Objective To investigate the way of resection of high-sacrum tumors and the reconstruction way of the sacrum. Methods From October 2001 to October 2005,7 patients with high-sacrum tumors were enrolled. After resection, the pelviclring were recormtmcted with Chinese Great Wall pedicle screw system and fibulae graft,corresponding chemotherapy and radiotherapy were given after operation. Results The short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees, however dysuria occurred in 1 ease and 1 case cerebrospinal fluid leakageand 1 case postoperative infection and delayedunion among the 7 eases in this group. In the follow-up period of 6 months to 3 years,4 eases died for tumor recurred or metastasis. Conclusions Surgical procedure,reconstruction of the sacrum and postoperative comprehensive treatment have important effects on the prognosis. Meanwhile,it is operative key to lessen operative hemorrhage,reserve the function of caudal equine and rebuild weight high post function of the pelvis after superior sacrum tumor is removed.

Ojective To determine the risk factors and the clinical distribution of multiple drug resistant bacteria in stroke- associated pneumonia (SAP) patients with multiple drug-resistant bacterial infections from in-tensive care unit, providing guidance for clinical treatment of SAP. Methods A retrospective study was de-signed to analyze the clinical data of the SAP patients from January 2012 to December 2015. Univariate analysis and multivariable regression analysis were taken for risk factors of MDR infections , and investigated the distribu-tion and drug resistance of MDR. Results There were 183 SAP patients, of which 131patients (71.6%) had MDR infection. There are 193 MDR strains in the 131 patients , the first 5 MDR strains were Acinetobacter bau-mannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Escherichia coli. MDR in-fection is highly associated with sever unconsciousness , time of stay in ICU longer than 7 days , ventilator time longer than 7 days and late-onset pneumonia and the difference was significant (P < 0.05). Conclusion SAP patients with MDR bacterial infections are in association with the following risk factors: sever unconsciousness , time of stay in ICU longer than 7 days, ventilator time longer than 7 days and late-onset pneumonia. The rate of MDR bacterial infections was high , and these MDR strains were widely different degrees of resistance to many antibiotics.

Objective To observe the effects of Ulinastatin on pulmonary vascular endothelium permeability and respiratory function in patients with extrapulmonary acute respiratory distress syndrome(ARDS exp). Methods The data of 39 patients with ARDS exp were retrospectively analyzed.According to whether treated with Ulinastatin or not, all patients were divided into Ulinastatin group(n = 21)and control group(n = 18); The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index(PVPI) and respiratory function were measured before and after the treatment. Results The mortality rate of Ulinastatin group was lower than that of control group (28.6% vs 38.9%). The time of decreasing EVLWI, PVPI and improving PaO2/FiO and respiratory function in Ulinastatin group was shorter than that of control group, and the effect was superior. Conclusion Ulinastatin could reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with extrapulmonary acute respiratory distress.

Objective To optimize the spray pelletization technology for Compound Jiakang Tablets.Methods The experiment was performed by orthogonal design,and the inspection criteria key were granule uniformity,granule size and the content of astragaloside IV,combined with the granule hygroscopic velocity.Results The optimal spray pelletization parameters were as follows:the frequency of main fan was(35.0?5)Hz,atomizational pressure was 0.1 mPa,the rate of spray was 1.2 Hz,the density of extract was 1.20 g/mL.Conclusion The granules made by this technology are uniform,burly,stable,and are beneficial for pressing into tablet.

Objective To investigate the effects of sustained inflation (SI) combined with small tidal volume ventilation on lung recruitment and hemodynamics in patients with acute lung injury (ALI). Methods Patients with severe trauma followed by ALI were selected for this study. Patients underwent small tidal volume ventilation (baseline) for 1 h and then SI with 20 cm H 2O?30 s(SI 1), 30 cm H 2O?30 s(SI 2), 40 cm H 2O?30 s(SI 3) and 50 cm H 2O?30 s(SI 4) for 1 h, respectively. Parameters of pulmonary mechanics and hemodynamics were measured at 1 h after baseline, SI and returning baseline, respectively. Results Compared with those of the baseline, no changes of parameters were found after SI 1 and SI 2, but EELV and Cst increased significantly after SI 3 and SI 4. Paw, PAP and PVRI decreased significantly after SI 3 and SI 4. After SI interruption, all the physiological variables returned to baseline. SI had no significant effect on HR, AP and CI. Conclusion Treatment with SI combined with small tidal volume ventilation in patients with ALI can provide lung recruitment and improve lung compliance, but it has no significant side effect on hemodynamics.

