BACKGROUND: Cranial defects need decompressive craniectomy owing to severe craniocerebral injury or spontaneous cerebral hemorrhage.Cranioplasty is generally necessary at 3-9 months after first surgery.Autologous cranial bone,as an ideal repair material,has aroused wide attention from neurosurgeons.OBJECTIVE: After 3 9 months of subperitoneal embedding,autologous cranial valves with periosteum were taken out for repair of cranial bone defects.Cranial valves were observed in terms of size and shape as well as periosteal changes.METHODS: In totally 100 severe cranial injury patients presenting with severe cerebral hemorrhage,brain herniation end high intracranial pressure after hematoma removal needed decompressive craniectomy and were included in this study.Craniotomy was performed with intact periosteum left.The mid/upper left quadrant abdominal skin was dissected to expose the superficial fascia.The convex surface of cranial valve was made close to the subcutaneous fat,followed by incision suture.Autologous cranial valves with periosteum were taken out after 39 months.Prior to and after preservation,the length,width,thickness,and diagonal length of cranial valves with periosteum were measured.RESULTS AND CONCLUSION: 6-year clinical observation revealed that 72 cases of cranial valves were preserved for 3-4months,showing sharp valve edge,without absorption or shrank cranial valve,bright red,soft,slightly thickened periosteum; 1case of cranial valve was preserved for 9 months,showing blunt valve edge,obvious absorption,markedly reduced valve,light-colored periosteum,obvious osseous hyperplasia; the cranial valves of other cases showed phenomena between these two.These findings demonstrate that subperitoneal preservation of autologous cranial valve with periosteum can maintain the size,shaoe,and activity of cranial bone.

Objective To study the repairing skull defect postoperative scalp raw muscle necrosis application as the clinical treatment of skin cream and tension suture technique.Methods A retrospective analysis of 26 cases of skull defect postoperative scalp necrosis in June 2007 to June 2014 was recorded.Given the tension suture after surgical debridement suture with raw muscle elephant skin creams besmear in the treatment of wounds.Results Twenty-four cases of scalp necrotic wounds healing,1 case was given after the repair material from the scalp necrotic wounds healing,1 case of secondary intracranial infection,given the repair material from brain abscesses clear postoperative wound healing.Conclusion Adopting the raw flesh like a skin cream for the treatment of tension suture after surgical debridement,can achieve rapid cure local infection,promote the healing of the scalp necrotic wounds,reduced the skull to operation failure and postoperative scalp defect repair necrosis repair material from risk,obtain ideal treatment effect.

Objective To explore the surgical indication,key point and curative effect of small bone window in removing the frontal brain contusion and basal ganglia hematoma.Methods The clinical data of 118 patients with frontal cerebral contusion (38 cases) or basal ganglia hematoma (80 cases) were retrospectively analyzed,and the patients were given small bone window surgery.Results The postoperative curative effect was evaluated by daily life activities Barthel index.In 118 patients,56 cases (47.5％) were postoperative independent (Barthel index 100 scores),34 cases (28.8％) were mild dependence (Barthel index 75-95 scores),16 cases (13.6％) were moderate dependence (Barthel index 50-70 scores),10 cases (8.5％) were severe and totally dependence (Barthel index 0-45 scores),and 2 cases (1.7％) were death.Conclusion Small bone window in removing the frontal brain contusion and basal ganglia hematoma has small trauma,fully removed lesions,shorter operation time,fewer complications,quicker recovery,no skull repair,and lower mortality and disability rate.

BACKGROUND:Different kinds of skul repair materials have different physicochemical properties and biocompatibilities. OBJECTIVE:To summarize the research and application progress in skul defect repair materials. METHODS:A computer-based search of China Academic Journal Network Publishing Database, Wanfang and PubMed databases was performed for articles published from 1988 to 2014 with the keywords of“bone repair materials, physical and chemical properties, biocompatibility, titanium al oy, autologous skul”in Chinese and English, respectively. RESULTS AND CONCLUSION:By the literature retrieval, the clinical application and research progress of bone repair materials are analyzed, properties and clinical application of different types of skul repair materials at different periods are compared, to master the physical and chemical properties and biocompatibility of different skul repair materials as wel as to summarize the timing and methods of skul repair in individual patients. Titanium and titanium al oys have been used widely as skul repair materials because of their good biocompatibility, physicochemical properties, and fewer complications. Autologous skul bone flaps have been the ideal materials for skul repair because its origin is consistent, without any rejection. Bone tissue engineering technology developed in recent years provides a new research direction for skul repair, because it can be used to copy autologous skul .

OBJECTIVE:To establish the quality standard of Liuwei dihuang pill (concentrated pill). METHODS:Radix Rehmanniae Preparata,Dioscorea opposita,Poria cocos and Alisma orientalis in Liuwei dihuang pill (concentrated pill) were identified by TLC and the contents of paeonolum and loganin were determined by HPLC.RESULTS:The TLC spots were clear and well-separated yet free of interference of negative sample.The linear ranges of paeonolum and laganin were 0.100 6～1.006 ?g (r=0.999 9) and 0.309 6～2.322 ?g(r=0.999 6),respectively,and their recovery rates were 98.2%(RSD=2.3%,n=6) and 95.3%(RSD=0.42%,n=6),respectively.CONCLUSION:The established standard is applicable for the quality control of Liuwei dihuang pill.

