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15 August 2017, Volume 45 Issue 8 Previous Issue    Next Issue

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Keep up with the pace of the times, comprehensively improve the level of treatment for nerve trauma ZHANG Sai, CHEN Xu-yi 2017, 45 (8):  785-788.  doi: 10.11958/20170675 Abstract ( 1198 )   PDF (436KB) ( 3511 )   With the emergence of new technologies such as brain imaging, bio-sensing, human-computer interaction, cloud computing and large data, the treatment of traumatic brain injury has entered a new era. However, it must be clearly recognized that the central nervous system (CNS) trauma remains a worldwide medical problem. Based on the existing medical knowledge, it is important for promoting CNS trauma treatment levels including nerve trauma standardized treatment, professional management team, multi modal monitoring and data analysis, actively participating in domestic and international multi-center clinical research. Medical workers should dare to explore and innovate, keep up with the pace of the times, and truly achieve the overall improvement of nerve trauma. Related Articles | Metrics

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Precise medicine of traumatic brain injury PENG Tang-ming, CHEN Li-gang 2017, 45 (8):  788-790.  doi: 10.11958/20170651 Abstract ( 756 )   PDF (315KB) ( 3589 )   With the efforts of several generations, modern medicine has been from experience medicine and evidencebased medicine to the precise medicine. The precision medicine has also become a common goal for global clinical workers. However, traumatic brain injury involves a wide range and various types of injuries. The extent of the brain damage caused by trauma is complex. There is still a big gap between current medicine and precise medicine in the treatment of traumatic brain injury. Therefore, to achieve "accurate, punctual, sharing and individualized" precision medicine of traumatic brain injury, we must follow the objective routines of traumatic brain injury, and constantly improve the monitoring and treatment means of traumatic brain injury, and constantly improve the clinical research with globalization, multi-center, large data and prospection. Related Articles | Metrics

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Interpretation of three important problems in clinical treatment from guidelines for the management of severe traumatic brain injury (fourth edition) issued by the United States in 2016 LIU Bai-yun 2017, 45 (8):  791-795.  doi: 10.11958/20170676 Abstract ( 946 )   PDF (418KB) ( 3855 )   Guidelines for the Management of Severe Traumatic Brain Injury (Fourth Edition) have received extensive attention both at home and abroad after releasing by the Brain Trauma Foundation of the United States in 2016. The interval between the published newest version of the Guidelines and the Third Edition has already approached 7 years. In accordance with more rigorous evidence- based medicine standards, the Fourth Edition includes 94 updated research findings as evidence, in combination with the proposition of more accurate treatment recommendations and problem solutions. Combining the domestic situation and problems in the treatment of severe traumatic brain injury at present, three most important clinical issues related to the Fourth Edition of the guidelines are interpreted and analyzed in the present study, including decompressive craniectomy, mild hypothermia therapy and intracranial pressure monitoring, so as to improve the level of treatment of traumatic brain injury in China. Related Articles | Metrics

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Prevention and control strategy of hospital-acquired infection in neurosurgical intensive critical unit TU Yue, YANG Xiao-sa 2017, 45 (8):  795-798.  doi: 10.11958/20170689 Abstract ( 1184 )   PDF (351KB) ( 3644 )   Hospital acquired infection (HAI) is one of the common complications of hospitalized patients and poses a serious threat to public health worldwide, which causes an exacerbation, prolonged hospitalization and increased medical costs. Because of higher illness severity and more invasive operations, patients in neurosurgical intensive critical unit (NICU) are more susceptible to HAI such as hospital acquired pneumonia (HAP) and surgical site infection (SSI), leading to the increase of mortality. Therefore, the prevention and treatment of HAI is an important challenge during the treatment of diseases in NICU. In this paper, we summarized the common types, pathogenic characteristics, prevention measures and antimicrobial treatment of HAI in NICU, aiming to provide ideas and reference on HAI treatment for medical personnel in NICU. Related Articles | Metrics

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Clinical and evidence-based study of coagulopathy after traumatic brain injury YUAN Qiang, HU Jin 2017, 45 (8):  799-803.  doi: 10.11958/20170677 Abstract ( 981 )   PDF (373KB) ( 3534 )   Coagulopathy after traumatic brain injury is a coagulation dysfunction caused by brain tissue injury, which is characterized by over activations of coagulation, fibrinolysis and anticoagulation. It is the result of the interaction of multiple factors and multiple links with complicated pathophysiology. This study reivewed the clinical features and evidence-based evidences of coagulopathy after traumatic brain injury in order to summarize and discuss the latest progress in the diagnosis and treatment of coagulopathy after traumatic brain injury. Related Articles | Metrics

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Intracranial pressure monitoring in the management of traumatic brain injury GAO Guo-yi, JIANG Ji-yao 2017, 45 (8):  803-805.  doi: 10.11958/20170664 Abstract ( 855 )   PDF (338KB) ( 3596 )   Intracranial hypertension remains the key biomarker of severe traumatic brain injury for neurosurgery doctors. The monitoring of intracranial pressure (ICP) provides the technical support of precision and effective treatment strategy. In this article, the authors analyze the methodology, timing, function and development trend of ICP monitoring. The developing process of ICP monitoring contains the efforts of exploring a safe and precise technique to reflect the pressure in an injured brain. The modern ICP monitoring technology provides sufficient information flow for the management of craniocerebral trauma. Neurosurgeons could follow the information in the value and trends of ICP monitoring and implement it into decision making throughout the whole process of patient management. With the advanced data collecting and analyzing system the clinician can look into the waveform and parameter generalized by ICP value, and can interpret to the pathophysiological profiling in brain. ICP monitoring could exert efficacy not only in reflecting the mechanism of brain injury but also in the directing the clinical practice. Related Articles | Metrics

