Objective To explore the efficacy of craniotomy and aneurysm clipping in elderly patients with ruptured intracranial aneurysms.Methods Totally 75 elderly patients with ruptured intracranial aneurysms in our hospital who underwent craniotomy and intracranial aneurysm clipping:approaching into head by wing point based on CT image,selecting the appropriate position and angle for clipping the aneurysm.Surgical efficacy and postoperative complications were observed.Prognosis was assessed by Glasgow Outcome Scale (GOS).Results 77 aneurysms presented in 75 patients and 76 aneurysms were clipped.The main postoperative complications were intracranial hematoma (5 cases),pulmonary infection (4 cases),electrolyte imbalance (10 cases),intracranial infection (2 cases),arrhythmia (3 cases),gastrointestinal bleeding (5 cases),cerebral infarction (3 cases).GOS assessment demonstrated that prognosis in 48 cases was good (64.0％),16 cases was moderate disability (21.3％),6 cases was severe disability (8.0％),2 cases was vegetative survival (2.7％),3cases was in death (4.0％).The cure rate was 64.0％ and the overall good-prognosis rate was 85.3％.Conclusions Craniotomy and aneurysm clipping has a better surgical efficacy and a high cure rate in elderly patients with ruptured intracranial aneurysm.

BACKGROUND: In clinical practice, delayed brain injury after carbon monoxide (CO) poisoning occurs in 3% to 30% of the persons who suffered carbon monoxide poisoning and is in the main presence of dementia, psychiatric symptom and extrapyramidal symptoms. At present, its pathogenesis is unclear.OBJECTIVE: To investigate the pathological damage mechanism of delayed brain injury after CO poisoning and the protective effect of hyperbaric oxygen on delayed brain injury.DESIGN: A randomized controlled animal experiment.SETTING: Staff Room of Aviation Health, Department of Aerospace Medicine, the Fourth Military Medical University of Chinese PLA.MATERIALS: This experiment was carried out in the Laboratory of Aviation Pathology and Molecular Biology, Department of Aerospace Medicine, the Fourth Military Medical University of Chinese PLA in March 2004. Totally 80 healthy male Sprague-Dawley, of clean grade, were used in this experiment. The animals were randomized into 3 groups: normal control group (n=10), model group (n=35) and hyperbaric oxygen group (n=35).The latter two groups were separately divided into 7 time points: poisoning 6 hours, 1,3,5,7,14 and 21 days, 5 rats at each time point.METHODS: In the model group, acute CO poisoning rat models were developed by placing the rats in the poisoning jar which contained the mixture of CO and air for 60 minutes. The volume faction of CO was kept at 2 500×10-6. In the hyperbaric oxygen group, modeling was the same as that in the model group. Three hours after poisoning, the rats were given 115-minute hyperbaric oxygen treatment. Pressure was 0.2 Mpa and the volume fraction of oxygen was over 0.90. The first three days after poisoning, hyperbaric oxygen treatment was conducted twice per day, then once per day, with one day of non-administration in a week. There was no intervention in the normal control group. MAIN OUTCOME MEASURES: ① The characters of pathological changes in brain tissue of rats at each time point after poisoning were detected with histopathological and immunohistochemical methods; ② Neuronal apoptosis was detected with electron microscopy and in situ TdT-mediated-dUTP nick end labeling(TUNEL).RESULTS: After rats were modeled, the rate of death was about 10%. ① In the model group, general pathological injury occurred in the brains of rats. Denatured necrosis appeared in the neurons of cerebral cortex, hippocampus, corpus striatum, cerebellum and other regions. Injuries in cerebral cortex, hippocampus and other regions were severe. Results of haematoxylin-eosin and TUNEL staining and electron microscope observation demonstrated that apoptosis occurred in hippocampal neurons. The apop totic neurons increased on the 3rd day after poisoning, reached the peak on the 7th day (P ＜ 0.01), then gradually decreased. In the hyperbaric oxygen group, the denatured necrosis of neurons in the brains was significantly lightened, and the injuries of hippocampal region of rats at each time point were significantly attenuated in comparison with model group; The number of necrotic neurons was decreased, especially on the 5th and 7th days after poisoning (P ＜ 0.01). Hyperbaric oxygen promoted the expression of Bcl-2 in hippocampus of modeled rats, especially on the 3rd and 5th days after Coexposure (P ＜ 0.01).CONCLUSION: General delayed neuronal injury is found in the acute CO poisoning rat, with the presence of delayed neuronal necrosis and apoptosis. Hyperbaric oxygen treatment can effectively reduce denatured and necrotic neurons and promote the expression of apoptosis-inhibiting gene bcl-2, then inhibit neuronal necrosis and apoptosis.

Objective To explore the changes of neutrophil elastase (NE) and surfactant protein A (SP-A) in acute lung injury(ALI) rats,and the effect of antioxidant. Methods Sixty healthy mature Wister rats were divided into 2 groups, the control group and treatment group. The rats in two groups all received peritoneal injection of E. coli to establish the ALI animal model. 30 minutes after injection of E. coli,the rats in treatment group were injected reduced glutathione from vena caudalis. The levels of NE in blood and expressions of SP-A in lung tissue were detected at 3,6 and 12 hours after injection of E. coli. Results ALI symptom appeared 3 hours after injection of E. coli in the control group, obvious after 6 hours, the rats vomi-ted pink secretion after 12 hours. Lung edema and bleeding were found by pathologic examination. No obvious symptom was found in treatment group after 3 hours, slight tachypnea after 6 hours, slight edema in pulmonary tissue after 12 hours. After administration of reduced glutathione,levels of NE at 3,6 and 12 hours in the treatment group were lower than those in the control group,and indicated statistical significance in 6 and 12 hours(P <0. 05) ;Levels of SP-A in 3,6 and 12 hours in the treatment group were higher than those in the control group, and indicated statistical significance in 3,6 and 12 hours (P < 0. 05). Conclusion Dysfunction of pulmonary surfactant is secondary in ALI, degradation of SP-A is the one of reasons, the application of reduced glutathione as antioxidant, could effectively suppress NE to decompose basosexine elastin of cells and destroy surface active protein, has protective effect on ALI.

Hyperbaric oxygen (HBO) medicine is an applied interdiscipline concerning basic me-dicine,clinical medicine,physics and psychology.Indications of HBO treatment involve multiple systems of the body.Based on the practice of almost 30 years,we explore how to adopt heuristic and experiencing style to strengthen the combination of theory and clinical application fortifying practical operation in the teaching. Meanwhile,discussing obstacles in HBO treatment and learning frontiers and progress through literatures or animal experiments can cultivate students' solid theoretical foundation and basic analysis and operation skills,and improve their interest in clinical and scientific research work of hyperbaric oxygen.