Objective To investigate the therapeutic effects of glucocorticoids(GC)on brain damage in rats with severe acute pancreatitis(SAP).Methods Thirty two rats were randomized into the normal control group(Group A),acute pancreatitis group(Group B),common carotid therapeutic group(Group C)and lateral ventricle therapeutic group(Group D).The rats in group C and D were respectively given methylprednisolone through common carotid artery and lateral ventricle. All rats were killed 24r h later to determine the weight of water content in the brain.The pancreatic and brain tissues were stained with HE.Meanwhile,the brain samples were immunohistochemically stained and the medulla sheath specially stained to determine TNF-α and IL-2.Histopathological scoring of pancreas and counting of leukocytes in the brain were conducted.Results Group A had no obvious pathologic changes.Group C and D had fewer TNF-α positive cells in the brain than Group B.IL-2 was negative in each group.Brain edema,leukocyte number and demylination of myelinated nerves in Group C and D were significantly different from those in Group B(P＜0.05).Conclusion Demylination of myelinated nerves is the characteristic change in SAP.Brain edema,leukocyte infiltration and nerve cell degeneration would happen as well.TNF-α plays an important role in the development of SAP.GC has effects on prevention and therapy of brain damage in rats with SAP.

Objective To study the feasibility of local resection for the tumor of the ampulla of Vater. Methods The result of 14 cases with carcinoma of the ampulla of Vater treated by local resection and 18 cases undergoing Whipple procedure in this hospital between 1988.5～1999.5 was analyzed. Results The postoperative morbidity for local resection was 7% and 39% for Whipple procedure respectively, P 0 05,and 5 year survival rate was 30% and 62% respectively, P

Objective To investigate the polymorphism of the vitamin D receptor(VDR)gene in relation to primary hyperparathyroidism(PHPT). Method Polymerase chain reaction and restriction analysis were used to determine VDR genotypes in 30 patients with PHPT and in normal subjects.ResultsThe frequency distribution of VDR genotypes in PHPT patients was 0 in BB,1(3.3%) in Bb, 29(96.7%) in bb; and in normal persons was 2(3.3%) in BB, 11(18.4%) in Bb, and 47(78.3%) in bb. There was a significant difference between PHPT patients and normal persons in distribution of BB, Bb, bb genotypes (P≤0.05).ConclusionsThere is some distribution alterations of VDR gene polymorphism in PHPT patients.

ObjectiveTo evaluate nonoperative management of adult blunt hepatic injury. MethodThe outcome of 132 cases with adult blunt hepatic trauma admitted in this hospital between Oct 1982 and Oct 2002 was analyzed. Thirty-four cases (25.8%) were treated by nonoperative management. Before 1995, only a portion of patients underwent CT scan and after 1995, diagnosis of liver injury was established by CT scan in all cases. ResultThe nonoperative management rate before 1995 was 16.7% (14/84) and after 1995, it was 41.7% (20/48)(P0.05). ConclusionWith the progress of image monitoring and life support system, some patients of blunt hepatic injury could be managed by conservation therapy.

Objective To summarize the experience on diagnosis and treatment of primary hyperparathyroidism(PHPT).Methods Clinical data of 91 PHPT patients treated in Beijing Jishuitan Hospital from November 1992 to December 2008 were analyzed retrospectively.Results Among 91 PHPT cases,88 were diagnosed as parathyroid adenoma(96.7%),3 were diagnosed as parathyroid carcinoma (3.3%).Serum calcium and PTH levels increased in all cases.Main clinical manifestations were osteodynia and kidney stones.The accuracy rate of preoperative B-ultrasound.CT and ECT~(99m)Tc-MIBI on location was 83.5%(76/91),60.9%(14/23)and 98.6%(69/70)respectively.Parathyroidectomy was performed in all but one cases,in which parathyroid carcinoma was managed by ipsilateral hemithyroidectomy and modified neck dissection.The cure rate of primary operation was 97.8%(89/91).Ninety cases were followed-up from 8 months to 14 years postoperatively,87 cases with parathyroid adenoma achieved complete remission,2 with parathyroid carcinoma suffered from tumor recurrence and 1 died.Conclusion Patients with chronic bone diseases,repeatedly recurrent nephrolithiasis,peptic ulcer disease should be a suspect of PHPT.The routine examinations of serum calcium and phosphorus are to be conducted.UItrasonography and ECT~(99m)Tc-MIBI should be considered as the methods of first choice for preoperative localization.

Objective To investigate the effect of delighted thinking on improving negative emotion of depression patients. Methods 100 depression patients were randomly divided into the observation group and the control group with 50 in each according to admission sequence. Both groups was executed antidepressionant drugs treatment and routine psychiatric care simultaneously. The observation group was given delighted thinking training on the basis of above treatment. The emotional recovery of two groups was observed. Results There was significant difference on facial expression, communication and limbs language after executing delighted thinking training in the observation group. And there was significant difference on scores of Hamilton depression rating scale (HAMD) at discharge. Scores of Nurses' Observation Scale during early, middle and late stage of delighted thinking training greatly improved compared with those before training. Conclusions Delighted thinking contributes to throw off negative thinking pattern of self-denial, stimulate positive passion threshold, improve depressed mood and raise treatment effect for depression patients.

