Objective To evaluate prognostic indicators in severe traumatic brain injury and intracania hamatomas with hernia and analyze which is the most important indicator.Methods Data of 84 cases with severe traumatic brain injury were retrospectively analyze .Age,GCS,pupil reflex,midline shift,compression of the cisteme,decompression time and complex injury were considered as possible prognostic indicators.SPSS13.0 was employed to analyze the data,Logistic regression(Forward conditional)analysis was done to confirm which are the most important prognostic indicators for severe traumatic brain injury and to evaluate the practical value in predicting prognosis(X2= 22.92,P＜ 0.01).Results 48 patients died and 36 survived.56(67%)patients had a bad prognosis(GCS≤3)and 28(33%)had a good prognosis(GCS ＞3).Those who had a shorter decompression time(≤3h)had a better prognosis than those who had a longer decompression time(＞3h),with the mortality rate of 11% and 67% respectively.Lesser cisteme compression predicts better outcome.GCS,pupil reflex,midline shift,and complex injury didn' t enter the logistic regression equation.According to compression time,90.5% of the cases' prognosis was accurately predicted,according to compression time and cisterne compression,95.2% was accurately predicted.Conclusion The mortality rate of severe traumatic brain injury with hernia was high and surgical intervention was effective.Decompression time and cisteme compression were the most important factors affecting prognosis in severe traumatic brain injury and they could predict prognosis of most cases correctly.

Abstract: Objective To understand the distribution and drug resistance of pathogenic bacteria of bloodstream infection in Fujian Province, and to provide reference for clinical rational drug use. Methods Bacteria identification and antimicrobial susceptibility test were carried out on the isolated strains of blood culture samples in 31 medical institutions in Fujian Province according to the unified plan. The data were statistically analyzed by WHONET 5.6 software according to the Clinical and Laboratory Standards Institute (CLSI) drug sensitivity executive standard in 2021. Results After removing the duplicate strains, 10 356 strains of bacteria were collected, including 3 668 strains of Gram-positive bacteria (35.4%) and 6 688 strains of Gram-negative bacteria (64.6%). The top 5 bacteria are Escherichia coli, Klebsiella pneumoniae, coagulase negative Staphylococcus, Staphylococcus aureus and Pseudomonas aeruginosa. In this study, the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) was 24.5%, and the detection rate of methicillin-resistant coagulase-negative Staphylococcus aureus (MRCNS) was 76.8%. Vancomycin, teicoplanin and linezolid resistant staphylococci were not found. The detection rate of penicillin resistant Streptococcus pneumoniae was 3.2%. Vancomycin resistant Enterococcus faecalis and Enterococcus faecium were 0.8% and 1.1% respectively. The resistance rate of Escherichia coli to carbapenems was 0.8%, and the resistance rate to levofloxacin was 41.9%; the resistance rate of Klebsiella pneumoniae to carbapenems was 15.0%. The resistance rate of Acinetobacter baumannii to carbapenems was 45.1%; the detection rate of Pseudomonas aeruginosa was only 14.2%, and it maintained a high sensitivity to most drugs. Conclusions Most bloodstream infections in Fujian Province are caused by Escherichia coli, Klebsiella pneumoniae and Staphylococcus. The drug resistance of some strains is not optimistic, so we should continue to strengthen the clinical application management of antibiotics and use them correctly and reasonably. Keywords: Bloodstream infection; bacteria; antibiotics; drug resistance monitoring

Objective To evaluate the safety and accuracy of CT-guided cutting needle biopsy for the hepatic lesions near diaphragmatic dome.Methods A total of 25 cases with hepatic lesions near the diaphragmatic dome were undertaken CT-guided cutting needle biopsy using 16 gauge or 18 gauge core biopsy needles.Results Histological examination showed malignancy in 17 cases and benign in 8 with 2 false negative results(8%),and there were no false positive results.The specificities of malignant and benign lesions were 100% and 75%,respectively.Overall accuracy was 92%.Pneumothorax,needle tract hemorrhage,and subcapsular hepatic hemorrhage occurred in 2(8%),1(4%)and 1(4%),respectively.Conclusion CT-guided cutting needle biopsy for the hepatic lesions near diaphragmatic dome is a reliable and relatively safe diagnostic method.(J Intervent Radiol,2007,16:838-840)

