Objective To explore the application value of percutaneous dilational tracheostomy in the neurological intensive patients. Methods The clinical data of 298 neurological intensive patients treated with percutaneous dilational tracheotomy were analyzed retrospectively from June 2010 to July 2016. Results Percutaneous dilational tracheostomy was successfully performed in all of the 298 cases. The mean operation duration was (6.8 ± 2.2) minutes with a rang of 2 to 15 min. There were 1 case with tracheal tube placement difficulties, 1 case in whom the trachea spatium was strayed into, 1 case with arrhythmia, 10 cases with mild bleeding and 5 cases with moderate bleeding. No severe bleeding, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula and other complications caused by the operation were found. And no death case was found. Conclusions Percutaneous dilational tracheostomy is a rapid and minimally invasive technique, which is a better choice for patients with severe neurological diseases.

Objective To study the pulmonary protective effect of large dose of ambroxol hydrochloride injection in postoperative patients with severe hypertensive intracerebral hemorrhage.Methods One hundred and sixty postoperative patients with hypertensive intracerebral hemorrhage were selected,and the patients were divided into conventional dose group and large dose group by random digits table method with 80 cases each.The therapeutic effect,partial pressure of oxygen,oxygenation index,acute physiology and chronic health evaluation Ⅱ score,antibiotic application time and hospitalization period in intensive care unit were compared between 2 groups.Results After treatment,the partial pressure of oxygen and oxygenation index in large dose group were significantly better than those in conventional dose group:(94.7 ± 7.2) mmHg (1 mmHg =0.133 kPa) vs.(86.5 ± 8.1) mmHg and (420.3 ± 35.5) mmHg vs.(356.0 ± 28.7) mmHg,the acute physiology and chronic health evaluation Ⅱ score was significantly lower than that in conventional dose group:(8.2 ± 3.4) scores vs.(11.6 ± 3.5) scores,the antibiotic application time and hospitalization period in intensive care unit were significantly shorter than those in conventional dose group:(8.5 ± 3.7) d vs.(13.4 ± 5.8) d and (7.3 ± 2.5) d vs.(9.7 ± 5.2) d,and there were statistical differences (P＜ 0.05).The total effective rate in large dose group was significantly higher than that in conventional dose group:92.5％ (74/80) vs.83.8％ (67/80),and there was statistical difference (P ＜ 0.05).Conclusion The pulmonary protective effect of large dose of ambroxol hydrochloride injection is significant in postoperative patients with hypertensive intracerebral hemorrhage.

Objective To construct a radiomics model for predicting hematoma enlargement in early hypertensive intracerebral hemorrhage and explore its predictive value.Methods A retrospective collection of 212 patients with hypertensive intracerebral hemorrhage within 6 h of onset,admitted to our hospital from February 2010 to August 2018,was performed.CT examination was performed within half an hour of admission.CT re-examination was performed 24 h after admission to determine whether there was hematoma enlargement.The regions of interest were delineated on the first CT,and 431 image indicators were extracted from the Matlab software.The LASSO regression model was used to screen out the most predictive imaging features,and the selected features and support vector machine classifier (SVM) were used to build the prediction model.Receiver operating characteristic (ROC) curve was used to evaluate the predicted effect of the model.Results After 24 h of admission,the incidence of hematoma enlargement was 18.9％ (40/212).Eighteen imaging ensemble features (including 4 first-order statistics features:standard deviation,kurtosis,uniformity,and variance;one shape-and size-based feature:surface to volume ratio;7 textual features:long run low grey level emphasis,inertia,correlation-angle 90,short run emphasis,correlation-all direction,long run emphasis,and inverse difference moment;6 wavelet features:autocorrelation-3,informational measure of correlation2-3,long run high gray level emphasis-4,short run high gray level emphasis-4,short run low gray level emphasis-7,and sum variance-3) were combined with SVM to establish a prediction model by LASSO regression model.The area under ROC curve was 0.928,enjoying sensitivity and specificity of 92.5％ and 83.5％,respectively.Conclusion The constructed radiomics model is helpful in predicting the expansion of hypertensive cerebral hemorrhage.

