Through investigation on the cognition and status of the cultivation of innovative ability of the students,we found that the innovative ability of medical students was extremely weak.Their practical ability was out of joint to the cognition of innovative ability.We are trying to analyze the reasons and resolve the problem.

Background Although remarkable progress has been made in microsurgery, surgery of intracranial aneurysm still encounters various complications. Cerebral ischemia and postoperative disorders of nervous system could be induced by various specific operation procedures. To improve the outcomes in intracranial aneurysm surgery and to minimize the occurrence of postoperative ischemic complications, it is necessary to perform real-time monitoring on ischemic damages for the corresponding functional areas. To elevate the sensitivity of Eps changes for the detection of cerebral ischemia induced by operation, we monitored Motion Evoked Potential ( MEPs), Somatosensory Evoked Potential (SSEPs)and Brainstem Auditory Evoked Potential (BAEPs) in microsurgical operations of intracranial aneurysms. And then the correlation between Eps changes and clinical outcome was investigated.Methods MEPs, SSEPs, and BAEPs were recorded intra-operatively for 25 cases in intracranial aneurysms. Monitored results and clinical outcome were analyzed in a prospective observational design.Results The MEPs in 5 of 21 cases, the SSEPs in 5 of 25 cases and the BAEPs in 1 of 3 cases showed inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels. 3 patients developed advanced weakness, which showed abnormal SSEPs in only one patient while showed abnormal MEPs in all 3 cases.Conclusions The MEPs is more sensitive than SSEPs in monitoring the motor ischemic impairments. The monitoring results were correlated to the clinical outcome closely. Monitoring Eps in keyhole microsurgery of intracranial aneurysms could improve the sensitivity in detecting insufficient distal collateral flow. And then successful completion of potentially hazardous maneuvers would be attained.

Objective To study the homology characteristics of clinicaly isolated and colonized linezolid(LZD)-resistant Enterococcus faecalis (E.faecalis) strains from a patient.Methods Ten E.faecalis strains (2 were isolated from urine specimens and 8 were from stool specimens) isolated from a patient with pulmonary infection were performed antimicrobial susceptibility testing, homology of E.faecalis was determined by pulsed-field gel electrophoresis (PFGE).Results Before and after patients received LZD therapy, 2 E.faecalis strains isolated form urine specimens were both resistant to LZD (MICs: 8 mg/mL, 16 mg/mL, respectively), among 8 strains from stool specimens (6 were isolated before therapy, and 2 were isolated after therapy), LZD susceptible, intermediate, and resistant strains were 4, 2, and 2 respectively(MICs: 0.25-12 mg/mL).10 strains of E.faecalis were homologous by PFGE typing.Conclusion In this case, the detection of E.faecalis from urinary tract and intestinal tract is homologous, which suggested that LZD-resistant Enterococcus may be colonized in vivo for a long time, and may be shift to cause bacterial infection.

Objective To investigate the reasons of failure of burr hole craniotomy with drainage in patients with chronic subdural hematoma (CSDH) and advantages of survived neuroendoscopic surgery. Methods One hundred patients with CSDH, admitted to our hospital from May 2015 to May 2019, were enrolled. All patients were initially treated by burr hole craniotomy with drainage; 15 showed drainage failure and received survived neuroendoscopic hematoma evacuation. The preoperative and postoperative clinical features and treatment efficacy of these 15 patients were analyzed. Results Out of the 15 failed patients, 6 had drainage tube misplacement, and the other 9 showed drainage obstacle with separated hematoma. In 6 with drainage tube misplacement, 2 had drainage tube placed into the brain tissues, 3 had drainage tube located in the subendothelium of the hematoma, and one had drainage tube located outside the hematoma. Fifteen patients underwent neuroendoscopic hematoma resection, and the curative effect was significant. After 6 months of follow-up, the hematoma disappearance. Two patients were left with limb weakness due to catheter injury and brain tissues during the initial operation. Glasgow outcome scale indicated good prognosis in the remaining 13 patients. Conclusions Burr hole craniotomy should be standardized, and the drainage tube should be located in the hematoma cavity and thorough rinse should be performed. Neuroendoscopic hematoma evacuation is an effective remedy for failure of the first drilling and drainage surgery.