Objective To investigate the effects of blockade of OX40/OX40L costimulation pathway on mice islet allograft tolerance in CD40/CD154 costimulation pathway blockade mice.Methods C57BL/6 mice were induced into diabetes mellitus as recipients,and were transplanted with DBA/2 mice islets.The recipients were divided into four groups,(1) treated with IgG as controls,(2) anti-OX40L mAb,(3) anti-CD154,(4) combined treatment of anti-OX40L mAb and anti CD154mAb.The mean survival time (MST) of islet allograft was observed.The expression of OX40 in activated T cells of CD154 deficient mice was detected.Effector T cells were obtained from the spleen of CD154 deficient mice cultured with or without anti-OX40L mAb for 3 days.The proliferation of T cells was assayed.Results The MST in the control group,anti-OX40L mAb group,anti-CD154 mAb group and anti OX40L mAb + anti-CD154 mAb group was 19,22,48,and ＞150 days respectively (P ＜0.05).The OX40 expression was readily induced in the 66％ activated T effector cells.CD154 deficient T effector cells proliferation was inhibited by the addition of anti-OX40L mAb in the culture in a dose-dependent fashion.Conclusion The blockade of OX40/OX40L costimulation pathway can promote islet allograft tolerance in CD40/CD154 costimulation pathway blockade mice by inhibiting the proliferation of T cells.

Objective To evaluate the effectiveness of arthroscope-assisted surgical technique in treating knee fractures and knee peripheral fractures.Methods From September 2000 to December 2005,there were 46 cases with knee or knee peripheral fractures,in whom artbroseope-assisted surgical technique was performed in 36 cases including 24 males and 12 females,with mean age of 30.5 years (18-52 years).Of 36 cases,26 cases with patella fractures were treated by internal fixation of tension band using cancellous bone screws,four with distal end femoral fractures by retrograde interlocking using intramedullary nail and six with fractures of tibial plateau and tibial condyle crista by internal fixation u- sing cancellous bone screws.Results The mean hospitalization was eight days.A follow up for 3-36 months(average 14 months)in 36 cases showed fracture healing.Of 36 cases,32 cases regained full knee range of motion,four left with terminal flexion,with mean loss of 15?,and had thigh circumference (10 cm above knee)1.1 cm(range 0.6-2.0 cm)shorter than health side and two had slight pain in the knee joint.Lysholm knee joint function score was 86.5+7.6 for patellar fractures,tibial plateau frac- tures and condylar crista fractures.Conclusion As for knee or knee peripheral fractures,arthroscope- assisted surgical technique can provide fine monitoring,decrease trauma and complications,fixate inter- nally and help early ground exercise.

Objective To investigate the effect of one-lung ventilation (OLV) on the occurrence of subcutanous emphysema during retroperitoneal laparoscopic urologic surgery (RPLUS).Methods Twenty-seven ASA Ⅰor Ⅱ patients,aged 29-64 yr,with body mass index 19-25 kg/m2,scheduled for elective RPLUS,were randomly divided into 2 groups:two-lung ventilation (TLV) group (group Ⅰ,n =15) and OLV group (group Ⅱ,n =12).In group Ⅰ,the patients were tracheal intubated and TLV was performed.In group Ⅱ,the left-sided double lumen endobronchial tube was inserted and TLV was performed,OLV on the non-operated side was performed starting from 10-15 min before pneumoperitoneum and TLV resumed at the end of pneumoperitoneum.The end-tidal CO2 partial pressure and minute ventilation volume were measured before pneumoperitoneum (T1),at 30 and 60 min of pneumoperitoneum (T2,3),and at 30 min after the end of pneumoperitoneum (T4).The CO2 absorption capacity was calculated.The degree of pneumoderma was assessed and the occurance of pneumoderma was recorded at the end of pneumoperitoneum.Results Compared with group Ⅰ,the CO2 absorption capacity was significantly reduced,and the degree and incidence of pneumoderma were significantly decreased in group Ⅱ (P ＜ 0.05).Conclusion OLV on the non-operated side can reduce the CO2 absorption capacity,decrease the degree of subcutaneous emphysema and reduce the occurrence of subcutanous emphysema during pneumoperitoneum in patients undergoing RPLUS.

Objective To investigate the feasibility and role of single-dose three-dimensional dynamic contrast-enhanced magnetic resonance angiography(SD 3D DCEMRA)in evaluating soft-tissue hemangioma of limbs.Methods The transit time(TT),signal intensity of peak enhancement(SPE)and duration of peak enhancement(DPE)of the femoral,popliteal and anterior tibial arteries at the level of the middle section were assessed in 30 healthy volunteers after intravenous bolus injection of single-dose contrast media at the rate of 3 ml/s.Forty-five patients with soft-tissue hemangioma and 9 patients with schwannoma of the extremities underwent both conventional MRI and SD 3D DCEMRA.The acquisition time of SD 3D DCEMRA ranged from 10 to 12 s,and early arterial,late arterial and venous phases of SD 3D DCEMRA images were acquired consecutively.The conventional MRI and SD 3D DCEMRA findings of the 45 patients with hemangioma were observed and compared with those of the 9 cases of sehwannoma.Results(1)The TT,SPE and DPE of the femoral,poplitcal and anterior tibial arteries were(15?5)s,(400?50),(11.9? 2.6)s;(19?7)s,(320?45),(16.8?3.6)s and(27?10)s,(270?39),(22.0?6.6)s respectively. The comparison of TT(F=6.91,P0.01).The tumoral feeding artery was visualized in all cases(100%).(3)Two cases of hemangioma missed on conventional MRI were correctly diagnosed on SD 3D DCEMRA owing to the visualization of both the tumoral mass and the feeding artery.(4)For schwannoma,neither the dynamic visualization of tumoral mass nor the feeding artery was demonstrated on SD 3D DCEMRA.Conclusion SD 3D DCEMRA is technically feasible to evaluate the limb soft-tissue hemangioma.Dynamic visualization of tumoral mass and demonstration of the tumoral feeding artery are the characteristic features of the tumor on SD 3D DCEMRA.

