Volume 97  ·  Issue 21  ·  2017

Hospital-acquired infection in critically ill neurosurgical patients is one of the key factors affecting clinical therapeutic outcome and prognosis. With the development of microscopic technology, neuronavigation technology, robotics technology, neurointerventional technology, intraoperative anesthesia technology and sub-specialties of neurosurgery critical care management, more and more operations can be carried out in neurosurgery, and the management of neurocritical patients has also become the focus of neurosurgery. Studies have shown that at present, community central nervous system infections show a downward trend, while hospital-acquired infections caused by staphylococcus and gram-negative bacteria show an upward trend. Among them, the infections involving severe neurosurgical patients are mainly central nervous system infections and pulmonary infections, while others include catheter-related infections, urinary tract infections and local wound infections. The mortality rate of central nervous system infection can be as high as 10% ~30%, and patients will have severe neurological dysfunction in the later stage^[1]While the associated pulmonary infection rate of neurosurgical critical patients was 50.7%, which seriously affected the overall survival rate and disability rate of neurosurgical critical patients.

Severe craniocerebral trauma has the characteristics of high morbidity, mortality and disability. According to statistics, in 2013, about 2.5 million people in the United States went to the emergency department for craniocerebral trauma, of which about 280,000 needed hospitalization and 56,000 died^[1]。 Currently, there are 5.3 million American people with different disabilities due to craniocerebral trauma^[2]。 Only 25% of survivors of severe craniocerebral trauma achieved long-term functional independence^[3]。 Statistical data show that the incidence of craniocerebral trauma in China has reached 100~200 people/100,000 per year, among which traffic accident injury is the first cause^[4]。 According to the preliminary statistics of China Craniocerebral Trauma Database, from 2008 to 2012, among the 11,937 patients with acute craniocerebral trauma admitted to 47 hospitals in China, the mortality rate of severe craniocerebral trauma was 27.23%, and the vegetative survival and severe disability rate was 53.17%^[5]。 The prognosis and treatment of patients with severe craniocerebral trauma have caused heavy physical, psychological and economic burden to patients themselves, their families and society. These patients have a long life expectancy after injury, and if they can't live independently, they also need to occupy huge family and social resources.

At present, due to the development of pre-hospital first aid, early diagnosis methods, intensive care system and the promotion of craniocerebral trauma treatment guidelines, the overall treatment level of craniocerebral trauma has been significantly improved, but the disability rate of severe craniocerebral trauma is still very high. In particular, patients who did not undergo rehabilitation treatment and nursing in the early stage developed complications and secondary disorders such as joint contracture, heterotopic ossification and orthostatic hypotension, which delayed the rehabilitation process and affected the rehabilitation effect. Early regular and active rehabilitation treatment can significantly improve the rehabilitation outcome and improve the quality of life of patients.

The establishment of the mechanism of coronary thrombosis has promoted the development of reperfusion therapy for ST segment elevation myocardial infarction (STEMI). In recent years, the results of research on coronary thrombosis aspiration are not consistent, and the guidelines and clinical application are also greatly affected.

Neurosurgery is one of the specialties with more critical patients, and bacterial infection is the difficulty and focus of clinical diagnosis and treatment of critical neurosurgery patients, especially hospital-acquired infection of critical neurosurgery patients is one of the important reasons that affect clinical treatment effect and prognosis of patients. According to the literature reports, the overall incidence of acquired infection in various neurosurgical central hospitals in China is about 6% ~12%^[1,2,3,4,5]The main types are hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), central nervous system infection and surgical incision infection (SSI). In addition, it also includes common infections in critically ill patients, such as urinary tract infection, catheter-associated bloodstream infection, digestive tract infection and pressure ulcer. According to the statistics led by Academician Zhao Jizong of Beijing Tiantan Hospital, the incidence of brain trauma accompanied by open skull fracture, scalp laceration or scalp laceration for more than 4 hours in neurosurgery in China is 10% ~25%; Clean-contaminated surgery includes surgery into paranasal sinus or mastoid, repair of open skull fractures or those with obvious defects in aseptic techniques, and the incidence of infection is 6.8% ~15%; The infection rate of clean surgery is 2.6% ~5%^[6]。 In the epidemiological aspect of bacteria, it is mainly coagulase-negative staphylococcus, staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterococcus, etc^[7]。

