL grade,between the two groups was statistically significant difference in ADL classification( P<0.01). Conclusion In the hematoma volume larger, high intracranial pressure in hypertensive cerebral hemorrhage in the surgical treatment of patients,the early line to attract a joint hematoma puncture decompressive craniectomy was a reasonable and feasible surgical method which can improve these patients prognosis.

Objective To discuss the diagnosis and treatment of superior sagittal sinus thrombosis.Methods The early diagnosis and treatment of superior sagittal sinus thrombosis was induced and summarizd,7 cases in our hospital treated from 2005.6 to 2008.9.were analyzed.Results In this investigation,3 cases were puerperal women,and the other 4 had no special medical history.Brain edema of difference degree was found in all cases on CT scans,including sulcus (7 cases),compression of cistern(5 cases) or even disappeared of cistern(2 cases).CT scanning also revealed dense triangle in 2 cases,multiple small encephalomalacia focus of frontal lobe lesions in 3 cases,and sub-arachnoid hemorrhage(SAH) in 2 cases.The digital subtraction angio-grapby(DSA) also was underwent,of 2 superior sagittal sinus not seen,of 4 appear unevenness,of 7 Arterio-venous circulation delayed and of 5 collateral circulation vasodilatation.After treatment,the clinical symptoms and signs of all patients were improved.All of them could be self-supporting.Followed up for 3 years,the mortality was 0,and no one cerebral hemorrhage again.Conclusion The early diagnosis and treatment of superior sagittal sinus thrombosis could reduce the morbidity and mortality, also could improve prognosis.Especially for the one without cerebral hemorrhage,using heparin at the beginning was an effective and safe way.

Objective To investigate the early diagnosis and treatment of pelvic fracture with vaginal injury.Methods From January 2000 to July 2010,13 patients suffered from pelvic fracture with vaginal injury were treated in our hospital,whose average age was 31.7 years.According to the Tile classification,there were 4 cases of type B1,1 case of type B2,4 cases of type B3,3 cases of type C1,and 1 case of type C2.Emergency repair of vagina together with open reduction and internal fixation of pelvic fracture was performed in 3 patients.After the patients' condition became stable,5 patients with shock were treated with emergency repair of vagina together with primary external fixation of pelvic fracture.Prompt repair of vagina together with open reduction and internal fixation or primary external fixation of pelvic fracture was performed in 2 patients who underwent delayed diagnosis.Two cases of extensive pelvic abscess due to missed diagnosis of vaginal laceration were treated with debridement and external fixation of pelvic fracture,and reconstructions of vagina were performed after infection control.Results Twelve patients survived,and 1 patient died 6 h after admission.Eleven patients were followed up for 8 to 36 months (average,17 months).Among 9 patients who underwent one-stage repair of vagina,5 married patients had normal sexual life,1 suffered from pain during sexual intercourse,and 3 unmarried patients had normal menses.Two patients who underwent second-stage reconstruction of vagina suffered from pain during sexual intercourse.At final follow-up,the mean Majeed score was 82.2 (range,56 to 96),and the results were excellent in 6 cases,good in 3 cases,fair in 2 cases.Conclusion Vaginal injury should be highly suspected in females with anterior pelvic ring fracture.Early diagnosis and repair of vaginal injury is crucial to good clinical outcomes.Delayed diagnosis and treatment may lead to severe complications.

Objective To investigate the effects of modafinil,a new wake-promoting agent,on simulated flight performance during 48 h sleep deprivation(SD).Method Six male healthy young volunteers were exposed to two periods of 48 h continuous wakefulness during the crossover experiment.In one period,three 200 mg doses of modafinil were given and in the other,separated by two weeks,matching placebos were administered.The SD time started from 8:00 of the first day to 8:00 of the third day.Drug was given at 0:00,16:00 of the second day and 0:00 of the third day.Flight performance in J7-E flight simulator was tested at 21:00 of the first day and 1,3,5,7 h after each drug administration.Result The scores of simulated flight performance in the placebo group decreased with time during SD and became significant at 1:00～7:00 of the third day.Numbers of errors increased with time during SD,especially in the left ascending turn stage and the descending & landing stages.Compared with the placebo,flight performance was significantly increased after the third administration of modafinil.Numbers of errors during 48 h SD and at 1:00～7:00 of the third day in modafinil group was 19% and 40% lower than those in placebo group respectively.Conclusion Simulated flight performance during 48 h SD is significantly improved after repeated administration of modafinil,especially when the impacts of SD and the circadian trough are combined.

Objective To investigate the effects of modafinil,a new wake-promoting agent, on vestibular function during 24 h sleep deprivation(SD). Method Eight male healthy young volunteers were exposed to two 24 h periods of continuous wakefulness during the crossover experiment. In one period, 200 mg doses of modafinil were given and in the other, separated by one week, matching placebos were administered. The SD time started from 8:00 of the first day to 8:00 of the second day. Drugs was given at 0:00 of the second day. Vestibular function was tested at 21:00 of the first day and 1 ,3,5,7 h after drug administration. Result The accuracy of saccade tracking and the gains of VVOR(visual-vestibular optokinetic reflex)and OKN(optokinetic nystagmus)in the placebo group decreased during 24 h SD, especially at 1: 00～5:00 of the second day, while OKN gains in the modafinil group was increased significantly. There were no significant differences of other vestibular function between modafinil group and placebo group. Conclusion Twenty four SD can influence vestibular function in certain degree,but optokinetic nystagmus can be improved by modafinil.