Objective To find out the causes of the failure of the replanted finger and to increase the survival rate of replantation.Methods The trauma,operation condition and nursing care after operation of the 24 failure cas- es of 31 replantation of severed fingers that have been treated in this hospital from January 1999 to December 2006 were retrospectively analyzed.Results Of the 31 necrotic fingers,there were 21 necrotic fingers caused by untimely treatment of vascular articulo,7 by infection,1 by smoking and 2 by uncooperative treatment because of out-of-bed activity.There were 9 replantation of fingers loss of blood supply in one day,12 fingers from one day to three days, 8 fingers from four days to seven days,2 fingers more than nine days.Conclusion The operation indication should be strictly mastered.There should be a complete debridement and haemostasis during the operation,the quality of vascular anastomose should be improved and the pressure of the anastomosing vascular should be avoided.Strict ob- servation after operation,intensive nursing and timely treatment of vascular articulo are the key factors for improving the survival rate of replantation of severed finger.

Objective To compare the curative effect of high ligation+exfoliation and subfascial endoscopic perforator surgery(SEPS)for superficial varicose veins in calf+invagination spot-striping surgery in great venous varicosity.Methods Study group(42 patients)accepted SEPS+invagination spot-striping surgery and control group (42 patients)accepted traditional surgeries.Operation duration,bleeding volume in operation,the time of beginning movement away from bed after operation,hospitalization duration,the degree of pain,the scar,the recrudescence af- ter operation and the instance of the ulcer heals of two groups were compared.Results Operation duration,bleeding volume in operation,the time of begin movement away from bed after operation and hospitalization durations of study group were significantly lower than those of control group(P0.05).All of the patients in study group recovered without severe syndromes such as venous thrombosis,skin necrosis,lower limb functional disorder etc.They had no recrudesce after 4～16 months and were satisfied with the curative effect.Con- elusions The clinical curative effect of SEPS+invagination spot-striping surgery in great venous varicosity is superi- or to that of traditional operation and it has the advantages such as minor wound,few scars,light pains,short hospi- talization duration,without recrudescence,the ulcer heals quickly and so on.

Objective To investigate the effects of four interior-warming drugs( galangal,cinnamon,evodia rutaecarpa,and dried ginger)on the tension of ileum smooth muscle and Ca2+-ATPase on the cell membrane in rabbits. Methods The effects of galangal,cinnamon,evodia rutaecarpa,and dried ginger were examined on normal ileum smooth muscle,in vitro intestinal muscle contraction caused by acetylcholine(ACh),barium chloride(BaCl2 )and histamine(His), and ACh-induced calcium release by using BL-420E+ biological signal collection and processing system.The average tension was measured within 1 min before delivery and within 3 minutes after the treatment,and the inhibition rate was calculated according to the average tension value.The effects of sera containing galangal,cinnamon,evodia rutaecarpa,and dried ginger on Ca2+-ATPase activity on the cell membrane of the intestinal smooth muscle were examined by phosphorus method. Results Galangal,cinnamon,evodia rutaecarpa,and dried ginger at high concentrations could restrain in vitro intestinal contraction in normal circumstances(P<0.05 or P<0.01).Significant inhibitory effects on intestinal contraction caused by ACh,His and BaCl2 were found in low,medium and high concentration groups(P<0.01).There was a dose-effectiveness relationship between the inhibition rate and final drug concentrations.The ACh-induced intracellular and extracellular calcium dependent contraction were significantly inhibited by the four interior-warming drugs( P < 0. 05 or P < 0. 01). The Ca2+-ATPase activities were( 0. 384 ± 0.070),(0.302±0.016),(0.307±0.016),(0.296±0.016),(0.313±0.003)U·mg-1 ,respectively,in intestinal smooth muscle in normal control group and high concentration groups of galangal,cinnamon,evodia rutaecarpa,and dried ginger(P<0.01). Conclusion Interior-warming drugs may relax intestinal smooth muscle by reducing the intracellular calcium release and the extracellular calcium inflow via receptor-controlled calcium channels,and inhibiting the Ca2+-ATPase activity in smooth muscle.