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Preliminary study on polyetheretherketone implant applied to cranioplasty of skull defect ZHANG Guo-bin, ZHANG Shu-sheng, JIN Zheng, CHEN Yue-da, ZHANG Xin, WANG Xiu-yu, 2017, 45 (8):  806-808.  doi: 10.11958/20170653 Abstract ( 899 )   PDF (688KB) ( 3666 )   Objective To study on the procedure, safety and effectiveness of polyetheretherketone (PEEK) implant applied to cranioplasty of skull defect. Methods A total of 11 cases (10 male, 1 female) of unilateral skull defect, more than 6 months post operation, were included in this study. PEEK implant was custom- made by three- dimensional numerically controlled processing depended on the data obtained from 1 mm-slice CT scan before cranioplasty individually. Autoclaved implants were applied to cranioplastic surgeries under general anesthesia. Findings of imaging examination and vital signs were compared before and after operation. Vital sign changes and circumstances during procedure were noted, and following- up reviews were performed on 2- week, 3- month and 1 year after operation respectively. Results Wounds healing were uneventful in 11 cases, no postoperative paresthesia presented. Surgical complications including temporary subcutaneous exudates were cleared up by puncture and aspiration in 5 cases, subcutaneous hematoma duo to drainage removal in 1 case, of which an emergency evacuation was performed and the implant was still with instant incision closure and then smooth recovery eventually. No significant abnormal fluctuation of laboratory examination was reported, moreover no artifact interference was found on postoperative CT scan or MR image. The subjective feelings and external sensory effects are satisfactory in patients. No emerging dysfunction of central nervous system or other organs was found, and no long-term complication was appeared. Conclusion It is feasible and safe to apply PEEK implant to cranioplasty without additional operative difficulty. This kind of material is an ideal alternative for repairing skull defect to patients with good financial condition and specific demands for postoperative status especially. Related Articles | Metrics

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Clinical curative effect observation of different concentrations of hypertonic saline in patients with intracranial hypertension after traumatic brain injury YANG Xi-ping, ZHANG Xin-yu, TU Yue, SHANG Chong-zhi, WANG Fei, ZHANG Sai 2017, 45 (8):  810-814.  doi: 10.11958/20170674 Abstract ( 822 )   PDF (376KB) ( 3573 )   Objective To study the effects of different concentrations of hypertonic saline (HS) and 20% mannitol on decreasing intracranial pressure (ICP) in patients with moderate-sever traumatic brain injury (TBI). Methods A total of 60 patients were randomly assigned into 7.5% HS group, 3% HS group and 20% mannitol group, 20 patients in each group. All of patients were treated with conventional treatment according to the diagnostic and treatment practices of TBI. When ICP was above 20 mmHg for more than 5 minutes, patients were administered corresponding hypertonic dehydrator. The levels of ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP), urine volume per hour and serum sodium were monitored continuously within 6 hours after the initiation of therapy. Results All agents could significantly decrease the ICP (P < 0.05), but the onset time in 7.5% HS group was less than that of the other two groups (P < 0.05), and the decreased magnitude of ICP and the effective time of decreasing ICP in 7.5% HS group were more than those of the other two groups (P < 0.05). Both 7.5%HS and 3%HS could increase MAP and CPP. There was no statistical difference in serum sodium between both groups , but the diuretic effect in both groups was worse than that of 20% mannitol group. Conclusion The rapidly infusion of 7.5% HS could significantly decrease the ICP, increase the MAP and CPP without obvious side-effect in patients with moderate- sever TBI, and which is a safe and effective therapy for intracranial hypertension after traumatic brain injury． Related Articles | Metrics

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Treatment experience of intracranial infection after severe traumatic brain injury caused by multi drug-resistant Klebsiella pneumonia: a case report SHANG Chong-zhi, TU Yue, ZHAO Ming-liang, SUN Shi-zhong, WANG Hui-min, ZHOU Xing, ZHAGN Sai 2017, 45 (8):  814-816.  doi: 10.11958/20170652 Abstract ( 1679 )   PDF (344KB) ( 3843 )   Intracranial infection is a common and serious complication of acute severe traumatic brain injury, with high mortality and disability rates, which significantly affects the prognosis. In recent years, with the widespread use of antibiotics, antibiotic-resistance rates of pathogens have risen year by year, and the choice of sensitive antibiotics is less and less, sometimes even in difficulties of no drugs available. This paper reviewed the treatment process of 1 case with intracranial infection caused by multi drug-resistant Klebsiella pneumonia after severe traumatic brain injury . The aim is to summarize the clinical experience. Related Articles | Metrics

