To improve the microsurgical curative effect of petroclival cholesteatoma (PCC), 52 patients harbouring PCC removed from 1993 to 2002 were analyzed retrospectively. Of all patients in this group, total tumor removal was achieved in 47 patients (90%), subtotal removal in 5 (10%). The new cranial nerve injuries occurred postoperatively in 4. Operative death occurred in 1 patient due to severe lung infection (1 9%). The key goal of surgical resection of the tumor was good. Suitable basicranial approaches and skillful microsurgical technique can increase the total removal rate, and decrease its mortality and morbidity.

To probe the treatment effects of the syringomyelia using microsurgical technique, a total of 127 patients with syringomyelia confirmed by CT or MRI in our department were analyzed retrospectively. The patients underwent occipitocervical decompression, syringostomy or syringo subarachnoid shunting (S S shunting) with microsurgery. All patients were followed up for more than 1 5 years and the treatment results were evaluated The results indicated that the collapse of the syrinx was achieved in 84 patients who underwent S S shunting or syringostomy. Decreased size of the syrinx was also noted in 43 Arnold Chiari malformation and spinal dysraphism patients who underwent occipitocervical decompression alone. The authors consider that the patients with syringomyelia should be microsurgically treated. The occipitocervical decompression, syringostomy or S S shunting may be an alternative method of surgical treatment for syringomyelia.

Objective To evaluate the diagnosis and microsurgical treatment of intraspinal abscesses. Methods The clinical manifestations, diagnosis, and microsurgical treatment of sixty-two patients with intraspinal abscess were retrospectively analyzed. Among them, 36 were male and 26 were female, with an average age of 41 years. Thirty-seven were suffering from extradural abscesses, 23 subdural abscesses and 2 intramedullary abscesses. The diagnosis was made based on the history, clinical manifestations, MRI and myelogram. Prompt decompressive laminectomy and removal of the abscesses were carried out. Results Fifty-one patients were followed up. Of them, 27 completely recovered, accounting for 52.9%; in 18 the recovery was graded as good, accounting for 35.3%; and in 6 the recovery was fair, accounting for 11.8%. Conclusion Early diagnosis and microsurgical intervention of intraspinal abscesses could result in satisfactory recovery.

Objective To sum up the experiences in microneurosurgical treatment of spinal cord cavernous hemangiomas (SCH). Methods A retrospective analysis was made of 17 cases of SCH admitted from March 1992 to December 2002. Operations were performed via a posterior midline approach under a microscope. Results Total SCH resection was done in 13 cases, and subtotal removal in 4. The postoperative neurological status was improved in 11 cases, unchanged in 4, and aggravated in 2. No postoperative death occurred. Conclusion Spinal MRI examination is a reliable diagnostic method of SCH. Skillful microneurosurgical technique can achieve a rather good result.

The paper is to report the study of pharmacokinetics of transdermal administered nicotine in the brain of freely moving rat by using microdialysis with stable labeled isotope as internal standard. The pharmacokinetic behavior of nicotine in Sprague Dawley rat brain was investigated after intranasal administration (3.75 mg). Brain fluid samples were collected by intracerebral microdialysis with DL-nicotine as internal standard. Concentrations of nicotine and DL-nicotine in the sample were measured by HPLC-MS/MS. Main pharmacokinetic parameters were calculated and analyzed by Das 2.0 pharmacokinetic software. The recovery of nicotine and the delivery of DL-nicotine were the same. The fate of absorption and distribution was two compartment model and the values of t1/2alpha was 170.31 min, t1/2beta was 263.30 min and the AUC(0-infinity) was 2.75 x 10(5) microg x L(-1) min separately. DL-nicotine can be used to calibrate the recovery of nicotine, and the new method of stable isotope microdialysis can be used to study the pharmacokinetics of freely moving rat. It will make sense for the treatment of addiction of tobacco and provide a new thought for the research of pharmacokinetics-pharmacodynamic combination.

Objective To analyse the changes of a district general hospital before and after management by Shanghai Renji Medical Group through current situation survey,and explore the conditions for the development of district general hospitals.Methods The Zhujiajiao People's Hospital of Qingpu District in Shanghai was selected,and patients(n=50)and hospital staff(n=100) were conducted current situation survey with questionnaires which included the knowledge and evaluation of the hospital's current situation as well as the changes before and after management by Shanghai Renji Medical Group.Results Half year after management by Shanghai Renji Medical Group,great progress in medical work was achieved,with a favourable development trend.The rate of satisfaction on medical service evaluated by inpatients reached 89.60%,and 81.91% hospital staff had confidence in the sustainable development of the hospital. Conclusion Management by Shanghai Renji Medical Group has brought prospects for the Zhujiajiao People's Hospital.Under current environment,only certain conditions are met can a district general hospital achieve sustainable development.

