BACKGROUND: Intra-oral, extra-oral, and combination of intraoral and extra-oral incisions often use in mandibular angle contouring surgery. Minimally invasive incision at auriculocephalic sulcus in mandibular angle osteotomy is a new approach, but its report is rare. OBJECTIVE: To observe the anatomical structure of the mandibular angle and its related blood vessels and nerves, and to provide the anatomical basis for the minimally invasive incision at auriculocephalic sulcus in mandibular angle osteotomy. DESIGN, TIME AND SETTING: A single sample observational experiment was performed at Department of Anatomy in the Second Military Medical University from February to May in 2008. MATERIALS: A total of 15 adult skull specimens (30 laterals), including 11 female and 4 male, and 15 adult mandible (30 laterals) were used in the experiment. METHODS: Anatomical study was performed on 30 laterals of 15 skull specimens, observing distributions and arrangement of blood vessels and nerves as well as their position relation with mandibular angle. After sawing the mandible bones along mark lines, the distances from the mental foramen, mandibular foramen, and each section of mandibular canal to the edge, internal wall and external wall of the mandible bone were measured. The results were expressed as Mean?SD. MAIN OUTCOME MEASURES: The anatomical level, blood vessels, nerves and mandibular canals of mandibular angle region were observed. RESULTS: The distances from great auricular nerve, external jugular vein, cervical branch of facial nerve, facial artery and facial vein to the mandibular angle were (19.48?6.45), (13.84?3.78), (9.58?3.05), (22.62?7.16) and (20.08?6.45) mm, respectively. The distance from the location of marginal mandibular branch of facial nerve running out of the parotid gland to the mandibular angle was (7.79?2.57) mm. The distance from the location of mandibular canal at outer margin of third molar to the mandibular angle was (16.97?2.24) mm. CONCLUSION: The anatomical structure of the mandibular angle region is complex, and there are many important blood vessels and nerves. Minimally invasive incision at auriculocephalic sulcus is relatively safe in anatomy.

Mitochondria are involved not only in energy metabolism but also in free radical metabolism. Superoxide anion can be generated through a way of electron leak of respiratory chain and the reactive oxygen species (ROS ) can be formed in the further reactions of O2* in mitochondria. The role of mitochondria in anti-oxidant functions and cell apoptosis is discu ssed in terms of electron leak of respiratory chain, uncoupling of oxidative pho sphorelation, mitochondrial pore, Box- or/and PTP-mediated release of cytochro me c from mitochondria and so on. The signaling act of ROS is emphasized in the regulation of cell apoptosis.

Interference of P with determination of Ca in food and the effect of interference suppressing agents of La, Sr and 8-hydroxyquinoline were studied. The results showed that 1) interference of P with Ca related to P/Ca ratio, the relative absorbance of Ca were getting increase along with, the decrease of P/Ca ratio if P/Ca ratio about 0.6; 2) La was more effective than the other interference suppressing agents. The relative absorbance of calcium reached to about 90% when 0.5% or 1% La was used in the P/Ca ratio of 30; 3) Sr had two actions. On one hand Sr had some suppressing action on P interference, and on the other hand Sr depressed the Ca absorption signal obviously; and 4) 8-hydroxyqui-noline had some but not very effective interference suppressing action. The content of Ca determined in food SRM were lower than certified value using 0.1% 8-hydroxyquinoline as interference suppressing agent.

Objective The purpose of this study was to investigate the preparation of a pulmonary self-expanding valved stent and the percutaneous implantation of a valved stent in the pulmonary valve position without cardiopulmonary bypass.Methods A bovine jugular valve conduit was trimmed to remove the extraneous materials to reduce profile,and then was sutured onto nitinol stents to form a pulmonary self-expanding valved stent.In vitro,it was tested by a pulsatile mock loop system.Through a 24F delivery system,the valved stents were deployed in the pulmonary valve position of 8 pigs,and then in vivo assessment with echocardiography and a postmortem examination were carried out.Results The pulmonary self-expanding valved stent has an inner diameter of (21.9 ± 1.6) mm,an outer diameter of (24.6 ± 1.5 ) mm,a length of (27.9 ± 4.3 )mm,and an effective orifice area of ( 1.8 ±0.2) cm2.7 of the 8 valved stents were exactly deployed in the native pulmonary valve position,1 valved stent failed.The transvalvular pressure gradient was (7.9 ± 3.3 ) mm Hg by catheter measurement,(9.3 ±4.1 ) mm Hg by Doppler echocardiography.The angiography showed no migration,no regurgitation and no paravalvular leak.The echocartiography showed all the new valves opened and closed well with 2 cases of mild regurgitation.Postmortem examination confirmed the valved stent straddled the pulmonary annuli without migration,the native valve was locked between the stent and arterial wall.Conclusion The acute study demonstrates that the self-expanding valved stent can be successfully implanted in the pulmonary position by a catheter delivery system and function well.Percutaneous pulmonary valve implantation without cardiopulmonary bypass is feasible and has a wide clinical perspective.