Objective To explore the effect of cerebrospinal fluid release combined with controlled decompression under intracranial pressure monitoring on prevention of intraoperative intracranial swelling in patients with acute severe craniocerebral injury. Methods According to the inclusion and exclusion criteria, 90 patients with acute severe craniocerebral injury were randomly divided into study group (48 cases) and control group (42 cases). Patients in the study group underwent ventricular intracranial pressure probe placement, and then the standard decompressive craniectomy. During the operation, cerebrospinal fluid release combined with controlled decompression under intracranial pressure monitoring was applied to prevent brain swelling. Patients in the control group underwent standard decompressive craniectomy combined with controlled decompression to prevent brain swelling. The incidence of intraoperative brain swelling and cerebral infarction within 3 d after surgery, and the mortality within 1 month after surgery were evaluated. Prognosis was evaluated by GOS score after 3 months of follow-up. Results The brain swelling rate, cerebral infarction rate, mortality within 1 month, and Glasgow Coma Scale (GOS) score at 3 months after operation in the study group were better than those in the control group with statistical significance:10.4％(5/48) vs. 28.6％(12/42), 29.2％(14/48) vs. 64.3％(27/42), 18.8％(9/48) vs. 35.7％(15/42)], (2.83 ± 1.08) scores vs.(1.83 ± 0.76) scores, P<0.05. Conclusions Cerebrospinal fluid release combined with controlled decompression under intracranial pressure monitoring can reduce the incidence of intraoperative brain swelling and improve the prognosis of patients with acute severe craniocerebral injury.

Objective To compare the effects of urapidil and sodium nitroprusside on blood pressure and prognosis in patients with hypertensive intracerebral hemorrhage. Methods One hundred and fifty patients with hypertensive intracerebral hemorrhage from January to December 2017 were divided into urapidil group and sodium nitroprusside group according to the medication, each group with 75 patients. The changes of blood pressure, heart rate, hematoma size and neurological function were compared between the two groups. Results At 10 and 30 min after treatment, the systolic blood pressure and diastolic blood pressure of patients in urapidil group were lower than those in sodium nitroprusside group (P＜0.05). At 60 min after treatment , there was no significant difference on blood pressure between the two groups (P＞0.05). At 10, 30, 60, 120 and 240 min after treatment, the heart rate of patients in urapidil group were significantly lower than those in sodium nitroprusside group (P＜0.05). At 24 and 72 h after treatment, there was no notable difference in the size of hematoma between the two groups (P＞0.05). At 1 month after treatment, the neurological scores between the two groups were significantly different: (10.1 ± 2.1) scores vs. (13.8 ± 5.9) scores, P＜0.05. Conclusions Urapidil can effectively control blood pressure in patients with hypertensive intracerebral hemorrhage. Moreover, it exerts better long-term neuroprotective effect, compared with sodium nitroprusside.

Objective To study the method and therapeutic effect of microsurgical treatment by unilateral subfrontal approach in patients with large olfactory groove meningiomas. Methods The clinical data of 16 patients with large olfactory groove meningiomas who had underwent microsurgical treatment by unilateral subfrontal approach from January 2010 to December 2017 were analyzed retrospectively. Results Total removal of tumor (Simpson Ⅰ and Ⅱ grade) was achieved in 14 cases and subtotal removal of the tumor (Simpson Ⅲ) was in 2 cases. No patient died from the microsurgery. The treatment effect was satisfactory in all patients during the follow- up. Conclusions The microsurgical treatment by unilateral subfrontal approach in patients with large olfactory groove meningiomas conforms to the concept of minimal invasive surgery, which provides enough surgical space, and the effect of surgery is satisfactory. So the approach is a good choice for the removal of large olfactory groove meningiomas.

