Objective To evaluate the clinical value of fetal holoprosencephaly complicated with face malformation by two-dimensional(2D) and three-dimensional(3D) ultrasonography.Methods Fetal faces and brains were examined regularly with 3D ultrasonography when they were suspected abnormal with 2D ultrasonography and compaired the diagnoses with postnatal or induced delivery results.Results 11 cases of holoprosencephaly complicated with face malformation were diagnosed using 2D and 3D ultrasonography.Among these cases,there were 4 with single median mostril,2 with proboscis,2 with cheiloschisis,2 with multipte face malformation,1 with arhinia.They were all comfirmed by postnatal or induced delivery.Conclusions 3D ultrasonography provides visualized,three-dimensional,more precise and clearly fetal structure imagine.It has important supplement to 2D ultrasonography.2D ultrasonography combined with 3D ultrasonography can greatly enhance the diagnosis rate to holoprosencephaly complicated with face malformation.

Objective To find out the microalgae species in the spring water and the pollution route in the production process of drinking spring water. Methods 42 samples were collected from the workshop, the spring source, the product line and the repeated barrels in a water plant. The microalgae were examined by microscope, CCD imaging system and scanning electron microscope. Results 18 microalgae species were detected from the 42 samples including 4 species in Cyanophyta, 9 in Chlorophyta, 4 in Bacillariophyta and 1 in Euglenophyta. The dominant species occurred in samples of the floor around the workshop and the floor beside the wellspring bump were Achnanthes biasolettiana and Cymbella affinis, in the spring source were Chlamydomonas sp. and Ulothrix tenerrima, in the spring water barrel was Scenedesmus obliquus. Chlorella vulgaris was detected in all processes before the super-filter,and after filtered, no microalgae was detected, but in the product water, Chlorella vulgaris was still detected after enriched culture. Conclusion Usually, the microalgae polluted drinking spring water products is mainly Chlorella vulgaris and the pollution route is reusing of barrels.

Objective To develop a multiplex polymerase chain reaction (PCR )method for detecting and genotyping moxifloxacin-resistant Clostridium difficile (C.difficile)isolates.Methods Specific PCR primers of slpA genotypes gr,hr,fr,gc08 and 078 were designed according to the differences of slpA nucleotide sequences in different C.difficile genotypes,and the house-keeping gene tpi specific PCR primers were also added for the construction of multiplex PCR method.Nine common intestinal normal and pathogenic strains were used to verify the specificity of slpA multiplex PCR for the detection of C.difficile.Forty-six C.difficile reference strains,belonging to 11 slpA genotypes,were used to verify the ability of the multiplex PCR method for dectecting and genotyping.Thirty-nine moxifloxacin-resistant clinical isolates were genotyped by the multiplex PCR,and its clinical value was evaluated by comparing with slpA sequence typing (slpA ST)method.Results All the 9 intestinal normal and pathogenic strains were negative when detected by the multiplex PCR.And tpi of 46 C. difficile reference strains were positive,and 36 strains belonging to slpA genotypes gr,hr,fr,gc08 and 078 were genotyped correctly.Other 10 strains which belonged to other 6 genotypes were non-typeable. Among 39 moxifloxacin-resistant clinical isolates,all were positive of tpi,and 32 isolates were typed correctly by the multiplex PCR method,including 22 slpA genotypes gc08,6 genotypes hr,2 genotypes fr,and 2 genotypes 078,which were consistent with slpA ST.However,7 isolates could not be typed by multiplex PCR,which were identified as other genotypes not included in the multiplex PCR by slpA ST. Conclusions A convenient and rapid multiplex PCR method for the detection of C.difficile is established successfully,which can distinguish among five slpA genotypes.slpA genotype gc08 is the common genotype of moxifloxacin-resistant clinical isolates.

