Objective To explore clinical and cytological features of CSF in meningeal carcinomatosis.Methods The data of clinic, imaging, and cerebrospinal fluid in 44 cases with meningeal carcinomatosis were analyzed retrospectively.Results 31 cases appeared headache or notalgia, 18 cases had cranial nerve lesions, 25 cases showed meningeal irritation sign. MRI enhancement scanning found abnormally diffused piamater enhancement in 3 cases. Cerebrospinal fluid pressure of 32 cases increased, cell population of CSF increased in 41 cases and the most cells were activated monocytes and lymphocytes. All the 44 cases found tumor cells in cytological examination of CSF. 5 cases were intracalvarial primartumors, and the others were metastatic tumors. Cytologic classification showed adenocarcinoma of 33 cases, malignant lymphoma of 3 cases, undifferentiated carcinoma of 2 cases and squamous cell carcinoma of 1 case. Conclusions The clinical manifestations and imaging results of meningeal carcinomatosis lack specificity, and cytological examination of CSF is a reliable diagnosing method for this disease.

Objective To study the HLA-DRB1 genotupe and their relation with OBI infection.Methods HLA-DRB1 genotyping was conducted in 102 patients OBI infection and 201 health controls,by using polymerase chain reaction sequence-based typing (PCR-SBT)method.The association between HLA-DRB1 genotype and OBI was also studied.Results Compared to 201 health controls,the allele frequency of HLA-DRB1 * 0405 (1.980 4％) (x2 =12.477 0,P =0.000 0,OR =16.367 3) * 0803 (4.257 3％) (x2 =30.689 8,P =0.000 0,OR =36.454 5)、* 1101 (5.545 9％) (x2 =4.471 2,P =0.034 5,OR =1.903 8)、* 1201 (1.481 6％) (x2 =8.591 9,P =0.003 4,OR =12.151 5) were markedly higher.The allele frequency of HLA-DRB1 * 0701(2.230 8％) (x2 =5.585 5,P=0.018 1,OR=0.417 7)、* 1301 (0.245 4％) (x2 =4.513 7,P=0.033 6,OR=0.147 4) 、* 1302(0.491 4％) (x2=11.369 1,P=0.000 7,OR=0.000 0) 、* 1312(0.245 4％) (x2 =5.0198,P=0.025 1,OR=0.136 5) 、* 1501(4.257 3％) (x2=10.763 1,P=0.001 0,OR=0.000 0)was obviously lower than than in HBV patients.Conclusion HLA-DRB1 * 0701、* 1301、* 1302、* 1312、* 1501 are closely related with susceptibility to OBI,and HLA-DRB1 * 0405、* 0803、* 1101、* 1201 is closely related with resistance to OBI.

OBJECTIVE:To explore the anti-shear force,stability and plasticity of reconstruction plate implantation,and to investigate its role in treating acetabular fractures complicated by free bone graft in the joint.METHODS:A computer-based online search of Science Direct and Ei databases (1960-01/2009-10) was performed for related English articles with the keywords of "acetabular fractures,modified ilioinguinal approach,reconstruction plate".In addition,CNKI and CBM database (1994-01/2009-10) were searched for related Chinese articles with the same key words in Chinese.Moreover,related works were manually searched.Studies regarding reconstruction plate implantation in treating acetabular fractures were included,including basic and clinical experiments.RESULTS:Acetabular top is weight loading region of human body,and the fracture should be reducted by the operation.Prior to reconstruction plate for acetabular fracture fixation,bone hook,and Kirschner wire can be used for temporary fixation,and the plate bending angle should be adjusted to accordant with lateral posterior wall or medial anterior wall of the acetabular top,followed by screw threading for fracture fixation.In addition,the screw entrance angle is very important.If the fixation of one plate is not satisfactory,one or two cancellous bone screw or Kirschner wire can be used to enhance the fixation.But the Kirschner wire tail should be bended to prevent dislocation into the pelvic cavity.Moreover,additional plate can be used for further fixation.Reconstruction plate fixation has advantages of anti-shear force,high stability and plasticity,which fully adapt the special appearance of acetabulum.Moreover,the incidence of postoperative plate loosening and breakage is low,and the satisfaction is high.Free bone blocks can be temporarily fixed by Kirschner wire,followed by reconstruction plate fixation.CONCLUSION:Reconstruction plate fixation has good clinical effect and few complications in treating acetabular fractures complicated by free bone blocks in the joint.

