Objective To identify the factors enhancing the contusive brain hemorrhage following unilateral decompression craniectomy in patients with severe traumatic brain injury (TBI),and to explore the relationship between the initial Rotterdam CT score and clinical outcomes.Methods A prospective study of 291 consecutive patients with TBI admitted from Jan 2008 through Dec 2012 was carried out.Patients treated with unilateral decompression craniectomy were enrolled for study.Patients without preoperative or postoperative cranial CT imaging were excluded.Of them,235 patients were followed up.Gender,age,the causes of injury,preoperative general condition including Glasgow Coma Scale (GCS) score,pupillary response,laboratory data and the initial CT scans before operation,contusion hematoma size in CT scans following operation and Glasgow Outcome Scale (GOS) score were recorded.With t test,x2 test and nonparametric rank sum test,differences in the above listed variables were compared between patients with enlarged hematoma size group and those without change in hematoma size.A Classification And Regression Tree (CART) was used to predict the size of hematoma.Correlation analysis was used to find the relationship between the Rotterdam CT scores and GOS scores.Results The differences in age (t =2.034,P =0.043),first Rotterdam CT score (Z =4.838,P ＜ 0.01),GCS score (Z =4.440,P ＜ 0.01),pupillary response (Z =3.235,P =0.001),the length of time elapsed between the trauma occurred and the decompressive craniectomy (Z =3.874,P ＜ 0.01),glucose level (Z =3.880,P ＜ 0.01) and cerebrum hernia magnitude (Z =2.529,P =0.012) were significant between the patients with hematoma expanded (n =120) and those without change in hematoma size (n =115).The results of the CART indicated that Rotterdam score got from the initial head CT,glucose level and the length of time elapsed between trauma occurred and decompressive craniectomy were strong predictors of the risk for expanded hemorrhagic contusions following decompressive craniectomy.Both age and size of the removed bone-flap also could predict the risk of postoperative expansion of hemorrhagic contusions.The overall predictive accuracy of the CART model was 83.3％.Correlation analysis results indicated that Rotterdam CT score was negatively correlated with GOS (r =-0.333,P ＜ 0.01).Conclusions Initial Rotterdam CT scores,glucose level and the length of time between trauma and decompressive craniectomy may predict the risk of contusions expansion following decompressive craniectomy.Rotterdam CT score was negatively correlated with GOS.

Objective:To investigate the priorities of each factor influencing the casualties in refugees living in border areas, so as to provide evidence for casualty forecasting in the refugees. Methods: We summarized the factors affecting the refugee casualty in the border area through searching and reviewing the related literatures. The identified factors were classified into 3 levels and the quantitative index system was established by using Delphi method, i.e. expert consulting method. The names and the meanings of each index were revised according to experts’ suggestions after 3 rounds of consulting. The weights of each index were determined by analytic hierarchy process (AHP) and comparing-reordering method. Results: A 3-level quantitative system was successfully constructed, which consisted of 4 first level indices (including natural factors, social factors, medical factors, and war factors), 12 second level indices, and 37 third level indices; the weights of all indices were determined. Conclusion: The result of our study can be used in predicting refugee casualty and provide a reference for the medical service of refugees living in the border areas.

n clinic.

Objective To assess and delineate the dosimetric shortcomings of conventional radiotherapy planning,as compared with the three dimensional treatment planning system, and to obtain a better technique in the treatment of lung cancers.Methods Thirteen patients with stage ⅢA ⅢB non small cell lung cancer were chosen in the present study. Using the Cadplan 6.0.8 treatment planning system , three different methods of radiotherapy planning: conventional planning, conventional and conformal planning, and conformal planning were designed for each patient. The total radiation dose was 66 ?Gy and DVHs were used to assess the dosimetric distribution in the gross tumor volume and the surrounding organs at risk. Results No significant dosimetric disparity in the target volume was found among the three designs, according to anticipated therapeatic requirements. The conformity indices were 0.13,0.24 and 0.35 for these three radiotherapy designs. The mean lung volumes which received radiation dose of≥20?Gy were 32%,26% and 25%.The mean maximum dose at the spinal cord were 42?Gy,49?Gy and 33?Gy.The mean esophageal volume which received radiation of ≥50?Gy were 32%,34% and 22%, and the mean radiation dose to the heart were 18?Gy,15?Gy and 12?Gy,respectively. Conclusions Conventional radiotherapy planning is able to meet the demands of dosimetric requirements for radiation treatment of lung cancers. The three dimensional conformal radiation therapy planning system is able to provide superior delivery of high dose to the target volume without inflicting too high a risk to the surrounding normal tissues and organs.