Craniocerebral trauma (TBI) is an important disease affecting human health in modern society, among which severe craniocerebral trauma (GCS ≤8 scores) is the most serious, and most survivors have various degrees of disability. The prognosis and treatment of patients with severe craniocerebral trauma have caused heavy physiological, psychological and economic burden to patients, their families and society. In previous studies, significant progress has been made in both the pathophysiological injury mechanism and the diagnosis and treatment of patients with severe craniocerebral trauma. Among them, the progress of intracranial pressure control management, various multi-parameter and multi-modal monitoring under the guidance of new technologies, the rapid development of neurocritical care medicine, and relevant standardized international and national guidelines have significantly improved the treatment effect^[1,2,3,4]。

In 1912, Herrick^[1]The relationship between coronary thrombosis and myocardial infarction was described for the first time. 1980 DeWood et al.^[2]It was confirmed that in patients with acute myocardial infarction (AMI) who underwent coronary angiography within 4 h, thrombi were present in 88% of the infarction-related vessels. 2007 Sianos et al.^[3]It was also found that coronary thrombosis was visible in 91.6% of AMI patients undergoing direct percutaneous coronary intervention (PCI). The establishment of the thrombotic mechanism of AMI has promoted the rapid development of reperfusion therapy.

To build a three-dimensional finite element models of a modified posterior cervical single open-door laminoplasty with short-segmental lateral mass screws fusion.

The C₂-C₇ segmental data were obtained from computed tomography (CT) scans of a male patient with cervical spondylotic myelopathy and spinal stenosis.Three-dimensional finite element models of a modified cervical single open-door laminoplasty (before and after surgery) were constructed by the combination of software package MIMICS, Geomagic and ABAQUS.The models were composed of bony vertebrae, articulating facets, intervertebral disc and associated ligaments.The loads of moments 1.5Nm at different directions (flexion, extension, lateral bending and axial rotation)were applied at preoperative model to calculate intersegmental ranges of motion.The results were compared with the previous studies to verify the validation of the models.

Three-dimensional finite element models of the modified cervical single open- door laminoplasty had 102258 elements (preoperative model) and 161 892 elements (postoperative model) respectively, including C_2-7 six bony vertebraes, C_2-3-C_6-7 five intervertebral disc, main ligaments and lateral mass screws.The intersegmental responses at the preoperative model under the loads of moments 1.5 Nm at different directions were similar to the previous published data.

Three-dimensional finite element models of the modified cervical single open- door laminoplasty were successfully established and had a good biological fidelity, which can be used for further study.

To evaluate whether there were differences between apparent diffusion coefficient (ADC) values derived from 3.0 T and 1.5 T MR diffusion-weighted imaging (DWI) in liver of patients with chronic hepatitis B.

From January 2016 to November 2016, a total of 40 chronic hepatitis B prospectively underwent both 1.5 T and 3.0 T DWI before liver biopsy, the interval between two scans was within 15 minutes, the protocol was respiratory-triggered DWI(RT-DWI). The ADC values were measured at both field strengths using ROI method. Bland-Altman tests and paired t-tests were used to compare ADC values obtained at 1.5 T and 3.0 T.

The ADC values of different b values for patients with mild inflammation at 1.5 T were(1.22-1.48(1.35±0.08)×10^-3 mm²/s), the ADC values of different b values for patients with mild inflammation at 3.0 T were(1.18-1.45(1.30±0.08)×10^-3 mm²/s); the ADC values of different b values for patients with moderate to severe inflammation at 1.5 T were(1.11-1.37(1.25±0.06)×10^-3 mm²/s), the ADC values of different b values for patients with moderate to severe inflammation at 3.0 T were(1.08-1.31(1.20±0.06)×10^-3 mm²/s). There were significantly differences between the ADC values of different b values for patients with chronic hepatitis B obtained at two field strengths (P<0.01).

Different field strengths have influence on ADC values in liver, the ADC values derived from 3.0 T are lower than the ADC values derived from 1.5 T.

To evaluate the effect of iodinate contrast agent (ICA) on the formation of DNA double-stand breaks (DSBs) in human peripheral blood lymphocytes during computed tomography (CT) examinations.

Peripheral venous blood (16 ml/person) of 36 volunteers were collected during the period of February to May 2016. Each blood sample was divided into 8 tubes and 4 groups on average, which were marked as groups of A, B, C, D randomly. 25 μl ICA was respectively added into one tube of each group and the groups of B, C, D accepted the same CT scan for once, twice and three times. The lymphocytes in these blood samples were separated by using density-gradient centrifugation, fixed and immunostained with γH2AX antibody. The average number of phosphorylated histone H2AX (γH2AX) foci per lymphocyte was counted under a fluorescence microscopy.

