Objective To investigate the application value of nasopharyngeal airway combined with polysom-nography in positing relieve airway obstruction before surgery for patients with obstructive sleep apnea-hypopnea syn-drom(OSAHS).Methods 69 patients with OSAHS were underwent consecutive 3 nights of sleep monitoring.At first night,the polysomnography figures were detected by using 36 polysomnography.At second night,patients were wearing nasopharyngeal airway all night and undergoing polysomnography figure monitoring.At third night,the airway pressures were measured by using ApneaGraph sleep monitoring and obstructive positioning system.The indicators of AHI, LSaO2 ,SaO2 and SaO2 <90% T before and after wearing nasopharyngeal airway were compared.The patients were divided into the treatment success group(S group)and treatment failure group(F group),according to AHI change before and after wearing nasopharyngeal airway.The indicators of the two groups were compared.The AHI in the lower part and proportion of lower portions blocking in the total congestion events under the ApneaGraph monitoring system were analyzed.Results 69 patients were successfully implanted nasopharyngeal airway,without nasal trauma,nasal bleeding,etc.63 cases of patients(91.3%)were well tolerated.The AHI and SaO2 <90% T at second night were lower than the first night,while LSaO2 and SaO2 were higher than the first night,the differences were statistically significant(t =13.811,13.307,10.852,4.277,all P <0.05).45 cases(71.4%)were in S group and 18 cases (28.6%)were in F group.LSaO2 in S group was higher than F group,while the lower AHI and lower portions blocking ratio were lower than F group,the differences were statistically significant(t =2.534,14.925,9.541,all P <0.05).Pearson correlation analysis showed the AHI at second night were positive correlated with the lower AHI and lower portions blocking ratio at third night(r =0.638,0.510,all P <0.05).Conclusion Nasopharyngeal airway combined with polysomnography could locate the overnight airway obstruction sites of OSAHS patients,and could be used as a simple base for locating before surgery for relieving upper airway obstruction.

Objective To investigate the application value of Atlas titanium cable in the treatment of comminuted patellar fractures (CPF).Methods 80 patients with CPF in our hospital from January, 2010 to January, 2013 were randomly selected and divided into observation group (n=40) and control group (n=40) by digital random method.Observation group adopted Atlas tita-nium cable internal fixation treatment while control group adopted the improved tension band steel wire in the hollow compression screws fixation treatment.Preoperative (t0), postoperative 1 month (t1), 6 months (t2) and 1 year (t3) Bostman patellar injury curative effect score (BPICES), operation time, intraoperative blood loss, postoperative knee joint exercise time for the first time, length of hospital stay, treatment costs and complications of two groups were compared.Results Preoperative BPICES of two groups had no statistical significant difference (p>0.05).Compared with t0, t2 and t3 BPICES and the rate of optimal curative effects, two groups increased; Compared with the control group, t2 and t3 BPICES and the rate of optimal curative effects of observation group also increased, and the difference was statistically significant (p<0.05).Operation time, intraoperative blood loss, postoperative knee joint exercise time for the first time, length of hospital stay of observation group were (52.26 ±10.29) min, (70.48 ±10.49) ml, (4.78 ±1.48) d and (5.98 ±1.06) d respectively, which were lower than the (79.95 ±8.42) min, (123.36 ±21.18) ml, (9.14 ±4.48) d and (11.18 ±2.68) d of the control group;Therapy cost of observation group was (16 284.47 ±2 145.78) Yuan, which was higher than the (9 892.48 ±1 456.42) Yuan of the control group (p <0.05).Compared with control group, peptide wire/wire Piercing the skin, pain, infection, skin irritation, slippery bursa phlogistic, internal fixation of fracture parted, fracture end separation and other complications total incidence of observation group were lower (p<0.05).Conclusion Atlas titanium wire trea-ting of patients with CPF had shorter operation time and hospitalization time , less postoperative complications.It can promote the rapid recovery of knee joint function, but its cost is higher.Thus it is suitable for CPF patients with better economic conditions .