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Inhibitory effects of N-acetylcysteine on inflammatory factors after acute spinal cord injury JIANG Ji-peng, CHENG Yuan-chi, LIU Bao-hu, BIAN Ke-feng, PANG Ai-bo, CHEN Xu-yi 2017, 45 (8):  817-821.  doi: 10.11958/20170654 Abstract ( 1071 )   PDF (647KB) ( 3869 )   Objective To investigate the inhibitory effects of N- acetylcysteine (NAC) on inflammatory factors after acute spinal cord injury, and the mechanisms thereof. Methods A total of 54 clean and healthy adult female SD rats were divided into three groups according to the principle of randomization: simple laminectomy group (Sham group), spinal cord injury group (SCI group) and N-acetylcysteine group (NAC group), with 18 rats in each group. The Sham group was treated with T9- 10 laminectomy only without spinal cord injury. Aneurysm clamp was used to establish rat model of T9- 10 spinal cord injury in SCI group and NAC group. At the time of 15 min and 12 h after injury, the rats of NAC group were injected Nacetylcysteine intraperitoneally (150 mg/kg). At the time of 24 h post modeling, 12 rats were sacrificed in each group for observing the severity of tissue injury by using hematoxylin- eosin (HE) staining (6 rats), and detecting the contents of inflammation factors including tumor necrosis factor (TNF)- α and interleukin (IL)- 6 by using enzyme- linked immunosorbent assay (ELISA) (6 rats). The remaining 6 rats in each group were raised for 8 weeks. During the first week, the ones in NAC group were injected NAC twice a day at 12 h intervals for 7 d. Additionally, the neurological function evaluation was performed at week 1, week 2, week 4, week 6 and week 8 after injury in rats by using the spinal cord injury motor function score (BBB) and the inclined plate test. Results The results of HE staining showed that the spinal cord was intact without hemorrhage and inflammatory cell infiltration in Sham group. The morphology and inflammatory status were significantly worse in SCI group than those in NAC group and Sham group. The results of ELISA showed that the expressions of TNF-α and IL-6 were significantly higher in SCI group and NAC group than those in Sham group (P＜0.05), while the expression levels of TNF-α and IL-6 were significantly lower in NAC group than those of SCI group (P＜0.05). The BBB scores and inclined plate test showed that both were significantly lower in SCI group and NAC group than those of Sham group (P＜0.05), and the results were better in NAC group than those of SCI group. Conclusion NAC may promote the recovery of neurological function in rats by reducing the local inflammatory response through diminishing the contents of TNF-α and IL-6 in spinal cord. Related Articles | Metrics

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Proteomics study of stress-induced depression in rat model based on the two dimensional electrophoresis YI Tai-long, TU Yue, ZHANG Sai, WEN Li, SUN Hong-tao, YANG Cheng, CHENG Shi-xiang 2017, 45 (8):  825-829.  doi: 10.11958/20170656 Abstract ( 912 )   PDF (682KB) ( 3644 )   Objective To screen altered proteins of hippocampus in the stress-induced depression (STRID) rat model, and explore the potential molecular mechanism. Methods Twenty Sprague-Dawley rats were randomly divided into the control group and STRID group, 10 rats in each group. Chronic unpredictable mild stress (CUMS) methods including fasting for solids and liquids, electric foot-shock, reversing day and night, cold water swimming, cage tilt, scare stimulation and tail pinch were conducted on STRID rats with no repeats for 28 days to make up the depression animal model. The control group was normally fed during this period. After the stress stimulation, the hippocampus protein samples were used for two dimensional electrophoresis to screen the differentially expressed protein, and then mass spectrum identification and function analyze were conducted. Results Compared with the control group, 34 proteins were altered in STRID group. Among which, 18 were up-regulated, and 16 were down-regulated. The differentially expressed proteins mainly located in cytoplasm, mitochondrion, extracellular exosome and myelin sheath. The involved signaling pathways included metabolic pathway, oxidative phosphorylation pathway, and Alzheimer’ s disease, Parkinson’ s disease and Huntington’ s disease pathways. Conclusion The altered proteins and dysfunction of nerve signaling, and the excess of oxidative phosphorylation in hippocampus of STRID rats may be one of the pathogenesises. Related Articles | Metrics

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Effects of neural stem cell transplantation on nerve function of rats with traumatic brain injury MA Yu-dong, MING Zong-yi 2017, 45 (8):  830-832.  doi: 10.11958/20170348 Abstract ( 824 )   PDF (587KB) ( 3622 )   Objective To study the effect of neural stem cell transplantation on neurological behavior and expressions of Caspase-3 and Caspase-9 in rats with traumatic brain injury (TBI). Methods A total of 108 SD rats were randomly divided into the sham group (n=36), traumatic brain injury group (TBI, n=36) and neural stem cell transplantation group (NSC, n=36). TBI model of rats was established by using improved Feeney method. Rats of NSC group were injected neural stem cells in cortex after traumatic brain injury was established for 1 week, and then nurological severity scores (NSS) of rats were evaluated at 7 days, 14 days and 21 days after cell transplantation in TBI and NSC groups, respectively. Rats of sham group were only cut the scalp and exposed the skull without striking. The expressions of Caspase-3 and Caspase-9 in brain tissues were detected by immunohistochemistry and Western blot method. Results Compared with NSC group at the same time points, NSS was decreased significantly in TBI group (P<0.01). Compared with the sham group, the optical density (OD) values of Caspase-3 and Caspase-9 positive expressions were increased significantly in TBI group (P<0.05). Compared with TBI group at the same time points, the OD values of Caspase- 3 and Caspase- 9 positive expressions were decreased significantly in NSC group (P<0.05). Conclusion The neural stem cell transplantation can promote the recovery of brain injury by down-regulating the expressions of Caspase-3 and Caspase-9. Related Articles | Metrics

