OBJECTIVE:To observe clinical efficacy and safety of intrathecal injection of meropenem combined with vanco-mycin for intracranial infections after craniotomy. METHODS:In retrospective analysis,46 patients with intracranial infections af-ter craniotomy selected from our hospital during May 2014 to Jun. 2016 were divided into control group(20 cases)and observation group(26 cases)according to treatment method. Control group was given Vancomycin hydrochloride for injection 1.0 g,ivgtt,bid+Meropenem for injection 2.0 g,ivgtt,tid. After cerebrospinal fluid release of lumbar cistern drainage,observation group was given Vancomycin hydrochloride for injection 20 mg slowly,and the given Meropenem for injection 20 mg,bid,after washing tube with 0.9% Sodium chloride injection 2 mL. Both groups received treatment for 2 weeks. Cerebrospinal fluid bacterial culture,clinical ef-ficacy,healing time and treatment cost were observed in 2 groups,and the occurrence of ADR and sequela in 6 months after treat-ment were recorded. RESULTS:The positive rate of cerebrospinal fluid bacterial culture of 46 patients was 45.7%. The healing rate of observation group(92.3%)was significantly higher than that of control group(65.0%). Healing time and treatment cost of ob-servation group were significantly shorter or lower than control group;and total incidence of ADR (7.7%) was also significantly lower than control group (40.0%),the incidence of sequelae (3.8%) was significantly lower than control group (20.0%),with statistical significance(P<0.05). CONCLUSIONS:Therapeutic efficacy of intrathecal injection of meropenem combined with van-comycin is superior than intravenous administration for intracranial infections after craniotomy,can significantly shorten the treat-ment time and reduce treatment cost with good safety.

Objective To summarize the management and diagnosis of testicular tumors in children.Methods The clinical characteristics, diagnosis, treatment and outcome of patients with pediatric testicular tumors, who were referred to Department of Pediatric Surgery, Shengjing Hospital of China Medical University from January 2003 to December 2013 ,were analyzed retrospectively.Results All of the 76 prepubertal patients were diagnosed initially with a painless scrotal mass.The mean age of the patients at diagnosis ranged from 1 to 156 months[mean(32.3 ±4.4) months].There were 39 cases(51.3％) with ages of0-1 years,18 cases (23.7％) with ages of 1-3 years,10 cases (13.2％) with ages of ＞ 3-7 years,9 cases(11.8％) with ages of ＞ 7-14 years.There were 37 cases in left side and 39 cases in right.And there were 59 cases (77.6％)of benign tumors and 17 cases(22.4％)of malignant tumors.Of the benign tumors,42 cases(55.2％)were teratomas, including 34 cases of mature teratoma and 8 cases of immature teratoma;11 cases were epidermoid cyst;11 cases were other benign tumors as lymphangioma.Among the 17 cases of malignant tumors, 16 cases (21.1％) were yolk sac tumors, which were I stage;1 case was embryoma.Thirty-three patients had abnormal alpha fetoprotein (AFP)concentrations before surgery,including 9 patients with mature teratoma,7 patients with immature teratoma, 16 patients with yolk sac tumors, 1 patient with embryonal carcinoma of testis.Of the 59 cases of benign tumors,testis-sparing surgery was done in 50 tumors, the other 9 patients underwent testis-excising because of tumor severely oppressing testis.All the 17 cases of malignant tumors underwent testis-excising.There were 76 cases in the follow-up.One patient with yolk sac tumor died for pulmonary metastasis during the follow-up.Others were alive and free of tumor recurrence.Conclusions The age range of the prepubertal testicular onset was 1 year or younger, most of the tumors were benign, and the most common subtype was teratoma.AFP highly expressed in yolk sac tumors, it was help to diagnosis.Testis-sparing surgery should be performed for the benign tumors and testis-excising for the malignant tumors.

Objective To study the prevalence and distribution of dental trauma in children and adolescents. Method A total of 347 patients with the permanent anterior teeth injured aged from 6 to 25 years were treated and selected from July 2008 to June 2009. Data of gender, age, site of accident occurred, number of teeth injured, and location and type of injury were taken from the dental records. Results Of them, there were male 219, female 128, and the ratio of male/female was 1.7:1.0, The highest incidence of tooth injuries occurred a-mong children of 10 to 13 years old. The common site of dental trauma was school. The majority of dental casualties had one tooth (38.0%) and two teeth (38.0%) injured. Of all types of dental injury, subloxation (19.8%), and enamel and dentin fractures without pulpa involvement (18.7%) were the most seen ones. Con-clusions The dental trauma in children and adolescents is a major problem that can not be ignored, and should be given persistent attention to prevent.

