Objective To explore a novel operative management for irreducible atlantoaxial dislocation. Methods Fifty-four patients, which as 32 males and 22 females aged from 7 to 63 years old with a mean of 32 years, were diagnosed with irreducible atlantoaxial dislocation, including 18 patients with os odontoideum, 22 occipitalization, 5 malunion of odontoid fracture and 9 relaxation of transverse ligament of atlas. Forty patients presented signs and symptoms of myelopathy or spinal cord injury. All of the patients underwent the operation of open reduction and release by transoral approach. The longus collies muscles, longus capitis muscles, anterior longitudinal ligament, atlantoaxial articular capsules, the apical odontoid ligament and alar odontoid ligaments may be included, were transected, followed by arthrodesis via posterior approach in one stage. Different methods of posterior arthrodesis were conducted as followed: C1,2 transarticular screw fixation in 5 cases, occipitocervical fixation using pedicle screws of axis and occipitocervical plate in 37 cases, and C1,2 joint fixation with plates and screws in the lateral masses of the atlas and axis in 12 cases. Results A complete reduction was achieved in 41 cases, and the other 13 patients obtained partial reduction. Forty-eight patients were followed up from 4 to 40 months, 15.7 months at the average. All of them achieved solid arthrodesis. According to Odom's scoring system, among the 38 patients with preoperative upper cervical myelopathy, 15 patients were assessed as excellent, 14 good, 8 fair and 1 poor. During the operation, cerebral spinal fluid leakage occurred in 1 case, and pedicle screwing failed in 1 case. After the operation, respiratory failure was found in 1 case, nasal sound in 3 cases, dysphagia in 1 case. One patient became quadriplegia due to myelitis caused by septicemia at two weeks after the operation. The internal fixation loosened in 1 case at 2 months postoperatively. Conclusion Transorally surgical release for reduction and posterior arthrodeses could achieve satisfactory outcomes in patients with irreducible atlantoaxial dislocation.

Objective To measure wall shear stress (WSS) in common carotid arteries of normal subjects and patients with intima-media thickening and analyze the spatial distribution of low wall shear stress by quantitative analysis of blood flow shear stress visualization software.Methods Color Doppler flow images of common carotid arteries in normal subjects (control group) and patients with intima-media thickening (study group) were extracted from DICOM files.Two-dimensional distribution images of WSS,three-dimensional distribution images of WSS and the value of WSS in the common carotid arteries were obtained by this new algorithm.Then,the data and images of WSS were analyzed.Results WSS in the common carotid arteries of the control group were ranged from 4 to14 dyn/cm2.WSS in the common carotid arteries of the study group were ranged from 2 to 6 dyn/cm2.Compared to mean WSS values [(6.91 ±1.20) dyn/cm2] in common carotid arteries of the control group,mean WSS values [(2.87 ± 0.59)dyn/cm2] in common carotid arteries of the study group was significantly lower (t =17.828,P =0.000).Conclusions Low WSS areas have been emerged in local common carotid arteries in the patients with intima-media thickening.The reduction of WSS caused by local hemodynamic change might be related to common carotid artery intima media thickening.

Objective To evaluate the various patterns of hepatic perfusion disorders with multi-slice spiral CT and to emphasize the significance of recognition for them . Methods In a period of 1 year, the all CT images of 1568 patients received multi-slice spiral CT examination of upper abdomen were analyzed retrospectively. The CT findings, etiologies and mechanisms of different pattens of hepatic perfusion disorders were investigated. Results 103 cases were demonstrated to have hepatic perfusion disorders. 69 cases were associated with tumors and the other 34 cases were non-tumor associated. The etiologies of various hepatic perfusion disorders were classified as (1)arterioportal fistulae(41.7%), (2) portal venous inflow obstruction(23.3%), (3) inflammartory hyperemic changes(17.5%), (4) steal phenomenon by hypervascular tumors(6.8%), (5) hepatic venous outflow obstruction(4.9%), (6) aberrant hepatic blood supply (3.9%) and (7) uncertain causes(1.9%). There was significant correlation between the CT images of perfusion disorders in shape and distribution and the causes of them. Conclusion Multi-slice spiral CT provides a new effective technique for demonstrating and understanding various hepatic perfusion disorders. Familiarity with the spiral CT appearances of these perfusion disorders will result in more accurate evaluation for various pathologic or physiologic states reflected by them.

Objective To establish animal model of prolactinoma with Fischer 344 (F344) rats.MethodsFemale F344 rats were injected with estradiol benzoate-treated and 0.9% sodium chloride respectively. After 50 days of treatment, MRI scan was performed and animal's living status was observed, and pituitary weight, serum prolactin level, pathological and PRL immunohistochemistry changes were also detected.ResultsAll estradiol benzoate-treated rats formed the prolactinoma after treatment for 50 days and the growth of body weight was retarded obviously. Pituitary weight and serum PRL increased significantly in estradiol benzoate-treated animals compared with those treated with 0.9% sodium chloride. Pituitary adenomas were found in MRI scan and HE stain was positive. The forming rate of tumor was 100%.ConclusionThe animal model of pituitary adenoma established with F344 rat has more characters such as having a short tumor forming period, easy and stable, and coincided with features of prolactinoma.

