Affiliated Hospital. Second Military Medical College. ShanghaiForty-two cases of chronic subdural hematoma were treated by irrigation and drainage. Symptoms of elevated intracranial -pressure, localizing neurologic signs and cerebral angiography established the diagnosis. Operative treatment consisted of evacuation of the hematoma by repeated irrigation through burr holes made on the frontal and parietal side of the hematoma. A plastic tube was placed through the parietal hole for continuous drainage for three to four days. The above mentioned treatment is simple to perform and rather safe even for the senile and debilitated patients. Among 44 patients all 19 preoperatively unconscious patients regained consciousness postoperatively. Twenty-three cases were followed up from one to seventeen years. All patients recovered completely without recurrence of hema-toma or epilepsy, except one patient who is still having hemiparesis at present.

AIM:To explore the roles of brain-stem auditory evoked potential(BAEP) in early monitoring the hearing loss and brain damages in hyperbilirubinemia and nitric oxide(NO) in the pathogenesis of bilirubin-induced hearing loss and brain damages.METHODS:Different doses of bilirubin solution(30 mg/kg,60 mg/kg,90 mg/kg,120 mg/kg and 150 mg/kg) were injected into the abdominal cavity of 15-day old SD rats to make the animal model of hyperbilirubinemia.The serum concentrations of bilirubin were detected by a micro-gauge.The bilirubin concentrations in the brain tissues were examined via a diazo method.The Na+-K+ATPase activities in the brain tissues were analyzed by rooting phosphorus.The NO contents in the brain tissues were assayed via the method of nitrate reductase.BAEP were recorded with an evoked potential recorder.RESULTS:After making the ejection,parts of the rats in the high dosage groups(120 mg/kg and 150 mg/kg) showed the abnormal neuro-behaviors.After 6 hours of the ejection,the bilirubin concentrations in serum and in brain tissues,and NO contents in the brain tissues were increased significantly.The Na+-K+ATPase activities in the brain tissues were decreased obviously,and the PL and IPL of BAEP were prolonged significantly in all the experimental rats except the ones in low dosage group(30 mg/kg).The changes of them were closely related to the dose of injected bilirubin.CONCLUSION:The PL and IPL of BAEP are the objective and sensitive indexes for early monitoring the hearing loss and brain damages in hyperbilirubinemia.NO may plays a certain role in the pathogenesis of bilirubin induced hearing loss and brain damages.

Objective　To evaluate the effect of Naogongfude (NGFD, a traditional Chinese medicine orally administrated) on learning and memory and the expressions of synaptophysin (SY) and Tau-protein in cerebral cortex and hippocampus in aged rats and to explore the possible mechanism. Methods　Rats were divided into normal and neural disturbance groups according to the outcomes of active avoidance reaction (AAR) test, and then each group was randomly divided into control and NGFD-treated experimental groups. Animals were orally fed with NGFD for 2 months (5 ml/d) in experimental group or routinely fed in control and taken AAR and passive avoidance reaction (PAR) tests. After the rats were sacrificed, the synaptosome count, the expression of SY and Tau-protein, and the neuron apoptosis in cerebrum were examined. Results　The rats after 2-month NGFD administration had an increased AAR acquisition, obviously delayed AAR extinction and prolonged step through latency (STL) of PAR. The number of synaptosomes was raised and the immunoreactive intensity of synaptophysin was increased remarkedly, while Tau-protein immunoreactivity and apoptotic cells were decreased in cerebrum. Conclusion　NGFD does have the effect of improving brain function and putting off the aging of rat brain according to the results of behavior study and morphological observation.