Objective:To evaluate the effects of low dosage sufentanil used for blind nasotracheal intubation.Methods:Sixty cases for maxillofacial surgery were divided into 3 groups randomly with 20 in each group. Patients in groupⅠwere administered with fentanyl and midazolam by vein, those in groupⅡ with fentanyl and droperidol by vein,those in group Ⅲ with sufentanil at 0.1~0.2 ?g/kg. Intramuscular premedication of atropine-midazolam and blind nasotracheal intubation were performed in all cases after surface anesthesia for routine. Blood pressure(BP), heart rate (HR), mean artery pressure (MAP), blood oxygen saturation of pulse (SpO_2), intubation complication(IC), intubation achievement ratio(IAR), sedation score (Ramsay score), patient satisfaction(PS), and the incident rate of amnesia(IRA) in the three groups at T1 (before administering drug), T2 (after administering drug) and T3 (when tracheal tube was inserted into tracheal) were measured and observed. Results:In groups I and Ⅱ Ramsay score increased to 3～5, MAP and SpO_2 decreased (P0.05).Conclution:The low dose sufentanil can be applied for the sedation and analgesic before blind nasotracheal intubation.

Objective To evaluate the clinical efficacy and safety of insulin enteric-coated soft capsules in patients with type 2 diabetes mellitus. Methods Totally 260 patients were enrolled in this multi-center,randomized, open, parallel-controlled clinical trial. Patients were orally administered with the capsule (capsule group, n = 135) or subcutaneously injected with insulin (control group, n = 125)one hour before the breakfast and supper time for 12 weeks. Results In the capsule group, the glyeosylated hemoglobin A1 c (HbA1 c)and fasting/postprandial blood glucoses were significantly decreased. In terms of the proportions of subjects achieving HbA1c goals using American Diabetes Association standard (HbA1c ≤7.0%)and International Diabetes Federation standard (HbA1c≤6.5%), they were 38.9% and 21.4% in capsule group and were 45.1% and 30. 2% in control group (P = 0. 323; P = 0. 109). The incidences of adverse reactions were not significantly different between these two groups (P = 0. 618). The satisfaction score was significantly higher in capsule group than in control group (P = 0. 000). Conclusion The insulin enteric-coated soft capsule has similar effectiveness and safety with insulin injections, and meanwhile is more popular among subjects.

Objective To establish the methods of three-dimensional eonformal(3DCRT) and intensity-modulated radiotherapy(IMRT) for whole pelvic irradiation in post-hysterectomy cervical carcinoma, And to optimize the methods for clinical practice. Methods Between 2004 and 2005,10 patients with cervical carcinoma who underwent hysterectomy with high risk of recurrence were selected for this study. The following observations and measurements were used for the study: Set-up errors with supine or prone position were measured to determine appropriate immobilization position. Influence of full and empty bladder on irradiated normal tissue volume was measured. Treatment errors were detected and CTV/PTV were then delineated. 3DCRT and IMRT planning and comparison were applied. Results The set-up error was within 5 mm of three dimensions in prone position and more than 5 mm in supine position, the difference of which was statistically significant. The percentage of irradiated volume of the bladder and bowel was smaller when the bladder was full comparing with empty bladder. In prone position and with full bladder,portal films showed the movement of isocenter in three directions. The total uncertainty was [7.4±1.6]mm. For 95% confidence interval,the margin from CTV to PTV was 1 cm. CIPTV for 3,4,5,and 6 fields 3DCRT was 0.46,O. 67, O. 68, and O. 68, respectively. When beyond 4 fields, the advantage of adding fields was not significant.Four fields planning was feasible for clinical practice. CI for 5,7,9,11 ,and 13 fidds IMRT was 0.75,0.83, 0.84,0.85 ,and 0.85 ,respectively. When beyond 9 fields,the advantage of adding fields was not significant. Nine fields planning was feasible for clinical practice. Conclusions For whole pelvic radiotherapy for post-hysterectomy cervical carcinoma,prone position was better than supine position for immobilization due to smaller set-up errors. The full bladder is recommended during radiotherapy, planning,For clinical practice,4 fields planning is feasible in 3DCRT while 9 fields planning is feasible in IMRT.

