Objective To investigate the clinical effect of standard large bone flap decompression for severe craniocerebral injury.Methods This study was performed in 58 patients with severe traumatic brain injury,according to different surgical methods,the patients were divided into control group and study group,29 cases in each group.The control group was treated with conventional bone flap craniotomy,and the study group was treated with large bone flap decompression surgery.The clinical effect and complications were compared between the two groups.Results After operation,the patients were followed up for 5 months.The mortality of the study group (10.34%)was significantly lower than that of the control group (27.59%),and the difference was statistically significant (χ2 =3.98,P <0.05).In addition,the good rate of the study group (55.17%)was significantly higher than that of the control group (27.59%),and the difference was significant (χ2 =4.55,P <0.05).The preoperative intracranial pressure had no significant difference between the two groups.While at postoperative 1d,3d and 5d,the intracranial pressure of the study group was significantly lower than that of the control group,and the difference was statistically significant (t =3.55,4.02,6.12,all P <0.05).The scores of GOS and BAI in the study group were significantly higher than those in the control group (t =5.02,4.21,P <0.05 ).The incidence rates of complications such as cerebrospinal fluid leakage,trauma of cerebral infarction,trauma of epilepsy,hydrocephalus,wound infection of the study group were sig-nificantly lower than those of the control group,and the differences were statistically significant (χ2 =4.00,5.02, 456,4.22,3.99,all P <0.05).Conclusion Compared with conventional craniotomy,open standard big bone flap decompression can significantly reduce the mortality rate,decrease intracranial pressure,and improve the quality of life of patients,it has better curative effect and prognosis for patients with severe craniocerebral injury,and is worthy of clinical application.

Several problems were existed in present military hygiene teaching.In recent years,integrated reforms were done about the improving undergraduate and teacher's activities,strictly choosing teaching contents,doing well extra curriculum,and serious examination in nursing teaching.Furthermore,the new presumptions were also discussed.

The new course standard of nursing specialty in military hygiene was established against the main problems in military hygiene teaching and considering the peacetime and wartime need of nursing post.In this paper,guiding ideology,content choosing and the request of operational skill of this standard were discussed in detail.

Objective:To observe the curative effect of modified amniotic membrane transplantation for agricultural pterygium.Methods: A total of 276 cases (276 eyes) with early pterygium were randomized divided into traditional group (138 cases) and modified group (138 cases) as random table. The traditional group was treated with pterygium excision in combination with autologous conjunctival transplantation; the modified group was treated with modified amniotic membrane transplantation; to observe the curative effect of the two groups.Results: After all of patients were followed up for 1 year, 122 cases were cured and 16 cases were recurrence, and the recovery rate was 88.41% in traditional group; 131 cases were cured and only 7 cases were recurrence, and the recovery rate was 94.93% in modified group and was better than traditional group; the difference between the two groups was statistical significant (x2=5.02,P<0.05).Conclusion: The modified amniotic membrane transplantation method is simple in operation, mini invasive for eye tissue, and can retain conjunctival tissue in utmost; it also can improve success rate of surgery and be an effective mean for treatment of pterygium.

Objective To assess the effectiveness and safety of acupuncture and moxibustion for treatment of vertebrobasilar insuffciency (VBI). Methods Randomized controlled trails (RCTs) of VBI treated by acupuncture and moxibustion were collected. 8 RCTs were included and assessed. The data was statistically analyzed by Meta-analysis and Funnel plot analysis. Result 8 RCTs were all trails of low methodological quality. Meta-analysis indicated after combination OR=4.36, confidence interval of 95% was 2.88～7.45. The rhombus was located at the right side of the medium line (Z =6.33, P

