Objective To investigate the effect of endovascular cooling on perioperative brain injury in patients undergoing intracranial aneurysm resection.Methods Sixteen Hunt-Hess Ⅱ -Ⅳ patients of both sexes aged 18-64 yr undergoing intracranial aneurysm resection were randomly divided into 2 groups(n = 8 each): mild hypothermia group(group MHT)and nonnothermia group(group NT).A CL-2295AE catheter was placed in the femoral vein after anesthesia induction to perform endovascular cooling.Bladder temperature was reduced to 34 ℃ and maintained for 24 h.The hemodynamic parameters were recorded during and after operation.Coagulantion function and electrolyte levels were determined at 24 h before operation and at 12 and 24 h after operation.The serum neuron-specific enolase(NSE)and S100B concentrations were determined at 1 d before operation and at 1,3and 7 d after operation by ELISA.Neurological function was assessed with GOS grade at 1 and 3 months after operation.Results There was no significant difference in hemodynamic parameters,electrolyte levels(Na+ ,K+ ,Ca2+)and coagulantion function(PT,APTT,Plt)between the two groups(P ＞ 0.05).The GOS grade was significantly higher,while serum NSE and S100B concentrations were significantly lower after operation in group MHT than in group NT(P ＜ 0.05).Conclusion Endovascular cooling(34℃,24 h)can reduce the brain injury safely and effectively during the perioperative period in patients undergoing intracranial aneurysm resection and improve the prognosis.

Objective To analyze the timing and frequency of spontaneous gasping during cardiopulmonary resuscitation in a rat model,and evaluate its value bearing some relation to duration of cardiac arrest (CA ) in predicting the severity of post-resuscitation myocardial dysfunction.Methods Twenty-seven healthy Sprague-Dawley rats were randomly (random number)divided into 3 groups according to different durations of CA:CA 4 min (n=9),CA 6 min (n=9)and CA 8 min (n=9).CA of rats was electrically induced and untreated for 4,6 or 8 min respectively in the corresponding groups,and then cardiopulmonary resuscitation (CPR)was initiated and continued for 8 min in all animals.The emergence timing and frequency of spontaneous gasping during cardiopulmonary resuscitation and resuscitation outcomes were documented.Myocardial function such as cardiac output,ejection fraction and Tei index was measured by echocardiography prior to CA and at 1 h,2 h and 4 h post-resuscitation.Results The earliest appearance of gasping with highest frequency was observed in the CA 4 min group during CPR.Gasping appeared later with decreased frequency observed following longer duration of CA.There were statistically significant differences in the timing and frequency of gasping among the 3 groups.In the CA 4 min group with frequent gasping,all animals were successfully resuscitated with 8-min CPR with the least number of defibrillation,which was significantly better than that in the CA 8 min group.During the evaluation of post-resuscitation myocardial function,cardiac output,ejection fraction and myocardial work index (Tei index) were better in the CA 4 min group with frequent gasping,worse in the CA 6 min group and worst in the CA 8 min group, showing statistically significant differences in cardiac function among the 3 groups. Conclusions The spontaneous gasping appeared sooner with higher frequency during cardiopulmonary resuscitation indicated shorter duration of CA,and predicted better success of resuscitation and post-resuscitation myocardial function.