The numbers of γH2AX foci were increased approximately 82.9% ((0.064±0.025) vs (0.035±0.010) foci/cell) if ICA was simply added into the blood. With the increase of CT radiation, the foci numbers of the groups of B, C, D would increase and the samples containing ICA could have a more amount of foci numbers than those without ICA (B: (1.217±0.158) vs (0.774±0.258); C: (2.128±0.185) vs (1.569±0.201); D: (3.812±0.490) vs (2.938±0.480) foci/cell). The more radiation it had, the more significant the difference of foci numbers would be ((0.489±0.323), (0.549±0.278), (0.692±0.462) foci/cell).

The ICA itself can lead to an increase of the DSBs level and the application of ICA can amplify the DNA damage as assessed with γH2AX foci formation during diagnostic X-ray procedures.

To analyze the effect of preoperative depression on early postoperative cognitive function after general anesthesia during laparoscopic colon cancer surgery.

One hundred and fifty ASA Ⅰ-Ⅱ general aneasthesia patients (male70, female 80)from Sir Run Run Shaw Hospital in May of 2015 to April of 2016, aged 50-85, undergoing selective laparoscopic colon cancer patients were included. Evaluated preoperative depression by self-rating depression scale and evaluated postoperative cognitive function on 1, 3, 7 days by post-operative quality recovery scale. Use the multi-factor logistic regression to select the risk factors.

There were 115 (76.7%) patients occurred poor cognitive function. According to SDS, The results of logistic regression analysis showed that the risk factors for postoperative poor cognitive function was severe depression(OR 1.295, 95% CI 1.012-13.184, P=0.048).

Preoperative severe depression is a risk factor on postoperative cognitive function in laparoscopic colon cancer patients during general anesthesia.

To compare the cannulated screw internal fixation (IF) and hemiarthroplasty (HA) for displaced femoral neck fracture with cost-utility analysis (CUA).

From January 2014 to August 2015, a total of 87 patients above 60 years old with displaced femoral neck fracture were admitted into the study and divided into 2 groups according to surgery type. There were 41 cases in IF group and 46 cases in HA group. During 1 year follow-up we collected the total cost due to fracture and applied EQ-5D index to evaluate the clinical effects. The value of EQ-5D index will be transformed to quality adjusted life year (QALY). Eventually the data including cost and QALY were used to calculate the cost utility ratio (CUR) for patients in each group.

All the patients completed the operation successfully. The total cost of IF and HA was 45 796 yuan and 56 657 yuan (P<0.05), while the QALY was 0.79 and 0.83 respectively (P>0.05). The CUR showed that patients in IF and HA group spent 57 970 yuan and 68 261 yuan for each QALY which means patients in HA group spent more 10 292 yuan for each QALY than that in IF group.

Both IF and HA can provide satisfactory clinical outcome in 1 year follow-up, however the total cost of IF was obviously less than HA. Therefore IF may be more cost-effective for the treatment of displaced femoral neck fracture in terms of health economics.

To evaluate the incidence and risk factors of recurrence after endovascular treatment of vertebrobasilar dissecting aneurysms (VBDAs).

Retrospective analysis was used for the clinical information of 40 cases of vertebrobasilar dissecting aneurysms treated with endovascular methods in our department between January 2007 and December 2015.According to whether recurrence occurred, the patients were divided into recurrence group (10 patients) and non-recurrence group (30 patients). The data of the patients′ age, sex, hypertension history, smoking history, aneurismal size, presenting symptoms, degree of embolization, GCS scores, aneurismal localization and treatment methods were analyzed to evaluate the risk factors for recurrence after endovascular treatment.

There were 40 patients performed long-term angiographic follow-up.The recurrence rate after endovascular treatment was 25.0% (10/40) in the present study, and they all occurred in reconstructive group.Among the patients who underwent stent-assisted coil embolization, recurrence in aneurismal body occurred in 6 patients, and recurrence in aneurismal neck 3 cases. In these cases, 7 recurrences occurred with complete embolization, and 2 recurrences occurred with partial embolization.Recurrence occurred in 1 case that underwent single stent placement.The incidence of recurrence in reconstructive group was higher than that in destructive group (33.3% vs 0.0) with significant difference.

The recurrence rate was high in VBDAs treated with endovascular methods.The only independent risk factor for recurrence was reconstructive methods and that suggests the necessity of long-term angiographic follow-up.

To investigate the mechanism of inflammation of smooth muscle cells induced by oxidized low-density lipoprotein through Sirt1 in the atherosclerosis.

The expression of Sirt1 had been measured in the plaque tissues of human and mice. The affection of overexpression of SIRT1 on the oxLDL induced-inflammatory response and ROS generation had been detected in this study.