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The clinical comparative study on the therapeutic effects of NICU patients implemented by NICU professional doctors and non-NICU professional doctors GUO Lin-yue, WANG Peng, GAO Chuang, SU Wan-qiang, HUANG Jin-hao, QIAN Yu, WANG Jia-qi, GONG Zhi-tao, SONG Yi-ming, SUN Jian, JIANG Rong-cai 2017, 45 (8):  833-837.  doi: 10.11958/20170691 Abstract ( 771 )   PDF (375KB) ( 3579 )   Objective To explore the implementation styles on the therapeutic effects on the neurosurgical intensive care unit (NICU) patients. Methods Patients were enrolled during February 3, 2015 to February 3, 2016. The key point time was August 3, 2015 when the treatment in our NICU was fully implemented by NICU professional doctors. Based on this time point, all the enrolled patients were divided into non-NICU professional doctor implementing (NNPDI) group and NICU professional doctor implementing (NPDI) group. Thus non- NICU professional doctors and professional doctors were the leaders of diagnosis and treatment in tow groups. The length of hospital stay, complications, prognosis and other therapeutic outcomes were compared between two groups. Results The length of hospital stay was longer in NPDI group than that in NNPDI group (P＜0.05). The incidence of water-electrolyte imbalance was lower in NPDI group than that in NNPDI group (P＜0.05). There were no significant differences in the incidence of the ventilator-associated pneumonia (VAP), the hepatic and renal insufficiency, the intracranial infections and stress ulcers between the two groups (P＞0.05). The proportion of referral to other wards and fatality rate were both lower in NPDI group than those in NNPDI group (P＜0.05). And the discharge rate from NICU was higher in NPDI group than that of NNPDI group (P＜0.05). There was no significant difference in the rate of patients left hospital without treatment between the two groups (P＞0.05). Conclusion The NICU professional doctor implementing may be contribute to, at least in part, the improving of prognosis of NICU patients without obvious advantages in most complications. The level of professional management remains to be improved. Related Articles | Metrics

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The effectiveness of lactobacillus acidophilus combined with electroacupuncture on gastrointestinal function in patients with traumatic brain injury HOU Ya-hong, ZHANG Sai 2017, 45 (8):  837-840.  doi: 10.11958/20170754 Abstract ( 937 )   PDF (364KB) ( 3681 )   Objective To observe the effectiveness of lactobacillus acidophilus combined with electroacupuncture on gastrointestinal function in patients with traumatic brain injury. Methods A total of 167 patients with traumatic brain injury treated in our hospital from June 2013 to December 2016 were randomly divided into combining treatment group (n= 84) and lactobacillus acidophilus group (n=83). The lactobacillus acidophilus group was given routine treatment and lactobacillus acidophilus. The combining group was given the routine treatment, electroacupuncture treatment and lactobacillus acidophilus. Data of gastronintestinal function, infection, pH of gastric juice, serum two amine oxidase (DAO) and D-lacticacid level were compared between two groups. Results Compared with lactobacillus acidophilus group, the incidence rates of reflux (χ2=7.948), vomit (χ2=7.514), diarrhea (χ2=4.521), abdominal distension (χ2=5.968), pulmonary nfection (χ2=4.521) and enterogenic infection (χ2=4.531) were significantly decreased in the combining treatment group (P＜ 0.05). After 20- day treatment, pH value of gastric juice (t=8.125) was significantly increased, the serum DAO value (t= 6.383) and D-lacticacid level (t=6.745) were decreased, in combining treatment group than those of lactobacillus acidophilus group (P＜0.05). Conclusion Lactobacillus acidophilus combined with electroacupuncture can improve the gastrointestinal function, stimulate gastric acid secretion and decrease serum levels of DAO and D-lacticacid. Related Articles | Metrics

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Advances in the application of neurophysiological monitoring in spinal cord injury BIAN Ke-feng, ZHANG Sai, ZHAO Yong-qing 2017, 45 (8):  841-845.  doi: 10.11958/20170659 Abstract ( 810 )   PDF (380KB) ( 4233 )   In recent decades, the development of the neurosurgery has changed from the traditional anatomical model to the modern anatomical- functional model. The nerve functions are maximally protected while lesions are removed as far as possible. Neurophysiological monitoring especially somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) can directly reflect the integrity of the sensory and motor nerve conduction pathways of the nervous system. At present, it has been widely used in the neurosurgery, spinal surgery, vascular surgery and other surgical fields. In recent years, more and more clinical surgeries involved spinal surgery, intraoperative neurophysiological monitoring could timely find any reversible spinal cord damage such as mechanical stretch, ischemia, and anesthetic drugs, which not only improve the quality of surgery, reduce iatrogenic spinal cord injury, but also greatly improve the prognosis of patients and reduce postoperative neurological dysfunction and complications. In this paper, the research progress of neural electrophysiological monitoring techniques in spinal cord surgery is reviewed. Related Articles | Metrics

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The molecular mechanisms of hypothermia cerebral protection WANG Jing, CHEN Chong, LI Xiao-hong 2017, 45 (8):  845-850.  doi: 10.11958/20170661 Abstract ( 765 )   PDF (401KB) ( 3603 )   Therapeutic hypothermia (TH), also known as targeted temperature management (TTM), is the intentional reduction of core body temperature to 32-35 ℃. Mild-to-moderate hypothermia and advanced cooling technology can be used as an effective component of multimodal therapy for ischemic encephalopathy, brain trauma, haemorrhagic stroke, or other forms of severe brain injury and acute neurological injuries to achieve neuroprotection. The events occured after an episode of acute neurological injuries and cerebral ischemia are multiple. And the possible explanation for the neuroprotective benefits of hypothermia therapy is inhibiting metabolic disruption, excitotoxicity, oxidative stress, cell apoptosis signals, inflammatory responses, and promoting neuronal integrity and blood-brain barrier integrity. To know the molecular mechanisms of action of TH, which exerts neuroprotective function, will provide clinicians a better understanding the indications and contraindications of this therapy, and provide a possible theoretical reserves and clinical practice for other therapies when used in conjunction with hypothermia. Related Articles | Metrics

