The chance of craniocerebral injury in children is high.Severe craniocerebral injury is still the difficult point in current clinical treatment.Children severe head trauma is different from adults.It is characteristic of severe primary injury,rapid progressing secondary injury,confusing vital signs,less contrecoup injury,high incidence of epilepsy,cerebral ischemia in familiar,and good prognosis.This article focused on 2 hot issues in recent therapeutic strategy of severe craniocerebral injury in children——intracranial pressure monitoring and hypothermia therapy.The former is simple,convenient,safe and practical,is worth popularizing widely.

Objective To explore the distribution of alkane, alcohol and ketone in indoor air of some apartments in Hangzhou. Methods 55 air samples were randomly collected from 31 apartments in Hangzhou by Carbotrap 300 air-sampling tube, during October-December, 2002, and April-May, 2003, then the volatile organic compounds in air samples were determined by heat-desorption GC-MS. Results 41 kinds of alkane, 11 kinds of alcohol and 9 kinds of ketone were found in air samples collected from 31 apartments in Hangzhou, average concentration of total alkane was 24.096 7 ?g/m3, average concentration of total alcohol was 3.670 7 ?g/m3, and average concentration of total ketone was 33.492 4 ?g/m3 respectively. The dominant indoor air pollutants were hexane, heptane, octane, nonane, decane, undecane, dimethylbutane, methylhexane, n-butanol, cyclohexanone, propanone, 2-butanone. The concentrations of alkane, alcohol and ketone in indoor air of apartments decreased with the time went on after the house decoration finished on the whole. 10 of 14 alkanes showed positive correlation to the temperature, 6 of them to the relative humidity at the sampling points. 2 of 11 alcohols and 3 of 9 ketones showed positive correlation to the relative humidity at sampling points. Conclusion The increasing temperature is the important factor for the release of alkanes in indoor air. The increasing relative humidity is the influence factor for the release of alcohols, ketones, and some alkanes in indoor air.

Objective The aim of this study was to discuss the technical details on laparoscopic total cyst excision with Roux Y hepatoenterostomy for the treatment of choledochal cyst in children.Methods Eight patients with type Ⅰ choledochal cyst (median age 3 6 years) underwent laparoscopic cyst excision with Roux Y hepatoenterostomy from July 2001 to April 2002.Under laparoscopic guidance, intraoperative cholangiogram was performed, the gallbladder and the dilated bile duct were completely excised. Roux en Y jejunojejunostomy was performed extracorporeally through umbilical incision (2 cm), and an end to side anastomosis was carried out intracorporeally.Results Median duration of operation was 4 8 hours (3 6 to 6 0 hours), intraoperative bleeding was between 10 to 50 ml. Hospital stay after the operation ranged from 3 to 8 days. There was no intra or postoperative complication.ConclusionLaparoscopic total cyst excision with Roux Y hepatoenterostomy was effective and safe procedure for children with choledochal cyst.

Objective To study the feasibility and efficacy of laparoscopic operation for choledochal cyst. Methods Under laparoscopy,intraoperative cholangiography was performed.The dilated commom bile duct and the gallbladder were excised,a Roux-en-Y cholangio-jejunostomy was constructed outside the abdominal cavity. Results 5 babies underwent the total cyst excision and hepato-cholangio-jejunostomy successfully and quickly recovered.Only a girl transferred to open operation because of previous operative history. Conclusions Laparoscopic treatment of choledochal cyst is feasible and satisfied outcome.

Objective To investigate the effects of external fixator with dynamic device under low frequency and controlled micromovement on the callus calcification and mechanical property of healing bone.MethodsForty-five sheep were performed transverse osteotomy with a gap of 2 mm on the mid-shafts of both tibias,and the hind limbs were fixed with unilateral external fixators connected to a controlled micromovement device.Ten days after osteotomy,one hind limb of each sheep was randomly selected for micromovement(30 min/d).According to different micromovement frequencies,the sheep were randomly divided into 3 groups: 0.5 Hz group,1 Hz group and 5 Hz group(n=15).The amplitude of micromovement was 0.25 mm and the micromovement stopped by the end of the fourth week postoperation.The other hind limb of each sheep was served as control group without micromovement.Morphometry of callus was done at the end of 4,6 and 9 weeks after osteotomy.Bone formation velocity,bone mineral density and biomechanical properties were compared at the end of 9 weeks.Results The areas of mineralized bone and osteoid in different miromovement groups were larger than that of control group at the end of 4,6 weeks postoperation(P

160 s and core temperature was 36-37℃.Blood ga- ses,platelets,plasma free hemoglobin and coagulation factors were measured during ECMO support. The blood supply was monitored in the limbs cannulated with the femoral artery cannula.Results Two patients were successfully treated with ECMO without major complications.The circulatory and respiratory function of the patients was stable.The chest X-ray showed a no clouding of lungs and he- patic function was greatly improved in case 2 who underwent a successful heart transplantation follo- wing mechanical cardiocirculatory support as a bridge,Two patients received ECMO support for 5 and 3 days respectively.Both patients recovered well.No any severe acute rejection occurred and heart func- tion was NYHAⅠ.Conclusion When candidates suffered acute cardiogenic shock,ECMO can provide safe and effective mechanical circulatory support as a bridge to heart transplantation.