Objective To explore the effect of 3M Tegaderm transparent film on prevention of puncture complications in patients underwent aortocranial angiography via the femoral artery.Methods A retrospective analysis was carried out on 200 patients underwent aortocranial angiography via the femoral artery from February 2012 to February 2014.Eighty patients without using the transparent dressing paste were as the control group,and other 120 patients using 3M Tegaderm transparent film for fixation of arterial sheath were as the observation group.The occurrences of complications,such as arterial sheath breakage,angiographic tube breakage,femoral artery spasm,bruises at the puncture site and subcutaneous hematoma were analyzed,and the feasibility and effectiveness of 3M Tegaderm transparent film for fixation of arterial sheath were assessed.Results The incidence rate of arterial sheath breakage,angiographic tube breakage,femoral artery spasm,bruises at the puncture site and subcutaneous hematoma were significantly reduced in observation group compared with those in control group [5.8％ (7/120) vs.26.2％ (21/80)] (P ＜ 0.05).Conclusion Application of 3M Tegaderm transparent film with a low price and good security for fixation of femoral artery sheath can effectively reduce the occurrence of complications related to femoral artery puncture,which is worthy of wide spreading.

Objective To explore the efficacy and safety of arterial embolectomy with Solitaire AB stent in treatment of acute intracranial large artery occlusion.Methods The clinical data of 11 patients with acute intracranial large artery occlusion receiving arterial embolectomy with Solitaire AB stent from March to December 2013 were analyzed retrospectively.Among them,5 cases were with simple middle cerebral artery occlusion,1 case combined with occlusion in the intracranial part of the internal carotid artery,4 cases had simple basilar artery occlusion,and 1 case had occlusion in the intracranial portion of the vertebral arteries extending to intracranial portion of the basilar artery.Revascularization and postoperative hemorrhage were analyzed,and nosocomial as well as clinical outcomes after 3 months were evaluated.Results Ten patients showed successful revascularization,of which 8 cases reached the standard of perfect revascularization.After embolectomy,there was obvious stenosis in offending vessel of 4 cases,who were given balloon dilatation then.In 3 cases,the vessels were still narrow,so Solitaire AB stent was placed in the stenosis area to correct stenosis with the residual stenosis rate of less than 40％.Thus electrolytic interruption was given.There was no symptomatic intracranial hemorrhage.Three months after the operation,5 cases recovered,among whom 2 cases had obvious curative effect instantly,1 case had complete remissions in 1 week,and 1 case remained hemiplegia.Five cases died,and 4 cases discharged from the hospital because their family gave up the subsequent treatment.Conclusions Arterial embolectomy with Solitaire AB stent to treat patients with acute intracranial large artery occlusion has a relatively higher revascularization rate.The clinical outcome after 3 months can be significantly improved.Thus,it provides a safe and effective endovascular treatment for patients with acute intracranial large artery occlusion.

Objective To assess the application of Stroop color-word test ( SCWT) for screening of minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis.Methods Sixty patients aged 18-65 years with liver cirrhosis and 60 age, education level-matched healthy subjects were examined with SCWT.The SCWT indexes were compared between two groups .MHE was identified when patients had abnormal number connection test-A (NCT-A) and/or digit symbol test (DST).Results Time consuming and errors of card 2, 3, 4 and Stroop interference effects ( SIE) reflecting word-interference and color-interference in SCWT were increased significantly in liver cirrhotic patients [(17.28 ±0.69)sec,(12.96 ± 1.10)sec, (30.30 ±1.40)sec, (5.00 ±0.90)sec, (13.74 ±1.22)sec, (0.36 ±0.10) times, (0.50 ± 0.11) times, (0.50 ±0.11) times, (5.00 ±0.90) times,(1.98 ±0.23) times, respectively] compared to those in healthy subjects [(10.18 ±0.57) sec,(7.68 ±0.39)sec,(15.68 ±0.33)sec,(1.94 ±0.37) sec, (6.56 ±0.70)sec, (0.02 ±0.02) times,(0.10 ±0.04)times,(0.10 ±0.04)times,(0.04 ±0.02) times,(0.20 ±0.08) times, respectively; t =12.95, 6.98, 8.19, 7.02, 11.91, 10.09, 8.97,8.15, 17.94,11.37,all P=0.00];while there were no significant differences in time consuming and errors of card 1 between liver cirrhotic patients [ ( 7.10 ±0.40 ) sec and ( 0.04 ±0.03 ) times ] and healthy subjects [(6.72 ±0.36)sec and (0.02 ±0.02) times; t=1.89, 1.91, both P=0.06].The sensitivity of word SIE, color SIE and word SIE +color SIE of SCWT for primary screening of MHE was 0.83(50/60), 0.88 (53/60) and 0.98(59/60) respectively, whereas the specificity was 0.87(52/60), 0.80(48/60) and 0.83(50/60) respectively.ConclusionThe SCWT may serve as a convenient , effective and reliable tool for primary screening MHE.

