Advances in resuscitation and intensive care have led to high rates of survival among neonates with life -threatening conditions such as asphyxia,prematurity and congenital malformations.The sequelae of neurologic con-ditions arises in the neonatal period include lifelong disabilities such as cerebral palsy,epilepsy,intellectual and beha-vioral disabilities.There is an increasing demand for resource -intense strategies for acute neurological care within neo-natal intensive care unit.Neonatal neurocritical care is a multidisciplinary subspecialty that combines expertise in neo-natology,pediatric neurology,radiology,rehabilitation,surgery,and has led to improved outcomes in newborn that have critical illnesses.Neonatal neurocritical care focus the needs of the developing newborn brain,including attention to physiology to help prevent secondary brain injury,a protocol -driven approach for common conditions such as hypoxic -ischemic encephalopathy and seizures,education of specialized teams that use brain monitoring and imaging to evaluate the effect of critical illness on brain function.

Objective-To-explore-the-feasibility-and-safety-of-endoscopic-total-thyroidectomy-via-chest-wall-approach-.-Methods-Endoscopic-total-thyroidectomy-via-chest-wall-approach-was-performed-in-20-patients-with-nodular-goiter-from-January-2008-to-December-2012.Subcutaneous-operative-space-was-created-through-an-unilateral-areola-incision-,-through-which-laparoscope-and-surgical-instruments-were-introduced-.The-neck-suture-suspension-technique-was-used-to-reveal-the-thyroid-gland-.By-using-an-ultrasonic-scalpel-,-the-thyroid-was-separated-and-removed-completely-.-Results-All-the-operations-were-successfully-completed-without-conversions-to-open-surgery-.The-operation-time-was-90-180-min-(mean,-120-min).The-blood-loss-was-15-40-ml-(mean,-20-ml).The-postoperative-hospital-stay-ranged-from-4-to-7-days-(mean,-5.8-days).There-was-1-case-of-temporary-hoarseness.No-severe-hemorrhage-,-wound-infection-,-or-subcutaneous-effusion-was-found-.-Conclusion-Endoscopic-total-thyroidectomy-via-chest-wall-approach-is-a-safe-and-feasible-procedure-.

10.3969/j.issn.1000-3606.2013.06.024

Objective:To investigate the correlation between ankle-brachial index(ABI)and intracranial atherosclerosis in patients with ischemic stroke.MetlaTds:qhe ABI of 73 patients with ischemic stroke were detected using vascular Doppler ultrasound;head magnetic resonance angiography(MkA)was performed using a 1.5 T magnetic resonance imahing system,and the extent of intracranial artery stenosis was graded.The correlation between ABI and the grade of intracranial artery stenosis in patieras with ischemic stroke was analyzed.Results:The ABI in patients without intracranial artery stenosis(n=38)was significantly higher than those with intracranial artery stenosis(n=35)(0.975±0.114 vs 0.837±0.096,P<0.001).The ABI was significantly negatively correlated with the extent of intracranial artery stenosis(r=-0.736,P=0.001).Conclusions:The ABI was negatively correlated with the extent of intracranial artery stcnosis.It can he used as a preliminary screening means of intracranial atherosclerosis.

Objectives To examine the effects of enhanced external counterpulsation on arterial elasticity in stroke patients to provide clinical evidence for secondary prevention of patients with cerebral ischemic stroke. Methods Total 192 patients with ischemic stroke were enrolled and then divided into the EECP (n=107) and control (n=85) group. Auto-matic measurement synchronous atherosclerosis detector was use to measure brachial-ankle pulse wave velocity (BaP-WV) and cardio-ankle vascular index (CAVI). The difference of BaPWV and CAVI were evaluated before, at 36 hours and one month after EECP. Results The BaPWV and CAVI significantly decreased at 36 hours and 1 month after treat-ment in EECP groups compared to either pre-therapy or control groups (all P<0.05). Conclusions EECP can signifi-cantly reduce the BaPWV and CAVI and improve the arterial elasticity in patients with cerebral ischemic stroke. Thus, arterial elasticity may be an important index to evaluate the effects of EECP on cerebral ischemic stroke.