BACKGROUND:Dexmedetomidine is an efficient, highly selective alpha-2 adrenergic receptor agonist, with sedative, analgesia and anti-anxiety effects, it has little impact on the respiration.
OBJECTIVE:To observe the analgesic effect induced by intrathecal injection of dexmedetomidine in rat model of spared nerve injury.
METHODS:A total of 60 male Sprague-Dawley rats were randomly divided into three groups (n=12):normal control group, dexmedetomidine group and saline group. Except for the normal control group, spared nerve injury model was established in the rats of dexmedetomidine group and saline group. Dexmedetomidine group was treated with intrathecal injection of dexmedetomidine 3μg/kg every day within 14 days after injury. Saline group was given equal volume of saline for 14 days. The thermal withdrawal latency and mechanical withdrawal threshold were measured respectively before injury, after injury, before injection, and 2, 7, 14 days after intrathecal injection. Four rats were sacrificed in each group at day 2, 7 and 14 after injection, and the lumbar segments (L 4-6 Hematoxylin-eosin staining was performed to detect the morphology of the spinal dorsal horn neurons and ) of the spinal cord were removed. Real-time RT-PCR and western blot analysis were used to determine the expression of protein kinase C mRNA and protein in the spinal dorsal horn neurons. immunohistochemistry staining was carried out to assess the expression level and distribution of protein kinase C.
RESULTS AND CONCLUSION:The thermal withdrawal latency and mechanical withdrawal threshold in dexmedetomidine group and saline group were significantly decreased compared with normal control group before or after injection (P<0.05). However, both the thermal withdrawal latency and mechanical withdrawal threshold in dexmedetomidine group after intrathecal injection were significantly higher than those in saline group (P<0.05). The protein kinase C expression in spinal dorsal horn neurons was significantly decreased in dexmedetomidine group compared with saline, and reached to the most lowest levels as normal control group on 14 days after injection. Moreover, the apoptosis of spinal dorsal horn neurons in dexmedetomidine group was lighter than that in saline group, and was similar to the morphology of neurons in normal control group on 14 days after injection. Intrathecal injection of dexmedetomidine could attenuate the hyperalgesia induced by spared nerve injury, which might be associated with the inhibition of protein kinase C expression in spinal dorsal horn.

BACKGROUND:Dexmedetomidine is an effective high-selectivityα2-adrenoceptor agonist that has sedative, analgesic, anxiolytic effects, but slightly affects respiration.
OBJECTIVE:To observe the analgesic effect of dexmedetomidine on selective damage of sciatic nerve branch in a rat model by intrathecal injection.
METHODS:A total of 36 male Sprague-Dawley rats were randomly divided into normal control group, physiological saline group and dexmedetomidine group. A rat model of selective damage of sciatic nerve branch was established by knotting off the common peroneal nerve and tibial nerve in the physiological saline group and dexmedetomidine group. Rats in the dexmedetomidine group were daily injected with dexmedetomidine 3μg/kg by intrathecal injection within 14 days after injury. Rats in the physiological saline group were injected with physiological saline.
RESULTS AND CONCLUSION:Compared with the physiological saline group, the mechanical withdrawal threshold and the thermal withdrawal latency were significantly increased in the dexmedetomidine group (P<0.05). Neuronal nitric oxide synthase mRNA and protein expression levels were significantly decreased in the spinal dorsal horn (P<0.05). The injury to spinal dorsal horn neurons was obviously lessened. Moreover, neuronal nitric oxide synthase mRNA and protein expression levels and the injury to spinal dorsal horn neurons were similar between 14 days after administration and normal control group. Results indicated that intrathecal injection of dexmedetomidine could inhibit the expression of neuronal nitric oxide synthase in the spinal dorsal horn and relieve the pain induced by sciatic nerve injury.