Objective:To investigate the expression and significance of Toll-like receptor 4 (TLR4) in renal tissue and peripheral blood of children with idiopathic nephrotic syndrome(INS).Methods:The renal biopsy tissues of 78 children with INS diagnosed in the First Affiliated Hospital of Xinxiang Medical University from October 2015 to June 2018 and normal renal tissues of 21 children (control group 1) were collected, and the expressions of TLR4 in the renal tissue was detected by using immunohistochemical method.The expression of TLR4 in different renal pathological types and clinical types of INS was compared, and the correlation of TLR4 with 24-hour urinary protein and serum albumin was analyzed.The expression levels of TLR4 in peripheral blood of children with INS before and after treatment (active stage and remission stage) and 23 healthy children (control group 2) were detected by enzyme linked immunosorbent assay(ELISA). The serum expression levels of TLR4 in different renal pathological types and clinical types of INS were compared, and the correlation of TLR4 with 24-hour urinary protein and serum albumin was analyzed; The correlation between TLR4 expression in renal tubules and in the serum of children with INS was also analyzed.Results:(1)Compared with the expression of TLR4 in normal renal tissues[(0.93±0.26)%], the expression of TLR4 in glomeruli and interstitium of all pathological types of INS [mesangial proliferative glomerulonephritis (MsPGN): (0.93 ± 0.21)%, focal segmental glomerulosclerosis (FSGS): (1.02±0.25)%, membranous glomerulonephritis(MN): (1.03±0.09)%, minimal change disease(MCD): (1.02±0.27)%]was not significantly different ( F=0.741, P=0.562), but the expression of TLR4 in renal tubules[MCD: (82.94±4.62)%, MN: (63.54±1.98)%, MsPGN(42.32±2.97)%, FSGS: (22.60±2.07)%] was significantly increased ( F=1 929.842, P<0.01), Especially, the expression of TLR4 in renal tubules of MCD type INS was significantly higher than that of MN, MsPG N and FSGS [MCD: (82.94±4.62)%, MN: (63.54±1.98)%, MsPGN: (42.32±2.97)%, FSGS: (22.60±2.07)%], and the differences were statistically significant(all P<0.01). TLR4 expression in renal tubules was the highest in steroid-sensitive nephrotic syndrome (SSNS) type and the lowest in INS patients with steroid-resistant nephrotic syndrome (SRNS) type, and the differences were statistically significant( F=220.951, P<0.01). (2)The expression of serum TLR4 in INS children at the active stage [MsPNG: (143.36±12.99) ng/L, FSGS(75.94±7.29) ng/L, MN(210.22±14.66) ng/L, MCD(283.93±21.58) ng/L]was significantly higher than that in INS children at remission stage [MsPNG: (29.51±4.93) ng/L, FSGS(15.66±3.78) ng/L, MN(45.40±5.73) ng/L, MCD(62.29±7.90) ng/L]and control group 2[(0.69 ± 0.33) ng/L], and the differences were statistically significant(all P<0.01); the expression of serum TLR4 in INS children at remission stage was significantly higher than that in the control group 2 ( F=286.287, P<0.01). TLR4 had the highest expression level in serum of MCD type INS children at active and remission stages, followed by MN and FSGS successively.The expression of serum TLR4 was highest in SSNS and lowest in SRNS, and the differences were statistically significant ( F=147.438, P<0.01). (3)The expression of TLR4 in renal tubules of children with INS[(62.82 ±20.94)%]was positively correlated with the expression of TLR4 in serum[(213.26±73.33) ng/L] ( r=0.852, P< 0.05). The expression levels of TLR4 in renal tubules and serum of INS patients at active stage were positively correlated with 24-hour urinary protein level[(123.05±33.55) mg/kg] ( r=0.401, 0.427, all P<0.05), and negatively correlated with serum albumin level[(19.54±3.55)g/L] ( r=-0.602, -0.617, all P<0.05). Conclusions:The expression of TLR4 in renal tubules and serum of children with INS increases, and may be related to different renal pathological types and clinical types of children with INS, as well as disease activity.

