Objective To analyse the causes of shunt obstructions after ventriculoperitoneal shunting for children hydrocephalus and their therapy. Methods Ventriculoperitoneal shuntings were done in 156 children with hydrocephalus, in 26 cases of them, the shunts were obstructed. Surgical interventions were performed, and causes of obstruction were found and corrected. Results There were eight kinds of obstructive causes in the ventricular catheters, three kinds in the peritoneal catheters. All obstructions were corrected surgically, 26 patients recovered soon without complications and mortality.Conclusion If the causes of ventriculoperitoneal shunt obstructions can be found and corrected in time, the prognosis of patients is good.

The developing process of thermal comfort was analyzed based on physiology and psychology and the relationship between thermal comfort and human health, environment was discussed in this paper.It suggested that the thermo-stable and thermo-comfortable environment, which might decrease body's adaptability to environment, were not necessarily good for human health. It might have some impacts on human's physiological and psychological adaptabilities also to live in the environment with a great difference between the indoor and outside temperature simultaneously and alternately.

Objective To investigate the thermostability of aristolochic acid Ⅰand the effect of the compatibility on aristolochic acid Ⅰ in Caulis Aristolochiae Manshuriensis decoction and to explore the detoxification mechanism of compatibility for aristolochic acid Ⅰ.Methods Analyzing the contents of aristolochic acid Ⅰ by HPLC in the single decoction of Caulis Aristolochiae Manshuriensis,the concoction of Caulis Aristolochiae Manshuriensis with Cortex Moutan,the residues of decocted Caulis Aristolochiae Manshuriensis and the residues of concocted Caulis Aristolochiae Manshuriensis with Cortex Moutan,respectively.Results Aristolochic acid Ⅰ decreased after heating in pure water,a new peak was found in HPLC spectra and supposed to be the derivate of aristolochic acid Ⅰ,which was also found in the decoction of Caulis Aristolochiae Manshuriensis.The content of aristolochic acid Ⅰ in the concoction of Cortex Moutan with Caulis Aristolochiae Manshuriensis is lower than that in the single Caulis Aristolochiae Manshuriensis decoction.Furthermore,the quantity of aristolochic acid Ⅰ in the residues of Caulis Aristolochiae Manshuriensis after concoction is lower than that in the residues of single Caulis Aristolochiae Manshuriensis decoction.Conclusion Aristolochic acid Ⅰ is unstable in decoction and a part of it was changed into another compound.The stripping of aristolochic acid Ⅰfrom Caulis Aristolochiae Manshuriensis is not inhibited when Cortex Moutan concocted with Caulis Aristolochiae Manshuriensis.It is the chemical reaction of aristolochic acid Ⅰ,which could decrease the toxicity in the decoction or concoction of Caulis Aristolochiae Manshuriensis.

We retrospectively analyzed 23 cases of histiocytic necrotizing lymphadenitis (HNL) admitted to our hospital as fever of unknown origin (FUO).Fever,lymphadenopathy and skin rash were the most common clinical manifestation.The major laboratory features included cytopenia,abnormal liver enzyme and elevated inflammatory markers.Three of the 23 cases were finally diagnosed as infectious disease,5 as autoimmune disease,while the left 15 remained as HNL during the follow-up.Four of the 15 HNL patients resolved spontaneously,while the other 11 relieved by steroid use.Two patients relapsed during the follow-up.HNL was one of the rare causes of FUO.Since it would be accompanied with infectious,autoimmune or malignant diseases,long follow-up is necessary.

To study the effects of fentanyl on the MAC of sevoflurane. Method: One hundred and sixteen patients were given continuous infusion of fentanyl with CACI-pump (computer-assisted continuous infusion)to maintain different target plasma concentrations (Ct), meanwhile inhaled sevoflurane. All patients were randomly divided into seven groups receiving sevoflurane in oxygen with fentanyl target plasma concentration of 0?g/L (n=16), 0.5?g/L(n=20), 1?g/L(n=18), 2?g/L(n=16), 3?g/L(n=18), 4?g/L(n= 14) or 6?g/L(n= 14). Plasma concentraion of fentanyl was measured with radioimmunoassay. MAC determination, in response to the stimulus of skin incision, was made using the "up-down" method and logistic regression. Result: The MAC of sevoflurane from group 1 to group 7 were 1.94%, 1.89%, 1.55%, 1.29%, 1.09%, 0.86% and 0.35% respectively. Conclusion: We verify the MAC of sevoflurane, which is reduced by increasing plasma fentanyl concentration.

Objective To explore the teaching effects of the case study method in the comprehensive and designing experiments. Methods During the teaching process of the "Nursing Fundamentals", we organized students by groups to select medical samples, prepare and carry out experiment plans, as well as held sessions of experiment results reporting and teachers' comments. Results The experimental teaching plans designed by students covered the knowledge from 8 courses and 16 basic nursing operations. Teachers and students were all considering that the application of the case study method into the comprehensive and designing experiments of the "Nursing Fundamentals" had demonstrated the integration of both the teaching contents and the combination of knowledge, capability and quality. The exploration of students' creative thinking was paid attention to, their researching spirit when learning was also cultivated, the sense of professionalism and the awareness of "people-oriented ' nursing were strengthened, and the communication skills and adaptive capabilities were also trained. The teaching atmosphere was obviously activated, and the teaching effects were obviously improved. Conclusions The application of the case study method into the comprehensive and designing experiments enabled the students to well digest and completely understand knowledge from various subjects, as well as enhanced their capabilities of resolving practical problems, and it is also helpful to cultivate the overall quality of the nursing profession.