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Selection and identification of human monoantibody TRAb Fab fragment DU Xiao-ming, LI Ning, FANG Pei-hua 2017, 45 (8):  851-855.  doi: 10.11958/20170531 Abstract ( 1038 )   PDF (1494KB) ( 3909 )   Objective To select and express a human thyrotrophin receptor antibody (TRAb) Fab fragment from phage antibody library constructed with phage display technology. Methods With immobilized antigen, the reconstructed humanized TRAb Fab library was enriched by five rounds panning (adsorption-elution-amplification). The TSAb Fab and TBAb Fab fragment were selected by coated fusion proteins of hTSHRn and hTSHRc. The positive clones were identified and selected by Phage-ELISA. TRAb positive clones were identified by PCR and double restriction enzyme digestion. The soluble TRAb (TSAb, TBAb) Fab fragments were expressed. TRAb (TSAb, TBAb) Fab fragments were identified by Western blotting assay. The DNA fragment was sequenced from the positive clones. Results Following five rounds of biopanning, TRAb (TSAb,TBAb) Fab phage antibody was screened. The enrichment effect reached to 77 times and 94 times. The soluble TRAb (TSAb,TBAb) Fab antibodies were expressed from positive clones and identified by phage ELISA. Western blotting analysis showed that the phage displaying Fab had significant binding activity with antigens. These sequence analysis showed that all of the heavy chain Fd gene and light chain gene were derived from human immunoglobulin variable region. The light chain variable region of the monoclonal 48 was homologous to the immunoglobulin light chain Vλ homology of 94.4%, and the heavy chain variable region of the monoclonal 48 was homologous to the immunoglobulin heavy Fd chain VH4 homology of 88.9%. The light chain variable region of the monoclonal 56 was homologous to the immunoglobulin light chain Vλ homology of 95.6% , and the heavy chain variable region of the monoclonal 56 was homologous to the immunoglobulin heavy Fd chain VH3 homology of 84.6% . Conclusion We have successfully selected TRAb (TSAb, TBAb) Fab fragment from a human phage display immune antibody library. Related Articles | Metrics

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Effects of fermented cordyceps powder on the expression of NLRP3 in myocardium of diabetic rats LYU Yuan-jun, WANG Zhuo, CUI Zhuang, LI Jin-e, TAN Xiao-feng, LI Chang-ping 2017, 45 (8):  856-859.  doi: 10.11958/20170594 Abstract ( 862 )   PDF (930KB) ( 3705 )   Objective To investigate the therapy effect of fermented cordyceps powder on diabetic cardiomyopathy, and the effect on expressions of NLRP3, Caspase-1 and interleukin (IL)-1β in myocardium of diabetic rats. Methods A total of 45 male SD rats were randomly divided into normal control group (group CON), diabetes group (group DM) and fermented cordyceps powder administration group (group CS, 1 g·kg- 1·d- 1). Diabetes rat model was induced by tail vein injection with streptozotocin (45 mg/kg) in group DM and group CS. The rats in group CS were given fermented cordyceps powder solution by gavage at a single dose of 1 g·kg-1·d-1 for 18 weeks. Rats of group CON and group DM were given 0.9% NaCl in the same way. All rats were sacrificed after 18 weeks. The pathological changes in myocardium were observed by HE staining and electron microscope. The expression of NLRP3 in myocardium was detected by Western blotting. The expression levels of NLRP3, Caspase-1 and IL-1β in myocardium were detected by immunohistochemistry. Results (1) Myocardial necrosis and fibrosis and mitochondrial damages were observed under electron microscope in group DM. The above-mentioned pathological changes were improved in the group CS. (2) The result of Western blotting showed that the expression of NLRP3 in myocardium was significantly increased in group DM and group CS than that in group CON, and the expression of NLRP3 was significantly lower in group CS than that in group DM. (3) The result of immunohistochemistry showed that, compared with the group CON, the expressions of NLRP3, Caspase- 1 and IL- 1β in myocardium were significantly increased in group DM and group CS, and which were significantly lower in group CS than those in group DM. Conclusion Fermented cordyceps powder can improve diabetic cardiomyopathy through decreasing the expressions of NLRP3, Caspase-1 and IL-1β in myocardium. Related Articles | Metrics

