OBJECTIVE To study the risk factors and preventive therapeutic strategies of neurosurgical postoperative intracranial infection.METHODS Totally 1613 patients who had a neurosurgical operation from Jan 2005 to Jun 2008 in our department were chosen(64 cases with intracranial infection).The infection rate was 3.97%.The risk factors were studied retrospectively,?2 test was selected to analyze the factors which might cause infection.RESULTS The analysis of 1613 cases revealed that infection rate was closely related to ventricular drainage,long indwelling drainage,emergency subsequent surgery postcraniotomy,CSF leakage,the approach to the post fossa,surgical microscopy,operation time above 4 h and polluted operation;while had no significonce of sex,age,the season,application of antibiotics before the operation and emergency operation.CONCLUSIONS To decrease the infection rate,the suture should be complete to prevent CSF leakage,polluted region be cleaned effectively,strict asepticly technique be measured,the operation be finished as soon as possible,drainage be prevented from pollution carefully and the duration of the drainage be controlled strictly,especially to the ventricular drainage.

Objective To study the clinical value of grafting the musculocutaneous flap with uncovered in the special region to treat the open fracture and infection of tibia. Methods Twenty-eight patients including 19 males and 9 females with ankle and leg tissue defect were applied to graft the musculocutaneous flap with uncovered in the special region from July 2007 to January 2010. The tissue defeat in proximal part of the tibia were 6 cases, and 21 cases in middle and distal part, 1 case almost in whole part of the tibia. The bone occurred a defeat and infection in 23 cases, the bone necrosis occurred in 5 cases. The patients treated with iliac bone flap were 5 cases, anterolateral thigh flap were 21 cases, anterolateral thigh flap combined with fibula flap were 2 cases, the flap were transplanted by anastomosis in 26 cases. Results The tissue grafting were all survival and the survival rate were 100%. The callus formation were appear after operation from 3 to 6 months, and necrosis bone tissue almost were abstracted about 6 months. The wound were primary closure and not happened infection in 26 cases, the wound appeared infection under deep tissue in 2 cased,but being cured after 6 months by operation. The 21 patients were followed up from 3 months to one and helf year. The long-term was satisfaction and the donor area was perfect. Compared with closed graft, its area of the flap was small and need spend little time to treat the repair the defeat, and harness to recover the healthy of body and mind, also decrease the chance of infection in deep tissue. Conclusion It is demonstrated that grafting the tissue flap with uncovered in the special region is an ideal approach to treat the open fracture and infection of tibia.

[Objective]To evaluate diagnostic and the therapeutic options of osteoid osteoma of the spine associated with scoliosis. [Methods]Nine patients with osteoid osteoma of the spine were treated from 1997 to 2006.All patients presented with spine deformity as their main complaint at the first consultation.The mean age was 15.2 years (range 8-21 years).Two patients had their osteoid osteoma in the thoracic area,2 in the thorcolumbar area ,and 5 in the lumbar area.Three were well controlled after long term administration of nonsteroidal anti-inflammatory drugs,and the other 6 were treated with en bloc excision.[Results]All the 6 patients with en bloc excision of the tumor were pain-free post-operatively.The scoliotic curve disappeared or was less than 15 degrees in 5,but the structural curve persisted in 4.[Conclusion]The spinal osteoid osteoma should be suspected when back pain or painful scoliosis occurs in adolescents.Computed tomography is necessary to evaluate the location and features of the lesion.En bloc excision of the tumor can be suggested if the symptoms are not well relieved with nonsteroidal anti-inflammatory drugs.