Objective To analyse and explore the situation and causes of misdiagnosed primary hyperparathyroidism(PHPT),so as to develop some strategies for preventing and reducing misdiagnosis.Methods Clinical data of 94 misdiagnosed patients with PHPT treated in Beijing Jishuitan Hospital from November 1992 to April 2009 were collected and analyzed retrospectively.Results All cases were confirmed by operation and pathology.Among the 94 cases,90 cases were of parathyroid adenoma,and 4 cases of parathyroid carcinoma.The rate of misdiagnosis was 97.9%(94/96).The length of time of misdiagnosis was 2 months to 20 years;

Objective To explore the early diagnosis and optimum operative approach of traumatic diaphragma rupture (TDR) . Methods The clinical dada of 23 patients with TDR admitted to our hospital in recent 10 years were retrospectively analyzed. Results The diagnosis of TDR was made before operation in 12 cases1 (52.2%), and intraoperation in 8 (34.8), and misdiagnosed in 3 cases (13.1%). All the 23 patients underwent operation. Of the 23 patients, the operation was performed via thorax approach in 12 patients , via abdominal approach in 8, and via thorax-abdominal approach in 3. Hernation of the abdominal viscera into the thorax was observed in 18 cases, and single TDR in 5 cases.Empyema occurred after operation in 2 patients. 3 cases(13.1%) dead of hypovolemic shock and multiple organs failure. Conclusions The diagnosis of TDR may be difficult. The key of the diagnosis of TDR is to think of it. Once the diagnosis is made or suspected, the operation should be taken as early as possible. The choice of operative approach should be according to the injury mechanism and location; the choice of the operative procedure should be according to the intraoperative findings.

Objective: To investigate the level of injury first aid skills and its influencing factors among parents of preschool children in Dongxihu District, Wuhan City, so as to provide insights into carrying out targeted health education work. Methods: Parents of preschool children from kindergarten in Dongxihu District were selected using multi-stage stratified cluster sampling method. Basic information of preschool children, parents' demographic information, and parents' knowledge of injury first aid skills were collected through questionnaires. The level of injury first aid skills among parents was analyzed and its influencing factors were identified using a multivariable logistic regression model. Results: A total of 1 148 questionnaires were allocated and 1 131 valid questionnaires were recovered, with an effective recovery rate of 98.52%. The respondents included 242 men (21.40%) and 889 women (78.60%). The parents surveyed were mainly mothers, with 862 accounting for 76.22%. The level of injury first aid skills was 39.43%. Among the individual injury first aid skills, the proportions of mastering the treatment of cardiac arrest and arm fracture were relatively high, which were 94.69% and 94.16%, respectively, while the proportion of mastering the correct steps of cardiopulmonary resuscitation was the lowest, at 31.21%. Multivariable logistic regression analysis showed that the grade of children (middle class, OR=1.374, 95%CI: 1.021-1.847; senior class, OR=1.561, 95%CI: 1.147-2.125), age (30 to 34 years old, OR=1.712, 95%CI: 1.170-2.505), education level (high school/technical secondary school and below, OR=0.664, 95%CI: 0.515-0.857), and having learned injury first aid skills (OR=1.653, 95%CI: 1.284-2.129) were influencing factors of injury first aid skills among parents of preschool children. Conclusions The level of injury first aid skills among parents of preschool children is relatively low. The first aid ability of parents whose children are in small classes, older, less educated, and have not learned injury first aid skills should be specifically improved.

Objective To investigate the efficacy of combined monitoring of motor evoked potentials with transcranial electrical stimulation (TES-MEP),somatosensory evoked potentials (SEP) and spontaneous electromyo-graphy (s-EMG) in tuberculosis surgery involving the thoracic,lumbar and sacral vertebrae.Methods Twenty-seven patients with tuberculosis of the thoracic vertebrae (T2-L2) received intra-operative SEP and TES-MEP monito-ring.Combined SEP,TES-MEP and spontaneous EMG monitoring were employed in 11 patients with tuberculosis of the lumbar or/and sacral vertebrae (L3-S1).SEP and TES-MEP were used to precisely observe the status of the sen-sory and motor pathways; s-EMG responses were used to more accurately localize nerve root irritation.ResuIts (1) SEP monitoring was successful in all of the operations.TES-MEPs were successfully monitored in 35 of them (92.1％).Combined motor and sensory monitoring was successfully achieved in 35 cases (92.1％).Abnormal SEPs were observed in 3 cases (7.9％),while abnormal MEPs were observed in 11 cases (28.9％).Abnormality in both the SEP and TES-MEP occurred in 2 cases (5.3％).There were 9 cases (23.7％) where the SEPs were nor-mal and the TES-MEPs were abnormal.In only 1 case (2.6％) was the SEP normal and the MEP abnormal.The false negative rate was 0％ with combined SEP and TES-MEP monitoring,while the false positive rate was 5.3％.There were 2 cases complicated by post-operative neurological deficits.(2) Spontaneous EMG monitoring can accu-rately determine the functioning of lumbar nerve roots during lumbar or lumbosacral tuberculosis surgery.Among 5 cases where EMG responses were observed,4 cases occurred during the spinal canal and nerve root decompression,1 case occurred in the orthopedic reset phase.Conclusions (1) During tuberculosis surgery involving thoracic,lumbar or sacral vertebrae,combined monitoring of SEPs and TES-MEPs can reflect the physiological and pathological condition of the spinal cord after ruling out interfering factors.This can improve monitoring and help assure the safety of lumbar surgery.(2) Intra-operative s-EMG monitoring can accurately reveal nerve root function in real time,help-ing to avert nerve root injury in lumbar and lumbosacral tuberculosis surgery.