Objective To retrospectively explore the incidence and causes of apnea after operation for retinopathy of prematurity(ROP). Methods The clinical data of 17 premature infants with operation for ROP(ROP group)and the other 23 premature infants without ROP(control group)were collected.The occurrence of apnea(time of onset and remission and original diseases) was recorded after operation in ROP group and at adjusted 37 weeks of gestational age in control group.Follow-up was conducted for 4 weeks,and the prevalences of apnea were compared between these two groups.Results There was significant difference in prevalenees of apnea between ROP group and control group ( 52.9%vs 21.7%,P<0.05).In ROP group,time of occurrence of apnea was (38±40)h after operation,and time of remission was (126±145)h after onset.Among the infants with apnea,there were 3 cases of pneumonia(33.3%),1 case of hypoglycemia(11.1%)and 5 cases with unexplained causes(55.5%). Conclusion Infants after operation for ROP are more prone to apnea,and pediatricians and ophthalmologists are required to collaborate in the perioperative care.

Objective To evaluate the method, clinical efficacy and safety of one phase treat-ment of renal calculi associated with pyonephrosis by percutaneous nephrolithotripsy(PCNL) by pneu-matic combined with ultrasonic lithotriptor. Methods Sixty-six cases of renal calculi accompanied with pyonephrosis were treated with PCNL. The renal calyx was punctured under ultrasound gui-dance, then the tract was dilated from F8 to F16 by peel-away vascular access sheathes. After the in-sertion of the flexible sheath, metallic dilator was inserted and the flexible sheath was pulled out. The tract was dilated by metallic sheath to F21 and the operation sheath and nephroseope were placed into working tract. EMS III LithoClast Master was used. Ultrasonic powered lithotriptor probe with suc-tion was used to clear the liquor puris and calculus fragments with low-pressure or no-pressure. The combined pneumatic and ultrasonic powered lithotriptor was used to break and clear the calculi. Re-salts Of the 66 cases, there was no bacteremia or pyaemia intraoperatively and postoperatively. And there was no other severe complication occurred intraoperatively. One phase PCNL was successfully completed in 60 cases. Other 4 cases had residual calculi less than 1.5 em in diameter and received ESWL to break the calculi, 2 cases had bigger residual calculi and accepted second PCNL 1 week after the first intervention. In the follow-up period, the 3 month post-operative serum Cr was 56-203 μmol/L with an average decrease of 40 μmol/L, GFR was 5.0-56.2 ml/min with an average increase of 23.6 ml/min compared with the pre-operative data. At 6 months postoperative serum Cr was 56-158 μmol/L with average decrease of 31 μmol/L, GFR was 5.0-79.2 ml/min with an average in-crease of 30.2 ml/min. Conclusion Application of PCNL in the treatment of patients with renal cal-culi accompanied with pyonephrosis is safe, cost-effective and clinically efficient by pneumatic com-bined with ultrasonic lithotriptor.

Objective To investigate the method of the resectoscope combined with ureteroscope in seeking for the difficult ureteral orifice in glandular cystitis, which improved the success rate of double J stent insertion under endoscopy.Methods The clinical data of 8 patients with dififcult ureteral oriifce in glandular cystitis from March 2015 to May 2016 were retrospectively analyzed. All male patients, their age ranged from 38 to 64 years old, the average age was 44.3 years. The depth of the submucosa and muscle layer of the bladder lesion was treated by transurethral resection. The necrotic tissue of ureteral oriifce was excised, which revealed the changing of muscular layer of texture. Then, resected the muscle tissue, urine was seen through the thin layer of muscle tissue. Under the guidance of the guide wire was inserted, the ureteroscope observation was confirmed ureteral lumen and the double J stent was placed.Results All patients were successfully placed double J stent. The mean operation time was 83.2 min (range, 35.0~205.0 min). Intraoperative blood loss was range 20~50 ml. The catheter was removed in 3~5 d. The abdominal plain iflm was reviewed in 1 - 2 days and the position of the double J stent was good, there was no ectopic, distortion and so on. There was no complications occurred during the perioperative period.Conclusions Resectoscope combine with ureteroscope in seeking for the dififcult ureteral oriifce in glandular cystitis is an effective way of increasing the successful rate of ifnding dififcult ureteral oriifce. This method is safe,minimally invasive and avoiding open surgery.