Objective To investigate the effects of limb ischemic post-conditioning (LIpostC) alone or its combination with therapeutic hypothermia (TH) on systemic inflammatory response and lung injury after cardiac arrest (CA) and resuscitation. Methods Twenty-one healthy male pigs weighing (37±2) kg were randomly divided into 3 groups (n = 7 each): control group, LIpostC group, and LIpostC+TH group. The animal model was established by 10 minutes of untreated CA and then 5 minutes of cardiopulmonary resuscitation (CPR).Coincident with the start of CPR, LIpostC was induced by four cycles of 5 minutes of limb ischemia followed by 5 minutes of reperfusion in the LIpostC and LIpostC+TH groups. After successful resuscitation, TH was implemented by surface cooling to reach a temperature of 32-34℃ until 4 hours post-resuscitation, followed by a re-warming rate of 1 ℃/h for 4 hours in the LIpostC+TH group. Normal temperature was maintained in the control and LIpostC groups. The resuscitation outcomes in each group were recorded during CPR. At 15 minutes prior to CA (baseline) and during 4 hours post-resuscitation, the level of arterial lactate was measured and PaO2/FiO2 was calculated, and extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were measured meanwhile by a PiCCO monitor. At 15 minutes prior to CA (baseline) and during 24 hours post-resuscitation, the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured by enzyme linked immunosorbent assay (ELISA). Results Six animals in each group were successfully resuscitated. Coronary perfusion pressure (CPP), duration of resuscitation, number of shocks and epinephrine dosage during CPR were not statistically significant among the three groups. The baseline of arterial lactate, PaO2/FiO2, EVLWI, PVPI and cytokines prior to CA were also not statistically significant among the three groups. The levels of serum TNF-α and IL-6 after resuscitation were gradually increased in all the three groups; however, the values of TNF-αand IL-6 were significantly lower in the LIpostC and LIpostC+TH groups than that in the control group, and they were further decreased in the LIpostC+TH group when compared to the LIpostC group [TNF-α (ng/L): 305±22 vs. 343±26 at 4 hours, 350±29 vs. 389±18 at 24 hours; IL-6 (ng/L): 239±14 vs. 263±19 at 24 hours, all P < 0.05]. The levels of lactate reached the peak at 2 hours post-resuscitation and then gradually decreased in all the three groups; it finally returned to the baseline in the LIpostC and LIpostC+TH groups, which was markedly lower than that in the control group (mmol/L: 1.4±0.7, 1.2±0.3 vs. 3.1±1.7, both P < 0.05). During 4 hours post-resuscitation, PaO2/FiO2 was significantly higher and EVLWI and PVPI were markedly lower in the LIpostC and LIpostC+TH groups than that in the control group; additionally, PaO2/FiO2 and EVLWI were further improved in the LIpostC+TH group than the LIpostC group [4-hour PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 391±26 vs. 361±20; 4-hour EVLWI (mL/kg): 10.1±1.5 vs. 12.1±1.2, both P < 0.05]. Conclusion LIpostC can be used to alleviate systemic inflammatory response and lung injury after porcine CA and CPR, and its combination with TH further enhanced its protective effects.

Objective The aim of this study was to evaluate the optimal time for decompression in a 24-hour lasting porcine model.Methods After baseline data were recorded,24 pigs were randomly allocated into three groups as follows:one SAP-alone group,and two SAP + ACS groups (decompression at 6 and 12 hours,respectively).We used a N2 pneumoperitoneum to increase the intra-abdominal pressure to 25 mmHg and retrograde intra-ductal infusion of sodium taurocholate to induce severe acute pancreatitis (SAP).Systemic hemodynamic profiles,urine output,systemic oxygenation,and serum biochemical parameters of the animals were obtained.Results After induction of ACS,the hemodynamics and oxygenation of the study animals deteriorated significantly.The survival time of the 12-hour group was significantly shortened (P =0.008 vs.6 hours).Early decompression (6 h) restored systemic hemodynamics,oxygenation,organ function,and inflammatory intensity to a level comparable to that of the SAP-alone group.In contrast,animals in 12-hour group developed more severe hemodynamic suppression,oxygenation and organ dysfunction and inflammatory process.For instance,the cardiac output levels in the three groups were 2.70 ±0.50 for the SAP group,2.75 ±0.48 for the 6 hour-group and 2.19 ±0.43 for the 12 hour-group.Conclusion Early decompression could significantly reduce the mortality in a porcine model of SAP incorporating ACS,and also improve systemic hemodynamics,organ function and inflammatory intensity.

Objective To evaluate the effectiveness of regional electrocardiographic consultation network for primary medical institutions.Methods A distance electrocardiographic ( ECG ) consultation center was established in Yuyao People′s Hospital in September 2012, which was connected to 56 regional primary medical through internet.The online consultation was provided by ECG specialists in the center for general practitioners in regional primary health care institutions.Additionally, the ECG training course was also conducted monthly for general practitioners.The 2-year data of ECG consultation were retrospectively reviewed and the effectiveness of the consultation network was evaluated.Results During the past two years, 86 593 electrocardiograms were uploaded by primary medical institutions, in which 3 976 were required for consultation. The monthly number of electrocardiograms sent by general practitioners was increased from 3 269 ±290 in the first year to 3 947 ±376 in the second year ( P<0.01 ) .However, the requirements of ECG consultation were not significantly different between two years.Compared to the first year, the rates of consultation requirements, misdiagnosis and missed diagnosis for ECGs of atrial and ventricular premature beats, atrial fibrillation, supraventricular tachycardia, left and right bundle branch blocks,ⅠandⅡdegree atrioventricular blocks and myocardial infarction were significantly decreased ( all P<0.05) in the second year;meanwhile there was a tendency towards the reduction for ECGs of atrial flutter and Ⅲ degree atrioventricular block in the second year.Conclusion The regional electrocardiographic consultation network is effective to improve the capability of primary medical institutions in electrocardiographic diagnosis.