Objective:To explore the obliteration of the old mastoid cavity and reconstruction of the posterior canal wall after radical mastoidectomy. Method:Posterior canal wall reconstruction and mastoid obliteration of 11 ears of 10 patients with old mastoid cavity for 1 to 6 years after radical mastoidectomy were done using the pedicle postauricular composite skin flap (PPCSF),and their tympanoplasty were performed at the same time. Follow-up was performed at 3 to 30 months. Result:All PPCSFs survived. The old mastoid cavity of 11 ears vanished and reconstructed posterior canal wall remained in normal position without retraction. The drying ear time took 2 to 3 weeks postoperatively,and the symptoms of the radical cavity disease after radical mastoidectomy were cleared up nearly,and the average hearing threshold decreased 13.6 dB HL. The otorrhea and perforation of tympanic membrane resulted from infection happened to 1 of 11 ears three month after the operation. Conclusion: The PPCSF is an effective method in the obliteration of old mastoid cavity and reconstruction of the posterior canal wall. It can reduce drying ear time postoperatively, treat the radical cavity disease after radical mastoidectomy and is beneficial to the tympanoplasty at the posterior external at the same time.

Objective To investigate the influence of fixed nurse specialists triage to improve the quality of patient triage.Methods Nurses were divided into the fixed nurse specialist triage group (group A) and the out-patient department rotation nursing group (group B),respectively,each group was responsible for triage of patients in clinic of medical department for five days.Then the number of two subdiagnosis error and the average daily working overtime for doctors were compared.Results A total of 3806 patients were in clinic triage in group A,165 patients had triage error.A total of 3812 patients were in clinic triage in group B,308 patients had triage error.The average daily working overtime of doctors in group A was(5.24 ± 0.37)hours,and(8.16 ± 0.58) hours in group B.The errors in triage and working overtime of doctors had significant differences between two groups.Conclusions Fixed specialist nurse triage can significantly improve the quality of patient triage in clinic.

Objective To study CT and MRI findings of esthesioneuroblastoma.Methods Nine cases of esthesioneuroblastoma proved pathologically were presented.There were four male and five female,with mean age of 34.6 years.CT scan in four cases and MRI in seven cases were done and 2 cases had enhanced MRI.Results The location of lesions were in nasal cavity in 2 cases and in nasoethmoid region in 7 cases.Among nine cases,six cases were seen in the right side,and three cases in the left side.On CT and MRI,the lesion demonstrated a destructive solid mass,CT value ranged 29～36 HU.The lesions appeared as hamogeneous signal intensity which was higher than tongue muscle on T_1WI,and higher than grey matter on MRI T_2WI . Turbinal and ethmoid bony destruction were showed on all nine cases. The lesions invaded into opposite nose and ethmoid sinus in four cases,intruded into intracrainial cavity in eight cases, frontal sinus in six cases, orbit in eight cases in which two cases had eye protrusion, maxillary sinas in five cases and sphenoid sinus in five cases.Conclusion A esthesioneuroblastoma can be considered if a destructive solid mass occurs in nasal cavity and ethmoid sinus,with a middle signal intensity on T_2WI.

Objective To explore the causes of negtive results on emergency CT and prevent method in craniocerebral trauma.Methods 51 cases of craniocerebral trauma with negtive results on emergency CT were analyzed respectively during 2002 to 2004.Results The causes of negtive results on emergency CT in craniocerebral trauma were:the insufficient experience for technicians and doctors (12.8%);the atypical signs in early phase(48.6%);the delayed lesions after injury(16.2%) and the limitation of CT (24.2%).Conclusion CT technicians and doctors should be well trained primarily. Furthermore, CT images, clinical manifestations and other examinations should be combined with to obtain precise diagnosis. Finally, uncertaint cases should be examined again with CT or MRI.