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Protective effect and its mechanism of Shenkang injection on peritoneal mesothelial cells in CAPD mice WANG Li, XIA Tian, ZHANG Hong-zhen, LI Rong 2017, 45 (8):  860-864.  doi: 10.11958/20170502 Abstract ( 900 )   PDF (712KB) ( 3788 )   Objective To study the protective effect of Shenkang injection on peritoneal mesothelial cells (PMCs) of continuous ambulatory peritoneal dialysis (CAPD) mice, and explore the possible mechanism. Methods Forty ICR mice were randomly divided into blank control (A) group, peritoneal dialysis (B) group, low dose of Shenkang (C) group (2.5% dialysate + 5 mL/kg Shenkang injection), medium (D) group (2.5% dialysate + 10 mL/kg Shenkang injection) and high (E) group (2.5% dialysate + 20 mL/kg Shenkang injection). Mice were observed for 4 weeks. Fasting blood glucose, total cholesterol, triglyceride and C- reactive protein (CRP) were detected by biochemical assay. Tumor necrosis factor- alpha (TNF- α), transforming growth factor- beta 1 (TGF- β1), vascular endothelial growth factor (VEGF) and connective tissue growth factor (CTGF) levels of serum and dialysate were detected by ELISA. Pathological changes of peritoneal tissue were observed by HE staining. Expression and mRNA transcription levels of these four cytokines in the peritoneal tissue were detected by immunohistochemical staining and real-time PCR respectively. Results There were no significant differences in body weight, fasting blood glucose, total cholesterol and triglyceride between 5 groups of mice (P>0.05). Compared with group B, there was no significant difference in CRP level between group C and group E, but which was significantly decreased in group D (P<0.05). The serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were decreased in group C and group D. The serum and dialysate levels of TNF-α and TGF-β1 were significantly increased in group E (P< 0.05), but there was no significant difference between VEGF and CTGF in group E. Compared with group E, except for CTGF in dialysate of group C, the serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were significant decreased in group C and group D (P<0.05). Damaged PMCs were found in group B, which were improved in various degrees in group C, group D and group E. Compared with group B, the protein expression and mRNA relative transcription levels of TNF- α, TGF-β1, VEGF and CTGF tended to decrease gradually in group C, group D and group E (P<0.05). Conclusion A certain concentration of Shenkang injection can protect PMCs by inhibiting the expression of TNF-α, TGF-β1, VEGF and CTGF in CAPD mice, so as to control the occurrence and development of peritoneal fibrosis. Related Articles | Metrics

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The investigation and risk factors analysis of postcholecystectomy syndrome FENG Qi-zhen, WU Fei, LI Jian-jun 2017, 45 (8):  865-868.  doi: 10.11958/20170554 Abstract ( 962 )   PDF (334KB) ( 4000 )   Objective To investigate the incidence and risk factors of postcholecystectomy syndrome (PCS), and provide theoretical basis for the prevention of PCS. Methods A total of 338 patients with PCS were randomly selected in our hospital from May 1st 2013 to April 30th 2014, in which 316 cases were successful followed up including 101 males and 215 females. The data were collected from the 7 aspects including blood type, drinking history, smoking history, diabetes history, mental anxiety, dietary tendence and preoperative symptoms, and which were analyzed by binary-logistic regression analysis. Results According to the PCS diagnostic criteria, 115 patients were diagnosed with PCS (36.39%). The anxiety status and preoperative discomfort were closely related to the occurrence of PCS, with statistically significant difference (P<0.05). Conclusion The diagnosis and treatment of PCS are more complicated. We should focus on the prevention of PCS according to its risk factors, and pay attention to preoperative communication and individualized analysis of patients in order to reduce the occurrence of PCS. Related Articles | Metrics

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The effect of ultra-early stent-assisted coil embolization in the treatment of ruptured widenecked intracranial aneurysms GAO Pei-long, HU Qun-liang, LI Jian-wei, TIAN Zhu, SU Ya, HAO Zhan-po 2017, 45 (8):  868-871.  doi: 10.11958/20170470 Abstract ( 835 )   PDF (423KB) ( 3542 )   Objective To explore the efficacy of ultra - early stent - assisted coil (SAC) in the treatment of intracranial rupture of wide - necked aneurysms. Methods The angiographic and clinical data of 24 patients (including 8 male, 16 female, age ranged from 29 to 86 years, with a median age 59) with acutely ruptured wide-necked intracranial aneurysms treated with SAC were retrospectively analyzed. The postoperative complications and clinical results were observed. The postoperative embolization was assessed according to the Raymond grading standard. The assessment of the follow-up results from 6 to 12 months after procedure was observed according to the modified Rankin Scale (mRS) score. Results Procedurerelated complications occurred in 3 patients (12.5% ). All of them were hemorrhagic events, of which 2 cases died. Perioperative death was found in 3 cases. Of the 19 surviving patients, 17 showed good recovery (mRS 0-2). After 6 to 12 months of DSA, no recurrence of aneurysm was found in 10 follow-up patients. Conclusion Ultra-early stent-assisted coil treatment for intracranial wide- neck rupture aneurysm can improve the success rate of embolization and reduce the recurrence. Related Articles | Metrics

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Multi - modality imaging in the diagnosis and differential diagnosis of small renal mass ZHANG Dai, XIN Xiao-jie△, ZHANG Sheng, MU Jie, WANG Ying 2017, 45 (8):  872-876.  doi: 10.11958/20170163 Abstract ( 922 )   PDF (443KB) ( 3946 )   Objective To compare contrast- enhanced ultrasonography (CEUS), contrast- enhanced CT (CECT) and combined detection of two methods in the diagnosis of small renal masses, and differential diagnosis of different types of small renal masses by CEUS. Methods In 95 cases of small renal masses, there were 79 patients with small renal cell carcinoma and 16 patients with benign tumor. The diagnostic results of the three methods were compared based on the pathological results, which were used as the "gold standard" for the diagnostic efficacy. The ROC curve was drawn, and the area under the curve (AUC) was compared. The characteristics of the two groups were analyzed and compared by Q-Lab software in CEUS. The angiographic parameters included arrival time (AT), time to peak (TTP) and peak intensity (PI). CEUS patterns for several pathologic types of renal tumors with larger sample sizes were compared. The characteristic manifestations of small renal masses under CEUS were analyzed. Results The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of CEUS were 87.37%, 93.67%, 56.25%, 91.36%, 64.29% and 0.750, the values for CECT were 88.42%, 93.67%, 62.50%, 92.50%, 66.67% and 0.775, and the values for combined detection of two methods were 95.79%, 98.73%, 81.25%, 96.30%, 92.86% and 0.869 respectively. The sensitivities of the three methods were high, but the specificities were the same. The combined detection showed better diagnostic efficacy than that of single diagnostic method. The AT and TTP of CEUS were earlier in small renal carcinoma group than those of benign nephrotic group, and PI was higher than that of benign nephrotic group (P＜0.05). There were significant differences in the contrasts of contrast enhancement methods between clear cell carcinoma, papillary cell carcinoma, chromophobe cell carcinoma, and angiomyolipoma (P＜0.01). There was little difference in contrast enhancement between the other types of carcinoma. False envelope can be observed by CEUS.‘Cystic area’of the detection rate was increased significantly by CEUS than that of conventional ultrasound. Conclusion Combined detection of CEUS and CECT can improve the diagnostic accuracy of small renal tumors. CEUS has great clinical value in the differential diagnosis of small renal masses, which is worthy of clinical promoting. Related Articles | Metrics