Objective:To investigate the significance of ventricular intracranial pressure monitoring in the treatment of traumatic multiple intracranial hematoma (TMIH).Methods:The clinical data of 14 TMIH patients treated with ventricular intracranial pressure monitoring from January 2016 to August 2021 in Beijing Luhe Hospital, Capital Medical University were analyzed retrospectively. The patients were followed up 6 months after injury, and the Glasgow outcome score (GOS) was assessed.Results:All the 14 patients successfully completed ventricular intracranial pressure probe placement. Among them, 8 patients recovered well after continuous monitoring of ventricular intracranial pressure and continuous cerebrospinal fluid drainage. Their ventricular intracranial pressure probe was placed for 5 to 10 (7.3 ± 2.2) d, with no intracranial infection occurred; and their GOS was 5 scores 6-month follow-up after injury. Six cases underwent craniotomy for hematoma removal due to the expansion of intracranial hematoma or aggravation of edema, and decompressive craniectomy was performed during the operation; 6-month follow-up after injury, GOS of 5 scores was in 3 cases, 4 scores in 2 cases, 3 scores in 1 case.Conclusions:The condition of TMIH patients is complex and changeable, and ventricular intracranial pressure monitoring can improve the prognosis of TMIH patients.

ObjectiveTo study the effects of Toddalia asiatica alcohol extract on autophagy and apoptosis of non-small cell lung cancer A549 cells， and to explore its possible mechanism. MethodA549 cells were cultured in vitro. Cell counting kit-8 （CCK-8） was used to detect the proliferation of A549 cells， and cell survival rate was calculated to screen the drug concentration. The apoptosis in each dose group and that after the use of 3-methyladenine （3-MA）， an autophagy inhibitor， were detected by flow cytometry combined with Annexin V-FITC/PI double staining. Western blot was used to detect the expression levels of apoptosis-related proteins such as B cell lymphocytoma-2（Bcl-2）， Bcl-2-associated X protein（Bax）， microtubule-associated protein 1 light chain 3 （LC3）， cleaved cysteinyl aspartate-specific protease-3 （cleaved Caspase-3）， activated poly （Adenosine diphosphate） ribonucleotide polymerase （cleaved PARP1）， PARP1， activated death activator （t-Bid）， Bid， and ubiquitin-binding protein p62 in each group and those after the use of 3-MA. ResultCompared with the conditions in the control group， the cell survival rate in 0.25 g·L^-1 group （P<0.05）， and 0.5， 1， 2， 4 g·L^-1 groups （P<0.01） was decreased after 24 h intervention. Additionally， the cell survival rate was reduced in a concentration-dependent manner at 48 h and it was less than 10% at 4 g·L^-1 （P<0.01）. Compared with the conditions in the control group， the total apoptosis rate in 0.5 g·L^-1 group was increased （P<0.05）， and the apoptosis rate in 1 and 2 g·L^-1 groups was also increased （P<0.01）. Compared with the 2 g·L^-1 group and 3-MA group， the 3-MA combined with T. asiatica alcohol extract had significantly decreased apoptosis rate （P<0.01）. Compared with the conditions in the control group， elevated expression of pro-apoptotic proteins cleaved PARP1， Bax and t-Bid in 1 and 2 g·L^-1 groups （P<0.05， P<0.01）， and reduced expression of Bid in the 2 g·L^-1 group （P<0.01） were found. Compared with the conditions in the control group， the expression of anti-apoptotic protein Bcl-2 （P<0.05， P<0.01） and the level of p62 （P<0.01） were down-regulated in 0.5， 1， 2 g·L^-1 groups， while the level of LC3 Ⅱ protein was up-regulated （P<0.01）， with certain concentration dependence. ConclusionT. asiatica alcohol extract could significantly inhibit the proliferation of A549 cells， which might be related to promoting autophagy and inducing apoptosis.