Objective To explore the operation indication of fracture of rib with fracture internal-fixation.Methods The clinical data of 103 cases with Fracture of rib,treated by fracture internal-fixation(n =49)and conservative treatment (n =54) respectively,were retrospectively analyzed.Results The hospital stay time,VAS scores and the healing time of surgical group were lower than that of non-surgical group.Fracture internal-fixation could significantly reduce the incidence of lung infection,deformities of chest and delayed hemathorax.Conclusions Internal fixation of fracture is much better than other routine therapies for fracture of ribs.The patients with indication of operation should operate actively.

ObjectiveTo investigate the feasibility and effect of complete thoacoscopes and laparoscopes combination operation for thoracoabdominal injuries.MethodsFrom March 2007 to March 2011,the clinical data of 36 patients (observation group) with thoracoabdominal injuries who were performed with complete thoracoscopes and laparoscopes combination operation were analyzed retrospectively,and compared with 36 patients (control group) treated with traditional standard operation in the same period.The intraoperative and postoperative situation was compared between two groups.ResultsAll the patients in observation group were successfully performed by complete endoscopic surgery.There were no operative mortality and complications related to operation,such as diaphragmatic hernia,delayed hemopneumothorax.The operative time of observation group was (98 ±38 ) min,operative blood loss was ( 120±45 ) ml,drainage flow within 24 h was(230 ±55) ml,drainage tube duration was(5 ±2) d,postoperative pain vasual analogue scale (VAS) score was (3.31±0.87) scores,hospitalization cost was ( 1 2.3±7.6) thousand yuan,postoperative recovery time of intestinal function was (2.29±1.02) d,hospital stay was ( 10±3 ) d.Those values of control group were respectively ( 135±31 ) min,(220±30) ml,(400±160) ml,(9±3) d,(6.82±1.67) scores,(23.4±8.5) thousand yuan,(5.46 ±2.31 ) d and ( 16±2) d.There were significant differences between two groups(P ＜0.05).The occurrence rate of cardiopulmonary complication of observation group [ 11.1％(4/36) ] and control group [ 13.9％(5/36) ] had no significant difference (P＞0.05).ConclusionsComplete thoracoscopes and laparoscopes combination operation for thoracoabdominal injuries is a safe and mini-invasive treatment with quicker recovery,less cost and morereliable effect.Therefore,it deserves further clinical application.

Exosomes are homogeneous membrance-derived microvesicles shed by cells,their sizes ranged from 40 to 100 nm.As for microparticles,they are small heterogeneous vesicles at diameters of 100 to 1000 nm shed by cells.Both of them exist in a wide range of body fluids,including peripheral blood,urine,saliva,ascites,amniotic fluid and cerebrospinal fluid,with various kinds of biomolecules like proteins and RNAs.Exosomes and microparticles play important roles in cell-to-cell information transmissions and substance exchanges,contributing to both physiological and pathological processes.Exosomes,functioning as the carders of material transportation,serve as targeted therapy in disease treatments.Microparticle,a new type biomarker,plays an important role in diagnosing the early-stage of diseases and predicting the prognoses.The central nervous system diseases are lacked of early-stage diagnoses and effective treatments because of the complexity and unpredictability.This review is to focus on the specific comparisons between exosomes and microparticles as well as their central nervous system functions and mechanisms,and also to explore the new treatments of the central nervous system diseases.

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.

Objective To understand the clinical characteristics of traumatic brain injury (TBI) patients and provide fundamental data for reducing the incidence of TBI and improving its treatment efficacy.Methods Medical histories of TBI inpatients from January 2011 to December 2016 were collected from the TBI database of Neurosurgical Department at Tianjin Medical University General Hospital.Information including gender,age,causes of TBI,injury severity,sources of the inpatients,interval from injury to treatment,diagnosis,and treatment were analyzed retrospectively.Results A total of 2 368 TBI patients were enrolled,aged mainly 30-60 years.There were more male patients (n =1 741) than female patients (n =627) (2.78 ∶ 1),while the gender ratio was reversed among patients above 60 years old (2.09 ∶ 1) (P ＜ 0.05).Traffic accident (60.14％) remained the major cause of TBI,while the proportion of electric motorcycle accident was 17.35％,followed by fall from height (13.64％).The proportion of mild TBI patients from suburb counties was lower than that of patients from the six urban areas (P ＜ 0.05),while the proportion of heavy TBI patients from other provinces was higher than those of both urban and suburb counties (P ＜ 0.05).The average interval from injury to specialist treatment was 7.53 hours.Patients who received treatment within 3 hours had better improvement than those who were treated 3 hours after TBI (P ＜ 0.05).The main injuries were skull fracture (33.07％) and brain contusion (30.32％).A total of 783 patients (33.07％) underwent surgery,among which 693 patients received the most common procedure of craniotomy hematoma evacuation (including decompressive craniectomy).The improvement rate of patients with intracranial pressure monitoring was higher than those without intracranial pressure monitoring (P ＜ 0.05).The improvement rate of the surgery group was significantly higher than that of the non surgery group (P ＜0.05).Conclusions The ratio of elderly female TBI patients is on the rise;TBI presents an increase in traffic accidents;mild TBI patients choose to receive treatment in close hospitals while those with severe TBI choose comprehensive hospitals;and the interval from injury to treatment is long.The following strategies including improving the traffic facilities,strengthening the education of traffic safety on elderly females and pedestrians,and optimizing the TBI medical treatment process would reduce the incidence of TBI and improve the efficiency of treatment.