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Analysis of risk factors of new onset atrial fibrillation after on-pump coronary artery bypass grafting XUE Fen-long, CHAI Jun-wu, CHEN Hong-lei, ZHOU Wei, WANG Kai△, KONG Xiang-rong 2017, 45 (8):  877-880.  doi: 10.11958/20170317 Abstract ( 1038 )   PDF (363KB) ( 4541 )   Objective To investigate the risk factors of postoperative atrial fibrillation (POAF) in patients with onpump coronary artery bypass grafting (ONCAB). Methods The clinical data of 200 patients with ONCAB were retrospectively analyzed. The patients were divided into POAF group (n=52) and non POAF group (n=148) according to the occurrence of POAF after operation. The perioperative data including age and gender of all patients were collected and analyzed. The index of opinion of statistical results was classified by two categories Logistic regression analysis, and the related risk factors of POAF were analyzed. The receiver operating characteristic (ROC) curves of the age, red blood cell (RBC), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were analyzed in two groups. Results The incidence rate of POAF was 26%, mostly occurred in the postoperative period from 1 d to 3 d. Compared with non POAF group, the age, the proportion of patients with age ≥ 62.5 years or older, the proportion of patients with LAD ≥ 35 mm, left ventricular end- diastolic diameter and perioperative transfusion of RBC were increased in POAF group, and data of mechanical ventilation time, ICU stay time and hospitalization time were prolonged, but the LVEF level decrease (P < 0.05). Among them, the elderly (≥ 62.5 years), increased LAD (≥ 35 mm), the higher perioperative transmission amount of RBC were the independent risk factors of POAF after ONCAB, and the higher LVEF was a protective factor for ONCAB. The optimal thresholds for age, RBC, LAD and LVEF were 62.5 years, 1U, 35.5 mm, and 0.34. Conclusion The occurrence of POAF after ONCAB is related with age ( ≥ 62.5 years old)， LAD ≥ 35 mm and perioperative transfusion of RBC, which can be used as clinically to predict the occurrence of POAF. Related Articles | Metrics

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The clinical features and risk factors of children with post-infectious bronchiolitis obliterans treated with invasive mechanical ventilation because of severe pneumonia LI Xiao-qing 2017, 45 (8):  881-884.  doi: 10.11958/20170723 Abstract ( 913 )   PDF (324KB) ( 3686 )   Objective To summarize the clinical features and risk factors of children with post-infectious bronchiolitis obliterans (PBO), who were treated with invasive mechanical ventilation because of severe pneumonia, and to provide clinical reference for early diagnosis, early treatment and improvement of prognosis of pediatric patients with PBO. Methods The pediatric patients treated with invasive mechanical ventilation because of severe pneumonia, who were hospitalized in PICU of Tianjin Children’ s Hospital from October 2010 to December 2015 were included in this study. The pediatric patients who were diagnosed with PBO were used as the observation group. The general characteristics, clinical presentation, treatment time, treatment results, distribution of pathogens and relevant laboratory examination results were analyzed by using SAS 9.3 statistical software. Results A total of 73 pediatric patients were included in this study, including 49 male and 24 female, and their mean age was 8 months (P25-P75: 4-12), the minimum age was 1 month and the maximum age was 36 months. They were divided into PBO group (n=30) and control group (n=43). It was found that wheezing (27 cases, 90.0% ), persistent cough (22 cases, 73.3%) and exercise intolerance (22 cases, 73.3%) were the main clinical symptoms in PBO group. Results of physical examination showed wheeze (24 cases, 80.0% ) and crackles (21 cases, 70.0% ). Mosaic perfusion (25 cases, 83.3%) was the most prominent sign in lung CT scan. More than 2/3 of the pediatric patients were found moderate and severe pulmonary dysfunction. Pathogen detection rate was 50% in PBO group, and virus was prevalent (respiratory syncytial virus 4 cases, influenza virus 1 case, measles virus 2 cases and adenovirus 4 cases). The results of Logistic multivariate regression analysis showed that the risk factors included using corticosteroids at the beginning of disease (OR=8.515, 95%CI: 1.948- 37.224), prolonged mechanical ventilation (OR=1.116, 95%CI: 1.031-1.327) and postponing clinic time (OR=1.114, 95%CI:1.010- 1.227). Conclusion Once the severe pneumonia children, with the risk factors of using corticosteroids at the beginning of disease, prolonged invasive mechanical ventilation and postponing clinic time, are found the wheezing, persistent cough and exercise intolerance, and persisting wheeze and/or crackles, the PBO relevant examination should be executed as soon as possible to diagnosis and treatment. Related Articles | Metrics

