Objective To observe the microscopic anatomy structures of petroclival region via the retrosigmoid keyhole approach,then provide an anatomic basis for clinical application.Method Six adult cadaveric heads 6xed by 10% formaldehyde solution were used for simulating the retrosigmoid keyhole approach to observe major microscopic anatomy structures.Results By means of adjusting the microscope,structures such as the ipsilateral trigeminal nerves,cranial nerve,acoustic nerve,posterior nerves,anterior and lateral pons,lateral cerebellar hemisphere,anterior inferior cerebellar artery,vertebral artery,posterior inferior cerebellar artery were exposed via this keyhole approach.Conclusion This retrosigmoid keyhole approach is according with the minimally invasive principle,and represents a reasonable option for accessing the petroclival region.

Objective To investigate hemorrhagic transformation (HT) and outcomes in acute ischemic stroke.Methods The demographics,vascular risk factors,imaging and other clinical data in patients with acute ischemic acute were collected retrospectively and compared.Using the susceptibility weighted imaging (SWI) to diagnose HT,and the patients were divided into either a HT group or a non-HT group.The modified Rankin scale was used to evaluate the clinical outcomes.Multivariate logistic regression analysis was used to determine the independent risk factors for HT and poor outcome in HT patients.Results A total of 96 patients with acute ischemic stroke were enrolled and 34 of them had HT (35.4％).The age (66.21 ± 7.04 years vs.61.21 ±13.42 years; t =2.020,P=0.046) and infarct volume (3.88 ±2.20 cm3 vs.1.96 ± 1.37 cm3; t =5.67,P=0.001) in the HT group were significantly older or larger than those in the non-HT group.The proportions of hypertension (58.8％ vs.30.6％;x2 =7.228,P=0.007),diabetes (29.4％ vs.6.5％;x2 =9.293,P=0.002),atrial fibrillation (35.3％ vs.3.2％;x2=18.128,P=0.000),and cardiogenic cerebral embolism (35.3％ vs.3.2％ ; P =0.000) were significantly higher than those in the non-HT group,while the proportion of small arterial occlusive stroke was significantly lower than that in the non-HT group (38.2％ vs.62.9％ ;P =0.032).Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.168,95％ confidence interval [CI] 1.059-3.412; P =0.021),infarct volume (OR 3.461,95 ％ CI 1.317-6.270; P =0.044) and atrial fibrillation (OR 1.284,95％ CI 1.117-2.903; P =0.015) were the independent risk factors for HT.In the HT patients,age (69.46 ±7.17 years vs.64.19 ±6.31 years; t =2.248,P =0.032) in the poor outcome group was significantly older than that in the good outcome group.The proportions of hypertension (84.6％ vs.42.9％ ;x2 =781,P =0.016),diabetes (50.0％ vs.14.3％ ;x2 =6.053,P =0.014),cardiogenic cerebral embolism (61.5％ vs.19.0％ ; P =0.025) and hematoma HT (76.9％ vs.19.0％ ;x2 =11.104,P =0.001) were significantly higher than those in the good outcome group.Multivariate logistic regression analysis showed that the diabetes (OR 2.151,95％ CI 1.179-3.218; P =0.023),atrial fibrillation (OR 4.136,95％ CI1.010 to 8.413; P =0.046) and hernatoma HT (OR 2.134,95％ CI 1.219-4.452; P =0.039) were the independent risk factors for the poor outcomes of HT patients at 3 months after symptom onset.Conelusions The incidence of HT in patients with acute ischemic stroke was 35.4％.Age,infarct volume and atrial fibrillation were the independent risk factors for HT,and diabetes,atrial fibrillation and hematoma HT were the independent risk factors for the poor outcomes in HT patients at 3 months after symptom onset.