Objective To observe the correlation between neutrally adjusted ventilatory assist (NAVA) mode and improvement of inflammation and oxidative stress in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and as well as to investigate the effects of NAVA mode versus pressure support ventilation (PSV) mode on improving the success rate of weaning advantages.Methods A total of 40 patients with AECOPD-Ⅲ supported by mechanical ventilation treatment admitted from November 2012 to January 2014 into intensive care unit (ICU) were enrolled for prospective study.The patients were randomly divided into PSV mode (n =20) and NAVA mode (n =20) according to gender,age,APACHE Ⅱ score,medical history,PaCO2 of five factors and adopting the principle of minimum distribution of the imbalance index.The comparisons of the successful rate of weaning,48 h re-intubation rate and length of ICU stay were made between two groups.The level of C-reactive protein (CRP),serum amyloid A (SAA),human cartilage glycoprotein 39 (YKL-40) in serum were measured by enzyme-linked immunosorbent assay (ELSIA) on the 1st day,3rd day,5th day and 7th day after initiation of mechanical ventilation,and results of these laboratory tests in patients were compared with those in healthy subjects of control group.And simultaneously,the broncho-alveolar lavage fluid (BALF) was collected with Gibot method by employment of optic fiber bronchoscope on the given days for detection of YKL-40,and levels of YKL-40 were compared between NAVA mode and PSV mode.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test or repeated measures analysis of variance,and P ＜ 0.05 was considered to be significant.Results (1) There were no significant differences in leukocyte count and neutrophils percentage between NAVA mode and PSV mode (P ＞ 0.05).The magnitudes of decrease in concentrations of blood CRP and SAA in NAVA mode were significantly greater than those in PSV mode (P ＜ 0.01),but there was no significant difference in blood YKL-40 between NAVA mode and PSV mode (P ＞ 0.05).The magnitude of reduction in concentration of BALF YKL-40 in NAVA mode was significantly greater than that in PSV mode (P ＜0.01).(2) There was on significant difference in rate of final weaning between NAVA mode and PSV mode,but the rate of direct weaning was higher in NAVA mode than that in PSV mode (P =0.046),and the 48 h re-intubation rate was lower in NAVA mode than that in PSV mode (P =0.032).The length of ICU stay was shorter in NAVA mode than that in PSV mode (P =0.031).The peak of EAdi (electric activated diaphragma trigger) in 8 patients failing in direct weaning before first attempt was significantly higher than that in other patients with successful weaning patients (P =0.002).Conclusions NAVA mode can attenuate inflammation and oxidative stress in patients with AECOPD,and ultimately improve the rate of direct weaning and shorten the length of ICU stay.Further research is necessary to confirm the capability of NAVA mode for improving the ultimate rate of weaning in AECOPD patients.

Objective To analyze the epidemic characteristics of brucellosis in Nangang District of Harbin City,and to provide a scientific basis for making strategies in prevention and control of the disease.Methods Descriptive epidemiological methods were used,epidemic characteristics (time distribution,regional distribution and population distribution) of the disease in Nangang District of Harbin City in 2006-2015 were studied,and brucellosis cases were reported online through the national epidemic network.Results A total of 105 cases of brucellosis were reported,the average annual incidence rate was 7.84/100 thousand and no death case.The number of cases was the highest in 2014,it was 21 cases,the incidence rate was 1.57/100 thousand;the number of cases was the least in 2010,it was 3 cases,the incidence rate was 0.22/100 thousand;in 2006,the number of cases was 9,the incidence rate was 0.67/100 thousand;in 2015,the number of cases was 17,the incidence rate was 1.27/100 thousand.The incidence of the disease was mainly concentrated in summer and autumn,accounting for 65.71％ (69/105),the number of summer onset was 38,accounting for 36.19％ (38/105);the incidence of the autumn was 31,accounting for 29.52％ (31/105).In 2006-2012,the incidence of the disease was mainly concentrated in Wanggang and Hongqi townships,accounting for 60.00％ (30/50);after 2013,the cases in urban areas were on the rise,Wanggang and Hongqi townships accounted for 34.55％ (19/55).Incidence of male youth was the highest,male and female incidence ratio was 2.18:1.00 (72:33);incidence peak was 30-60 years old,accounting for 60.95％ (64/105);after analyzing the incidence of occupational groups,farmer was the highest,accounting for 43.81％ (46/105).Transmission route was contact with cattle and sheep and lived in the environment cattle and sheep were breed,the number of cases was 34.Conclusions The incidence of brucellosis in Nangang District of Harbin City is rising after 2013.Disease season focus in summer and autumn,occupation focus in farmers,and the scope of the outbreak has been expanded.We should further strengthen publicity and education in disease focus season,improve the awareness of protection,in order to effectively control the epidemic of brucellosis.