Objective To have a systemic review of the association between relative ratio in proton magnetic resonance spectroscopy (1H-MRS) and Alzheimer's disease (AD). Methods A search in Medline and China National Knowledge Infrastructure (CNKI) was performed,and relevant English and Chinese-language articles about assessing AD with 1 H-MRS were identifed.The data of relative metabolic ratios (NAA/Cr,Cho/Cr,mI/Cr ) from different brain regions (hippocampus,posterior cingulate gyrus,temporal lobe,parietal lobe,frontal lobe,occipital lobe) were extracted from the articles.The quality of the articles was evaluated according to the standard recommended by Newcastle-Ottawa criteria. The Meta-analysis was done with the Review Manager 4.2 to calculate pooled weighted mean difference (WMD) with 95％ confidence interval (95％ CI ),and linear correlation analysis between NAA/Cr ratio and mI/Cr ratio was done by SPSS 17.0.Results Thirty six articles (27 English articles,9 Chinese articles) were included. After heterogeneity test was done,fixed effects model or random effects model was selected. The meta-analysis showed that the NAA/Cr ratio in patients with AD was higher than that in controls ( WMD:-0.14,95％CI:-0.17 to -0.11 ).The mI/Cr ratio in patients with AD was lower than that in controls ( WMD:0.10,95％ CI:0.07 to 0.13 ).There were greatest changes in NAA/Cr ratio and mI/Cr ratio on the hippocampus ( WMD of NAA/Cr: - 0.27,95％ CI:- 0.36 to - 0.19 ; WMD of mI/Cr:0.21,95％ CI:0.10 to 0.33). There were also no differences between patients with AD and controls with respect to the Cho/Cr ratio (WMD:0.01,95％ CI:0.00 to 0.01,P ＞0.05). The NAA/Cr and mI/Cr changes are markedly correlated with each other in different brain regions ( r =0.947,P =0.004). Conclusion The hippocampus region is the first to present neuropathological changes in AD and the changes of NAA/Cr and MI/Cr might reflect the neurodegenerative process of AD.

Objective To review the clinical features,diagnostic work-up,classification,prognosis and treatment of systemic mastocytosis (SM).Methods The clinical data of 3 SM patients admitted to Peking Union Medical College Hospital (PUMCH) were retrospectively analyzed and the review of recent literatures was performed.Results All the 3 cases were pathologically diagnosed.According to WHO 2008 classification criteria,2 cases were diagnosed as aggressive SM (ASM) and the other one was diagnosed as indolent SM (ISM).Case 1 was a 60-year-old female patient who had overt mediator release syndrome manifesting as episodes of flushing,fever,vomiting,palpitation,hypotension and syncope.She was diagnosed as aggressive SM based on significantly increased number of abnormal mast cells (accounting for 6％ of all nucleated cells) in the bone marrow aspiration sample and biopsy specimen which accompanied with decreased other myeloid and erythroid elements.Her disease was refractory to the treatment of H2 antihistamines and led to a fatal outcome eventually.Case 2 was a 72-year-old male patient who underwent extended proximal gastrectomy with esophagogastric anastomosis due to endoscopically detected diffuse thickening of the gastric fundic mucosa.The diagnosis as indolent SM was established according to the dense infiltrate of abnormal mast cells in the surgically resected part of stomach and regional lymph nodes.He had been in complete remission for more than 6 years ever since then.Case 3 was a 41-year-old female patient who presented with fever,urticaria pigmentosa and diffuse bone lesions.A bone biopsy specimen demonstrated a dense infiltrate of mast cells while the assays for KIT-D816V mutation and FIP1L1-PDGFRα fusion gene yielded negative results.She was diagnosed as aggressive SM and a progression-free survival of more than 1 year had been achieved with the treatment of prednisone,interferon-α and pamidronate.Conclusions SM is a rare disease.Diagnosis is primarily dependent on histopathology.There is currently no curative therapy for systemic mastocytosis.Treatment is intended to reduce symptoms and improve quality of life.The prognosis of ISM is much better than that of ASM.

ObjectiveTo explore the application of peripherally inserted central venous catheter (PICC)and central venous catheter (CVC) in the surgical parenteral nutrition.MethodThe operation time,success rate,indwelling duration,abnormal biopsy,and adverse reactions of PICC and CVC were retrospectively compared.ResultsCVC had significantly shorter operation time than PICC groups [ (28.67 ±5.13) min vs.(45.20 ±6.89)min,P =0.035 ).The mean indwelling duration was significantly longer in PICC group than in CVC group [ ( 114.85 ± 10.29) d vs.(24.78 ± 8.42) d,P =0.033 ].PICC group was superior to CVC group in terms of five complication items,while only phlebitis was more frequent/severe in CVC group.ConclusionsPICC may be more suitable for long-term ( ＞4 weeks) catheter-based nutrition.CVC has short operation time and fast flow rate,and therefore is most suitable for rescue treatment for critically ill patients.