Objective To discuss the pattern of pre-hospital and in-hospital first aid of craniocerebral injury. Methods A retrospective study was carried out on 4 311 cases with craniocerebral injuries, who were directly sent into the emergency room of the department of neurosurgery, classified and cured by special doctors according to corresponding procedures. Results A total of 2 992 mildly and mediumly injured cases were cured. In 1 319 severely injured cases, 164 died within 24 hours and the other 1 155 were evaluated by GOS, showing that 750 got good recovery plus moderate disability (64.94%), 132 resulted in severe disability (11.43%), 44 in vegetation (3.81%) and 229 died (19.83%). The total fatality rate was 29.80%. Conclusions It is beneficial to cure of the severe craniocerebral injury by utilizing the following ways, ie, pre-hospital care, immediate sending into the wards, special diagnosis according to first aid procedures, operation and ICU.

Objective To discuss the correlation between tyre bursting and traffic accidents on highways. Methods A retrospective statistical analysis was carried out on traffic accidents resulted from tyre bursting on the Guangzhou-Shenzhen highway from 1998 to 2000. Results During three years, there occurred 2 484 cases of traffic accidents on the Guangzhou-Shenzhen highway, of which 848 cases resulted from tyre bursting, accounting for 34.14% (848/2 484). During a day, incidence from 10:00 to 16:00 was 55.54% (471/848), which was higher than that in any other time, and the highest incidence was at 14:00, accounting for 9.67% (82/848). During a year, incidence from April to September was 56.84% (482/848), higher than that in any other months. Considering the tyre factor, accidents resulted from burst of single right posterior tyre were 398 cases, occupying 46.93% (398/848) of the total, which was more than those resulted from burst of any other tyres. The second dangerous burst position was on the left posterior tyre, from which accidents reached 295 cases occupying 34.79% ((295/848)) of the total. Of all, 848 cases of tyre bursting accidents resulted in 12 deaths and 200 injuries, which accounted for 22.55% of the total death and wound (212/940). There were 58 cases of craniocerebral trauma, 32 chest trauma, seven abdominal injuries, 25 spinal cord injuries, four pelvic injuries, 52 branches injuries, 127 soft tissue injuries all through the body and 106 combined injuries. Conclusions Tyre bursting is a vital factor for traffic accidents on highways of South China. In order to effectively reduce traffic accidents on the highways, we must prevent overspeed driving, strengthen the regular check of the tyres and normalize corresponding management.

Purpose To investigate the expression and significance of epiderma1 growth factor receptor( EGFR)mutation-specific anti-bodies in 1ung adenocarcinoma. Methods Immunohistochemica1( IHC)technique was used to detect the expression of EGFR muta-tion-specific antibodies(EGFR-19,EGFR-21)and EGFR tota1 protein antibody(EGFR-P)in 171 cases of 1ung adenocarcinoma with resected specimens,and EGFR gene mutation was a1so performed by amp1ification refractory mutation aystem-PCR( ARMS-PCR). The expression of EGFR-19,EGFR-21 and EGFR-P mutant proteins was compared with EGFR gene mutation and their re1ationship with histo1ogica1 c1assification and c1inica1 characteristics were ana1yzed. Results The expression of EGFR mutant protein was corre1ated with the poor differentiation group inc1uding micropapi11ary and so1id predominant types( P=0. 021 ). EGFR-21 high expression was re1ated to p1eura1 invasion(P=0. 005). The coherence of IHC(with EGFR-19/21 antibodies)and ARMS-PCR was existed(Kappa>0. 4 ). Taking ARMS-PCR as a standard,the sensitivity and specificity of EGFR-19 and EGFR-21 were 65. 0% and 89. 4%, 70. 0% and 97. 6%,respective1y. Conclusions Expression of EGFR mutation-specific antibodies is associated with poor differentia-tion and p1eura1 invasion. It suggests a worse prognosis indicator in 1ung adenocarcinoma. Because of the coherence with ARMS-PCR, using IHC with mutation-specific antibodies to detect the mutant proteins of EGFR-19/21 may act as a pre1iminary screening method of EGFR gene mutation.

Objective To study the causes for dysphoria and discuss the medication methods of controlling the dysphoria in craniocerebral injury patients. Methods First, craniocerebral injury patients were grouped to analyze the causes for their dyshoria. Then, the patients were injected with Tramadol (1 mg/kg), Droperidol (0.05 mg/kg) and Midazolam (0.1 mg/kg). Successively, analgestic pump containing combined Tramadol that included Tramadol (15 mg/kg), Droperidol (0.15 mg/kg), Midazolam (0.4 mg/kg) and 100 ml 10 g/L Procaine was used for 50 hours, (1.5-2.5) ml/h, continuously. The medication time ranged from 40 hours to 160 hours. Results Of 71 patients with dysphoria, 43 patients with grades Ⅰ and Ⅱ dysphoria were under complete control, 19 with grade Ⅲ dysphoria (eight were injected with more load) under basic control, one with grade Ⅳ dysphoria under control and eight degraded to grade Ⅱ dysphoria but needed additional load. Of all, 63 patients were successfully controlled (89%) and eight (11%) got better, with effectiveness rate of 100%. Blood pressure, heart rate and breath remained clam, which was good for oxygen transferring to brain and reducing of encephalic pressure. Conclusions The causes for dysphoria in craniocerebral injury patients include stimulation of pain and acute psychopathic impediment. Continuous injection of Tramadol via analgesic pump is an ideal medication methhod for analgesia and sedation, for it can not only hold blood and medicament in invariableness, but also make the patients quiet, without bad reaction or affecting process of regaining consciousness.