Objective To study the impacts of B7-H3 molecule on the proliferation of T lymphocytes in different activation conditions and on the secretion of relevant cytokines.Methods Peripheral blood samples were collected from healthy subjects to separate peripheral blood mononuclear cells (PBMC) by Ficoll density gradient centrifugation.T lymphocytes were isolated from some of the PBMCs and purified with T Cell Enrichment Kit.PBMC and purified T lymphocytes were activated by anti-CD3/CD28 monoclonal antibodies (McAb) in vitro.Flow cytometry analysis was used to detect the expression of CD28 and CTLA-4 on T lymphocytes at different time points for further analyzing the activation states of T lymphocytes.On this basis, human B7-H3-Fc fusion protein was added into the mixed co-cultivation system on days 0, 1, 2, 3 and 4, and Hu-Fc fusion protein was used as isotype control.CCK-8 method was performed to detect the proliferation of T lymphocytes in each group.ELISA method was used to detect the secretion of cytokines (IL-2, IL-10 and IFN-γ) and to analyze the immune responses induced by stimulating T lymphocytes at different states of activation with B7-H3.Results B7-H3 molecule significantly inhibited the quiescent T lymphocytes from secreting IL-2 and IL-10, but had no significant impact on IFN-γ secretion.Moreover, it significantly promoted the activated T lymphocytes to secret IL-2 and IFN-γ, but had no obvious impact on IL-10 secretion.Results of the cell proliferation assay showed that B7-H3 molecule inhibited the in vitro proliferation of T lymphocytes in the PBMC, but had no obvious impact on purified T lymphocytes.ConclusionThe regulatory effects of B7-H3 molecule on the immune functions of T lymphocytes vary with the activation states of T lymphocytes.

Objective To investigate and analyze cognitive similarities and differences of nurses factors that lead to the tense nurse-patient relationship from both attitudes of nurses and patients. Methods By using the method of questionnaire, 284 nurses and 305 patients were investigated respectively in a top'three hospital of a city. Results There was a significant difference in cognitive scores of nurses factors that lead to the tense nurse- patient relationship (P < 0.01), patients' scores were (3.90±0.47) points which were higher than (3.52±0.35) points of the nurses′. In dimensions of prioritization, both nurses and patients believed that technical ability, professional knowledge and service attitude were the main factors leading to the tense relationship between nurses and patients. While nurses held that communication ability was more important, patients held that the nurse′s own personality was more important. Conclusions There are similarities and differences of attitudes to nurs's factors between nurses and patients regarding tension in nurse- patient relationship. The tense relationship between nurses and patients is affected to a great extent by nurses' professional knowledge, technical ability and service attitude. Managers should objectively evaluate and fully pay attention to cognitive similarities and differences of both sides, strengthen nurses′theoretical knowledge and clinical skills training, improve service attitude, and develop good character,in order to provide high quality nursing service for patients.

ObjectiveToinvestigatethecorrelationofobstructivesleepapnea(OSAS)andsilentbrain infarction (SBI) in elderly population. Methods A total of 1658 old subjects aged 60 in Beijing and Qingdao w ere screened. Polysomnography (PSG) w as used to conduct the diagnosis and grade of OSAS. MRI w as used to diagnose SBI. Results In al elderly subjects, the prevalences of OSAS and SBI w ere 32.1% and 22.4%. There w ere significant differences in the constituent ratio of the patients w ith hypertension and diabetes, as w el as apnea-hypopnea index (AHI), oxygen desaturation index (ODI), mean oxygen saturation and the low est oxygen saturation betw een the patients w ith OSAS of different severity and the control group. With the increased severity of OSAS, the incidence of SBI increased significantly. The incidences of patients w ith non-OSAS and mild, moderate and severe patients w ith OSAS w ere 13.2%, 30.5%, 43.5%, and 68.8%, respectively. There w as a significant difference betw een the 2 groups ( χ2 =13.365, P=0.004). Multivariable logistic regression analysis showed that hypertension (odds ratio [OR] 2.254, 95%confidence interval [CI] 1.325 to 8.347;P=0.002), diabetes melitus (OR 1.893, 95%CI1.471-8.432;P=0.003) and AHI ≥15 times/h (OR 3.106, 95%CI 1.583-12.571; P<0.001) were the independent risk factors for SBI in elderly population. Conclusions The incidence of OSAS w as higher in the elderly population aged over 60. The incidence of SBI in patients w ith OSAS w as significantly higher than that in patients w ith non-OSAS, and w ith the aggravation of OSAS, it show ed an increasing trend. Moderate to severe OSAS w as an independent risk factor for SBI in elderly population.