Objective To investigate the effect of thrombin and hemoglobin on aquaporin (AQP) and the correlation between AQP and hydrocephalus.Methods Eighty-four clean grade healthy male SD rats were randomly divided into 3 groups:a control group,a thrombin group,and a hemoglobin group using the random number table method.A hydrocephalus model was induced by injecting isotonic saline (0.3 ml),thrombin (0.3 ml[10,U/ml]) and hemoglobin (0.3 ml[150 mg/ml]),respectively into the cisterna magna.According to the deficiency and complement way,each group maintained 24 rats.The relative area of the lateral ventricles,the expression of AQP1 and AQP4,and the correlation between AQP and the area of the lateral ventricles were observed at 1,3,7,and 14 d after molding.Results (1) Compared with the control group,both the thrombin group and hemoglobin group showed hydrocephalus at 1 ,3 ,7 and 14 d,and they were most obvious at 1 day (6.94±0.19% and 6.58±0.15% vs.3.40±0.13%,6.06±0.12% and 5.79±0.09% vs.3.55±0.15%,5.80±0.13% and 5.58±0.08% vs.3.78±0.18%,5.66±0.14% and 5.47±0.13% vs.3.52±0.18 %,respectively).There were significant differences (all P<0.01).(2) The increase of AQP1 was mainly in the basal membrane and apical membrane of ventricular choroid plexus epithelial cells,and the increase of AQP4 was mainly in the ependymal cell of ventricle.The relative expression levels of AQP1 and AQP4 at 1,3,7,and 14 d in the control group were 1.09±0.07 and 1.30±0.15,0.91±0.06 and 1.18±0.12,1.33±0.17 and 1.16±0.08,1.22±0.11 and 1.00±0.10,respectively;the thrombin group were 4.40±0.14 and 3.69±0.11,3.88±0.11 and 3.17±0.07,3.55±0.07 and 2.86±0.13,and 3.36±0.07 and 2.70±0.07,respectively,the hemoglobin group were 4.24±0.07 and 3.55±0.10,3.77±0.08 and 3.04±0.09,3.46±0.07 and 2.76±0.08,and 3.31±0.10 and 2.62±0.08,respectively;the relative expression levels of AQP1 and AQP4 of the thrombin group and hemoglobin group at each time point were significantly higher than those of the control group.There were significant differences among the groups (all P<0.01).There were no significant differences in the relative expression levels of AQP1 and AQP4 mRNAs in the hemoglobin group at each time point (P>0.05);in the thrombin group and hemoglobin group,compared with those at 1 d,the expression levels of AQP1 and AQP4 at 3,7,and 14 d were significantly decreased (all P<0.01);compared with those at 3 d,AQP1 was decreased significantly at 7 and 14 d (P<0.05).The differences were statistically significant (P<0.05).(3) The relative expression levels of AQP1 (r=0.983,P<0.01) and AQP4 (r=0.987,P<0.01) in the thrombin group at each time point were positively correlated with the contralateral ventricular area;and the relative expression levels of AQP1 (r=0.964,P<0.01) and AQP4 (r=0.962,P<0.01) in the hemoglobin group at each time point were positively correlated with the contralateral ventricular area Conclusions After injecting thrombin and hemoglobin into subarachnoid space,it could cause the increased expression levels of AQP1 and AQP4 of ventricles and their surrounding areas.Thrombin and hemoglobin may be the important mediating factors of hydrocephalus after subarachnoid hemorrhage.

OBJECTIVE To enhance the control and management of nosocomial infection in operating room in order to reduce nosocomial infection rate.METHODS We estabilished some effective sterilization and isolation measures and infection monitoring systems,strictly carried out sterile operation rule and created the qualified environment of operating room.RESULTS The nosocomial infection rate of cleaning wound was 0.25%,there was no specific nosocomial infection.CONCLUSIONS Strengthening management of nosocimial infection in operating room can effectively prevent it and reduce the infection rate of cleaning wound.

Objective To study effects of palm pressing peripherally inserted untral catheter(PICC) and mandible-pressing-on-shoulder on PICC′s misplacement in jugular veins during intubation. Methods Seventy-six patients undergoing intubation with PICC were randomized into observation group and control group equally by random digital table. The palm pressing PICC method was used in the observation group and the mandible-pressing-on-shoulder method was used in the control group. The two groups were compared in terms of the incidence of PICC misplacement. Result The misplacement rate of PICC in the experiment group was significantly lower than that in control group (P<0.01). Conclusion Palm pressing method is much effective in prevention of PICC misplacement in jugular veins and worth promoting especially in hospitals of basic level.