Objective To establish a rabbit model of hypoglycemia and evaluate the accuracy and timeliness of hypoglycemia monitoring by continuous glucose monitoring system (CGMS).Methods Sixteen female New Zealand white rabbits were randomly divided into 4 groups, with 4 rabbits in each group.The rabbits in the control group were given intravenous infusion of saline.The animals in the experimental group were infused with insulin continuously, which were divided into 0.1 U/kg/h insulin group (RI=0.1 U group), 0.2 U/kg/h insulin (RI=0.2 U group) group and 0.4 U/kg/h insulin group (RI=0.4 U group) accordingly.During the experiment, CGMS was monitored for 240 min.Blood samples were collected at a 30-minute interval and the blood glucose level was measured by a hand glucose meter.Results A total of 1296 CGMS monitoring data were obtained during the study period, and 136 BG monitoring data matched with CGMS time were obtained.After the insulin administration, BG and CGMS were significantly decreased.The reduction rates of BG and CGMS were 0.016 and 0.017 mmol/L/min in the RI=0.1 U insulin group, 0.04 and 0.027 mmol/L/min in the RI=0.2U insulin group, and 0.049 and 0.032 mmol/L/min in the RI=0.4 U group.According to whether BG monitoring value was lower than 4.4 mmol/L, the BG-CGMS paring data were divided into hypoglycemia and normoglycemia.In hypoglycemia, the average deviation of BG-CGMS was 0.55 mmol/L (the upper and lower limits were-0.98 and 2.08 mmol/L, respectively) and the absolute difference percentage (RAD) was 40.2% ± 45.2%.The mean deviation of BG-CGMS in normal blood glucose was-0.19 mmol/L (upper and lower limits were-1.38 and 1.00 mmol/L, respectively) and 5.8% ± 5.3% in RAD.The error grid analysis (EGA) showed that the proportion of zone A was 93.4%, 0.7% in zone B, and 5.9% in zone D, and the zone D was distributed in area of low BG and high CGMS.Conclusions The results of this study indicate that CGMS has a significant hysteresis phenomenon when blood glucose is reduced rapidly.When the blood glucose levels fall below 4.4 mmol/L, CGMS may have a risk of overestimating blood glucose.Such risk should be fully considered during CGMS clinical application.

Adult ; Bone Neoplasms ; diagnosis ; surgery ; Cervical Vertebrae ; Humans ; Male ; Osteochondroma ; diagnosis ; surgery

Objective To evaluate the effect of dexmedetomidine on liver injury in the rats with ob?structive jaundice. Methods Forty?five healthy male Sprague Dawley rats, weighing 250-300 g, aged 8-9 weeks, were divided into 3 groups ( n=15 each) using a random number table: sham operation group ( S group) , obstructive jaundice group ( OJ group) and dexmedetomidine group ( D group) . Obstructive jaun?dice was induced in rats by division and double ligation of the common bile duct in OJ and D groups. Dexmedetomidine 100 μg∕kg was injected intraperitoneally at 72 h after establishment of the model in group D. At 3, 5 and 24 h after administration, blood samples were collected from hearts for determination of the plasma alanine aminotransferase (ALT) and C?reactive protein (CRP) levels. After blood sampling at each time point, the specimens from the external right lobe of the liver were obtained for detection of the expres?sion of Toll?like receptor 4 ( TLR4) mRNA ( by real?time polymerase chain reaction) and TLR4 content ( by enzyme?linked immunosorbent assay) in liver tissues and for pathological examination of liver tissues ( with light microscope) . Results Compared with group S, the plasma ALT and CRP levels were significantly increased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly up?regulated, and TLR4 content in liver tissues was significantly increased in OJ and D groups ( P<0?05) . Compared with group OJ, the plasma ALT and CRP levels were significantly decreased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly down?regulated, and TLR4 content in liver tissues was significantly decreased in group D ( P<0?05) . The degree of damage to liver tissues was significantly attenuated in group D compared with group OJ, and was aggrava?ted in group D compared with group S. Conclusion Dexmedetomidine can reduce liver injury in the rats with obstructive jaundice.

Objective To propose prevention and management of vascular crisis according to cause analysis, and improve the survival rate of digital replantation. Methods The vascular crisis of 132 digits of 98 cases were observed during intraoperative. The replantation was performed under different time and different conditions. The causes of vascular crisis, and propose effective prevention and management of vascular crisis were restrospective analysis. Results From March 2006 to June 2007, 35 amputated digits occurred vascular crisis during intraoperative, 19 amputated digits occurred during postoperative. After using warm physiological saline and injecting the papaverine partly, we proceed operations research with regard to the non-catabatic amputated digits. As result 58 digits survived, the achievement ratio was 89.2%. From July 2007 to March 2009, 10 amputated digits occurred vascular crisis during intraoperative,5 amputated digits occurred during postoperative. After non-surgical treatment, we performed operations research regard to the non-catabatic amputated digits. After blood supply recover, we imbed PCA pump into flex tendinous sheath to avoid the occurrence of vascular crisis postoperative. As result 66 digits survived, the achievement ratio was 98.5%. postoperative 9 cases out of fullow-up, 89 cases follow up ranged from 6 to 8 months. Recovery of the hand function was good. Conclusion Good and adequate anesthetic and an appropriate ambient temperature during operation are important factors to prevent occurrence of vascular crisis in digital replantation. Paying enough attention to these factors can effectively improve the survival rate of replantatian.

