Objective　To explore the phenomenon of neural apoptosis after chronic compressive spinal cord injury. 　Methods　A newly designed chronic progressive compressive spinal cord injury model of rat was adopted in this study. Forty-five Wister rats were divided into mild, moderate, and severe group according to the compressive degree of the spinal cord. The Feulgen stain and TUNEL were used to investigate the apoptosis and its characteristics in different kinds of neural cells. 　 Results　Apoptosis index in moderate injury group was the highest. Apoptotic cells largely located in ventral, lateral and dorsal column of the white matter. Most of them were oligodendrocytes. Positive neuron occasionally presented in laminae Ⅲ～Ⅸ part of the sections. Most of them located in dorsal gray horn. 　Conclusions　 Apoptosis is an important event in secondary pathophysiological process of chronic progressive compressive spinal cord injury. Apoptosis is one of the reasons for neural cell death. The apoptosis of oligodendrocytos may contribute to myelin sheath disruption of white matter.

After a description of the new connotations of information literacy education in medical undergraduates in the era of omnimedica such as visual information literacy education, media information literacy education and mobile information literacy education, new strategies were proposed for the information literacy education in medical undergraduates in the era of omnimedia, including updating teaching model, adding education contents, and improving omnimedia presentation ability.

BACKGROUND: Clinical studies have discovered heart rate variability (HRV) is closely correlated with autonomic nervous system, sub-health and sudden death. Medical studies have summarized some chaotic medical science and homeostasis relevance theory. But so far the combination could still not systematically explain the clinical manifestation or summarize the diagnostic standards for sub-health and effective index to prevent sudden death. OBJECTIVE: To elucidate the correlation among autonomic nervous system, sub-health and sudden death by using chaotic medicine and homeostasis, so as to provide theoretical basis for evaluating sub-healthy state using HRV and preventing sudden death HRV. RETRIEVAL STRATEGY: A computer-based online search of Pubmed was undertaken to identify the articles published in English between January 1995 and June 2007 with the keywords of "chaotic medicine, heart rate variability (HRV), Sudden death, Sub-health, homeostasis". Meanwhile, the Weblog and CNKI database were searched for relevant articles dated from January 1995 and June 2007 with the same keywords in Chinese. Fifty-six papers were searched. After the first trial, only articles ①closely correlated with chaotic medical science, sudden death and sub-health, and ②published recently or in authority magazine in same field were selected. Repetitive studies were excluded. LITERATURE EVALUATION: The review articles, basic and clinical experiments about chaotic medical science, HRV, sudden death, sub-health, and homeostasis as well as articles published in related weblogs were selected. DATA SYNTHESIS: ①In any individual composed of multi-cells and multi-system, there are at least three-level chaotic system: overall chaotic system, cardiovascular chaotic system maintaining the blood pressure and cell chaotic system. Healthy state is that the three chaotic systems are in normal condition. Disease and sub-healthy state is the sub-stable state of chaotic system caused by the overstress of central nervous system, overexcitation of autonomic nerves and HRV decrease when there is some cell or cardiovascular system malfunction, and the information is feedback to central nervous system. ②Based on the theory about chaotic medicine and homeostasis, there are four states in individual chaotic motion: health, disease, sub-health, and homeostasis border before sudden death. The health is the homeostasis of body; disease and sub-health are the sub-homeostasis and may develop from healthy state because various factors; they may transform each other and both of them may lead to sudden death for unsteady. ③The extreme tension of central nervous system and over-excitation of autonomic nerves result in the destabilizing overall chaotic motion. Stimulation induces system destabilizing and sudden death because the patient cannot maintain arterial blood pressure. CONCLUSION: Long-term healthy state is unpredictable, but we can forecast 1-2 days situations by short-term HRV testing for 512 times in the early morning of every day, and judge the healthy state after sleep, and the change tendency of healthy state. Accordingly, we could predict person is in healthy state, sub-healthy state or unsteady border state that could cause sudden death.

0.05),which led to an important difference in the levels of hsCRP between the groups (P

Objective To summarize the value of laparoscopic operation using an ultrasonic scalpel for the radical treatment of Hischsprung’s disease (HD) in infants and children. Methods Laparoscopic operation was performed in 20 infants and children with HD under general anesthesia from February 2003 to January 2006. The CO_2 pressure of pneumoperitoneum was set at 10~12 mm Hg. By way of three abdominal ports, the diseased colon and rectum were mobilized by dissecting the supplying vessels and severing the peritoneal reflection in the pelvic floor. The modified Soave pull-through procedure was employed to incise and mobilize the rectal mucosa at 0.5 cm above the dentate line. The lateral ligament of rectum was severed and the intraabdominal cavity was reached through the peritoneal reflection. The diseased colon was pulled through the anus passing the level of the transition zone for resection. Then coloanal anastomosis was made between the proximal colon and the cutting edge of the anal canal above the dentate line. Results All the procedures were completed smoothly. The operation time was 120~210 min (mean, 132 min). The length of resected colon was 20~55 cm (mean, 35 cm). The intraoperative blood loss was 5~20 ml (mean, 14 ml), with no need of blood transfusion. Enterocolitis happened in 2 cases postoperatively. Follow-up observations in the 20 cases for 3~36 months (mean, 12.5 months) found no complications. The patients had 1~2 times of fecal discharge per day during follow-up. Conclusions Laparoscopic pull-through procedure using an ultrasonic surgical scalpel has advantages of minimal invasion, little hemorrhage, simple performance, quick recovery, and low complication rate.