Objective To investigate the changes of perioperative blood glucose in patients with ruptured intracranial aneurysms under keyhole clipping and their prognostic influence factors.Methods Totally, 147 patients with ruptured intracranial aneurysms, admitted to our hospital from July 2010 to July 2012, were selected.The changes of serum glucose on admission and at non-fasting state every day at the hospital, random blood sugar before operation and one day after the operation were analyzed;modified Rankin scale (mRS) was performed to evaluate short-term prognosis of the patients 14 day after the operation;Logistic regression analysis was used to analyze the prognostic influence factors of ruptured intracranial aneurysms under keyhole clipping.Results In the 147 patients with ruptured intracranial aneurysms, 57 (38.8％) had preoperative increased blood glucose and 99 (67.3％) had postoperative increased blood glucose;77 patients had ratio of postoperative/preoperative blood glucose＜1.2, 38 had ratio=1.2-1.5, and 32 had ratio ≥ 1.5.Seventy-eight patients had a good prognosis, while 69 patients gained a poor prognosis.As compared with the good prognosis group, the poor prognosis group had significantly larger percentage of patients with age elder than 60 or with postoperative blood glucose＞7.0 mmol/L, higher Hunt-Hess scale scores and ratio of postoperative/preoperative blood glucose, with significant differences (P＜0.05);multi-factor unconditional Logistic regression analysis indicated that age, postoperative and preoperative blood glucose ratio, postoperative blood glucose and Hunt-Hess scale scores were the independent factors of prognosis.Conclusion In patients with age＞60, Hunt-Hess scale Ⅳ or Ⅴ, postoperative blood glucose＞7.0 mmol/L and postoperative/preoperative blood glucose ratio ≥ 1.5, poor prognosis can be predictive.

Objective To explore the related factors affecting postoperative pneumonia in patients with cavernous cerebrovascular malformation (CCM).MethodsClinical data of 151 CCM patients admitted to our hospital from January 2010 to January 2017 were retrospectively collected. Patients were divided into postoperative pneumonia group (n=11) and postoperative non-pneumonia group (n=140) according to the occurrence of postoperative pneumonia. Univariate Logistic regression analysis, multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve were used to screen the relevant factors influencing the occurrence of postoperative pneumonia in CCM patients and evaluate the predictive value of relevant factors in postoperative pneumonia.ResultsAs compared with patients from postoperative non-pneumonia group, patients from postoperative pneumonia group had significantly increased modified Rankin scale (mRS) scores and significantly higher percentage of CCM combined with hemorrhage, and significantly decreased Glasgow coma scale (GCS) scores (P<0.05). Multivariate Logistic regression analysis showed that preoperative GCS scores (OR=4.75, 95％CI: 1.14-19.80,P=0.032) and mRS scores (OR=15.61, 95％CI: 3.22-75.58,P=0.001) were independent factors influencing the occurrence of postoperative pneumonia. ROC curve showed that the sensitivity and specificity of mRS scores≥4 to predict postoperative pneumonia were 45.5％ and 95.7％, respectively, and the sensitivity and specificity of GCS scores≤13 to predict postoperative pneumonia were 54.5％ and 85.7％, respectively.ConclusionFor CCM patients with preoperative GCS scores≤13 or mRS scores≥4, more attention should be paid to perioperative lung management and occurrence of postoperative pneumonia should be vigilant.