[Objective]To compare the effects of topical different concentration mitomycin C(MMC)in preventing postlaminectomy peridural adhesion.[Method]Laminectomies were performed at L1 in 40 rats.Cotton pads soaked either with 0.01 mg / ml(group L),0.05 mg /ml(group M),0.1 mg / ml(group H) MMC or saline(group C) were applied to the operative sites.The rats were killed 4 weeks after surgery.The specimens were prepared for determination of the degree of scar adhesion according to Rydell method,the content of Hydroxyproline(HOP),the area of peridural fibrosis and the count of fibroblasts.[Result]Dense peridural fibrosis with marked peridural adhesion showed in group C.No obvious adhesion formed in group H.In group M and L,peridural adhesion wasn't avoided.The content of HOP,the area of peridural fibrosis and the count of fibroblasts showed various degrees decrease in all MMC-treated groups.[Conclusion]Local application of 0.1 mg/ ml MMC may be a successful method of reducing postlaminectomy peridural fibrosis and completely avoided peridural adhesion.

Objective To discuss the clinical value of combined determination of fasting blood glucose (FBG),glycosylated hemoglobin(HbA1c)and high-sensitivity C-reactive protein (hs-CRP)in patients with acute cerebral infarction.Methods 105 patients with acute cerebral infarction were scored using the standard of Europ Stroke Score(ESS) ,and the level of FBG,HbA1c and hs-CRP were measured.All the patients were divided into three groups,according to the level of FBG and HbA1c,and the index of three groups were compared.Results The hyperglycemic group without diabetes had lower ESS score than the group with normal blood glucose(P <0.01 )and the group with hyperglycemia and diabetes(P <0.05).Also the hyperglycemic group without diabetes had higher level of hs-CRP than the group with normal blood glucose(P <0.01)and the group with hyperglycemia and diabetes (P <0.05).Conclusion Patients with acute cerebral infarction associated with high FBG and high HbA1c had high hsCRP, and severe prognosis.

Objective To investigate the effects of ketamine in relieving postoperative pain after laparoscopic cholecystectomy(LC).Methods Forty patients undergoing selective LC from July to August 2006 were randomly divided into ketamine group and control group,with 20 patients in each group.Incision pain and non-incision pain was assessed at 1,2,4,6,12,24 h and once each day for the first 3 days postoperatively with visual analogue pain scale(VAS)and sedation scale.Adverse effects and analgesic requirements were recorded.Results Patients in ketamine group had significantly lower scores in incision pain and non-incision pain compared with those of control group(F=22.805,P =0.000;F=18.109,P=0.000).Incidence of postoperative nausea and vomiting was not significantly different(P=1.000)between ketamine(55%)and control group(60%).No significant difference was noticed in analgesic requirements between ketamine group(3 cases)and control group(9 cases)(P=0.082).Conclusions Preoperative administration of ketamine significantly improves postoperative analgesia after laparoscopic cholecystectomy,but does not reduce the incidence of postoperative nausea and vomiting.

Objective To explore the safety and feasibility of improved jejunostomy in operation for patients with esophageal carcinoma.Methods All these 214 patients underwent resections of esophageal carcinoma and jejunostomy were divided into 2 groups,130 patients in routine group and 84 patients in improved group.A 1.5 to 2.0 centimeter in width pedicled omentum were left during dissociating the stomach for patients of improved group.Double purse-string suture were left on the prepared jejunostomy.Pedicled omentum was placed around jejunum tube which was fixed by double suture to peritoneum.Then the operating time,discharging time,leakage,infections,tube shedding and intestinal obstruction were analysed.Results All patients in both groups were healed.There's a statistically significant difference(P<0.05)in operating time and intestinal obstruction between the improved group and the routine group.There isn't a statistically difference(P>0.05)in discharging time,leakage,infections and tube shedding.Conclusion Improved jejunostomy can reduce the operating time,and it's a safe and feasible way in jejunum tube placement.

Objective:To explore the current situation of obtaining high quality and efficient medical service in clinical application of mobile tele-consultation terminal about cell phone. Methods: The technical basis of mobile teleconsultation terminal of cell phone and its application status in domestic and abroad were analyzed. This method was compared with other tele-consultation method at service, mode and cost and other aspects.Results: In the clinical application, mobile tele-consultation terminal about cell phone has many positive roles and advantages, for example, it could enhance the level of diagnosis and treatment for doctor who work in district and community, and resolve medical burden for patients, and promote grading diagnosis and treatment.Conclusion:The mobile tele-consultation terminal can obtain high quality and efficient medical service by investing lower capital. And with the continuous development of the network tele-consultation technique, satellite consultation technique and mobile terminal consultation of cell phone in future, they will further enhance the hospital medical service ability.