AIM: To study the pharmacokinetics of ? Asarone in the volatile oil from Acorus. Tatarinowii Schott. in mice. METHODS: We developed a GC method for ? Asarone determination in blood. The GC system consisted of HP 35 capillary column with Helium as carrier gas, oven starting temperature set at 30℃ , then was raised to 220℃ at a rate of 6℃/min , stayed for 5 minutes, injector temperature set at 250℃ , detector temperature at 320℃ . Injection volume was 2.0 ?L with splitless inject mode. Methanol was used as solvent and ? naphthol as interior standard substance. CONCLUSION: The calibration curve in blood was linear in the range of 0.04?g/ml to 40?g/ml . The minimum detection limit was 0.04?g/ml . The recovery for ? Asarone in blood was 95.3% with RSD 3.92% . After oral administration of volatile oil from Acorus. Tatarinowii Schott., the intracorporal process of ? Asarone in mice accorded with 2 compartment model with 1st order absorption. 6.5min and 93.6min were obtained as t 1/2? and t 1/2? respectively.

Objective To explore the protection of the facial-acoustic nerve during microsurgery for acoustic neuroma via the suboccipital retrosigmoid approach. Methods The clinical data of 25 cases with acoustic neurinoma treated by the suboccipital retrosigmoid approach were retrospectively analyzed. Results Total removal was achieved in 22 patients and subtotal in 3 patients. 20 with Cochlear nerve anatomic preservation at 2 weeks after surgery and 3 patients with effective hearing and 13 patients lost effective hearing but retained measurable hearing and 9 patients completely lost hearing( the New Hannover Classification V grade). The facial nerve was preserved anatomically in 18,H-B Grade I ～ IV in 15,Grade V ～ VI in 10. There were not cerebrospinal fluid leakage, intracranial infection and death in all cases. Conclusion When operating,the relation between the tumor and the important structure surrounding could should be understood fully. Then removed the tumor piece by piece with microsurgical techniques. That the effective way to keep the facial nerve and its function being protected,and could improve the prognosis of the operation.

Objective To study the reasonable treatment to the patients with raptured intracranial aneurysms of hunt-hess Ⅲ-IV grade in the cerebral vasospasm stage. Methods The clinical data of 80 patients with ruptured intracranial aneurysms of hunt-hess Ⅲ-IV grade were analyzed retrospectively. All of the patients were clipped closed by microsurgery (36) or embolized intervention(44) in 3～18 days after disease. According to the time of surgical intervention after disease,they were divided into 42 patients with early(3～10 days) surgical group and 38 patients with advanced(11～18 days) surgical group. The different operative methods and different treatment periods were compared in order to evaluate the effect to the prognosis, the DIND incidence and the ruptured again aneurysms during operation incidence. Results There was no statistical significance in the effect about early or advanced surgical intervention to the prognosis, the DIND incidence and the ruptured again aneurysms during operation incidence (P > 0.05). There was no statistical significance in the effect about advanced interventional embolization or clipping closed by microsurgery to the prognosis,the DIND incidence and the ruptured again aneurysms during operation incidence(P > 0. 05). There was statistical significance in the effect about early interventional embolization or clipping closed by microsurgery to the prognosis,the DIND incidence and the ruptured again aneurysms during operation incidence(P< 0.05). The interventional embolization had better prognosis,more lower DIND incidence and more lower ruptured a-gain aneurysms during operation incidence than the clipping closed by microsurgery. Conclusion The patients with ruptured intracranial aneurysms of hunt-hess Ⅲ-IV grade in the cerebral vasospasm stage should be earlier intervened surgically,then it seems that interventional embolization is more reasonable which is worth referencing in clinic. The good operation habits during operation and the effectively strengthening management after operation had positive significance to ensure operative effect and to improve prognosis.

Objective To study the possible reasons and the processing strategy of brain injury operation complicated with intracranial hemorrhage.Methods The clinical data about 22 patients who were digged skull operation because of brain injury and complicated with intracranial hemorrhage in operation in neurosurgery from 2007 June to 2008 February were retrospectively analyzed,and different types intracranial hemorrhage were classified.Results In 22 patients,12 patients were complicated with epidural hematoma,in which the patients (9/12,75.0%) complicated with opposite hematoma were common;5 patients were complicated with intracerebral hematoma,in which the patients (3/5,60%) complicated with ipsilateral hematoma were common;4 patients were complicated with acute subdural hematoma,and all the patients complicated with opposite hematoma;1 patient was complicated with sub-flap hematoma.Conclusions In the patients who are complicated with intracranial hemorrhage because of digging skull operation to brain injury,epidural hematoma are most,then intracerebral hematoma,subdural hematoma,sub-flap hematoma.The important measures of preventing secondary intracranial hemorrhage are definiting force mechanism and distinguishing fracture line before operation,gradiently decompressing,completely removing crushing brain tissue,protecting reflux veins,rigorously stopping bleeding during operation.