Objective To evaluate the impact of aderent perirenal fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN). Methods Clinical data of 52 patients who underwent RLPN for a small renal tumor from October 2013 to December 2015 was analyzed retrospectively. All the patients were divided into two groups according to the presence of APF by preoperative computed tomography imaging. Clinical data was collected including patients' age, gender, BMI, history of hypertension, history of diabetes, American Society of Anesthesiologists score (ASA), intra-abdominal fat (IAF), tumor size, RENAL Nephrometry score (RNS), operative time, warm ischaemia time (WIT), estimated blood loss (EBL), and length of hospital stay. Results Between the two groups, the BMI, tumor size, WIT, length of hospital stay were similar [(26.70 ± 3.33) kg/m2 vs (25.65 ± 4.01) kg/m2, (3.53 ± 1.21) cm vs (3.64 ± 1.05) cm, (27.17 ± 7.55) min vs (25.21 ± 5.64) min, (12.54 ± 4.06) d vs (10.61 ± 3.70) d, P > 0.05)], as well as the ASA and RNS. APF patients were older [(59.25 ± 11.03) y vs (49.71 ± 11.86) y, P = 0.004]. There were a high proportion of men (75.0% vs 46.4%, P = 0.036), patients with hypertension (62.5% vs 28.6%, P = 0.014), and patients with diabetes (41.7% vs 14.3%, P = 0.026). In the APF group, IAF was more [(2.02 ± 0.47) cm vs (1.35 ± 0.66) cm, P = 0.000], operative time was longer [(146.08 ± 45.45) min vs (119.32 ± 28.83) min, P = 0.017], and EBL was higher [(82.92 ± 45.73) ml vs (51.79 ± 25.10) ml, P = 0.005]. Conclusion The adherent preirenal fat sticking renal results in a longer operative time and a higher EBL, but has no influences on the WIT and length of hospital stay. APF makes it difficult to expose the tumor, not to remove it.

Objective To study the differences of clinical manifestations,etiology and hospitalized outcomes of purulent meningitis in preterm and term infants.Method All preterm and term infants with purulent meningitis hospitalized in the Hospital from 2006 to 2015 were enrolled in this study.The data of neonate's condition,maternal condition,clinical manifestations,complications,etiology,treatment and outcomes of the preterm and term infants groups were compared.Result During the study period,44 preterm infants and 118 term infants were included.The time of onset for purulent meningitis of preterm infants group was statistically earlier than that of term infants group [11.2 (3.2,19.8) d vs.14.3 (5.6,23.9) d,P ＜ 0.05].The prognosis of preterm infants group was statistically worse than that of term infants group (P ＜ 0.05).Among them,the incidences of clinical manifestations in preterm infants group compared to term infants group were:fever (54.5％ vs.78.8％),seizure (11.4％ vs.26.3％),lethargy and poor response (59.1％ vs.38.1％),slow weight gain (9.1％ vs.0％),apnea (45.5％ vs.0.8％) and cyanosis (15.9％ vs.4.2％);all the differences between two groups were significant (P ＜ 0.05).The time of onset for purulent meningitis with complications was statistically earlier than those without complications [9.5 (4.1,20.5) d vs.13.8 (5.9,22.0) d,P＜0.05].The duration of treatment for purulent meningitis with complications was longer than that without complications [(42.2 ± 8.8) d vs.(28.7 ± 7.1) d,P ＜ 0.05],and the positive rate of pathogens was also statistically higher than those without complications (73.8％ vs.26.7％,P ＜0.05).Coagulase-negative staphylococcus was the main pathogen for both preterm and term infants group.Klebsiella pneumoniae was more common in preterm infants group than in term infants group (40.0％ vs.10.4％,P ＜0.05).Conclusion Preterm infants with purulent meningitis had early onset time,atypical clinical manifestations,and poor prognosis.The treatment course for purulent meningitis with complications is prolonged.The pathogens for neonatal purulent meningitis have already changed.The detection rate of conditional pathogens is increasing yearly,for which the clinicians should take note seriously.

Objective To study the occurrence of nosocomial infection ( NI ) situation in the neonatal intensive care unit ( NICU ) of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2012 to October 2013,and analyze risk factors of NI. Methods A retrospective study was per-formed in the NICU,of which all neonates hospitalized over 48 hours were included and the occurrence situation and risk factors of NI were analyzed. Results This study included 1 357 neonates,and 175 neonates developed 202 times NI. The overall incidence of NI was 14. 89% (202/1 357),and the incidence density was 10. 44 per 1 000 NICU patient-days (202/19 355). The lower the birth weight is,or the smaller gestational age is,the higher the NI rate is. The NI rate was 75. 00% in neonates whose birth weight <1 000 g,and the NI rate was 52. 63%in neonates whose gestational age <30 weeks. The most common infection type was pneumonia[43. 07% (87/202)]and sepsis[26. 73% (54/202)]. The hospital stay of the NI neonates was longer and the cost of hospitali-zation is higher than non-NI neonates ( Median stay:20 days and 10 days. Median cost:21 045. 32 yuan and 8 108. 23 yuan)(both P<0. 01). Univariate analysis showed there were significant differences between NI neo-nates and non-NI neonates on gestational age,birth weight,5 min Apgar score,asphyxia rescue history,previons antibiotics use,mechanical ventilation,peripherelly inserted central catheter( PICC) ,closed thoracic drainage tube and chest or abdominal surgery before NI. The logistic regression analysis indicated that previous antibiotics use, mechanical ventilation and PICC were important risk factors for NI. Conclusion The NI rate in NICU is still high. Previous antibiotics use,mechanical ventilation and central venous catheter are risk factors of NI.