Objective To explore the diagnostic value ofcerebrospinal fluid (CSF) lactic acid (LA) level in bacterial meningitis after craniotomy for cerebral hemorrhage in adults.Methods The clinical data of 162 patients with cerebral hemorrhage,admitted to and accepted craniotomy in our hospital from April 2013 to April 2018,were retrospectively collected;patients were divided into infected group (n=75) and non-infected group (n=87) according to whether postoperative bacterial meningitis occurred;univariate analysis was used to compare the differences of CSF-LA concentration and other indicators of CSF between patients of the two groups;multivariate Logistic regression analysis was used to screen the independent factors affecting the occurrence of postoperative bacterial meningitis;receiver operating characteristic (ROC) curve was used to analyze the predictive values of CSF-LA and other indicators in postoperative bacterial meningitis.Furthermore,17 patients with positive bacterial CSF were divided into Gram-positive (G+) bacteria group (n=9) and Gram-negative (G-) bacteria group (n=8);the predictive values of CSF-LA and other indicators for postoperative meningitis of G-bacteria patients were analyzed in the same way.Results (1) The CSF-LA concentration in infected group ([6.3±2.8] mmol/L) was significantly increased as compared with that in non-infected group ([3.3±1.6] mmol/L,P＜0.05);the results of multivariate Logistic regression analysis showed that CSF-LA was an independent influencing factor for postoperative bacterial meningitis (odd ratio=l.547,95％ confidence interval:1.029-2.326,P=0.036);ROC curve results revealed that the area under the curve of CSF-LA concentration in the diagnosis of bacterial meningitis after craniotomy was 0.854 (95％ confidence interval:0.790-0.904),and the optimal cut-off value was 4.61 mmol/L,with sensitivity of 69.3％,specificity of 92.0％,positive predictive value of 88.1％ and negative predictive value of 77.7％.(2) The CSF-LA concentration in G-bacteria group ([9.9±2.9] mmol/L) was significantly increased as compared with that in G+ bacteria group ([5.2±3.1] mmoi/L,P＜ 0.05);ROC curve results revealed that,in patients with positive bacterial CSF,the area under the curve of CSF-LA concentration in diagnosis of meningitis with G-bacteria after craniotomy was 0.861 (95％ confidence interval:0.610-0.978),and the optimal cut-off value was 7.20 mmol/L with sensitivity of 87.5％,specificity of 88.9％,positive predictive value of 87.5％,and negative predictive value of 88.9％.Conclusion Detection for concentration of CSF-LA can help predicting bacterial meningitis afier craniotomy for cerebral hemorrhage and identify G+ and G-bacteria meningitis.

Objective To summarize the preliminary experience of endovascular recanalization in treating chronic symptomatic internal carotid artery occlusion.Methods Four patients with chronic symptomatic internal carotid artery occlusion,admitted to and underwent endovascular recanalization in our hospital from August 2013 to August 2014,were chosen in our study; their clinical data were retrospectively analyzed.Results Four patients were successfully opened the internal carotid arteries;cerebral CT angiography showed that all arteries were unobstructed.One appeared intra-operative iatrogenic internal carotid artery cavernous sinus fistula,and successful occlusion of the fistula with internal carotid artery patency was achieved after one week.Three months after the operation,two showed unobstructed internal carotid artery by DSA and the other stated no abnormalities during the telephone follow up.Conclusion Endovascular recanalization is a safe and effective treatment method for chronic symptomatic internal carotid artery occlusion.

Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.

Objective To investigate the distance change of bilateral internal carotid artery in acromegalic patients. Methods Twenty patients with acromegaly were included in this study from August 2016 to March 2018 in Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University. There were 7 males and 13 females with an average age of 40.2±12.6 years (range from 21 to 62 years old). Forty sex and age matched patients with non-functional pituitary adenoma were selected as controls. The 3D printing software was used for reconstructing the internal carotid artery. Distances of the bilateral internal carotid arteries were measured on the reconstructed images. Results The maximum distance between bilateral siphon carotid ectasias (25.1±3.9 mm vs. 23.2±2.9 mm, P=0.041) and distance between bilateral lacerum segments (26.2 ±3.1 mm vs. 23.8 ±4.1 mm, P=0.022) were significantly longer in patients with acromegaly than in those without. Although the distance between bilateral cavernous segments (20.7 ±4.3 mm vs. 22.4 ±3.1 mm, P=0.076) tended to be shorter, the difference was not statistically significant. The distance between bilateral ophthalmic segments was not significantly different between the two groups (15.7±5.1 mm vs. 16.0±2.5 mm, P=0.783). Conclusion The distance of bilateral internal carotid artery of acromegalic patients is different from that of patients with non-functional pituitary adenomas. Patients with acromegaly have significantly longer distance between bilateral siphon carotid ectasias and distance between bilateral lacerum segments compared with the patients with non- functional pituitary adenomas.