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 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.

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 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

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.

Background Optic neuropathy is one of the diabetic eye complications.Rosiglitazone,a peroxisome proliferator activated receptor γ(PPARγ) agonist,plays a very important role in arresting the pathogenesis and development of diabetes.However,the role of PPARγ in diabetic optic neuropathy is unclear.Objective This study was to investigate the protective effect of rosiglitazone against diabetic optic neuropathy and its mechanism.Methods Male Sprague-Dawley rats were randomly divided into the control group,diabetic group and rosiglitazone group,with 10 rats for each group.Diabetic models were induced by injecting 50 mg/kg of streptozotocin via the caudal vein,and rosiglitazone(5 ng/[kg· d])was used in the rats of the rosiglitazone group by intragastric administration every day for four weeks.At the end of the experiment,the fasting blood sugar(FBS) was tested in all the animals.The level of vascular endothelial growth factor(VEGF) in the blood plasma was detected by ELISA.Optical neural tissues were obtained from the rats of each group,and Lauck fast Blue myelin stain was used to examine the morphology of the optical myelin.The expression of neural cell adhesion molecule (NCAM) mRNA and protein in the optic nerve was detected by real time PCR and Western blot,respectively.Results The levels of FBS,blood plasma VEGF,NCAM mRNA and protein in the optic nerve were significantly different among the control group,diabetic model group and the rosiglitazone group after the administration of 5 nmg/(kg · d) rosiglitazone for 4 weeks (F =6.12,P＜0.01 ; F =5.14,P＜0.05 ; F =4.75,P＜0.05 ; F =4.87,P＜0.05).Compared with the control group,the level of FBS significantly increased in the diabetic model group(t =2.26,P＜O.05),and that in the rosiglitazone group significantly declined in comparison with the diabetic model group(t=2.08,P＜0.05).The optic nerve exhibited a normal morphology in the control group as revealed by the Lauck fast Blue myelin staining;however,severe demyelination of the optic nerve and proliferation of glial cells were found in the diabetic model group,and mild demyelination of the optic nerve and proliferation of glial cells were seen in the rosiglitazone group.Blood plasma VEGF was(28.76±4.21)ng/L in the control group and(134.28±11.36)ng/L in the diabetic model group,showing a significant difference between them (t=2.36,P ＜ 0.05).Compared with the model group,the blood plasma VEGF was significantly lower in the rosiglitazone group ([42.67 ± 5.83] ng/L) than that in the diabetic model group (t =2.17,P＜ 0.05).Expression of NCAM mRNA and protein in the optic nerve significantly decreased in the diabetic model group compared with the control group(t =2.21,t =2.58,both at P＜0.05);while those in the rosiglitazone group were significantly elevated in comparison with the diabetic model group(t =2.19,t =2.67,both at P＜O.05).Conclusions Rosiglitazone can protect optic nerve from damage in diabetic rats mainly by downregulating blood plasma VEGF level and upregulating NCAM expression.

OBJECTIVE To evaluate the use of antibiotics after coronary artery bypass.METHODS Forty patients were assigned into two groups,vancomycin group and cefradine group.Each included 20 patients.We compared the infection cases,cost of hospitalization,and cost of medicine after CABG.RESULTS There were no difference of(infection) between two groups,the cost of hospitalization was fewer in cefradine group.(CONCLUSIONS) The short-term use of cefradine after CABG could achieve the goals of preventing infection of CABG,and save medical resources.