ObjectiveTo investigate the effects of acupuncture on neuromuscular block of vecuronium and analgesia under general anesthesia.MethodsNinety ASA Ⅰ or Ⅱ patients,aged 29-80 yr,weighing 50-80kg,scheduled for laparoscopic chotecystectomy,were randomly divided into 3 groups (n =30 each):acupuncture at acupoints combined with general anesthesia group (group A),acupuncture at non-acupoints combined with general anesthesia group (group B) and general anesthesia group (group C).Bilateral Hegu (LI4),Neiguan (PC6),Zusanli (ST36),yanglingquan (GB34),and Quchi (LI11) acupoints were selected in group A.In group B,the points adopted were the midpoints between the meridians in which the acupoints were selected in group A and the adjacent meridians on the lateral side,at the level of selected meridian points correspondingly.Electric stimulation was started from 15-30 min before anesthesia induction and continued until the end of operation.Anesthesia was induced with iv injection of fentanyl,propofol and vecuronium and maintained with intermittent iv boluses of fentanyl and vecuronium.All the patients received patient-controlled intravenous analgesia after operation.The effect time,onset time,clinical duration and recovery index of vecuronium,consumption of anesthetics during operation,and consumption of fentanyl for postoperative analgesia and postoperative adverse reactions were recorded.Results Compared with group C,the elinical duration was significantly prolonged,the consumption of anesthetics during operation and consumption of fentanyl for postoperative analgesia were significantly reduced,and the incidence of nausea was significantly decreased ( P ＜ 0.05 ),while no significant changed was found in the effect time,onset time,and recovery index in group A ( P ＞ 0.05).Compared with group B,the amount of fentanyl consumed during and after operation was significantly reduced in group A ( P ＜ 0.05 ).ConclusionAcupuncture can prolong the clinical duration of vecuronium,and enhance the analgesic efficacy during and after operation under general anesthesia.

Deep vein thrombosis (DVT) has attracted great attention because of its high morbidity in orthopedics department, which could easily cause lethal pulmonary embolism (PE). Based on the domestic and foreign findings from the prophylaxis and nursing of DVT, this thesis summarized the key problems in orthopedic patients. It firstly defined the conception of DVT,and then emphasized the morbidity and severity of DVT in orthopedics department. After that it reviewed the possible risk factors that contributed to DVT. Moreover it also pointed out some matters needing attentions through discussing and analyzing the nursing and prophylactic measures against DVT, and it also gave some recommendations on it. It expounded the nursing progress on prophylaxis of the deep venous thrombosis in department of orthopedics, so as to provide reference for clinical work and study.

Objective:To investigate the correlation between thromboelastography (TEG) and portal vein thrombosis in patients with cirrhotic esophagogastric varices.Methods:210 hospitalized patients with cirrhotic esophagogastric varices treated in Zhongshan Hospital Affiliated to Fudan University from December 2016 to December 2017 were retrospectively included. They were divided into portal vein thrombosis group (PVT group) and non portal vein thrombosis group (NPVT group) according to whether they were complicated with portal vein thrombosis. The correlation between the results of TEG coagulation reaction time (R value), coagulation time (K value), αAngle, maximum amplitude (MA) and coagulation composite index (CI) and portal vein thrombosis was analyzed. The characteristics of coagulation status in patients with portal vein thrombosis in cirrhosis were compared.Results:A total of 91 patients (43.3%) were complicated with portal vein thrombosis. The R value in the PVT group was significantly lower than that of NPVT group [5.49(5.22-5.77) vs 5.98(5.76-6.20), P=0.006]. Logistic regression analysis showed that Child Pugh grade ( OR=2.883, 95% CI: 1.630-5.098, P<0.001) and R value ( OR=0.739, 95% CI: 0.575-0.950, P=0.018) were independently associated risk factors of PVT. The R value of patients was significantly correlated with Child Pugh grade ( r=0.147, P=0.034), platelet ( r=-0.358, P<0.001), prothrombin time (PT) ( r=0.334, P<0.001) and international standardized ratio (INR) ( r=0.328, P<0.001). Conclusions:The decrease of TEG-R value is closely related to PVT in liver cirrhosis.

Objective:To compare the effect of middle meningeal artery embolization (MMAE) versus conventional therapy for chronic subdural hematoma (CSDH).Methods:Retrospective analysis of 38 patients with 48 CSDHs treated with MMAE from May 2019 to May 2021 was performed. Comparisons were made with a conventional treatment for 126 patients with 126 CSDHs from January 2016 to May 2021. The MMAE and conventional treatment patients were matched by the propensity score matching method, and a total of 25 pairs of patients (31 pairs of CSDHs) were successfully matched. The CSDH recurrence, rescue treatment, radiographic follow-up outcome, clinical improvement and complication between the two groups were compared by t test, χ 2 test or Fisher exact probability methods. Results:The rescue treatment rate in MMAE group was significantly lower than that in conventional treatment group [0 (0/31) vs 19.4% (6/31), P=0.024] and the complete resolution rate at 6 months follow-up in MMAE group was significantly higher than that in conventional treatment group [96.8 (30/31) vs 74.2% (23/31), P=0.026]. In terms of CSDH recurrence, there was a trend of lower recurrence in the MMAE group [3.2%(1/31) vs 22.6% (7/31), P=0.053]. The complete resolution rate at 3 months follow-up was 61.3% (19/31) in MMAE group and 45.2% (14/31) in conventional treatment, clinical improvement rate was 92.0% (23/25) in MMAE group and 88.0% (22/23) in conventional treatment, good outcome rate (mRS≤2) was 92.0% (23/25) in MMAE group and 84.0% (21/25) in conventional treatment, complication rate was 0(0/25) in MMAE group and 4.0% (1/25) in conventional treatment, and there were no significant differences in all above-mentioned parameters ( P>0.05). Conclusions:The MMAE may be considered as a safe and effective treatment for CSDH, and MMAE for CSDH is associated with lower trend of recurrence, lower rescue treatment rate and better radiographic follow-up outcome than conventional therapy.