In this study, the effect of prophylactic anti-inflammation on the development of smoke-induced emphysema was investigated. Young male guinea-pigs aged 1.5-2 months (weighing 198.3+/-26.9 g) were randomly divided into 4 groups: group A (cigarette smoke exposure only), group B (cigarette smoke exposure plus pentoxifylline-rich (PTX, 10 mg/d) forage feeding), group C (cigarette smoke exposure plus intermittent cortical steroid injection (Triamcinolone acetonide, 3 mg, i.m., every three weeks) and control group (group D: animals with sham smoke exposure, raised under the same conditions). Animals in group A, B and C were exposed to smoke of cigarettes for 1 to 1.5 h twice a day, 5 days a week. All animals were killed at the 16th week and followed by morphometrical analysis of the midsagittal sectioned lung slices. Smoke exposure of 16 weeks resulted in visible emphysematous development in Group A but not in Group B and C. It was evidenced by the indicator of air-space size, mean linear intercept (Lm): 120.6+/-16.0 microm in Group A; 89.8+/-9.2 microm in Group B and 102.4+/-17.7 microm in Group C. The average Lm in either group B or group C was shorter than that in Group A (ANOVA and Newman-Keuls test, F=8.80, P=0.0002) but comparable to that (94.8+/-13.2 microm) in group D (P>0.05). It is concluded that long-term prophylactic anti-inflammation inhibits pulmonary emphysema induced by cigarette smoking in the guinea pigs.
Anti-Inflammatory Agents/*pharmacology ; Pentoxifylline/pharmacology ; Pulmonary Emphysema/etiology ; Pulmonary Emphysema/pathology ; Pulmonary Emphysema/*prevention & control ; Random Allocation ; Smoking/*adverse effects ; Triamcinolone Acetonide/*pharmacology

Drugs, Chinese Herbal ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional

BACKGROUND:Clinical limb ischemia-reperfusion with no reflow phenomenon after vascular injury repair seriously affects the prognosis of patients. Therapeutic effect of hyperbaric oxygen in myocardial ischemia reperfusion is exactly confirmed, but hyperbaric oxygen is rarely reported in the treatment of limb ischemia-reperfusion.
OBJECTIVE:To detect the expression of vascular endothelial growth factor and intracellular adhesion molecule 1 and to investigate the effect of hyperbaric oxygen on the prognosis of limb ischemia-reperfusion with no reflow phenomenon.
METHODS:By clinical screening, cases of main arterial injury of the limbs were selected and subjected to vascular repair for restoring limb blood supply. After surgery, al the cases were randomly divided into two groups (Combined treatment group and surgical group), 16 cases in each group. Combined treatment group was treated with hyperbaric oxygen combined with clinical anticoagulant, antiplatelet treatment;surgical group treated with only postoperative clinical treatment. Another 16 adult healthy volunteers were selected to receive hyperbaric oxygen as hyperbaric oxygen group. Expressions of vascular endothelial growth factor and intracellular adhesion molecule 1 were detected using enzyme-linked immunosorbent assay at 8, 72 hours and 7 days after surgery.
RESULTS AND CONCLUSION:In the combined treatment and surgical groups, patients exhibited higher expressions of vascular endothelial growth factor and intracellular adhesion molecule 1 than those in the hyperbaric oxygen group (P<0.01). After 72 hours, the expression of vascular endothelial growth factor was significantly higher in the combined
treatment group than the surgical group (P<0.01). At 8 and 72 hours, the expression of intracellular adhesion molecule 1 was lower in the combined treatment group than the surgical group (P<0.05). These findings suggest that hyperbaric oxygen can induce high expression of vascular endothelial growth factor and inhibit intracellular adhesion molecule 1, which is crucial for improving growth of blood capil ary, formation of endothelial cells, reducing no reflow phenomenon.

Objective To investigate the dynamic changes in peripheral blood of patients with acute pancreatitis α-MSH,TNF-α,PCTS and the value of the patient assessment of disease severity.Methods Emergency surgery in the Second Affiliated Hospital of Anhui Medical University from March 2011 to March 2014 were treated 68 cases of acute pancreatitis patients,36 patients with mild,32 cases of severe group.All patients were extracted 1,3,5,7 days after admission blood,and α-MSH was measured by enzymelinked immunosorbent assay,the content of TNF-αand PCT.Results Compared with the mild group,the serum of patients with severe group of α-MSH concentrations were lower (P ＜ 0.05),while serum TNF-αand PCT levels higher than the mild group (P ＜ 0.05);in disease severity assessment,α-MSH sensitivity of 82.35％ and a specificity of 88.24％,the accuracy was 87.5％,TNF-α sensitivity of 76.47％ and a specificity of 82.35％,the accuracy was 81.25％,PCT sensitivity of 70.59％ and a specificity of 76.47％,75.00％ accuracy,PCT + TNF-α + α-MSH sensitivity of 88.24％ and a specificity of 94.12％,93.75％ accuracy;area under the PCT,TNF-α,α-MSH and the combination of the three curves 0.690,0.696,0.768 and 0.885,respectively.Conclusions Serum α-MSH,monitoring TNF-α,PCT levels have some clinical value in patients with acute pancreatitis disease severity assessment,including α-MSH in the condition assessment of the sensitivity,specificity and positive predictive value were higher than the latter two,and peripheral α-MSH in patients with a low level indicates a serious condition,poor prognosis;addition,combined detection with higher clinical value in the assessment of disease severity.