Volume 100 ·  Issue 19 ·  2020

In the past ten years, the accumulation of experience and the renewal of concept of neurocritical care medicine at home and abroad have promoted the progress of neurosurgical critical care management in China. In 2013, the China Neurosurgery Critical Care Management Cooperation Group was established and published China's first "Expert Consensus on Neurosurgery Critical Care Management (2013 Edition)"^[1]。 The majority of medical staff engaged in neurocritical care work have continuously mastered and deepened the relevant knowledge and concepts of neurocritical care medicine, standardized medical behavior, and improved the level of diagnosis and treatment of neurosurgery critical care in China. Neurosurgery Critical Care Medicine is an interdisciplinary subject that integrates neurosurgery, critical care medicine, neurology, emergency medicine, critical care, critical care rehabilitation, etc. Multidisciplinary collaboration has always been the development direction of neurosurgical critical care medicine.

Adult severe community-acquired pneumonia (SCAP) refers to infectious pulmonary parenchymal and interstitial inflammation that occurs outside the hospital, including acute severe pulmonary infection with definite incubation period and onset within 48 hours after admission. Lower respiratory tract infections are the diseases with the highest mortality rate in low-and middle-income countries in the world, and the mortality rate of SCAP can be as high as 34% ~50%. In addition to respiratory viruses, bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Legionella pneumophila, Bouteria pertussis, Mycobacterium, Nocardia, etc.), atypical pathogens (Mycoplasma, Chlamydia, Rickettsia) and fungi are also pathogenic microorganisms that cannot be ignored by SCAP.

To investigate the effect of intravenous infusion of methylene blue on the recovery of general anesthesia and postoperative cognitive function in total thyroidectomy.

Forty patients scheduled for total thyroidectomy with general anesthesia from July, 2015 to December, 2015, aged 18-65 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, were divided into two groups (n=20 each) using a random number table method: methylene blue infusion group (group M) and control group (group C). General anesthesia was induced with target-controlled infusion of propofol, and intravenously injecting sufentanil and cisatracurium besylate. The patients were mechanically ventilated after tracheal intubation. For the patients in group M, methylene blue was dissolved in 5% glucose 250 ml at 3 mg/kg dose and was intravenously infused within 30 min at the beginning of the operation. The patients in group C received 5% glucose 250 ml. The plasma concentration of propofol was adjusted to control the Bispectral Index (BIS) value between 40-60. Awakening time and plasma concentration of propofol at awakening were recorded. Coma recovery scale (CRS-R) score was recorded 30 min postoperatively. Digit Symbol Substitution Test (DSST), Digital Span Test (DST), Train Making Test A and B (TMT-A and TMT-B) were used to evaluate the cognitive function of patients at 1 day before surgery, 1 and 3 days after surgery.

The awakening time of group M and group C were (9.5±2.1) s and (7.0±2.0) s, respectively. The plasma concentration of propofol at awakening in M group and group C were (1.2±0.2) μg/ml and (1.7±0.2) μg/ml, respectively. Compared with group C, the awakening time was significantly prolonged, the plasma concentration of propofol at awakening was significantly decreased in group M (both P<0.05). Within 10 min of awakening, the CRS-R score of group M was significantly lower than that of group C (P<0.05), while there was no significant difference of CRS-R score between two groups at 20 min after awakening (P>0.05). There was no significant difference of cognitive function scores between group C and group M at 1 day and 3 day after operations (all P>0.05).

Intravenous methylene blue may briefly affect the recovery of general anesthesia, but has no significant effect on postoperative cognitive function.

To investigate the effects of general anesthesia or spinal anesthesia on the early prognosis of patients after hip replacement.

