Objective To summarize the peri operative therapeutic experience from 67 severe traumatic head injuried patients with a score of 3 8 on Glasgow coma scale (GCS). Methods 67 severe head injuried patients with a score of 3 8 on GCS admitted to our department from Feb. 1992 to Oct.1998 were analyzed. Results Forty five (67 2%) out of 67 patients survived and 22 died. Among the surviving patients 34 (50 7%) achieved a good recovery or moderate disability and left other 11 patients severe deficits(16 5%). Conclusions The prognosis of severe head injuried patients could be improved by correct management before hospitalization, early evacuation of intracranial hematoma with large decompressive craniotomies, intracranial pressure monitoring, moderate hypothermia therapy and other effective prevention and treatment of cerebral vasospasm and complications.

To understand the degree of local medical students' clinical practice skills, evaluate teaching achievements and reveal weaknesses by analyzing the test papers and grades, so as to provide scientific advices for reform in clinical education.

BACKGROUND:Peri-fracture nerve injury can inhibit osteoclast activity and promote early fracture healing. OBJECTIVE:To investigate dynamical y the effects of traumatic brain injury on the bone mineral density, microstructure, biomechanics property and bone metabolism in rat models of fractures. METHODS:Sixty-three male rats were randomly divided into three groups:sham group, simple fracture group and fracture combined with brain injury group. After 3, 6, and 3 months, the animals were sacrificed in batches under anesthesia, and then, the bones and serum specimens were used to detect the bone mineral density, microstructure, biomechanics property, serum cross-linked N-telopeptide of col agen type I and osteocalcin levels. RESULTS AND CONCLUSION:Compared with the simple fracture group, the fracture combined brain injury group had significantly increased bone mineral density of the proximal tibia, bone volume fraction of the cancel ous bone, trabecular thickness, cross-sectional area of tibial cortical bone and total area of the bone marrow, ultimate load and stress of the tibia, serum cross-linked N-telopeptide of col agen type I and osteocalcin levels at 3 and 6 weeks after modeling (P<0.05), but no differences in the above-mentioned indexes were found among the three groups at 3 months after modeling. These findings indicate that traumatic brain injury can increase the bone mineral density at the fracture site, improve bone microstructure and enhance biomechanical properties, thereby promoting bone healing and bone metabolism at the fracture site.

Objective To study the surgical treatment of major blood vessels invaded by tumors in order to raise the resection rate and postoperative survival rate. Methods Clinical data were analyzed on 26 patients undergoing (resection) of tumors along with reconstruction of major blood vessels from October 1998 to February 2004. Results Tweety-three cases were followed up for 2～65 months with median 42.8 months. Doppler ultrosonography and CTA examination were performed respectively during the follow-up process.In 5 patients with carcinoma of the head of pancreas who had inferior vein cava replaced and in 1 patient with cholangiocarcinoma who had portal vein replaced,3 were complicated with carcinoma embolism formation at 3,12 and 15 months respectively after surgery,(postoperative) graft patency was 50%;all of the 6 patients had recurrence of the tumor at 3,6,8,12,24 and 31 months respectively after surgery.Seven patients with tumor in pelvic cavity or in posterior space of peritoneum were followed up for about 2 years,1 of them had tumor recurrence ,but the graft kept patent,2 patients with sarcoma in the limbs were followed up for 1 year without tumor recurrence or vessel obstruction.Eleven patients with tumors in the neck were followed up for 3 months to 5 years without tumor recurrence or vessel obstruction. Conclusions (Combination) of resection of neoplasm and reconstruction of major blood vessels is safe,effective and practical method for patients with major wessels invaded by tumor.

Objective To investigate the effect of standardization regional lymphadenectomy in radical resection of ductal adenocareinoma in the pancreatic head.Methods On the basis of routine panereaticoduodenectomy(whipple proceduce),we performed the standardization regional lymphadenectomy,the emphasis of the procedure was the resection of wide nodes,particularly the mesenteric root lymph nodes(14abcd),the paraaortic lymph nodes(16a2b1),the hepatoduodenal ligament lymph nodes(12abpeh),hepatic artery(Group 8)and coeliacus lymph nodes(Group 9). Results Eleven patients underwent this procedure,there was no operative mortality,1 case occurred pancreatic fistula,the lymph nodes metastasis occurred in 7(63.6%)patients,the posterior pancreaticoduodenal lymph nodes(Groupl3)and superior mensenteric artery(Groupl4)was the predominant metastatic site of the tumor,the rate of the second site metastasis to lymph nodes was 57.1%.of the 11 cases follow-up 1 died. Conclusion The radical pancreaticoduodenectomy combined with wide resection of standardization regional lymph nodes is a safe and effective procedure of the treatment of adenocarcinoma of the head of the pancreas.but the long-term survivalrate must be valued objectively with many cases.