Objective: This study aimed at determining the characteristics of the glucose homeostasis and its relationship with iron overload of the patients with β-thalassemia major (β-TM). Method: From Sun Yat-sen Memorial Hospital between January 2014 and December 2015, a total of 57 transfusion-dependent β-TM patients with 5-18 years old were enrolled in this study and fasting blood glucose(FBG) and insulin level, serum ferritin (SF), serum iron, transferrin, total iron binding capacity, unsaturated iron binding capacity were determined.Insulin resistance index (IRI), insulin sensitivity index and β-cell function index (BFI) were also estimated. Besides, in 36 patients cardiac T2* and liver T2* were estimated. Result: (1) Four patients(7%) with β-TM were diagnosed diabetes mellitus, and 14(24%) had impaired fasting glucose. (2) The incidence of abnormal glucose metabolism was significantly different according to levels of SF and degrees of the cardiac iron overload(χ²=9.737, P<0.05; χ²=17.027, P<0.05). It rose while the level of SF increased and the degree of cardiac iron overload aggravated. (3) The incidence of abnormal glucose level was not significantly different in cases with different degree of liver iron overload.The severe group of liver iron overload had significantly higher levels of INS, HOMA-βFI, HOMA-ISI, HOMA-βFI than the non-severe group (Z=-2.434, -2.515, F=8.658, all P<0.05), while no differences were found in the level of FBG, HOMA-βFI between two groups. (4) The result of logistic regression analysis indicated that the cardiac T2* was a significant predictor for the incidence of abnormal glucose metabolism in TM patients (P=0.035, OR=1.182%, 95%CI=1.048 to 1.332). Conclusion The high prevalence of abnormal glucose metabolism in β-TM patients was mainly closely related with the internal iron overload, especially in organs.The cardiac T2* was an independent risk factor for the incidence of abnormal glucose metabolism in TM patients.

Objective To examine the proportion and reasons of drop-out from antiretroviral therapy(ART)among 8 367 adult HIV-infected individuals in Dehong prefecture,Yunnan province. Methods All adult HIV-infected patients receiving ART before September 30 of 2014 were examined for the situation of drop-out from ART. Results The proportion of drop-out from ART among adult HIV-infected patients in Dehong prefecture was 14.4%(1 202/8 367). Results from the univariate logistic regression analyses indicated that drop-out from ART was significantly correlated with factors as:living area,gender,age,marital status,HIV transmission route,baseline CD4+T cell counts and initial treatment regimen of the patients. After adjusted for potential confounding variables by multiple logistic regression model,drop-out from ART was significantly correlated with residential area,marital status,HIV transmission route,baseline CD4+T cell count and initial treatment regimen of the patients. HIV-infected patients who were living in Mangshi city,Lianghe county or Yingjiang county,being married or living with partner,HIV infection through sexual contact,with baseline CD4+T cell counts≤200 cells/mm3,and ART included in the initial treatment regimen etc.,were less likely to drop out from ART. The proportion of drop out from ART was significantly decreasing along with the increasing time of ART. Data from specific investigation revealed that among the 1 202 patients who dropped out from ART,704(58.6%)were lost to follow-up,303(25.2%) did not adhere to treatment,74(6.2%)moved out the region,64(5.3%)were Burmese that had returned to Burma,29 (2.4%) stopped the treatment according to doctors’advice,18(1.5%)were incarcerated and 10 (0.8%) were under other reasons. Reasons for the drop-out varied,according to the situation of patients. Conclusion The proportion of drop-out from ART varied significantly according to the characteristics of HIV-infected patients in Dehong prefecture that underscoring the needs for tailored responses to reduce drop-out of ART. Focus should be targeted on reducing the loss to follow-up and improving the treatment adherence.