A method was developed for the determination of 54 volatile hydrocarbons in workplace air by thermal desorption/gas chromatography-hydrogen flame ionization detector. The workplace air was adsorbed by Tenax-TA thermal desorption tubes, then desorbed by thermal desorption and detected by gas chromatography. The experimental results indicated that the coefficients efficiency of 1,1-dichloroethylene, dichloromethane, trans-1,2-dichloroethylene, cis-1,2-dichloroethylene, 2,2-dichloropropane, bromochloromethane, 1,1,1-trichloroethane, 1,2-dichloroethane, 1,1-dichloropropene were 0.9941-0.9986. The detection limits of bromochloromethane, dibromomethane, trichloromethane, bromodichloromethane, 2,2-dichloropropane, dibromochloromethane, bromoform were 5.4-10.3 ng, the minimum detectable concentration was 0.01-0.1 mg/m~3 (the air volume=0.5 L). The coefficients efficiency of other 38 volatile hydrocarbons was above 0.999, the minimum detectable concentration were 0.001-0.01 mg/m~3. The detection limits of alkenes were 0.4-2.7 ng, alkanes 1.4-3.7 ng, aromatic hydrocarbons 0.2-1.0 ng and naphthalene 2.2 ng. The desorption efficiencies of 54 volatile hydrocarbons were 92.1%-113.1% and the relative standard deviations(RSDs) were 0.6%-17.4%. Except for the RSD values of cis-1,2-dichloroethylene, 1,1-dichloroethane, 1,1,1-trichloroethane, 1,1-dichloroethylene, 2,2-dichloropropane, trichloromethane, trans-1,2-dichloroethylene, dichloromethane, bromochloromethane were 5.1%-17.4%, those of other volatile hydrocarbons were below 5%;The experimental results indicated that the breakthrough capacities of 9 volatile hydrocarbons were 400-4000 ng, those of the other volatile hydrocarbons were above 10 μg. Except for the loss rates of 2,2-dichloropropane, bromodichloromethane were 10%-15% in stable experiment, those of other volatile hydrocarbons in Tenax desorption tubes were below 5%, which indicated that 54 volatile hydrocarbons stored in Tenax tubes were stable. The method is a quick and accurate for the detection of volatile hydrocarbons in workplace air.

Objective To investigate the efficacy of continuous veno-venuous hemodialysis/filtration(CVVHD/F) for the treatment of multiple organ dysfunction syndrome(MODS)caused by severe infection and to explore the mechanism in children.Method Nineteen cases of pediatric septic shock with MODS were treated with CVVHD/F in Children's Hospital Affiliated to Shanghai Jiaotong University from December 2002 to November 2007.The clinical data were studied including mortality rate,serum electrolytes,arterial partial pressure of oxygen (PO2),artery partial pressure of carbon dioxide(PCO2),FiO2/PO2,urine output,blood pressure,doses of vasoactive agents,Cr,BUN,etc.Results Cannulation and CVVHD/F were well performed in a total of 19 cases,with median age 33.4±36.5 months(from 3 months to 8 years) ,with their gender ratio of male(13 cases)to female (6 cases) to be 68.4% and 31.6%.The mean pediatric crifcal illness score(PCIS) was 69.1±10.4 and Median Pediatric Risk of Mortality score(PRMS Ⅲ)12.66±7.85,respectively.The duration of CWHD/F was 92 hours(ranged from 16 hours to480 hours).FiO2/PO2,PCO2,and PO2 were iraproved significantly after 12 to 24 hours CVVHD/F in patients with acute respiratory distress syndrome(ARDS) or lung edema (P<0.05).The concentrations of serum kalium,natrinm and HCO3- level resumed to well-balanced in 24 hours (P<0.05).The serum Cr and BUN were decreased to normal range(P<0.05).The mortality rate was 63.2%.Conclusions CVVHD/F was effective for treatment of septic shock with MODS in pediatric by improving oxygenation,maintaining normal serum electrolytes,conecting metabolic acidosis,increasing the tissue perfusion and eliminating the serum Cr and BUN.

Objective To explore small size toe tissue flap for aesthetic reconstruction of the thumb and / or finger. Methods Six kinds of small size toe tissue transplants had been applied in repairing skin-bone-joint composite tissue defects of the thumb or finger in 74 cases. Results Among 83reconstructed flaps of the 74 patients, 81 flaps survived completely. Follow-up examination made three to forty-eight months postoperatively showed that the outward appearance were excellent in most cases. The function of the thumbs or fingers were good. The donor feet can walk normally with no pain. Conclusion A variable combinations of toe tissues including skin, soft tissue, bone and joint can be harvested to form a lot of small size transplants for refined aesthetic reconstruction of thumb and finger. The functional and aesthetic results are good and the treatment course is shortened.

Objective To quantitatively analyze the image quality of megavoltage cone-beam CT (MVCBCT) under different scanning conditions to provide reference in clinical applications. Methods Si-emens ONCOR linear accelerator with MVCBCT was used to scan the phantom under different conditions. The image quality was evaluated in terms of image noise, uniformity, spatial resolution, contrast resolution, the number of Monitor Units(MUs) used in imaging,and the size of the reconstruction matrix. The comparison of the image quality between MVCBCT and conventional simulator CT was also analyzed. Results The image noise was decreased with the increase of the number of MUs. The uniformity index showed that the system u-niformity was weakly dependent on MU numbers or the size of the reconstruction matrix. Except for the ima-ges with 5 MUs,all other images had the spatial resolution of 0.4 lp/mm with a reconstruction matrix of 256 ×256. Better low contrast resolution was achieved by using more MUs. For typical pelvis and head-and-neck patients,the imaging dose at the center was 0.8 cGy/MU and 0.7 cGy/MU, respectively,and the maxi-mum dose was about 1.2 cGy/MU. For typical abdomen patients,the image maximum dose and center dose was 1.3 cGy/MU and 0.7 cGy/MU,respectively. Conclusions The image quality of MVCBCT is inferior to the conventional kilo-voltage CT. However,with the optimization of the parameters in imaging,we can a-chieve sufficient image contrast in the bone,air and some soft-tissue structures with low imaging dose to pa-tients. Such images can be used for IGRT.