Objective To evaluate the effect for the treatment of severe asthma. Methods The data of 47 patients with severe asthma who were admitted to emergency department were retrospectively anayzed. Results Of total 47 patients ,45 were rescued, with the survival rate of 95.7%. Arterial blood gas was improved after treatment (P < 0.01). Conclusion Appropriate commencement, mode, strategy, and early weaning of mechanical ventilation, combined with the administration of bronchodilators and eorticosteroids are the important way to rescue patients with severe asthma.

Objective To evaluate the effects of serum procalcitonin (PCT)-guided antibiotic therapy in elderly patients with early-onset stroke-associated pneumonia (EOP).Methods Totally 179 eligible elderly patients with EOP were randomly devided into 2 groups:standard therapy group (standard group,n=88) and PCT-guided group (PCT group,n=91).Patients in standard group received antibiotics according to antibiotics guidelines in China by the treating physicians.Patients in PCT group were treated with antibiotics for 5 days,then the antibiotic treatment was based on serum PCT levels as follows:discouraged if PCT＜0.25 μg/L and encouraged if PCT≥0.25 μg/L.Length of hospitalization,duration of antibiotics,costs of hospitalization and antibiotics,clinical efficacy,andmortality,National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI) on the 28th day were observed.Results There were no significant differences in clinical efficacy,mortality,NIHSS score and BI between the two groups on the 28th day [(85.7％ vs.86.3％),(8.8％ vs.7.9％),10.1 (7.8,16.2) vs.9.8 (6.0,15.5),60.1(42.5,82.3) vs.57.9 (39.2,84.8),respectively,all P＞ 0.05].The length of hospitalization,antibiotic duration,costs of hospitalization and antibiotics were lower in PCT group than in standard group [19 (10,38) d vs.26(17,42) d,10 (7,14) dvs.15 (6,21) d,3350 (2052,6163) yuanvs.10355 (6877,15421) yuan,7532 (4810,12116) yuan vs.5358 (3089,8144) yuan,respectively,all P＜0.05].Conclusions PCT guidance of antibiotic therapy is effective and safe for the treatment of early-onset stroke associated pneumonia in elderly patients.It can reduce the antibiotic duration and costs of hospitalization.

Objective To investigate the therapeutic effect of medication-based acupuncture on osteoporotic compression fracture and explore clinical effective intervention in the patients. Method Fifty-six patients were randomized to acupuncture-medicine and medicine groups, 28 cases each. The clinical therapeutic effects were evaluated after treatment. Bone density, BGP and IL-6 were measured before and after treatment. Result BGP and IL-6 decreased significantly in the two groups after treatment compared with before (P<0.01) and decreased more in the acupuncture-medicine group than in the medicine group (P<0.05). BMD increased significantly in the acupuncture-medicine group after treatment compared with before (P<0.05) and did not increased significantly in the medicine group after treatment (P>0.05). Conclusion Warm needling moxibustion plus medication is effective than medication alone in treating osteoporotic compression fracture. It can decrease serum BGP and IL-6 contents and relieve the clinical symptoms in the patients. Acupuncture plus medicine not only produces a marked analgesic effect but also has a positive role in preventing the aggravation of osteoporosis and avoiding second fracture.

Objective To investigate the clinical effect and safety of spleen-preserving surgery by microwave tissue coagulation (MTC) therapy.Methods Retrospectively analyzed the clinical data of 45 cases undergoing spleen retaining surgery by MTC therapy (observation group) and comparative study was used on another 45 cases experiencing splenectomy (comparative group),clinical effect and complications were compared.All cases were patients from Jan.2010 to Jun.2013.Results All cases were cured.Hospitalization of observation group is obviously shorter than that of comparative group(P =0.007).The rate of complication in observation group(4.44％) is lower than that in comparative group (20.00％),but the time and amount of bleeding in operation of observation group is much more than that of comparative group.Conclusion MTC can effectively guarantee patients safety,shorten hospital stay,and be worthy of popularization.