To illustrate the location of HSP-70 (heat\|shock protein\|70)correlative response in acute stage between middle and inner ear when mammalian middle ear infected by bacteria, and investigate the possibility to cause autoimmune inner ear injure by HSP-70 that induced by otitis media. An animal model of acute otitis media was established by inoculating Klebsiella pneumoniae (K.p) into middle ear of guinea pigs. Animals were sacrificed 1,3,5 and 7days after inoculation.Investigation of the locations of HSP-70 in middle ear mucosa and cochlea structures were detected by immunocytochemical technique .The results showed that light stain of HSP-70 existed in the superficial epithelium cells of normal mucosa and cochlea structures such as stria vascularis, spiral ligament and Corti′s organ.Heavy stain appeared in the same sites in the infected ears . No different positive sites was observed in all animals.Our findings suggested that HSP-70 were expressed in middle ear mucosa and inner ear structures during acute middle ear infective stage.The HSP-70 provide a material base for causing autoimmune inner ear injure during middle ear bacteria infection.

Objective To investigate kupffer cells (KCs) expressing indoleamine 2,3-dioxygenase(IDO)in the inhibition of allogeneic T-cell proliferation in vitro. Methods Real-time PCR was used to investigate the expression of IDO mRNA and FasL mRNA in KCs pretreated with or without IFNγ. High performance liquid chromatography was used to analyze the catabolism of tryptophan by IDO from KCs. Allogeneic T-cell response was used to confirm the inhibition of KCs in vitro. The proliferation of lymphocytes was detected using [3 H] thymidine incorporation. Cell cycle and lymphocyte apoptosis were evaluated by flow cytometric assay. Results Real-time PCR revealed IDO mRNA and FasL mRNA expression in KCs pretreated with IFN-γ. IDO catabolic effect was confirmed by a decrease in tryptophan and increase in kynurenine concentration. KCs expressing IDO and FasL from BABL/c mice acquire the ability to suppress the proliferation of T-cells from C57BL/6, which could be blocked by the addition of 1-methyl-tryptophan and anti-FasL antibody. The co-cultured T-cells with KCs expressing IDO and FasL could induce allogeneic T-cell apoptosis and exhibited cell-cycle arrest in G1. Conclusion In addition to the Fas/FasL pathway, IDO may also play an important role in KCs to inhibit allogeneic T-cell proliferation in vitro.

Objective To investigate the diagnosis and treatment of mucin-producing intrahepatic biliary tumor (MPIBT).Methods We retrospectively analyzed the clinical,radiologic,surgical and pathologic findings of 16 MPIBT cases from January 2004 to December 2011.Results There were six men and ten women,age ranged from 44 to 69 years (mean 60 years).Clinical presentation included jaundice with abdominal dull pain in 5 patients,acute cholangitis in 4 patients,painless jaundice in 2 patients,upper abdominal dull pain in 3 patients,no obvious symptoms in 1 patient,body weight loss more than 5 kg within 3 months in 5 patients.The most characteristic appearance of MPIBT on magnetic resonance cholangiopancreatography were asymmetry of intrahepatic bile duct dilatation and the dilatation in both extraand intrahepatic bile duct distal to the hepatic mass and not sudden interruption in extrahepatic bile duct.The primary tumor located in the left hepatic bile duct in 15 cases,in the right hepatic bile duct in one.13 MPIBT cases received hemihepatectomy and extrahepatic bile duct resection and Roux-en-Y anastomosis was done in 8 cases,3 received palliative biliary drainage.Pathologically 13 was papillary adenocarcinoma and 3 was papillary adenoma.The 1-,2-,3-year survival rates for the 16 MPIBT patients were 81％,66％,56％,respectively.Conclusions MPIBT had no specific clinical manifestations,MRCP might be an effective means for the diagnositic strategy and assessment of tumor extension before surgery,radical resection was the first choice of treatment,palliative biliary drainage could prolong the survival time.