Objective To examine the proportion and reasons of drop-out from antiretroviral therapy(ART)among 8 367 adult HIV-infected individuals in Dehong prefecture,Yunnan province. Methods All adult HIV-infected patients receiving ART before September 30 of 2014 were examined for the situation of drop-out from ART. Results The proportion of drop-out from ART among adult HIV-infected patients in Dehong prefecture was 14.4%(1 202/8 367). Results from the univariate logistic regression analyses indicated that drop-out from ART was significantly correlated with factors as:living area,gender,age,marital status,HIV transmission route,baseline CD4+T cell counts and initial treatment regimen of the patients. After adjusted for potential confounding variables by multiple logistic regression model,drop-out from ART was significantly correlated with residential area,marital status,HIV transmission route,baseline CD4+T cell count and initial treatment regimen of the patients. HIV-infected patients who were living in Mangshi city,Lianghe county or Yingjiang county,being married or living with partner,HIV infection through sexual contact,with baseline CD4+T cell counts≤200 cells/mm3,and ART included in the initial treatment regimen etc.,were less likely to drop out from ART. The proportion of drop out from ART was significantly decreasing along with the increasing time of ART. Data from specific investigation revealed that among the 1 202 patients who dropped out from ART,704(58.6%)were lost to follow-up,303(25.2%) did not adhere to treatment,74(6.2%)moved out the region,64(5.3%)were Burmese that had returned to Burma,29 (2.4%) stopped the treatment according to doctors’advice,18(1.5%)were incarcerated and 10 (0.8%) were under other reasons. Reasons for the drop-out varied,according to the situation of patients. Conclusion The proportion of drop-out from ART varied significantly according to the characteristics of HIV-infected patients in Dehong prefecture that underscoring the needs for tailored responses to reduce drop-out of ART. Focus should be targeted on reducing the loss to follow-up and improving the treatment adherence.

Objective To explore the efficacy and safety of Solitaire stent arterial embolectomy in the treatment of acute cardiogenic cerebral embolism.Methods The data of 24 patients who underwent Solitaire stent arterial embolectomy,either alone or in combination with reorganization type tissue plasminogen activator (rt-PA) intravenous thrombolysis,to treat acute cardiogenic cerebral embolism in our hospital were collected.These results between October 2012 and March 2016 were compared with 21 control patients who were treated using only rtPA Ⅳ thrombolysis.The short-term efficacy,long-term clinical outcomes,complications,and mortality rate of these two groups were compared,and the clinical outcomes of these patients with posterior circulation infarction in the two groups were further assessed.Results The time between onset and rt-PA administration in the study group (median time:3.17 h) was significantly shorter than that in the control group (4.00 h,P＜0.05);rt-PA dose used in both two groups was 50 mg.NIHSS scores and Glasgow Coma scale scores at discharge,and modified Rankin scale (mRs) scores 3 and 6 months after treatment in the study group were significantly higher than those in the control group (P＜0.05).There were no significant differences in symptomatic intra-cerebral hemorrhage,high perfusion encephalopathy,incidence of hernia,or mortality between the two groups (P＞0.05).The mRS scores 3 months after treatment in patients with posterior circulation infarction (2) were significantly lower than those in the control group (3,P＜0.05).Conclusions As compared with simple venous thrombolytic therapy,Solitaire stent embolectomy can significantly improve short-term neurological function and long-term prognosis in patients with acute cardiogenic cerebral embolism,enhance their life quality,without increasing the complication incidence and mortality rate.It is safe and effective,and patients with posterior circulation infarction can also be treated by arterial embolectomy.