Sirt1 decreased in smooth muscle cells region of human plaque. And in the smooth muscle cells region of mice plaque, Sirt1 was also significantly decreased about 5-fold (P<0.05). Although, oxLDL promoted inflammatory cytokines secretion and ROS generation, but this affection had been reversed by upregulating Sirt1.

oxLDL regulated smooth muscle cells inflammatory response via Sirt1. Thus, Sirt1 is a signaling molecular regulating smooth muscles inflammatory response in the process of atherosclerosis.

To study the changes of upper digestive tract and bile flora associated with acute liver failure in mice.

Mice were randomly divided into 2 groups: control group and acute liver failure group (group M). Acute liver failure in group M was induced by intraperitoneal injection of D-galactosamine (D-GaIN). The information of relative abundance and diversity were observed by high-throughput sequencing of V3 + V4 region in 16 S rDNA from bacteria of oral cavity, stomach, duodenal and bile.Bacterial translocation and changes associated with acute liver injury were identified by LEfSe (LDA effect size) analysis.

At the phylum level, compared with control group, the relative abundance of TM7 in oral cavity and stomach increased in group M. At the family level, compared with control group, group M resulted in a significant decrease in Pasteurellaceae in the stomach (P<0.05) and a increase in Lactobacillaceae in the bile (P<0.05).

The diversity of bacteria and relative abundance of each bacterium in upper digestive tract and the bile are significantly changed during the process of acute liver injure in mice.

To determine whether suction drainage is safe and effective compared with no-drainage in total hip arthroplasty.

The research was based on PubMed, MEDLINE, EMBASE, Highwire, the Cochrane Library, CBM, CNKI, VIP and WFSD.The data were analysed using RevMan 5.2.Twenty-seven randomised controlled trials involving 3 603 hips were included in the analysis.

The meta-analysis indicate that suction drainage increases the rate of homologous blood transfusion (OR=1.98, 95%CI: 1.49-2.64, P<0.000 01)and the length of stay (OR=0.66, 95%CI: -0.01-1.33, P=0.05) (P<0.05). No significant difference was observed in the incidence of infection(OR=0.80, 95%CI: 0.52-1.22, P=0.30), wound haematomas(OR=0.47, 95%CI: 0.21-1.10, P=0.08), oozing (OR=0.93, 95%CI: 0.63-1.36, P=0.71) , deep venous thrombosis(OR=2.12, 95%CI: 0.68-6.56, P=0.19), VAS(OR=-0.06, 95%CI: -0.37-0.24, P=0.68) when the drainage group was compared with the no-drainage group.

The comparison between suction drainage and no drainage in THA have indicated that no-drainage for easy total hip arthroplasty may be a better choice. However, orthopedic surgeon need to weigh the pros and cons of no-drainage in some complicated THAs.

At present, stroke is one of the main disabling and fatal diseases in all countries in the world. According to the "China Stroke Prevention and Treatment Report 2015", the overall standardized prevalence of stroke in China is 2.1%, and its mortality rate is still increasing at an annual rate of 8.1%. Stroke has become the first cause of death among Chinese nationals. At present, the status of stroke in China is related to the aging of our society and the changes of lifestyle. However, in recent years, air pollution is also a factor that cannot be ignored. Studies have shown that air pollution has become one of the main risk factors of stroke^[1]。 According to the national air quality situation in 2016 released by the Ministry of Environmental Protection of China, the air pollution situation in China is still severe. In 2016, among 338 cities at prefecture level and above, only 84 cities met the ambient air quality standard, and the PM 2.5 concentration in 338 cities in China was 47 μ g/m³。 The Global Burden of Disease Study shows that air pollution has become the fifth leading risk factor for stroke in East Asia in the context of overall risk factors for stroke^[2]。 Therefore, in China, the relationship between air pollution and stroke has become a scientific problem that has to be paid attention to. Below, we review the research on the relationship between air pollution and stroke, in order to provide evidence-based basis and direction for the prevention and treatment of stroke in China.

Systemic infection (sepsis) is an infection-induced dysregulated body response that leads to life-threatening organ dysfunction^[1]。 Despite the great progress in clinical diagnosis and treatment technology in recent years, systemic infection is still the main cause of death in critically ill patients caused by infection. Disorders of immune inflammatory response play a crucial role in the development of systemic infections^[2]。 Applying inappropriate immunomodulatory therapy in the absence of immune monitoring may be counterproductive, so accurate and quantitative evaluation of immune function in patients with systemic infection is crucial for rational immunomodulatory therapy.