Objective To evaluate the value of systemic ultrasound examination in prenatal diagnosis of fetus skeletal system anomaly combined with chromosomal abnormalities. Methods In 12 146 patients examined by systemic ultrasound in Sichuan Provincial People's Hospital from 2006 to 2013, 21 fetus with skeletal system abnormalities and chromosomal abnormalities were included in the study. And the correlation between skeletal system abnormalities and chromosomal abnormalities in fetus was evaluated. Results This study involves 21 cases of abnormal fetal skeletal system combined with chromosomal abnormalities. Among them, there were 5 cases of trisomy-21, 11 cases of trisomy-18, 3 cases of trisomy-13, 1 case of [46, XYt (6, 9)], and 1 case of (46, XY, 6 q-). In 19 cases, other system malformations were found, including nervous system abnormalities, facial deformity, cardiac structural abnormalities and intrauterine retardation. In the rest 2 cases, skeletal system abnormalities were the only structural malformation detected on prenatal ultrasound examination. Conclusion Systemic ultrasound can't only detect fetal skeletal system abnormalities but also provide clues for specific chromosomal abnormalities, which was useful in optimizing prenatal diagnosis.

Objective To investigate the correlation between the glial fibrillary acidic protein(GFAP),neuron-specific enolase(NSE),synaptoghysin (SYN),neurite outgrowth inhibitor-A(Nogo-A)expression and neurological outcome in tissue surrounding the infarct during the recovery after cerebral ischemia-reperfusion injury in rats.Methods A 2-hour middle cerebral artery occlusion(MCAO)and reperfusion model in rats was induced by the intraluminal suture method.The modified neurological severity score(mNSS)was performed at day 28,35,42,and 49.Immunohistochemistry was used to detect the expressions of GFAP,NSE,SYN,and Noga-A in tissue surrounding the infarct.Results The mNSS score decreased gradually over time after cerdnal ischemia-reperfusion injury in rats.Except day 35(5.11±0.737)vs.day 42 (4.54±0.519),and day 42 vs.day 49(4.29±0.488),there were significant differences at all other time points(all P<0.05).The numbers of GFAP positive cells deergased gradually form day 28 to day 49,in which,the numbers of GFAP positive cells at day 42(51.00±13.59)vs.day 49(44.38±11.94) were significantly less than those at day 28(69.00±15.10)(P<0.05).There were no significant differences in the numbers of NSE positive cells at all time points,but their integrated optical density(IOD)increased gradually.There were significant differences between day 28(6 218.57±1 864.25)and day 42(9 414.00±2 491.12) or day 49(12 522.50±3 106.99),and between day 35(7 343.40±1 533.35)and day 49(all P< 0.05).There were no significant differences at all other time points.The SYN express (IOD)increased gradually.and it was significantly lower at day 49(66 503.00±12 834.61)than that at day 28(43 905.14±13 208.59)(P<0.05).The numbers of Nogo-A positive cells decreased gradually,and they were significantly less at day 49(42.13±14.45) than those at day 28(59.57±15.25)(P<0.05).The GFAP expression was positively correlated with the mNSS scores(r=0.993,P=0.007).The NSE(r=-0.954,P=0.044)and SYN(r=-0.992,P=0.008) expression was negatively correlated with the mNSS scores.Conclusion The neurological outcome was associated with the downregulation of GFAP expression and the upregalation of NSE and SYN expression during the recovery after cerebral ischemia-reperfusion injury in rats.