Objective:Labview and VC were used to design software based on the Active One biopotential measurement system to realize the visual evoked potential based brain-computer interface.Methods:The data acquisition software was designed by Labview,the human-interface,real time signal processing and dynamic link library software were designed by VC.Data transmission between Labview and VC was realized through the dynamic link library using shared memory technology.The multimedia timer,DirectDraw technology and parallel port data output were used to design the visual stimulation interface.The 5 points averaging filter combining with averaging method were used to detect the visual evoked potential and the correlation coefficient was computed for signal recognization.Results:The experiments showed that the visual stimulator can produce effective visual stimulation.The data transmission method using the dynamic link library can satisfy the requirement of the system.Conclusions:The real-time signal processing method can improve signal-noise ratio and realize detection and recognization of visual evoked potential.The system can determine which module the subject was fixating and the result was feedback to the subject in real time.

Objective To study the effect of hydrogen sulfide (H2S) on acute cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) and explore its mechanism.Methods (1) A total of 48 adult male SD rats were randomly allocated into a normal group,a SAH group,a low dose NaHS group and a high dose NaHS group (n=12).Rat models of SAH were induced by injecting autologous blood into the prechiasmatic cistern.Rats in the later two groups were given 0.7 mg/kg and 2.8 mg/kg NaHS,respectively,0.5 h after modeling.Neurological scale scores were assessed 24 h after modeling;HE staining,TUNEL and immunohistochemical double-staining were employed to detect the morphology of approximated A2 blood vessel of anterior cerebral artery (ACA),tube wall thickness and endothelial cell apoptosis,respectively.(2) Brain microvascular endothelial cells (BMECs) were chosen and divided into blank control group,100 μmol/L OxyHb prevention group,25 μmol/L NaHS pretreatment group and 100 μmol/L NaHS pretreatment group.The cells were collected and observed 24 h after treatment,and then,the number of endotheliocytes was counted,and the Caspase-3 protein expression was detected by Western blotting.Results (1) The neurological scale scores (8.5±2.4) were significantly lower,the vessel wall ([43.5±6.2] μm) was significantly thickened,the lumen area ([30 488±938) μm2) was obviously reduced,and the number of TUNEL positive cells ([36.51±11.45]％) was remarkably increased in the SAH group as compared with those in the normal group (16.1 ±1.7,[25.8±3.5] μm,[51707± 1422] μm2 and [2.86±0.75]％ in turn,P＜0.05).The neurological scale scores (11.6±1.9 and 15.4±2.3) were significantly higher,the vessel wall ([34.7±3.7] and [31.7±4.6] μm) was significantly thinned,the lumen area ([41 463±1104] and [45 244±1217] μm2) was obviously increased,and the number of TUNEL positive cells ([17.14±5.36] and [8.10±4.62] ％) was remarkably reduced in the low dose NaHS group and high dose NaHS group as compared with those in the SAH group (P＜0.05).The neurological scale scores in high dose NaHS group were significantly higher than those in the low dose group and the number of TUNEL positive cells was signficantly smaller than that in the low dose group (P＜0.05).(2) The number of apoptotic endothelial cells ([40.56±9.85] ％) and the expression of Caspase-3 (0.395±0.122) in OxyHb prevention group were significantly larger/higher than those in the blank control group (P＜0.05).The number of apoptotic endothelial cells and the expression of Caspase-3 in the low dose group ([16.65± 6.35]％ and [0.223±0.083]) and high dose group([14.12±6.65] ％ and [0.208±0.104]) were obviously reduced as compared with those in the OxyHb prevention group,with significant differences (P＜0.05).Conclusion H2S can effectively expand cerebral vasospasm,and its vasoprotective mechanism may be through inhibiting vascular endothelial cell apoptosis.