Objective To investigate the effects of Hui-hui Gan-song Yin(HGY) on the accumulation of extracellular matrix of rat glomerular mesangial cells(MCs) induced by high glucose.Methods The 40 SD rats were randomly divided into normal control group(distilled water), glurenorm group(10 mg/kg), HGY high-dose group(10 g/kg) and HGY low-dose group(5 g/kg), 10 rats in each group.The rats in each group were treated with corresponding drugs, twice a day.After 3 days, the serum containing each drug were prepared to culture rat MCs in vitro.The MCs were divided into the normal control group( 10% serum of rats in normal control group ) , high glucose group ( 30 mmol/L glucose +10% serum of rats in normal control group), glurenorm group(30 mmol/L glucose+10% serum of rats in glurenorm group), HGY high-dose group(30 mmol/L glucose+10% serum of rats in HGY high-dose group) and HGY low-dose group(30 mmol/L glucose+10% serum of rats in HGY low-dose group).The fibronectin(FN), ColⅠand ColⅣ levels were detected by Western blot.Results Compared with normal control group, the expression of FN, ColⅠand ColⅣ in high glucose group increased(P<0.01).The HCY suppressed the protein expression of FN, ColⅠand ColⅣ significantly(P<0.05).Conclusion The serum containing HGY could suppressed protein expression of FN , ColⅠand ColⅣ and inhibit the accumulation of extracellular matrix of MCs induced by high glucose, which could protect glomerulus and delay the development of diabetic nephropathy.

Objective To analyze the technique and clinical effect of percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi.Methods From February 2009 to May 2012,20 ureteral stenosis patients with the history of ureteral open surgery,postoperative residual or recurrent kidney renal calculi were treated.Fifteen cases were with hydronephrosis of 2-4 cm,4 cases were with hydronephrosis of 5-6 cm and 1 case was with hydronephrosis ＞ 6 cm.Subsequent calculi size ＜ 1 cm was found in 16 cases,1-3 cm in 3 cases,＞ 3 cm in 1 case.All patients were treated with percutaneous nephrolithotomy ultrasonic lithotripsy combined with balloon dilatation.The calculi clearance rate,hydronephrosis changes,complications,intraverous urography (IVP) and CT urography (CTU) situation before and after surgery were analyzed.Results All the 20 cases were completed surgery successfully.There was 1 case with renal hemorrhage 3 d after surgery and controlled with DSA hemostasis.There was 1 case accepted adjusting double-J tube by ureteroscopy.Seventeen patients'calculi were completed removed.Two cases with residual calyceal calculi size ＜ 5 mm was not further treated.There was 1 case treated with nephrectomy because of renal calculi with infection.The patients were followed up for 6-39 (12.5 ± 1.9) months.Hydronephrosis improved significant changes [2.1-4.0 (2.2 ±0.9) cm vs.2.5-7.5 (3.9 ± 1.2) cm,P ＜ 0.05].All patients achieved significant improvement in IVP and CTU comparing of preoperative and postoperative data.Conclusion The use of percutaneous nephrolithotomy combined with endoscopic balloon dilation is a safe and effective treatment option in the treatment of kidney calculi with ureteral stenosis.

Objective To introduce a new bilateral triceps brachii approach for the treatment of intercondylar fractures of the humerus, and explore the possibility for the operation without injuring the mechanism of extension of the elbow. Methods With fresh cadaver specimens, the triceps brachii was stripped off from the distal end of the humerus, the muscle belly was elevated and retracted bilaterally, then the height was recorded, and the exposure of the distal humerus was observed, especially to the trochlear region when the elbow were flexed at 15? , 30? , 45? , 60? , 80? respectively. Results Through the cadaver specimen observation and the clinical application, the reduction and fixation of the intercondylar fractures of humerus should be performed when the elbow is flexed at 45?－ 60?， at 15?－ 30? flexion, fracture over the supracondylar can be treated and finally at 80? flexion, the reduction of the trochlear region can be examined. Conclusion This bilateral approach through the triceps brachii is suitable for the treatment both of the intercondylar and epicondylar fractures.