Objective To compare the CLIP score, the JIS score, and the China staging system (CS) in the prediction of survival of patients with resectable hepatocellular carcinoma (HCC). Methods The Clinicopathologic and follow-up data of 224 patients who underwent hepatic resection for HCC from January 2000 to July 2005 were retrospectively studied. The patient distribution and the survival curve of each staging system were used to compare the ability to stratify and to discriminate prognosis. The likelihood ratio, chi-square test and the linear trend chi-square test were used to compare the homogeneity and the monotonicity of the relationship between stage and mortality rate of each staging system. The increase in the -2 log likelihood statistic on removal of any one staging system was in turn used as a means of ranking the individual staging systems according to their importance within the regression model. The statistical package used was SPSS version 16. 0 and Stata SE version 8.0. Results Based on the China staging system, the percentages of patients categorized as Ⅰa, Ⅰ b, Ⅱa,Ⅱb and Ⅲ a were 14. 3%, 17.4%, 21.9%, 31.7% and 14. 7% respectively, showing excellent stratification ability. However, nearly 81. 6% of the patients were classified as a CLIP score of 0-2, which showed poor stratification ability, and only 3. 1 % of the patients were classified as score 0 category of the JIS scoring system. In the follow-up period, the log-rank test and the corresponding Kaplan-Meier survival curves confirmed each staging system to be able to differentiate patient survival in the different stages. Individual pairwise comparisons revealed inconsistencies across the different staging systems. In particular, using the log-rank test, the JIS scoring system and the China staging system showed significant differences in patient survival on all pairwise comparisons. By contrast, the CLIP scoring system failed to differentiate significantly between score 2 and score 3 patients. The JIS scoring system could identify the best prognostic group who would benefit from curative and aggressive treatments, whereas the discriminatory value of the CLIP score was noted in the intermediate- and advanced-phase HCC patients. The China staging system was shown to have the best homogeneity, overall discriminatory capacity and monotonicity of gradient. The change in the -2 log likelihood statistic on removal of any staging system revealed that for this cohort of patients, the appropriate importance in the ranking of the independent contribution of each factor to the regression model was: CS> CLIP>JIS. Conclusion Among three clinical staging systems, the China staging system had the highest prognostic value, with better stratification and higher discriminatory capacity than the CLIP scoring system and the JIS scoring system for this cohort of patients who received partial hepatectomy for HCC. The CLIP scoring system performed better in identifying the worst prognostic patients.

Object: To investigate the effects of Huaiqihuang Granule, a compound Chinese herbal medicine, on expressions of nephrin and podocin of slit diaphragm of glomerular podocytes in rats with adriamycin-induced nephrosis and to explore the mechanism in reducing the proteinuria. Methods: Twenty SD rats were randomly divided into five groups: control group, model group, glucocorticoid group, Huaiqihuang Granule group and Huaiqihuang Granule plus glucocorticoid group. The 24-hour urine was collected 7, 14, 21 and 28 days after adriamycin injection respectively to measure 24-hour urinary protein, and all rats were sacrificed after 28-day treatment. Pathological changes in renal tissues were observed under a light microscope and an electron microscope. Expressions of nephrin and podocin mRNAs in renal cortex were determined by real-time polymerase chain reaction, and protein levels of nephrin and podocin were detected by Western blotting. Results: (1) In the model group and the treatment groups, the level of urinary protein increased significantly from the 14th day. (2) Under the light microscope, inflammatory cells and slight fibroplasia were found in renal interstitium of the model group, but there were less inflammatory cells in renal interstitium in the intervention groups than in the model group. Under the electron microscope, 29 days after adriamycin injection, extensive fusion of foot processes was observed. (3) The expressions of nephrin and podocin were higher in treatment groups than in the model group. (4) Proteinuria level was negatively correlated with the expressions of nephrin mRNA and nephrin and podocin proteins. Conclusion: The above results indicate that Huaiqihuang Granule can maintain the integrity of the slid diaphragram in podocyte, alleviate the lesion of glomerular filtration membrane, and decrease the proteinuria by up-regulating the expressions of nephrin and podocin. Huaiqihuang Granule plus glucocorticoid maybe has better effects than glucocorticoid alone.

OBJECTIVETo search for a simple and effective surgical approach to the management of moderate to severe pediatric concealed penis in children.

METHODSWe used Devine's technique via incision between the penis and scrotum in the treatment of 68 cases of moderate to severe pediatric concealed penis. The patients were aged 3 -13 (mean 6.5) years, 30 with moderate and 38 with severe pediatric concealed penis.

RESULTSThis strategy achieved good near- and long-term effects and satisfactory appearance of the penis, which was similar to that of circumcision. At 3 months after surgery, the penile length was 3 - 5.2 cm, averaging (2.35 +/- 0.35) cm.

CONCLUSIONDevine's technique via incision between the penis and scrotum is a simple and effective surgical option for moderate to severe pediatric concealed penis in children.

Adolescent ; Child ; Child, Preschool ; Humans ; Male ; Penis ; abnormalities ; surgery ; Scrotum ; surgery ; Urologic Surgical Procedures, Male ; methods