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-.

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.

10.3969/j.issn.1000-3606.2013.06.024

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 evaluate the accuracy of systolic pressure variation (SPV) in monitoring blood volume in patients.Methods Twenty-two ASA Ⅱ or Ⅲ patients (17 male,5 female),aged 49-79 yr,with body height 153-173 cm,weighing 55-89 kg,scheduled for elective coronary artery bypass grafting under cardiopulmonary bypass,were studied.Stroke volume variation (SVV) was monitored based on the arterial pressure wave and SPV measured based on the invasive arterial pressure wave after changing the title.After the chest was closed,the volume load test was immediately carried out.6％ hydroxyethyl starch 130/0.4 50-80 ml/min was infused via the jugular vein until cardiac index (CI) increased by 10％.HR,mean arterial pressure (MAP),SPV,CI,SVV,stroke volume index (SVI),systemic vascular resistance index (SVRI),central venous pressure (CVP),and pulmonary capillary wedge pressure (PCWP) were recorded in supine position (T1),at 30° head-down tilt before skin incision (T1'),before (T2) and after opening the chest in supine position (T2'),before (T3) and after the volume load test in supine position after closing the chest (T3'),in supine position after skin closure (T4),and at 30° head-down tilt after skin closure (T4').The difference in SPV and SVV (△SPV and △SVV) was calculated.The receiver operator characteristic curve for △SVV and △ SPV in determining blood volume changes was plotted.Results MAP,CVP,PCWP,CI,and SVRI were significantly increased,while SVV and SPV were decreased at T1' compared with those at T1 (P ＜ 0.05).HR was significantly increased,while CVP was decreased at T2' compared with those at T2 (P ＜ 0.05).MAP,CVP,PCWP,and CI were significantly increased,while SVV and SPV were decreased at T3' compared with those at T3 (P ＜ 0.05).MAP,CVP,and PCWP were significantly increased,while SVV and SPV were decreased at T4' compared with those at T4 (P ＜ 0.05).The area under receive operator characteristic curve for △SVV and △SPV in determining blood volume changes was 0.603 and 0.616 respectively,and there was no significant difference (P ＞ 0.05).Conclusion SPV can accurately monitor the blood volume in patients.

Objective To design Radio-Frequency Identification(RFID) reader with multi-antennas of different spatial location.Methods Design scheme of RFID reader with multi-antennas of difference spatial location was presented,i.e.a separated setting with a reader and multiple detected antennas was adopted.Each antenna only identified tags in its own area.The receiving information from tags contains antenna code and data in tag's IC.Hence the reader can point the tags position through different antenna code.Results The application of RFID with multi-antennas of different spatial location to management system of combat readiness medicine can provide safe,exact and real-time information collection,processing and query for combat readiness medicine.Conclusion The system can not only provide location identification,but also reduce system cost.It will have wide application in future.

【Objective】To observe the dynamic interference of cellular endotoxin specific receptors of Toll-like receptor 4(TLR4) mRNA and nuclear factor ?B p65(NF-?B p65) in rats with damp-heat syndrome of seasonal febrile disease by Ganlu Xiaodu Dan(GXD),and to explore the therapeutic mechanism of prescriptions with the actions of clearing heat and resolving dampness.【Methods】Wistar rats were randomized into 3 groups: A(normal control),B(models established by feeding of high-fat diet and colon bacillus under the high-temperature and high-humidity condition),and C(rat models treated with GXD).Reverse transcription-polymerase chain reaction(RT-PCR) analysis was used to detect the TLR4 mRNA level in hepatic macrophages and immunohistochemical method was used to detect the activation of NF-?B p65.【Results】The expression of TLR4 mRNA and NF-?B p65 was increased gradually in group B 6,12 and 24 hours after infection with colon bacillus,and the differences were significant,indicating that the expression of TLR4 mRNA and NF-?B p65 increased with the prolongation of disease course.In group C,TLR4 mRNA expression was decreased in different time points after infection,the difference of TLR4 mRNA expression 12 and 24 hours after infection was significant as compared with group B and group A(P

Objective To study the pathologic changes of hippocampus during the model development and explore the mechanism of epileptogenesis by observing the morphologic changes of hippocampal formation in rat of kainate-induced chronic temporal lobe epilepsy (TLE). Methods Thirty Wistar rats were injected of Kainic acid at dose of 2 ?g/20 ?l into the lateral cerebral ventricle under the guidence of stereotactic technique to make a epileptic focus, and subgrouped under acute phase, silent period and chronic phase. Another 10 rats received normal saline as controls. The rats were killed at 1 day, 15 day and 6 months after epileptic model establishment, and the hippocampus was taken out for HE staining, TUNEL staining, Timm’s staining, NSE staining. Results By cell counting, the neuron loss mainly occurred in acute phase, worst in CA3 and CA4, moderate in CA1 and CA2, and no loss in the dentate gyrus. The cell apoptosis in hippocampal structure was detected by TUNEL staining. Timm’s staining showed that mossy fiber began sprouting in silent period and increased continuously. Conclusion The morphologic changes of hippocampal formation in rat of kainate-induced TLE is mainly the neuron loss and the glia hyperplasy.

Objective The changes of CECs,EPCs and CPCs in the old type 2 diabetes mellitus retinopathy(DR)patients and the clinical purpose were discussed.Methods 30 cases of T2DM(including 10 DM cases without complications and 20 DM cases with retinopathy)and 10 cases of health controls were enrolled in this study.Results(1)The changes of CECs in DR Patients were significantly higher while the levels of EPCs and CPCs were significantly lower than those in the patients of the control group.(2)There were some corrlation beteen the level of CECs,EPCs and CPCs and the degree of diabetic retinopathy.(3)The serum EPCs levels in type 2 diabetics were negativey associated with body mass index,waist-hip ratio,abdominal circumference,FPG,triglyceride,UAER,creatinine.Conclusion The levels of EPCs and CPCs in T2DM-DR patients may be the important detected targets for early discovery and monitoring of DR.