Objective To study the effect of anticholinesterase agents on acantholysis in pemphigus vulgaris (PV) by using a mouse model.Methods Fifty-five neonatal BALB/c mice were divided into four groups:model group injected subcutaneously with the sera of patients with PV (n =15),pyridostigmine bromide group (n =15) and neostigmine methylsulfate group (n =15) subcutaneously injected with pyridostignine bromide and neostigmine methylsulfate respectively,in addition to the sera of PV patients,control group subcutaneously injected with sodium chloride physiological solution (n =10).The effect of anticholinesterase agents on acantholysis in PV was evaluated in terms of clinical presentation,histopathological manifestations and direct immunofluorescence findings.Results The injection of sera from PV patients induced characteristic changes of PV in neonatal BALB/c mice in the model group.The degree of acantholysis in the model group was higher than that in the pyridostigmine bromide group (H =21.584,P ＜ 0.001) and neostigmine methylsulfate group (H =20.641,P ＜ 0.001).No changes were observed in the control group.Conclusion Anticholinesterase agents can reduce the degree of acantholysis in the mouse model of PV.

[Objective]To study the curative effect and superiority of one stage anterior-posterior approach total spondylectomy and spinal reconstraction in the treatment of thoracolumbar malignant neoplasms.[Method]Twenty-four thoracolumbar malignant neoplasms patients treated by anterior approach total spondylectomy,spinal reconstractin with titanium mesh cage associated with bone graft or bone cement and posterior approach transpediuclar screw fixation.[Result]The follow-up of postoperation was from 9 to 35 months.All patients achieved relieve of pain after surgery,9 cases with incomplete paraplegia improved by 1.8 grades in average with Frankel neurological classifications,2 cases with dysfunction of urination and defecation were recovered,4 patients decease for metastasis in critical organ,all the patients showed bony fusion at 6~9 months,no internal fixation loosening or breakage case was found,1 case was recrudescent after one year.[Conclusion]Treatment of thoracolnmbar malignant neoplasms by one stage anterior-posterior approach total spondylectomy and spinal reconstraction can remove the neoplasms efficiently,reconstraction the spinal stabilization and improve the quality of life.

Huazhong University of Science and Technology is one of the five schools that trial implementing eight-year program medical education of first batch.Eight-year program medical students in Tongji college came into obstetrics and gynecology clinical contact in 2010.According to the characteristics of students and discipline,obstetrics and gynecology department used multiple teaching methods and means as PBL teaching,integrated case management,typical clinical case conference,clinical diagnosis and treatment,academic lecture,research report,experimental design,scientific research and experi-ment,etc.Available practice mode was reformed.Those students accomplished clinical practice,and achieved expected effect.

Objective To evaluate the safety and efficacy of hepatectomy in combination with portal azygous disconnection for primary hepatocellular carcinoma (HCC) complicated with severe portal hypertension (PHT). Methods Clinical data of 30 cases of HCC complicated with PHT treated in our hospital from April 2005 to April 2008 were retrospectively analyzed. All 30 cases were randomly divided into the single operation group (group Ⅰ ) and combined group (group Ⅱ ). Results After operation, there were no significant statistical differences in rates of complications such as hepatic encephalopathy, ascites, stress ulcer, etc. and recovery of liver function between the 2 groups. The WBC and PLT counts in the blood samples of group Ⅱ were higher than those in group Ⅰ after operation. The postoperative 1- and 2-year hemorrhagic rates were lower in group Ⅱ than in group Ⅰ .Conclusion Hepatectomy in combination with portal azygous disconnection is safe and feasible for treatment of HCC complicated with PHT.