Objective To investigate the etiological characteristics of Streptococcus pyogenes that caused scarlet fever in different periods in Guangdong province.Methods 22 isolates from different periods were analyzed through emm typing,PCR detection for super antigen genes,antibiotic susceptibility test and pulsed-field gel electrophoresis (PFGE).Results All isolates were susceptible to cefotaxim,levofloxacin and penicillin.Streptococcus pyogenes isolated after the year 2000 were 100％ resistant to erythrocin and clindamycin,but the resistant rate for strains isolated before the year 2000 was 9.1％ (1/11).There were 3 emm types indentified from 22 isolates including emm12.0 (59.09％,13/22),emm6.0 (36.36％,8/22) and emm1.0 (4.55％,1/22),which were detected in the isolates from the year 1997 and 2011,from 1978 and 1986,and from 2008,respectively.The positive rates for speA,speB,speC,speF,speG,speH,smeZ,and ssa genes detected by PCR were 54.55％,100％,100％,100％,100％,54.55％,0％,and 86.36％ respectively.Among all strains,95.45％ of the isolates carried 6 superantigen genes simultaneously.Three clusters of 10 PFGE subtypes were identified in 22 isolates.Cluster Ⅰ consisted of all strains from 1997 and one strain from 2011.Cluster Ⅱ consisted of strains isolated from 1978 and 1986.Cluster Ⅲ consisted of nine strains from 2011 and one from 2008.Conclusion S.pyrogenes isolates in Guangdong province were susceptible to penicillin but resistant to erythrocin.emm 12.0 accounted for the majority of the three types and there was a high frequency of super antigen genes.

Objective To investigate the antimicrobial resistance pattern of non-typhoidal Salmonella isolated from diarrhea cases in Guangdong province,China.The multidrug-resistant strains were analyzed by pulsed field gel electrophoresis(PFGE) typing.Methods All the non-typhoidal Salmonella strains isolated between 2009 and 2011 were serotyped,then the antimicrobial resistance was detected by the disk diffusion method and molecular typed by PFGE.Results 91.76％ (256/279) S.typhimurium isolates were multiple resistant to 3 and more antimicrobials.Forty S.typhimurium isolates were multiple resistant to 9 and more antimicrobials and 3 out of which were multiple resistant to all the 12 antimicrobials in vitro.96.91％ (94/97) Salmonella I4,5,12:i:-isolates were multiple resistant to 3 and more antimicrobials.Nine Salmonella I4,5,12:i:- isolates were multiple resistant to 9 and more antimicrobials and I out of which was multiple resistant to all the 12 antimicrobials1 in vitro.47％ (47/100) S.enteritidis isolates were multiple resistant to 3 and more antimicrobials.Only 1 S.enteritidis isolates was multiple resistant to 9 and more antimicrobials.4.27％ (27/632) non-typhoidal Salmonella isolates was resistant to ciprofloxacin,including 17 S.typhimurium and 6 Salmonella 14,5,12:i:- isolates.Also,there were 3 1.96％ ( 202/632 ) non-typhoidal Salmonella isolates was intermediary to ciprofloxacin.The PFGE patterns of the predominant strains which were highly resistant and multidrug-resistant had different genotypes and demonstrated significant genetic diversity.Conclusion The situation about the multiple antimicrobial resistances of non-typhoidal Salmonella in Guangdong province has showed the prevalent problem.The PFGE types of the multiple drug-resistant strains prompted these strains were come from different clones.This requires that we continue to strengthen the resistance monitoring and control of the rational use of antibiotics.

Objective To explore the incidence and clinical significance of corona mortis vessels.Methods From December 2015 to December 2017,48 patients with pelvic acetabular fractures were treated with the Stoppa approach,including 36 males and 12 females,aged 30 to 67 years,with an average age of 47.2±8.2 years.There were 52 sides of hemipelvis in the all including 44 cases of unilateral pelvic acetabular fractures and 4 cases of bilateral pelvic acetabular fractures.In the 48 patients,there were 6 pelvic fractures,40 acetabular fractures and 2 pelvic combined with acetabular fractures.According to Judet-Letournel classification:there were 6 cases of anterior column fracture,4 cases of anterior column with anterior wall fracture,2 cases of anterior column with posterior transverse fracture,4 cases of transverse fracture,6 cases of "T" shape fracture and 20 cases of double column fracture.According to Tile classification,there were 2 cases of B1 type,2 cases of B3 type,2 cases of C1 type,and 2 cases of C2 type.The time from injury to surgery was 5 to 16 days,with an average of 8.3±2.8 days.All patients were treated with the Stoppa approach for reduction and fixation.The incidence,number and type of corona mortis vessels across the superior pubic branch,and the diameter and the distance between the vessels and the pubic symphysiswere detected and recorded.Results In the 52 hemi pelvis,there were 46 sides with an anastomotic blood vessel,and no anastomotic blood vessel was found in 6 sides,with the incidence of corona mortis vessels of 88.5％ (46/52).Among them,36 cases were venous type,with the incidence of 78.3％ (36/46);8 cases were arterial type,with the incidence of 17.4％ (8/46);2 cases were mixed type,with the incidence of 4.3％(2/46);corona mortis venous blood vessel diameter was 1.8-3.7 mm,with an average of 2.9±0.5 mm;arterial blood vessel diameter was 2.4-3.0 mm,with an average of 2.7±0.3 mm;the distance between the vessels and the pubic symphysis was 48-71 mm,with an average of 56.9±5.8 mm.Conclusion The corona mortis vessels are common,with the incidence through Stoppa approach about 88.5％.In the clinical treatment of pelvic acetabular fractures,we should pay attention to careful separation of pubic branches exposed by the Stoppa approach,especially when using ilioinguinal approach to avoid corona mortis vessels injury and haemorrhage.