Objective: To observe the clinical characteristics and current treatment status in patients with chronic heart failure (CHF) at different grade hospitals in Xinjiang Area.
Methods: A total of 5357 patients with CHF diagnosis discharged from 20 different grade hospitals in Xinjiang area from 2011-01 to 2012-02 were enrolled. The age, gender, nationality, etiology of CHF, cardiac function, complications and current medication status in all patients were systemically studied.
Results:①There were 2295/5357 (42.8%) patients with Han nationality, 2255 (42.1%) with Uyghur nationality and 8.07 (15.1%) with other nationalities. The average age of patients was at (64.60 ± 12.77) years.②The etiology of CHF were, in turn, as: coronary artery disease (CAD) 50.8%, hypertension (31.8%), dilated cardiomyopathy (7.2%).③ The ratios of patients with NYHA III-IV in county hospital 440/682 (64.5%), in regional hospital 1180/1557 (75.8%) were higher than that that in grade A class 3 hospital 967/3118 (31.0%), ( =1390.362,P=0.000).④The patients in county hospital, regional hospital showed increased left atrial diameter (44.7 ± 8.8) mm, (39.5 ± 8.1) mm and left ventricular end-diastolic diameter (60.6 ± 11.1) mm, (56.9 ± 11.1) mm than those in grade A class 3 hospital (37.3 ± 7.1) mm and (53.8 ± 9.7) mm; while decreased LVEF (41.9 ± 10.5) %, (42.3 ± 13.0) % than that in grade A class 3 hospital (46.5 ± 12.8), allP<0.001.⑤The medication status in different grade hospitals as ACEI/ARB, β-blocker, aldosterone antagonist, diuretics, digitalis were at 72.8%, 66.8%, 46.6% , 45.5% and 26.8% respectively. The application of ACEI/ARB and β-blocker in county hospital (61.4% and 51.5%) and in regional hospital (72.3% and 58.3%) were lower than those in grade A class 3 hospital (75.6% and 74.3%); while the application of aldosterone antagonist in county hospitals (57.9%) and in regional hospital (73.8%) were higher than that in grade A class 3 hospital (30.6%), allP<0.001.
Conclusion: The etiology of CHF were mainly as CAD and hypertension in Xinjiang area, the patients in county and regional hospitals had more severe conditions than that in grade A class 3 hospital, which implying the distance between the guideline standard and real practice especially in basic level hospitals.

Objective: To study the relationship between dilated cardiomyopathy and nuclear lamina protein (LMNA) gene mutation in Kazak ethnics at Xinjiang area.
Methods: A Kazak familial dilated cardiomyopathy (FDCM) with 31 members was studied. In addition, 160 patients with idiopathic dilated cardiomyopathy (IDCM) with 160 healthy controls were enrolled in our study, and they were divided into 4 groups: IDCM-Kazak, IDCM-Han and Control-Kazak, Control-Han.n=80 in each group. Peripheral blood DNA were extracted, 12 exons with nearby introns of LMNA gene were detected by PCR and the ampliifed products were sequenced and compared with the standard template of CHROMAS and BLAST software to identify mutation sites. LMNA mutation in both Kazak and Han IDCM patients were investigated.
Results: A novel LMNA mutation (insC, CGG→CCG) at exon 7 was identiifed in a FDCM proband, it caused an amino acid substitution as Arg to Pro, and a known LMNA polymorphism loci rs4641 (c.1362C>T His454His) was fund at exon 10. In addition, LMNA polymorphism loci rs4641 genotype distribution (χ2=5.16,P=0.036) and allele frequency (χ2=4.50,P=0.034) were statistically different between IDCM-Kazak group and Control-Kazak group; while such differences were no statistic meaning between IDCM-Han group and Control-Han group. Logistic regression analysis indicated that LMNA polymorphism loci rs4641 was related to IDCM occurrence in Kazak ethnics (P=0.025, OR=0.412, 95% CI 0.189-0.896).
Conclusion: LMNA polymorphism loci rs4641 was related to IDCM in Kazak ethnics at Xinjiang area, which might be susceptible loci for IDCM occurrence.