A retrospective analysis of 261 patients who underwent hip arthroplasty under general anesthesia or spinal anesthesia from July 2015 to June 2019 was divided into two groups according to the anesthesia method adopted for surgery: General anesthesia group (group G, n=179) and Spinal anesthesia group (group S, n=82). Propensity score matching analysis with preset caliper width was used. 76 pairs of patient data were successfully matched, with 38 cases in each group. General information and important biochemical indicators of patients before surgery were corrected. Comparison of anesthesia time, operation time, intraoperative bleeding volume, blood transfusion volume, length of hospital stay, whether to stay in intensive care unit, lung infection, incision infection, urinary tract infection, deep vein thrombosis, unplanned reintubation, death in the hospital and other information.

After the propensity values were matched, the number of hospital stays in the group G and group S were (24±7) and (23±6) days, repectively, with no significant difference (t=0.691, P>0.05). The incidence of admission to the intensive care unit was 26.3% and 7.9%, compared with group G, the rate of patients admission to the intensive care unit was lower in the group S (χ²=4.547, P<0.05). There were no statistical differences of other indicators between the two groups (all P>0.05).

General anesthesia and spial anesthsesia have no significant difference in early prognosis of patients after hip replacement. Spinal anesthesia may associated with less intensive care unit stay after operation.

To explore the safe range and X-ray evaluation method of medial pin for humerus supracondylar fractures in children.

The CT data of 169 children′s elbow joints in Hebei Medical University Third Hospital from 2015 to 2019 were acquired. The three-dimensional model of the humerus were rebuilt in the software of Mimics research 20.0, 4 Kirschner wire were simulated to put in medial epicondyle of the humerus by the software. A₁ was in the anterior upper boundary, A₂ was in the posterior upper boundary, B₁ was in the anterior lower boundary, B₂ was in the posterior lower boundary. The angles between the four marker lines and the axis of the humerus were measured. The angles in anterograde position were the varus angle and the angles in lateral position were the posterior inclination angle.The statistical analysis was done to prove that the four lines were different from each other.

A total of 169 sacral CT data were included, including 120 males and 49 females, 94 left and 75 right. The average age was (8.1±1.8) years. The varus angles of the upper and lower bounds (angle a and b) were 29.4°±4.0°and 43.6°±6.6°, respectively.The posterior inclination angle of the anterior upper boundary (A₁) and the posterior upper boundary (A₂) were 10.8°±3.0°(a₁) and 4.3°±2.2°(a₂), respectively. The posterior inclination angle of the anterior lower boundary (B₁) and posterior lower boundary (B₂) were 18.3°±4.7°(b₁) and 6.1°±3.2°(b₂), respectively. The varus angle and the posterior inclination angle of the epicondyle in the humerus could be used to guide placing of Kirschner wire safely and effectively to fix the supracondylar fracture of humerus in children.

A safe insertion channel can be seen in the medial condyle of the humerus for children. It can be marked on the orthophoria and lateral X-ray plates by the varus angle and posterior inclination angle. In this study, those angles can be used to guide the insertion of Kirschner′s wire into the internal condyle of the humerus.

To measure the declination angle and inclination angle of talus in healthy adults to provide a detailed and reliable data standard for clinical nail angle and postoperative reduction evaluation.

A total of 40 healthy adult volunteers were included in Tianjin Hospital from March 2018 to February 2019, including 20 males and 20 females. Bilateral ankle joint data in DICOM format were obtained after CT scan. After three-dimensional reconstruction of talus by Mimics19.0 software, the declination angle and inclination angle of talus were measured by 3-matic function. Data were compared between groups by using t test.

The declination angle of healthy adult subjects was 26.3°±3.2° (20.1°-32.7°), and the inclination angle was 40.8°±2.5° (35.0°-45.7°). The declination angle in the male was 26.0°±3.3° on the left side, 26.1°±3.2° on the right side, and the inclination angle was 40.1°±2.5° on the left and 40.1°±2.5° on the right. The declination angle in the female was 26.5°±3.3° on the left side, 26.6°±3.2° on the right side, and the inclination angle was 41.4°±2.8° on the left and 41.6°±2.2° on the right. There was no significant difference in declination angle and inclination angle between the left and right talus of the same gender (t=-0.520--0.166, all P>0.05). There was no significant difference in the declination angle and inclination angle of the ipsilateral talus between the genders (t=-2.001--0.457, all P>0.05).

