Objective To compare the efficacy and safety of 7.2%hypertonic saline hydroxyethyl starch 200/0.5(HES) and 15% mannitol in the treatment of increased intracranial pressure( ICP) .Methods 112 neurosurgical patients at risk of increased ICP were randomized divided into 2 group to receive either HES or 15% mannitol at a defined infusion rate, which was stopped when ICP was<15 mmHg.Results Of the 112 patients, 58 patients received HES and 54 received mannitol 15%.In eight patients, ICP did not exceed 20 mmHg in treatment was not necessary.Both drugs decreased ICP below 15 mmHg (P<0.0001);HES within 6.0(1.2~15.0) min(all results are presented as median (minimum-maximum range) and mannitol within 8.7(4.2~19.9) min(P<0.0002).HES caused a greater decrease in ICP than mannitol (57% vs 48%; P<0.01).The cerebral perfusion pressure was increased from 60 (39~78) mmHg to 72 (54 ~85) mmHg by infusion with HES (P<0.0001) and from 61(47 ~71) mmHg to 70(50 ~79) mmHg with mannitol ( P <0.0001 ).The mean arterial pressure was increased by 3.7% during the infusion of HES but was not altered by mannitol.There were no clinically relevant effects on electrolyte concentrations and osmolarity in the blood.The mean effective dose to achieve an ICP below 15 mmHg was 1.4 (0.3~3.1) mL/kg for HES and 1.8(0.45~6.5) mL/kg for mannitol (P<0.05).Conclusion HES is more effective than mannitol 15% in the treatment of increased ICP.A dose of 1.4 mL/kg of HES can be recommended as effective and safe.The advantage of HES might be explained by local osmotic effects, because there are no clinically relevant differences in hemodynamic clinical chemistry parameters;efficacy.

Cellular immunotherapy such as that.initiated by dendritic cell (DC) is capable of eradicating cancer stem cells and restoring the homeostasis imbalance,and therefore has emerged as a promising approach to cure tumor.The first therapeutic DC vaccine in world has been approved by American FDA.However,the satisfactory therapeutic benefits of DC vaccine observed in vitro and in vivo (animal) studies could barely be recapitulated in clinical settings.The advantages of DC immunotherapy,achievements and challenges are introduced.

Objective To improve the recognition of abnormal image of soft tissue in cheeks. Methods Images of 47 cases with abnormal soft tissue in cheeks were retrospectively studied. Results (1) 15 cases were originated from soft tissue of the cheeks in which 8 cases were benign and 7 cases were malignant.6 cases were invaded by maxillofacial affection nearby,in which 1 case was benign and 5 cases were malignant.26 cases were involved by lesions of jaw bones,including benign tumor of jaw bones in 9, malignant tumor of jaw bones in 14 and chronic osteomyelitis of jaw bones in 3 and all had bony destruction; (2) According to originated position,21 cases were not originated from jaw bones,in which there were 5 cases (23.8%) with destruction of jaw bones;(3)In the 26 cases with abnormal soft tissue of cheeks originated from jaw bones, 9 were benign tumors in which all the soft tissue masses were mainly localized inside of the jaw bones, while 14 cases were malignant tumors in which all the soft-tissue masses were localized both inside and outside of the jaw bones. There was remarkable difference between the two groups(P=0.000).All 9 cases of benign tumors appeared as dilated destruction of jaw bones, while in the 14 cases of malignant tumors, 12 cases showed osteolytic bone destruction and the other 2 cases showed ossific bone destruction,there was significant difference between the two groups(P=0.000).Conclusion CT and MRI are of significance in judging original position, extent and differential diagnosis between benign and malignant lesions of abnormal soft tissue in cheeks.

The circadian levels of norepinephrine ( NE ) and dopamiae (DA) in the whole brain were determined spectrofluorometrically in control mice and in mice pretreated with ginseng saponin. All animals were adapted for a minimum period of 2 weeks to an environmental room equipped with, an automatically timed 12h-light and 12h-dark illumination cycle before experiment. Data obtained at 4 h intervals for 48h spans were analyzed by the mean cosinor method.It has been proved that the catecholamine concentrations in the brain vary diurnally. The whole brain NE and DA contents were highest during the middle of dark phase and decreased to a low levels after the onset of light phase. In administration of ginseng saponin altered the circadian pattern and ( or ) levels of brain catecholamine over controls. In order to check the above results reserpine was injected to mice. The levels of NE and DA remarkedly depleted at the times studied, and they showed a significant circadian rhythms as well.It seems that ginseng saponin selectively modulates the circadian variations of brain NE and DA, and its effects may be as a cosinor function of the time of day.