Objective:To investigate the relationship between serum thyrotropin(TSH)levels and major cardiovascular risk factors in elderly type 2 diabetes(T2DM)patients with normal thyroid function.Methods:A total of 510 elderly T2DM patients with normal thyroid function were included in this study, including 265 males and 245 females.Blood samples of all patients were collected after an overnight fast.Thyroid function and blood levels of lipids, glucose, glycated hemoglobin(HbA1c)and other components were measured.Basic information of all patients was collected and body mass index(BMI), visceral adiposity index(VAI)and lipid accumulation product index(LAP)were calculated.Results:The levels of BMI, VAI, LAP, triglycerides(TG), total cholesterol(TC), low density lipoprotein(LDL-C), HbA1c, fasting blood glucose(FBG)and 2h-postprandial blood glucose(2 h PBG)were higher in the high TSH group than in the low TSH group(31.7±5.5 kg/m 2vs.27.6±2.1 kg/m 2, 7.20±1.18 vs.5.88±0.51, 61.88±6.36 vs.52.76±7.09, 6.49±2.64 mmol/L vs.5.84±2.41 mmol/L, 2.73±1.30 mmol/L vs.1.99±0.54 mmol/L, (2.86±0.93 mmol/L vs.2.55±0.81 mmol/L, 9.10±1.35% vs.7.80±1.76%, 9.64±2.03 mmol/L vs.7.55±1.72 mmol/L, 19.20±2.99 mmol/L vs.15.33±2.36 mmol/L, t=5.32, 8.06, 10.88, 8.13, 8.30, 5.90, 5.83, 6.51 and 6.82, all P<0.05). Multivariate Logistic regression analysis showed that cardiovascular risk factors including HbA1c( OR=1.21, 95% CI: 1.01-1.52, P=0.020), LDL-C( OR=1.88, 95% CI: 1.78-2.01, P=0.000), LAP( OR=3.01, 95% CI: 2.98-3.12, P=0.010), and BMI( OR=2.58, 95% CI: 2.45-2.68, P=0.000)were influencing factors for TSH. Conclusions:In elderly patients with T2DM, TSH levels within the normal range but close to the upper limit are closely related to cardiovascular risk factors such as increased visceral fat and high TG levels, and may increase the risk of cardiovascular disease.

OBJECTIVE：To observe the safety and other related indexes of canagliflozin in the treatment of type 2 diabetes complicated with high risk of cardiovascular disease. METHODS ：Totally 306 patients，admitted to Hainan Provincial People ’s Hospital and Haikou People ’s Hospital ，with type 2 diabetes complicated with high risk of cardiovascular disease were selected from Dec. 2018 to Apr. 2019. They were divided into observation group （153 cases）and control group （153 cases）according to random number table . The control group was treated with in sulin，metformin or sulfonylureas conventional hypoglycemic therapy ， and the observation group was treated with Canagliflozin tablets 100 mg，once a day ，po，on the basis of control group. The course of treatment was 1 year in both groups. The levels of HbA 1c，BMI，SBP，DBP and eGFR before and after treatment were observed in 2 groups，and the incidence of safety （including death from cardiovascular causes ，myocardial infarction ，ischemic stroke ， hospitalization for heart failure and death from any cause etc. ） after treatment and serious ADR/ADE （including hypogly- cemia，diabetic ketoacidosis ，fracture，acute kidney injury 68622942。E-mail：zhaixin0123@126.com etc.）during the treatment were recorded. RESULTS ：A total of 5 patients in the control group were not followed up ， in which 3 quited and 2 were lost ；and 4 patients in the observation group were not followed up ，in which 1 quited and 3 were lost . Before treatment ，there were no statistical significance in the levels of HbA 1c，BMI，SBP，DBP and eGFR between 2 groups（P＞0.05）. After treatment ，HbA1c levels of 2 groups，BMI and SBP of observation group were all significantly lower than those before treatment with the same group ；HbA1c level and SBP of observation group were significantly lower than those of control group （P＜0.05）. eGFR levels of 2 groups after treatment were significantly higher than before treatment with the same group ，while the observation group was significantly higher than that of contrl group. The incidence of death from cardiovascular causes and death from any cause in observation group were significantly lower than control group （P＜0.05）. There were no statistically significant differences in other safety indexes and the incidence of serious ADR/ADE between 2 groups（P＞0.05）. CONCLUSIONS ：Canagliflozin can significantly reduce the incidence of death from cardiovascular causes and death from any cause in type 2 diabetes patients complicated with high risk of cardiovascular disease，ameliorate blood glucose and blood pressure ，and do not increase the occurrence of serious ADR/ADE.