The declination angle and the inclination angle of left and right talus in healthy adults are symmetrically distributed, and there is no significant gender difference, the results can be used to provide reference criteria for nail angle and reduction evaluation.

To explore the interhemispheric functional connectivity in patients with insomnia disorder using resting-state functional magnetic resonance imaging (rs-fMRI).

Fifty-four insomnia disorder patients were collected in Gansu Province Hospital from September 2017 to April 2019 as patient group, 16 males and 38 females,with an average age of (42±12) years old. Fifty-six healthy subjects were recruited as control group, 21 males and 35 females, with an average age of (38±11) years old. Polysomnography (PSG) was performed for patient group. All participants underwent neuropsychological assessments and rs-fMRI scan. The voxel-mirrored homotopic connectivity (VMHC) and the seed-based functional connectivity were calculated, and the differences between the two groups were compared. Correlation analysis was performed between the significant brain area for VMHC and FC with the duration of illness, neuropsychological scale and PSG parameters, and receiver operating characteristic(ROC) curve was used to evaluate the rs-fMRI parameters in diagnostic efficiency in insomnia disorder.

The VMHC of bilateral middle temporal gyrus (MTG) were significantly lower in patients group than those in healthy controls (t=-4.276, P<0.05). FC were increased between left MTG with right thalamus/middle cingulate gyrus, left thalamus,right cerebellar lobule Ⅳ-Ⅴ and left cerebellar lobule Ⅷ (t=4.719, 5.297, 6.044, 4.129, all P<0.05), and decreased between left MTG and right MTG (t=-4.139, P<0.05). There were significantly positive correlations between the MTG VMHC values and mini-mental state examination (r=0.288,P=0.035) or montreal cognitive assessments scores (r=0.283,P=0.038), and also between the FC of the left MTG-right cerebellar lobule Ⅳ-Ⅴ and sleep onset latency (r=0.302, P=0.027). The FC between the left MTG-right thalamus/medial cingulate gyrus presented highest diagnostic efficiency for insomnia with an area under the ROC curve (AUC) of 0.814.

Insomnia disorder patients have impairment of interhemispheric information interaction and integration.Impairment of interhemispheric coordination and abnormal FC of MTG might be important neuropathologic mechanism and neuroimaging biomarkers for cognitive dysfunction in patients with insomnia disorder.

To analyze the differences of clinical, imaging and neuropsychological features between frontal subdural effusion patients with behavioral-psychological or mood disorder and behavioral variant frontotemporal dementia (bv-FTD) patients.

A cross-sectional study in neurology and neurosurgery clinic population was conducted. From January 2016 to June 2019, 38 frontal subdual effusion patients with behavioral-psychological or mood disorder and 42 bv-FTD patients were enrolled. Demographic information, past medical history, clinical manifestation, imaging and neuropsychological features were collected. Chi-Square test or t-test was used to analyze differences of these features between the two groups.