This article elaborated the connotation and characteristics of research-oriented hospital as well as its inner connection with the development of key disciplines , based on the system dynamics model data analysis of the National TCM Clinical Research Base . It gave suggestions in increasing discipline input , strengthening personnel training , and improving achievement output to research-oriented hospital construction in order to promote the construction of research-oriented hospitals .

This article took the research work of 16 national clinical research base construction units as its background in order to dig the connotation of health service efficiency . Through data envelopment analysis , a comprehensive exposition was given on the inputs and outputs relation of medical and health service efficiency in order to propose appropriate policy recommendations. The study was guided by the scientific development concept in order to gradually improve the efficiency of health services and achieve a comprehensive , coordinat-ed and sustainable development of the hospital .

ObjectiveTo explore the effect of different methods of drainage tube and catheter drainage in the treatment of intraventricular hematoma.MethodsThe analysis was conducted in 83 cases,who were randomly divided into two groups,the treatment group with 48 cases adopting lateral venticle catheterization combined with bulletshaped tube,and the control group with 35 cases adopting conventional catheterization.The contrasted study was conducted on the clearance rate of cerebroventricular hematoma and the effect of the different drainages.ResultsThe clearance rate in treatment group was 27.1％ ( 13/48 ),50.0％ (24/48),14.6％ (7/48),at the time of ＜ 24h,24 ～72h,＞ 72h after the operation,and 5.7 ％ ( 2/35 ),17.1％ ( 6/35 ),48.6％ ( 17/35 ) in the control group.It showed statistical significance(x2 =6.2425,9.4678,11.3757,all P ＜0.01 ).The cases with type Ⅰ of ADL stage in treatment group (47.9％)were more than control group( x2 =6.8347,P ＜0.01 ).The morbidity in treatment group was 12.5％,which was lower than control group( x2 =6.9636,P ＜0.01 ).ConclusionThe lateral venticle catheterization drainage combined with bullet-shaped tube could avoid the obstruction,reduce the morbidity,and improve the therapeutic effect.

Objective To explore the experiences of patients with abnormal extubation of PICC tubes.Methods Fifteen patients with abnormal extubation of PICC tubes participated in the semi-structure interviews.Data were analyzed by Nancy's phenomenological procedure.Results The patients experienced complicated mood which combined negative experience and positive experience,with complainant,helpless,worry,fear for negative experience,relieved,secure for positive experience.Conclusions Patients with abnormal extubation possessed negative experience.Suggestions should be given to nursing staff to communicate with patients before the extubation in order to reduce the dispute of nurses and patients.At the same time,we should summarize the reasons and analyze the factors about the abnormal extubation,and take the targeted intervention measures in the clinical work to decrease the incidence rate of PICC extubation.

Objective To investigate the relationship between low serum calcium concentration and hematoma volume in patients with intracerebral hemorrhage.Methods Between January 2012 and October 2014,870 consecutive patients with intracerebral hemorrhage admitted to the Department of Neurosurgery,West China Hospital,Sichuan University were enrolled prospectively.The patients completed laboratory serum calcium concentration and head CT examinations within 24 h after attack,and the baseline data and laboratory findings were collected.According to the normal reference value of laboratory serum calcium concentration,the patients were divided into a hypocalcemia calcium group (<2.1 mmol/L;n=193) and a normal calcium group (2.1-2.7 mmol/L;n=677).Spearman correlation analysis was used to analyze the correlation between the blood serum calcium concentration and the hematoma volume on admission.Results (1) The hypocalcemia group compared with normal calcium group,the proportion of male patients was high (73.6% [n=142] vs.66.0% [n=447]),the median score for Glasgow coma scale was lower (9 vs.11),and the median hematoma volume was larger (33.86 cm3 vs.21.69 cm3).The differences were statistically significant (all P<0.05).(2) Spearman correlation analysis showed that the lower serum calcium level on admission was weakly negatively correlated with the volume of hematoma in patients with intracerebral hemorrhage (r=-0.113,P<0.01).Conclusion The study suggested that the hypocalcemia on admission was mostly males in patients with intracerebral hemorrhage,the condition was serious,the volume of hematoma was larger,and the lower serum calcium concentration was negatively correlated with the hematoma volume.

Objective To investigate the clinical pathologic significance of lymphangiogenesis in in colorectal cancer. Methods New lymphatic-specific markers D2-40 was used immunohistochemically to detect the lymphatic vessel density(LVD) in the intratumoural and peritumoral areas, and in normal tissue from 96 cases of colorectal cancer, which were analyzed with clinical pathologic parameters of those colorectal cancer. Results Significandy higher LVD was found in the intratumoural area(14.5±2.4), when compared with normal(5.9±1.1)and peritumoural areas(6.7±1.2) (P<0.01). LVD of the peritumoural area was higher than normal area (P< 0.01). However, peritumoural LVD was associated with both depth of invasion and liver metastasis (r=0.71,0.78 P<0.05), but not associated with tumour size, macroscopic type and lymph-node metastasis (P>0.05). Intratu-moural LVD was not correlated with tumour size, macroscopic type, the depth of invasion,lymph-node metastasis, and liver metastasis(P>0.05). Conclusion Lymphangiogenesis in the peritumoural area may be helpful in evalution of liver metastasis and prognosis.