Objective:To evaluate the results of 25 cases of cervical spondylotic myelopathy treated by the bilateral backward displacement of lamina and expansion of the nerve root canalsince 1994. Method: Thepostopera tire and preoperative CT and MR imaging were used to compare the efficacy of backward displacement and decompression of the spinal cord. Result: According to the criteria for assessment set up by Dr Yin Huafu, the result was excellent in 13 cases, good in 8 and acceptable in 3; one case failed to get any improvement. Conclusion: This operation is a safe and an effective procedure for the treatment of the majority cases of cervical spondylotic myelopathy. In some cases this procedure should be done in combination with anterolateral decompression.

Objective To investigate the relationship between urolithiasis and vitamin D 3 as well as vitamin K 3. Methods 36 adult male SD rats were randomized to control group、stone forming group、vitamin D 3 group、vitamin D 3+stone forming group、vitamin K 3 group and vitamin K+stone forming group.OPN and its mRNA of kidneys were detected,and the crystal components in urine were determined. Results Vitamin D 3 and vitamin K 3 could enhance the expression of OPN mRNA in rat kidneys of stone models.Vitamin D 3 could increase the concentration of calcium in urine significantly.Vitamin K 3 could inhibit the excretion of oxalate in urine and also inhibits the deposition of oxalate crystals in kidney. Conclusions The results indicated that vitamin D 3 may promote stone formation via various mechanisms,whereas vitamin K 3 could inhibit this process.

Objective To evaluate feasibility and reliability of using Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)in predicting mortality in critically ill patients with neurological diseases.Methods All 653 patients hospitalized in neurological intensive care unit (N-ICU) from Jan 2005 to Dec 2007 were retrospectively studied.SAPSⅡ scores were scaled upon admission at 24,48 and 72 h,and possibility of hospital mortality (PHM) was calculated based on SAPS Ⅱ score.Neurological diseases diagnosis made initially at time of hospitalization was classified into five categories:intracranial hemorrhage,cerebral infarction,neurologic infection,neuromuscular diseases and other neurologic diseases.At each of four time points,the SAPSⅡscores were compared between the survival group and death group,and the relationship of SAPS Ⅱ score and prognosis were analyzed.The calibration of the SAPS Ⅱ were accessed with the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and the discrimination with area under the receiver operating characteristic curve (AUROC).Multivariate logistic regression was used to analyze the relationship between disease category and prognosis.Results SAPS Ⅱ scores in the death group (46.53±12.22,47.28±13.84,48.58±14.18 and 49.06±14.61)at each time point were significantly higher than those in the survival group (34.70±11.78,30.28±12.24,29.79±12.36 and 29.69±12.96;t=11.12,14.02,14.43 and 13.49 at 0,24,48 and 72 h,respectively,P＜0.01).Furthermore,univariate logistic regression analyses demonstrated that SAPS Ⅱ score was correlated with prognosis (OR=1.080,1.100,1.109,1.100 at 0,24,48 and 72 h,respectively,P＜0.01).The scores at 48 and 72 h were more accurate in predicting mortality.SAPS Ⅱ had good calibration at each time points (x2=5.305,7.557,6.369 and 8.540,P＞0.05),however,the consistency of expected mortality with observed mortality was satisfactory only at 48 and 72 h(82.6%,83.4%),so was the discrimination ( AUROC=0.825,0.847 respectively).There was no correlation between disease categories and outcome.Conclusion SAPS Ⅱ scoring,best evaluated at 48 and 72 h after hospitalization,can be used as a reliable predictor of probability of mortality in patients hospitalized in N-ICU and prediction can be applied in these patients with all different neurology diseases.