Objective　To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy.　Methods　A total of 285 patients received the operation with mean age of 67 years (50-76 years) from January 2008 to April 2012.Mean level of PSA was 15.7 μg/L (1.8 -50.0 μg/L),and mean prostatic volume was 44 ml (26 -74 ml). No lymph node or seminal vesicle involvement was found by CT or MR and radionuclide bone scan revealed no metastasis.271 cases were confirmed diagnosis by prostatic biopsy and 14 were detected through pathological studies of TURP specimens.Gleason score ranged from 6 to 8.14 cases were in clinical stage T1b,29 cases in T1c,214 cases in T2 and 28 cases in T3a.Transperitoneal approach and modified technique involving bladder neck dissection,nervesparing technique and vesicoureteral anastomosis were applied on patients.　Results　Mean operative time was 105 min (55 -150 min).Mean intraoperative estimated blood loss was 240 ml (50-800 ml).Rectal injures occurred in 2 cases and were repaired under laparoscopy.Drainage tube and urinary catheter were removed 48 -72 h and 5 -8 d postoperatively.Postoperative hospital stay was 7 d (5 - 11 d).Positive surgical margin was present in 58 patients.Mean follow-up time was 29 months (3 -50 months).Complete continence were found in 208 patients immediately after catheter removal.68 patient recovered continence within 3 months and 9 patients remained incontinence 3 months after surgery. Normal erection presented in 42 of the 57 cases with nerve-sparing.　Conclusions　Transperitoneal laparoscopic radical prostatectomy is safe and efficient.Higher efficiency and lower complication rate have been achieved through modified laparoscopic technique involving bladder neck dissection,nerve-sparing technique and vesicoureteral anastomosis.

Objective To investigate clinical application of lateral supraorbital approach in microsurgery for tuberculum sellae meningioma.Methods A retrospective analysis was performed of the 46 patients with tuberculum sellae meningioma who had received microsurgery at Department of Neurosurgery,The First Affiliated Hospital to Soochow University from January 2010 to September 2017.Of the 46 patients,the lateral supraorbital approach was applied in 18 and the pterional approach in 28.The excision of tumor,operation time,hospital stay and visual improvement were compared between the 2 operative approaches.Results There was no significant difference in tumor excision rate between the patients using the lateral supraorbital approach and those using the pterional approach (P＞0.05).The operation time and hospital stay for the patients using the lateral supraorbital approach were significantly less than for those using the pterional approach (P＜0.05).Of the 12 cases with preoperative visual deterioration in the former patients,5 obtained no obvious visual change but 7 visual improvement;of the 23 cases with preoperative visual deterioration in the latter patients,9 obtained no obvious change,12 visual improvement and 2 further visual deterioration.Conclusion Neuro-microsurgery via the lateral supraorbital approach is a safe and mini-invasive treatment for tuberculum sellae meningioma.

Objective:To explore the clinical significance of the level and dynamic changes of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in the diagnosis and prediction of long‐term prognosis for patients with chronic obstructive pulmonary disease (COPD) combined with pulmonary heart disease among Han Chinese in Yunnan district .Methods:A total of 234 patients with COPD who were treated in The Second People′s Hospital of Qujing in Yunnan province during Jan .2013 and Dec .2013 ,were selected .Among them ,there were 98 patients with COPD combined with pulmonary heart disease ,80 patients with acute exacerbation of COPD ,and 56 patients with stable COPD .The clinical data ,results of blood gas analysis and echocardiography were recorded on admission and the levels of NT‐proBNP were measured .Results:The distances of 6 minute walk test(6MWT) in acute exacerbation of COPD and COPD combined with pulmonary heart disease groups were significantly less than that in stable COPD group(P< 0 .01) .The level of NT‐proBNP in COPD combined with pulmonary heart disease group was significantly higher than those in stable COPD and acute exacerbation of COPD group(P< 0 .01) .Kaplan‐Meier survival analysis showed that there was no significant difference regarding the rate of readmission and death during 12 months between the NT‐proBNP<1 000 pg/mL group and the NT‐proBNP≥1 000 pg/mL group(P>0 .05) .The rate of readmission and death during 12 months in the group with NT‐proBNP level decreasing ratio after treatment ≥30% was significantly higher than that in the group with decreasing ratio < 30% (P< 0 .05) .Conclusions: The detection of NT‐proBNP is of great significance to the early diagnosis of COPD combined with pulmonary heart disease .The dynamic changes of NT‐proBNP levels before and after the treatment are superior to single detection of NT‐proBNP level in predicting readmission rate and mortality risk for patients with COPD combined with pulmonary heart disease .