Among demographic variables, the proportion of patients older than 60 years old in frontal subdural effusion group was higher than that in bv-FTD group (50% vs 23.8%, P=0.015). For variables of past medical history, the proportion of patients with a history of traumatic brain injury (68.4% vs 9.5%) or with a history of craniotomy (31.6% vs 2.4%) in frontal subdural effusion group were higher than those in bv-FTD group (all P<0.05). Among clinical features, the proportion of excitement (52.4% vs 15.8%), language impairment (28.6% vs 5.3%) and memory decline (35.7% vs 10.5%) in bv-FTD group were all higher than those in frontal subdural effusion group (all P<0.05). However, the proportion of apathy (84.2% vs 47.6%) in frontal subdural effusion group was higher than that in bv-FTD group (P<0.05). In terms of imaging features, the proportion of symmetrical atrophy of bilateral frontal lobe in bv-FTD group was lower than that in frontal subdural effusion group (54.8% vs 78.9%, P=0.022). The proportion of atrophy of other brain lobes in bv-FTD group was higher than that in frontal subdural effusion group (52.4% vs 23.7%, P=0.009). As for neuropsychological features, the scores of MoCA, AVLT, VFT, SDMT and executive function (TMT-A, TMT-B, FAB) in bv-FTD group were lower than those in frontal subdural effusion group (all P<0.05). The score of neuropsychiatric inventory (NPI) in bv-FTD group was higher than that in frontal subdural effusion group (P<0.05). And among items of NPI, the proportion of agitation (28.6% vs 16.3%), disinhibition (16.7% vs 2.6%), appetite change (21.4% vs 5.3%), euphoria (35.8% vs 7.9%) and irritation(23.8% vs 2.6%) in bv-FTD group were all higher than those in frontal subdural effusion group (all P<0.05). However, the proportion of apathy in frontal subdural effusion group was higher than that in bv-FTD group (84.2% vs 47.6%, P<0.05).

Older age, history of brain trauma or craniotomy, patterns of cerebral atrophy, comprehensive cognitive assessment and NPI may be helpful in differential diagnosis between bv-FTD patients and frontal subdural effusion patients with behavioral-psychological or mood disorder.

To investigate the changes in the excitability and P2X receptor-mediated purinergic signals of peripheral bladder sensory neurons in the mice of interstitial cystitis/bladder pain syndrome (IC/BPS) model.

Fifty male C57 mice (2 months old, weighing 16~20 g) were used in the study. The retrograde tracer fluorescent dye 3′-tetramethylindole carbocyanine perchlorate (DiI) was injected into the bladder wall to retrograde label the lumbosacral (LS:L₆~S₂) and thoracolumbar (TL:T₁₃~L₂) bladder sensory neurons in DRGs. Two weeks later, cyclophosphamide (CYP, 80 mg/kg, every 48 hours) was injected intraperitoneally on day 1, 3, and 5 to establish the IC/BPS mouse model (CYP group, n=25). Mice of the control group (n=25) received intraperitoneal injections of the same volume of saline. On the 6^th day after CYP/saline injection,bladder tissues were collected. Histopathological changes in the bladder tissue were evaluated by hematoxylin-eosin (H&E) staining. The myeloperoxidase (MPO) test was used to evaluate the tissue′s inflammatory level. The whole-cell patch-clamp recording was used to investigate the excitability, ATP-evoked depolarization and P2X receptor-mediated currents in DiI-positive LS and TL bladder sensory neurons.

Compared with the control group, CYP (80 mg/kg) did not induce significant histological changes or affect MPO levels, but increased the excitability of LS and TL bladder sensory neurons.The rheobase of the LS neurons in CYP group and control group were (119±9), (144±8) pA, respectively.The rheobase of the TL neurons in CYP group and control group were (123±10), (162±17) pA, respectively.Compared with control group, the rheobase of both LS and TL neurons in CYP group decreased significantly (t=2.025,2.047,all P<0.05). CYP treatment also significantly altered the composition of ATP-evoked current type in LS bladder sensory neurons. The ratio of P2X2 receptor-mediated sustained current in LS neurons of CYP group was 39.3%, which was much higher than that in control group(9.5%).The ratio of P2X2/3 receptor-mediated slow desensitization current was 60.7%, which was significantly lower than that in control group (90.5%,P=0.025). And it suggested that P2X2 receptor function was upregulated in LS neurons of CYP-treated mice. The ratio of P2X receptor current types in TL bladder sensory neurons (P2X2/3 receptor-mediated slow desensitization or P2X3 receptor-mediated fast desensitization current) did not change.