Objective To investigate the risk factors involved in the refractory pneumonia caused by multidrug resistant acinetobacter baumannii (MDRAb) in pediatric Intensive care unit (PICU).Methods From January 2009 to August 2011,115 patients with MDRAb pneumonia were treated in Department of Emergency,Wuhan Children's Hospital,Wuhan.Another 45 patients with negative MDRAb (NMDRAb)pneumonia served as control.The patients in the two goups were analyzed using univariate and multivariate Logistic regression to find out the risk factors for MDRAb infection.Results Among the 176 clinical strains of acinetobacter baumannii isolated,128 (72.73％) strains were MDRAb.After drug susceptibility tests,acinetobacter baumannii showed the rates of resistance to β-lactams antibiotics not including cefoperazone-sulbactam were more than 70％,and the rates of resistance to carbapenems antibiotics were higher than 90％.All rates of resistance to antibiotics of betalactams and carbapenems in MDRAb were higher than those in NMDRAb significantly.There were very low rates of drug-resistance found in Amikacin,Levofloxacin,Ciprofloxacin and Minocycline ( ＜20％ ).Multivariate logistic regression revealed that ICU stay,length of time for mechanical ventilation,anemia,hypoproteinemia and the use of carbapenems were independent risk factors involved in MDRAb pneumonia.Conclusions MDRAb was an important conditional pathogen with high rate of drug-resistance to many antibiotics leading to pneumonia in PICU.It increased the mortality of patients significantly.To control the infection of MDRAb was the key to increasing efficacy of treatment of pneumonia in PCIU.

Objective To study the pathogenic bacteria strains with drug-resistance prevailing in patients with ventilator-associated pneumonia(VAP)in Pediatric Intensive Care Unit(PICU)in order to provide a reasonable guidance to the clinical use of suitable antibiotics.Method A retrospective clinical study in 46 patients with VAP was carried out in PICU of Wuhan Children's Hospital between January 2008 and June 2010.The prevalent strains of the pathogenic bacteria with drug-resistance isolated from lower respiratory tract by aspiration were analyzed.Results In total,119 pathogenic microbial strains were isolated including Gram-negative bacilli(G-,65.55%),fungi(21.01%)and Gram-positive cocci(G+,13.45%).Among pathogens,the most common pathogenic strains were Acinetobacter baummannii, Escherichia coli,Klebsiella pneumoniae,candida albicans and coagulase-negative staphylococci.Antibiotic susceptibility tests indicated that the situation of the multiple drug-resistances to antibiotics found in G- and G+ Was serious. Most of G- were sensitive to ciprofloxacin, amikacin, imipenem, meropenem,cefoperazone-sulbaetam and piperacillin-tazobactam.The G+ cocci were 100% susceptibility to vancomycin, teicoplanin and linezolid.Fungi were almost sensitive to all the anti-funaus agents. Conclusions The oredominant oathogens of VAP were G- bacilli,and their multiple drug-resistances to antibiotics were the serious problems.The monitoring of the drugresistance should be emphasized, and the option of antibiotics should depend on the antibiotic sensitivity test.

Objective To evaluate the effects of Radix Astr agali combined with prednisone and i mmunosuppressant for primary nephrotic syndrome (PNS)in adults and to compare the effects o f Radix Astragali in various prepata tions for PNS.Methods Randomized controlled trials were a pplied for systemic reviews.Electr onic and manual retrieve of Medline,Embase,Cochrane Library,CBMdisc a nd CEBM/CCD and relevant medical jou rnals in China were applied to search the RCTs of Radix Astragali,non -specific treatment,glucocorticoids and i mmunosuppresants for PNS,and the RCTs were analysed with RevMan 4.1.Results There were 14randomized controlled trials with 524cases involved.Meta-analysis showed that Radix Astragali could in crease the therapeutic effect of pre dnisone and immunosuppressant for PNS and re-duce its recurrence.Radix Astragali also had an effect in decreasing 24-hour proteinuria content and the pla sma levels of total cholesterol and albumin.There were no differences between single injection and compound decoction.Asymmetry showed in"Funnel plot"may be related to publication bias,l ow quality of methodology and small -size in sample.Conclusion Radix Astragali and its prescriptio n may become a prospect therapy for PN S and its recurrence and the com-bination of traditional Chinese med icine and western medicine can be more effective for PNS.The dedinite effect of Radix Astragali for PNS will be further con firmed by multiple -center,large -s ample randomized controlled trial.