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The analysis of influencing factors of emergency death in multiple trauma patients WANG Geng-zhuang, PAN Zhao-yu, PAN Li-feng 2017, 45 (8):  885-888.  doi: 10.11958/20170171 Abstract ( 895 )   PDF (336KB) ( 3462 )   Objective To analyze the related factors and the independent risk factors of death in patients with multiple injuries. Methods Data of 651 patients with multiple injuries treated in our hospital from June 2012 to June 2015 were retrospectively analyzed. According to the outcomes, patients were divided into effective group (n=608) and death group (n= 43). Data of gender, age, cause of injury, the primary diseases related with the trauma, ISS score, number of trauma, time from injury to the treatment and the body parts of injury were compared between two groups. Logistic regression analysis was used to analyze the risk factors of death in multiple trauma patients. Results The proportion of patients≥60 years old, ISS score ≥16 points, the number of trauma≥4, a major brain injury and time of trauma to the treatment ≥ 3 h were higher in death group than those of effective group (P＜0.05). The independent risk factors for emergency death in multiple injuries included patients≥60 years old, major brain injury, ISS score ≥16 points and time of trauma to the treatment ≥ 3 h. The cause of death in patients with craniocerebral trauma (cerebral laceration) accounted for up to 27.91% (n=12), intracranial hematoma accounted for 20.93% (n=9), and traumatic hemothorax accounted for 11.63% (n=5). Conclusion The related factors and independent risk factors should be paid attention to doctors in emergency department, and the emergency plan should be made to reduce the death rate of emergency patients with multiple injuries. Related Articles | Metrics

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Efficacy of ACEI and ARB in the treatment of idiopathic pulmonary fibrosis: a Meta-analysis ZHAO Chun-yang, YANG Li-chao, CAI Jia-yi, JIANG Ming-yan 2017, 45 (8):  889-896.  doi: 10.11958/20170205 Abstract ( 1010 )   PDF (926KB) ( 3725 )   Objective To evaluate the efficacy of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in the treatment of idiopathic pulmonary fibrosis through the method of system evaluation. Methods A computer-based online search of Pubmed, Embase, Cochrane Library, CNKI, CBM and Wanfang were used for database retrieval. Revman 5.0 was used to assess the bias of the included studies. The Stata 14.0 was used to evaluate the extraction indexes of efficacy, p (O2), p (CO2), DLco, FEV1 and VC. GRADE score was used to evaluate the level of evidence. Results A total of 17 articles (related with 1 381 patients) were included in this study, including 14 studies using ARB and 3 studies using ACEI. Compared with the control group ACEI and ARB drugs showed advantages in the treatment of pulmonary fibrosis (RR=1.34, 95%CI: 1.24-1.44, Z=7.81, P＜0.001). Auxiliary index analysis showed that the test groups were treated with enalapril (SMD=0.72, 95%CI： 0.21-1.22, Z=2.77, P=0.006), telmisartan (SMD=3.86, 95%CI: 2.44-5.27, Z=5.35, P＜0.001), valsartan (SMD=1.94, 95%CI： 1.33-2.55, Z=6.27, P＜0.001) and captopril (SMD=0.60, 95%CI： 0.11- 1.09, Z=2.41, P=0.016), the p(O2) levels were significantly improved in patients ≥65 years old (SMD=0.76, 95%CI： 0.52- 1.00, Z=6.18, P＜0.001) and patients ＜ 65 years old (SMD=3.97, 95% CI： 2.61- 5.32, Z=5.73, P＜0.001), and disease duration ≥ 5 years (SMD=1.39, 95%CI： 0.45-2.33, Z=2.89, P=0.004) and disease duration ＜ 5 years (SMD=3.26, 95%CI： 2.06-4.46, Z=5.34, P＜0.001) compared with those of control group (SMD=2.95, 95%CI： 1.95-3.94, Z=5.82, P＜0.001). The curative effect of telmisartan was better than that of other drug groups (P < 0.001), and which was much better for patients under 65 years old (P < 0.001). There was no significant difference in the disease duration between two groups (P= 0.307). The p (CO2) levels were significantly improved in patients treated with telmisartan [SMD=-12.94， 95%CI： (-14.01)- (-11.86)， Z=23.51， P＜0.001), valsartan [SMD=-1.95， 95%CI： (-2.56)-(-1.34)，Z=6.29， P＜0.001] compared with those of control group [SMD=-11.13， 95%CI： (-17.03)-(-5.24)， Z=3.70， P＜0.001]. The effect of telmisartan was better than that of valsartan (P < 0.001). In addition, values of DLco (SMD=0.64, 95%CI： 0.45-0.83, Z=6.72, P＜0.001), FEV1 (SMD=1.19, 95% CI： 0.52- 1.86, Z=3.47, P＜0.001) and VC (SMD=0.51, 95% CI： 0.16- 0.85, Z=2.85, P=0.004) were improved in test group compare with those of control group. And the GRADE scores of relevant indexes were low quality to moderate quality. Conclusion ACEI and ARB can improve the efficacy, the p (O2) and p (CO2) in the treatment of pulmonary fibrosis. Patients with age <65 years old and treated with telmisartan have the best curative effect, and which is not related to the disease duration. Related Articles | Metrics