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.

Objective To investigate the feasibility of two-port laparoscopy-assisted resection of the Meckel’s diverticulum in children. Methods Resection of the Meckel’s diverticulum was performed under a laparoscope in 13 children in our hospital from July 2002 to March 2006. Two 5-mm trocars were introduced at the infraumbilical ring and the right lower abdomen, respectively. When the Meckel’s diverticulum was found, the incision was prolonged to 2 cm long along the inferior border of the umbilicus, the diverticulum was removed externally and the intestine was anastomosed. Results The operation was completed successfully without conversion to open surgery. The mean operation time was 50 min (range, 40-70). The intestinal function of the patients recovered 24 hours after the operation, and then liquid food was given at 3 days postoperatively, and the patients was discharged from hospital within 5-7 days after the operation. The patients were followed up for 6-48 months (mean, 13), during which no one had recurrence, intestinal adhesion, or intestinal obstruction. Conclusions Two-port laparoscopy-assisted resection of Meckel’s diverticulum is safe and feasible for children. The recovery time and hospital stay are short after the procedure.

Objective To summarize the experience of l ap aroscopic pyloromyotomy for the treatment of infantile hypertrophic pyloric sten osis (IHPS). Methods Laparoscopic pyloromyotomy was employed i n 50 cases of IHPS from April 2001 to April 2004. The patients aged 12~90 days ( mean, 35 days). Three 3-mm-diameter trocars were introduced into the abdominal c avity via the left, right and upper abdominal wall, respectively. A non-traumati c grasping forceps was inserted through the left trocar to manipulate the gastri c wall near the pylorus. Through the right trocar, a retractable pyloromyotomy s calpel, a stripper and a dissecting forceps were in turn utilized to complete py loromyotomy. Results The operation was completed under laparos cope in 48 cases, while a conversion to open surgery was needed in 2 cases (1 c ase of prepyloric membrane and 1 case of pyloric mucosal injury, which were cure d by open repair). The operative time was 15~45 min (mean, 25 min). The nasogast ric tube was removed and oral feeding with milk was attempted 6 hours after the operation. The patients were discharged at 3~5 postoperative days. Follow-up for 3~6 months (mean, 4.5 months) in 42 cases showed that the patients were normall y developed. Conclusions Laparoscopic pyloromyotomy can be wel l performed in the presence of experience in open surgery, technical skills in l aparoscopy, effective anesthesia and proper surgical instruments.

Objective To compare the effectiveness of enteral nutritional emulsion (TPF-D) and enteral nutritional emulsion (TP) in patients with chronic wound and diabetes (CWD). Methods Totally 20 CWD patients in Beijing Jishuitan Hospital from June 2008 to June 2010 were enrolled in this study. Enteral nutritional emulsion (TP) was used for the first 5 days ( TP group) and enteral nutritional emulsion (TPF-D) was used for the second 5 days (TPF-D group). Changes of mean amplitude of glycemic excursions (MAGE), insulin dosage, and prealbumin (PA) were compared between TPF-D group and TP group. The adverse effects and post-operational complications were also observed. Results The every-day MAGE was (2. 56 ±0. 35) mmol/L in TPF-D group, which was significantly lower than that in TP group [ (3.23 ± 0. 42) mmol/L] ( P = 0. 01 ). The mean insulin dosage was (9.6 ± 1.7) U in TPF-D group, which was significantly lower than that in TP group [ ( 12. 2 ± 2. 5 ) U ] ( P =0.03 ). The increase of PA showed no significant difference between TPF-D group [ ( 12.7 ± 3. 3) mg/L] and TP group [ ( 13.4 ± 2. 8 ) mg/L ] ( P = 0. 08 ). No enteral nutrition-related adverse effect or post-operation complication was noted. Conclusion Compared with TP, TPF-D is more suitable for the CWD patients.

Objective To investigate the distribution of 16S rRNA methylase genes in Klebsiella pneumoniae strains producing Klebsiella pneumoniae ealbapenenase type 2(KPC-2).Methods A total of 37 Klebsiella pneumoniae isolates producing KPC-2 were collected.The minimal inhibitory concentrations (MICs)of these strains to amikacin,gentamyein and netilmicin were determinated by agal dilution method.Six 16S rRNA methylase genes(armA,rmtA,rmtB,rmtC,rmtD and npmA)were detected by PCR.Results The resistant rates to amikacin,gentamycin and netilmicin were 97.3%(MIC50≥1024μg/mL).Among those resistant strains,8 were armr/A positive,25 were rmtB positive,4 were both armA and rmtB positive.and no other 16S rRNA methylase genes were found.The total positive rate of 16S rRNA methylase genes was 78.4%(29/37).Conclusion 16S rRNA methylase genes armA and rmtB ale prevalent in Klebsiella pneumoniae strains producing KPC-2.