Objective To describe the characteristics of and emergency treatment for and outcomes of critical ill children with 2009 influenza A caused by H1N1 virus strain. Method A prospective observational study of 3 pediatric patients with severe influenza A of H1N1 virus strain complicated with acute respiratory distress syndrome (ARDS) from November to December 2009. Results The H1N1 virus strain was confirmed by using realtime reverse transcription polymerase chain reaction (Real-time RT-PCR). Two patients survived and one died. Fever and cough were the onset symptoms. The systemic responses to influenza A at first were relatively mild. The tragic deterioration occurred all of a sudden with cyanosis all over the lips and dyspnea. The roentgenography showed bilateral multiple tabular pulmonary effusion and diffuse opaque shadows. The length of time required to confirm the diagnosis of ARDS from the symptom onset was 4 to 6 days. All patients were severely hypoxic with the ratio of PaO2 to 0.7-0.9 fraction of inspired oxygen (FiO2) to be 70- 100 mmHg at admission to PICU. In order to avoid injury to the lung, the protective ventilation strategy was carried out with low tidal volume (6 mL/kg) and adequate pressure,and conservative fluid management. Conclusions The H1N1 strain influenza virus A is characterized by pyrexia, cough and other respiratory symptoms in the early stage of critically ill children. In a few days, cough increased along with a sudden burst of cyanotic lips and shortness of breath, highly suggesting ARDS. Timely oxygen therapy and respiratory support, conservative fluid management, and the prophylaxis of secondary infection may be the essential measures. More clinical data are needed to clarify the critical features and to evaluate the emergency therapy for H1N1 influenza A in critically ill children.

OBJECTIVETo investigate the effect of topical propranolol gel on the levels of plasma vascular endothelial growth factor (VEGF), basic fibroblastic growth factor (bFGF) and matrix metalloproteinases-9 (MMP-9) in proliferating infantile hemangiomas (IHs) of superficial type.

METHODS33 consecutive children with superficial IHs were observed pre-treatment, 1 and 3 months after application of topical propranolol gel for the levels of plasma VEGF, MMP-9 and bFGF by enzyme-linked immunosorbent assay (ELISA) in Department of General Surgery of Dongfang Hospital from February 2013 to February 2014. The plasma results of IHs were compared with those of 30 healthy infants. The clinical efficacy in IHs was evaluated by Achauer system. Differences of plasma results between the healthy group and the IHs group pre-treatment were analyzed using Mann-Whitney U-test. Paired sample comparisons of any two time points of pre-treatment, 1 month and 3 months after treatment in IHs were evaluated by Wilcoxon signed-rank test.

RESULTSThe clinical efficiency of topical propranolol gel at 1, 3 months after application were 45.45%, 81.82% respectively. The levels of plasma VEGF and MMP-9 in patients pre- treatment were higher than those in healthy infants [(362.16 ± 27.29) pg/ml vs (85.63 ± 8.14) pg/ml, (1376.41 ± 42.15) pg/ml vs (687.27 ± 44.1) pg/ml, P < 0.05], but the level of bFGF did not show significant difference [(176.03 ± 13.60 ) pg/ml vs (235.94 ± 35.43 ) pg/ml, P > 0. 05 ]. The concentrations of VEGF and bFGF at 1, 3 months after treatment decreased obviously [(271.51 ± 18.59) pg/ml vs (362.16 ± 27.29 ) pg/ml, (135.85 ± 12.66) pg/ml vs (176.03 ± 13.60) pg/ml], 1 month after treatment vs pre-treatment, P < 0.05; (240.80 ± 19.89) pg/ml vs (362.16 ± 27.29) pg/ml, (107.31 ± 5.82) pg/ml vs (176.03 ± 13.60) pg/ml, 3 month after treatment vs pre-treatment, P < 0.05, whereas the levels of plasma MMP-9 declined slightly [(1321.18 ± 48.74) pg/ml vs (1376.41 ± 42.15 ) pg/ml, (1468.68 ± 32.78) pg/ml vs (1376.41 ± 42 2.15 ) pg/ml, P > 0.05 ].

CONCLUSIONSPropranolol gel may suppress the proliferation of superficial infantile bemangiomas by reducing VEGF and bFGF.

Administration, Topical ; Case-Control Studies ; Child ; Enzyme-Linked Immunosorbent Assay ; Fibroblast Growth Factor 2 ; blood ; Gels ; Hemangioma ; blood ; drug therapy ; Humans ; Infant ; Matrix Metalloproteinase 9 ; blood ; Propranolol ; pharmacology ; Time Factors ; Vascular Endothelial Growth Factor A ; blood