Objective To explore the concept,denomination and technique of miniature tissue transplantation in hand clinic. Methods In 537 cases,local skin or composite tissue defect in 756 thumbs or fingers were repaired with 4 kinds of miniature island flap and 10 kinds of miniature vascularized composite tissue.Some of them were created in clinic practice.The precess,main points and indication of the operation were expounded and compared. Results In 639 fingers covered with miniature island flap,the transferred flaps were surviverd completely in 621 fingers(97.2%),survivered partly in 11 fingers(1.7%)and necrosised in 7 fingers(1%).In 117 fingers repaired with miniature vascularized composite tissue,all the transplanted tissues were survivered.In all the injuried fingers,beautiful outlook were recovered and no fat and clumsy were found,two-point difference was 6-8 mm,effctive sensibility and good function were restored,and all the patients were satisfied. Conclusion Miniature tissue transplantation were good methods to cover the local defect in fingers or thumbs,worth of generalization and aplication in hand clinic,and have an important significance for improve the trauma repair quality and treatment level in hand surgery.

OBJECTIVE: To investigate the alterations of bcl-2 gene family in the area of CA-3 in rats and the molecular mechanism of neuronal apoptosis following traumatic brain injury. METHODS: To investigate the alterations of bcl-2 gene family in the area of CA-3 in rats and the molecular mechanism of neuronal apoptosis following traumatic brain injury. RESULTS: The immunoreactivity of bcl-2 and bcl-x proteins decreased in the hippocampus ipsilateral impact site at 6 hours after injury, and this was the main cause of down-regulation of the value of (bcl-2+bcl-x)/ bax. During the period of 1-3 days after injury, bax protein expression increased significantly, while bcl-2 and bcl-x protein expressions decreased relatively slowly. The decreased value of (bcl-2+bcl-x)/ bax was mainly due to the bax up-regulation. CONCLUSIONS: The bcl-2 gene family is involved in neuronal apoptosis after traumatic brain injury, and the protein-expression alterations of the bcl-2 gene family members lead to apoptosis of the neuronal cells.

In this study, we evaluated the development potential of caprine mammary gland epithelial cells (CMGECs) after transfection and nuclear transfer into enucleated, ovulated oocytes. We first isolated CMGECs from udders of lactating goats which were transfected with expression plasmid for human lacterrin and selected by G418. Then we chose sixteen neomycin resistant lines and induced them with prolactin for the expression of human lactoferrin checked by Western blotting. The donor cells, expressing human lactoferrin of 75 kD, were fused and activated with enucleated ovulated oocytes. Pronuclear-stage reconstructed embryos were transferred into the oviducts of 16 recipient goats. There were fourteen (87.5%), thirteen (81.3%), and ten (62.5%) pregnancies confirmed pregnant by ultrasound on Day 30, 60, and 90, respectively. Three recipients carried the pregnancies to term and delivered one goat each. Nested PCR-RFLP analysis confirmed that all of the kids were clones of the donor cells. These results demonstrated that CMGECs after transfection remain totipotent for nuclear transfer.
Animals ; Cloning, Organism ; methods ; Epithelial Cells ; cytology ; Female ; Goats ; Humans ; Lactoferrin ; biosynthesis ; Mammary Glands, Animal ; cytology ; Nuclear Transfer Techniques ; Pregnancy ; Transfection