The excitability of bladder neurons in the IC/BPS model mice is increased, and the composition of the functional P2X receptors in LS neurons is changed. The excitability of bladder sensory neurons and P2X receptor function is enhanced at the early stage of functional bladder disorders before the detectable pathological changes and imply changes of purinergic signals in bladder sensory neurons might play an important role in the mechanism of IC/BPS pathogenesis.

To observe the formation of chondrocyte cluster in tibial plateau articular cartilage in human knee osteoarthritis (OA) and its significance for the development of knee OA.

According to Osteoarthritis Research Society International (OARSI) human articular cartilage histological grade system, cartilage samples of grade 0-1, grade 2-3 and grade 4 were obtained and histological sections were made to observe the formation of chondrocyte cluster. Immunohistochemical technique was used to detect the levels of collagen Ⅱ, collagen Ⅹ and Matrix metalloproteinase-13 (MMP-13) in chondrocyte cluster. Cartilage samples of grade 0-1 and grade 4 were obtained, and chondrocytes in transitional zone were extracted for culture to the third generation in vitro, and the proliferation rate and cell growth status at 24 h were observed. The data were compared with group t test between groups.

The superficial zone of cartilage tissue of grade 0-1 was intact and the number of chondrocytes was abundant, and there was no chondrocyte cluster formation in transitional zone. The superficial zone of chondrocytes in cartilage tissue of grade 2-3 was uneven, the number of chondrocytes decreased obviously, and there was no chondrocyte cluster formation in transitional zone. The superficial zone of chondrocytes in cartilage tissue of grade 4 was absent and there were lots of chondrocyte cluster formation. The level of collagen Ⅱ protein decreased in chondrocytes in cluster, while the levels of collagen Ⅹ protein and MMP-13 protein increased. The 24-hour proliferation rate of transitional zone chondrocytes cultured in vitro in grade 0-1 cartilage tissue was lower than that in grade 4 (8%±4% vs 16%±6%, t=3.722, P=0.002), and there was no obvious chondrocyte cluster formation in this group. While the chondrocytes from grade 4 cartilage tissue proliferated in the form of cluster.

The proliferation rate of transitional zone chondrocytes is low and no cluster is formed when the superficial zone exists in the early stage of knee OA. The proliferation rate of transitional zone chondrocytes is higher when the superficial zone is absent, and the chondrocyte cluster formed in the middle stage of knee OA.

To identify the key and potential regulatory genes affecting the progression and prognosis of patients with Ewing′s sarcoma metastasis by using bioinformatic method.

We identified differentially expressed genes (DEGs) between ES metastases and primary tumors by analyzing the gene expression profile downloaded from Gene Expression Omnibus (GEO), and performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of the DEGs. According to the analysis results, gene expression level verification and survival analysis of TCGA database, we screened out the key genes. Knockdown of EWSR/FLI1 fusion in ES cell line A673 was used to reveal the correlation between the expression level of key genes and EWS-FLI1.Then, the potential relationship between miRNAs and key genes was analyzed.

A total of 380 genes were identified as DEGs. In the enriched KEGG analysis, the most important pathways were the mismatch repair (MMR) signaling pathway (P=0.048) and the mitogen-activated proteins kinase (MAPK) signaling pathway (P=0.037). MSH2, MSH6, CACNA2D2 and MET were identified as key genes. The results showed that 61 microRNAs may regulate the expression of key genes. Survival analysis of ES patients showed that the 5-year survival rate of the high expression group of 4 key genes was lower than that in the low expression group. Survival analyses were conducted in TCGA SARC datasets, the results showed that MSH2, MSH6, CACNA2D2 and MET had a negative correlation with SARC patient overall survival. In addition, correlation analysis between four key genes and EWS-FLI1 expression showed that the expression of EWS-FLI1 may have regulation effect on the expression of four key genes.

It showed that MMR, MAPK pathways and four key genes may promote proliferation, invasion and migration of ES cells, and are related to a worsening of prognosis of patients with ES.