Objective To evaluate the long-term clinical outcomes and survivorship of fixed bearing total knee arthroplasty (TKA) and the risk factor for failure.Methods Between June 1993 and April 2002,285 Chinese patients accepted TKA with cemented fixed bearing platform in our center,and 226 patients (246 knees) were successfully followed up.The age was (62.2±9.4) years at index operation.The survivorship of TKA and the related impact factor were analyzed.The hospital for special surgery (HSS) knee score,range of motion (ROM) and radiological results were studied at the final follow-up.Results One hundred and sixty patients (177 knees) were followed up longer than 10 years.Survival rate was 93.6％±1.7％ at 10years,92.8％±1.8％ at 15 years,with reoperation of the implant as the endpoint.Main reasons for failure were infection and aseptic loosening.There were no statistically difference in survival rate between posterior cruciate ligament retaining and posterior stabilizing group,patellar resurfacing and non-resurfacing,rheumatic arthritis (RA) and osteoarthritis (OA) patients.Meanwhile,RA patients had lower longterm survivorship compared with OA patients.HSS knee score of 96 of the knees increased from 56.58±11.05 preoperatively to 92.29±10.95 postoperatively,and ROM increased from 84.8°±24.0° preoperatively to 99.7°±17.6° postoperatively.Totally,15 knees underwent revision surgery with the relating reason of infection for 10 knees,aseptic loosening for 3,and stiffness for 1 knee.Conclusion Fixed bearing TKA can fulfill satisfactory long-term clinical results,with more than 90％ of 10-year survival rate.The strategy for posterior cruciate ligament,patellar and preoperative diagnosis has no statistically impact on the long-term survivorship.

Objective. To observe the clinical outcomes of using a new instrumentation SOCON system in the treatment of degenerative spondylolisthesis.Methods. Retrospective clinical and roentgenograph review of 21 patients who suffered from degenerative spondylolisthesis with spinal stenosis treated by decompression, posterolateral intertransverse arthrodesis, and with transpedicle instrumentation of SOCON system.Results. Nineteen of 21 patients were completely recovery from their preoperative symptoms, 17 of 18 cases with grade one slippage reduced to normal spine alignment, 2 cases of grade two slippage fully reduced, and one case of grade two spondylolisthesis got 70% reduction. Post- operative satisfactory rate was 90.5%. Pain relief was 90.5%. Neither infection nor neurologic complication occurred in this series.Conclusion. Our short time follow-up and limited cases showed satisfactory preliminary result of surgical treatment of spondylolisthesis with SOCON instrumentation.

Low frequency sensorineural deafness is a common subtype of idiopathic sudden deafness. Certain patients suffered recurrent attacks without vertigo, much alike Meniere's disease. Few of them developed into definite Meniere's disease during long-term follow-up in many clinical studies. Although the pathophysiology of recurrent low frequency deafness is yet unknown, the desease is considered associated with early state of endolymphatic hydrops or migraine. Otologists shall be aware of its clinical course and careful explanation is necessary at time of initial informed consent.
Endolymphatic Hydrops ; complications ; Hearing Loss, Sensorineural ; complications ; diagnosis ; Hearing Loss, Sudden ; Humans ; Meniere Disease ; complications ; Vertigo

Objective To investigate whether the macromolecular materials could enter cerebrospinal fluid and brain tissues in craniotomy with incision or non-incision of dura and arachnoid. Methods Adult male SD rats were randomly divided into three groups according to the random number table. The dura and arachnoid of rats in group A were cut open during craniotomy after general anesthesia; epidural craniotomy was done in rats in group B after general anesthesia; rats in group C (control group) were only generally anesthetized. All the rats were injected with Evans blue, a tracer used to detect the results, half an hour before each time point (1,3, 6, 12, 24, 72 hours and 1 week) via vein. The rats were executed at each time point to obtain the specimens of brain. The content of Evans blue in brain tissue was measured by fluorescence spectrophotometer for statistical analysis. The water content in the brain tissue was measured in a part of rats selected in groups A and B preoperatively and at postoperative 3 and 27 hours. Results It was found that some regions of the brain tissue were stained light blue in group A at 1,3, 6 and 24 hours. The blue was much lighter in brain tissue obtained at 72 hours in group A, and no blue stained at 1 week in group A . The contents of Evans blue in the brain tissues of rats in group A at 1,3, 6, 12, 24, 72 hours and 1 week were (18.07±1.25) μg/ml, (36.21±0.78) μg/ml, (25.73±1.14) μg/ml, (16.53±0.84) μg/ml, (23.34±1.91) μg/ml, (43.34±2.25) μg/ml and (25.27±1.88)μg/ml respectively, which were significantly higher than (3.15±0.45)μg/ml, (3.36±0.33)μg/ml, (2.98±0.54)μg/ml, (3.47±0.55)μg/ml, (3.54±0.37) μg/ml, (2.88± 0.42) μg/ml and (2.85±0.22) μg/ml respectively in group B and (2.97±0.37)μg/ml in group C (P<0.01). There was no significant difference in water content in brain tissue before and after operation (P>0.05). Conclusion After craniotomy with incision of dura and arachnoid, some macromolecular materials can enter the subarachnoid space and the brain parenehyma through blood-brain barrier of the wound of the scalp if the dura is sutured loosely.