It introduced the definition of the caregiver and at home and abroad,and also reviewed influencing factors of family caregiver′s burden of the elderly patients. At last, it put forward the essentiality to perfect the nursing intervention and improve caregivers' coping capacity, as well as the transitional care model and the linkage"hospital-community-family",and improve national legislation and policy support in order to structure the social support system at the same time, so as to provide reference for study of reducing the family caregiver′s burden of the elderly patients.

Objective To explore the experience of the family caregivers of the old hip fracture patients with cognition impairment. Methods By using purpose sampling method,11 participants which treating from January to April 2017 were applied semi-structured in-depth interview,and then analysis the material. Results Four themes were analyzed about the caring demands of the family caregivers, including existing heavier caring burden,inadequate knowledge and skills,positive face to the caring task, desire to caregiver support system. Conclusions The family caregivers of the old hip fracture patients with cognition impairment exist heavier caring burden, the medical service institutions should call on national policy support and economic aid for caregivers, care about the mental health of caregivers and improve their coping ability, as well as provide professional knowledge and skills guidance and build a perfect caregiver support system at the same time in order to reduce the burden of caregivers early.

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease caused by abnormal accumulation of fat in the hepatocytes. Its prevalence is rising globally and has become the most common cause of chronic liver disease worldwide. The pathogenesis of NAFLD is multifaceted, involving insulin resistance, genetic and epigenetic factors, chronic systemic inflammation, mitochondrial dysfunction, endoplasmic reticulum stress, diet, gut microbiota, and other significant contributors. This article primarily delves into the mechanisms of mitochondrial dysfunction and endoplasmic reticulum stress in the development of NAFLD, aiming to provide new insights and therapeutic strategies for NAFLD.

Objective To evaluate the effect of propofol on the invasion of cerebral glioma in rats. Methods A total of 120 healthy adult male Wistar rats, weighing 250-280 g, were divided into 4 groups (n=30 each)using a random number table: sham operation group(group S), glioma group(group G) and different doses of propofol groups(group P1and group P2). The rats only underwent sphenotresia in group S. The model of brain glioma was established by injecting C6 glioma cells into the right caudate nucle-us in G, P1and P2groups. In P1and P2groups, propofol was infused at the rates of 20 mg·kg-1·h-1 and 40 mg·kg1·h-1, respectively, for 6 h through the tail vein at day 10 after establishing the model. The rats were sacrificed at day 18 after establishing the model, global brains were removed, and glioma was isolated. The weight of glioma was measured. The pathological changes were examined using hematoxylin and eosin staining. Immunohistochemical staining was used to determine the positive expression of glial fi-brillary acidic protein in glioma cells. The expression of vascular endothelial growth factor(VEGF)in both the periphery(within 2 mm diameter)and central region of glioma was detected by Western blot. Results No glioma was found in group S. The marked cavity and necrotic region in the central region of glioma and dense distribution of glioma cells and neovessels in the periphery of glioma were observed, and glial fibril-lary acidic protein was positively expressed in the majority of glioma cells in G, P1and P2groups. Com-pared with group S, the expression of VEGF was significantly up-regulated, and the number of positive cells was increased in G, P1and P2groups(P<0.05). Compared with group G, the weight of glioma was significantly decreased, the expression of VEGF was down-regulated, and the number of positive cells was decreased in P1and P2groups(P<0.05). There were no significant differences in the parameters men-tioned above between group P1and group P2(P>0.05). Conclusion Propofol can inhibit the invasion of cerebral glioma and provides anti-tumor effect in rats.