Objective To investigate changes of family parenting styles after the reforn and opening in China and its influence on mental health.Methods On the base of stratified convenience sampling,a valid sample of 429 were recruited from Wuxi and Hefei city residents:1960s group 103 persons,1970s group 107 persons,1980s group 116 persons,and 1990s group 103 persons.Subjects' childhood parenting styles were surveyed with the family upbringing style questionnaire(FUSQ) and their current mental health status was rated with the psychological symptom inventory-100 (PSI-100).Results (1) Except understanding-blame,and expects-demanding,and mother respect-humiliation and mother warmth-wildness,there were significant age differences on other parenting styles (P＜ 0.05),their scores were gradually increased from 1960s group ((38.29± 6.30)-(44.99± 7.36)) to 1980s group ((40.96±6.05)-(48.53±7.91)),1990s group declined((40.13±7.27)-(46.97±6.61)).(2) Most parenting style dimensions were significantly negatively correlated with symptom total score (r=0.095-0.308) and mental symptom scores (r=0.090-0.330).(3) The family parenting styles had significantly effects on the symptom total score (explained variance of 20.3％) and mental symptom scores (explained variance of 12.4％-21.5％).Conclusion There have been some positive,open and scientific changes on the family parenting styles after the reform and opening in China,childhood family parenting styles have long-term effects on mental health of youth and adult.

Cartoons were used in teaching of medical decision-making analysis course to analyze and reveal the connotations in different decision-making models according the difficulties of students in understanding the teaching decision-making models.The cartoons could effectively improve the understanding of abstract analysis model and the meaning of teaching analysis model in students because they could directly show the iterative and optimizing computation process in decision-making analysis, thus laying a solid foundation for the accurate analysis and ra-tional explanation of the results.Teachers should make full use of the visual cognition potential of students, and fo-cus their attention on the knowledge transmission and information exchange between teachers and students when they design the cartoons in order to improve the classroom teaching effect of teaching decision-making model.

Objective To establish normal reference interval for four items of blood coagulation on ACL‐TOP Automatic coagu‐lation analyzer .Methods The fasting anti‐coagulation blood samples were collected from 1 268 inpatients and people conducted physical examination ,all subjects without liver disease ,history of blood disease and coagulation disfunction .The prothrombin time (PT) ,activated partical prothrombin time(APTT) ,thrombin time(TT) and serum levels of fibrinogen(FIB) were determined by u‐sing ACL‐TOP automatic coagulation analyzer which was producted by America IL company .And data of determination results were used to establish the normal reference intervals of indexes in this laboratory .Results The precision and accuracy of this analy‐zer was good .There were differences of normal reference intervals between which established in this laboratory and which provided by the manufacturer .Conclusion Each laboratory should establish its own normal reference interval ,not blindly refer to reference interval provided by regents manual .

Objective To determine the incidence, clinical manifestation and risk factors of immune reconstitution inflammatory syndromes (IRIS) in highly active antirctroviral therapy (HAART) for HIV/AIDS patients. Methods Two hundred and twelve HIV/AIDS patients received HAART, and were followed up for 6 months. The incidence time and disease spectrum of IRIS were observed. Multiple logistic regression analysis was performed to identify the risk factors for IRIS. Results Among 212 patients, there were 59 (27.8%) experienced an IRIS event during the first 6 months of HAART, 2 of which died (2/59,3.39% ). Median time of IRIS onset was 21 days form HAART initiation. The disease spectrum included tuberculosis, herpes virus infections, pneumocystis jirovecii pneumonia, cryptococcal meningitis and penicillium marneffei infection. Risk factors of IRIS included baseline infections ( OR = 1. 655, P =0.010),fever during HAART ( OR = 2. 344, P= 0.006), and baseline CD4 + count ( OR = 1. 556, P = 0. 034).Conclusions IRIS usually occurred within the first month from HAART initiation, and tuberculosis and herpes virus infection are most common. The occurrence of IRIS is associated with the antigens burden and the decreased baseline CD4 + count.

Objective To investigate the clinical efficacy of new-type patent endotracheal tube in difficult endotrachea intubation patients.Methods Seventy-three patients with the abnormal airways were selected as our subjects.Patients were given the traditional endotracheal tube by mouth after anesthesia.The successes patients in terms of endotracheal intubation were as group Ⅰ (n =73).The failed patients were asgroup Ⅱ (n =63),who performed the secondary endotracheal intubation with new type patent endotracheal tube.Analyze the success rate of intubation of the two groups when on use the tube core.Results The first time intubation success rate and intubation success rate was (2.7％ (2/73),13.7％ (10/73) respectively) in Ⅰ group,and 73.02％ (46/63) and 98.41％ (62/63) respectively in the group Ⅱ,and there was the significant difference between two groups (x2 =36.01,31.08 respectively,P ＜ 0.01).Conclusion The new type endotracheal tube was proved with three advamage of good plasticity,without need of auxiliary core intubation with trachealtube and give full play to lead the soft cannula guide tubes leading role.Therefore,the new type patent endotracheal tube has more efficacy over traditional tube.