Objectives:To discuss clinical significance of enternal nutrition of Nutrison fibre in neurosurgical coma patients. Methods:The study group(20 cases,GCS≤5) was fed gastrically with Nutrison fibre by a nasal feeding tube, and the control group(20 cases,GCS≤5) was supported with common fluid diet.In all cases,triceps skin fold,blood sugar,albumin,total lymphocyte count,complications and nitrogen balance were observed. Results:There were not significant differences between the study group and the control group in nutritional status,but the rate of complication in study group was obviously lower than that in control group. Conclutions:Enteral nutrition with Nutrison fibre can decrease the complications in nurosurgical coma patients and improve the quality of life.

Objective To evaluate the feasibility and clinical value of endoscopic decompression with metal stent and colorectal tube for acute malignant colorectal obstruction. Methods With the aid of fluoroscopy, 26 cases with acute malignant colorectal obstruction were treated. Their obstructive sites consisted of rectum(n=14), sigmoid colon(n=8), descending colon(n=2) and transverse colon(n=1). Results In 18 of 26 patients, metal stents were successfully inserted (18/20, 90%), in 6 cases colorectal tube were successfully inserted(6/6, 100%), the total technical success rate was 92. 3% (24/26). Thereafter, 1 patient has no effect, 23 patients showed relief of obstructive symptoms within 1-2 days, the clinical success rate was 88.5% (23/26). Permanent metal stent placements were performed in 13 cases for palliative treatment, 10 underwent subsequent elective surgical resection after 7 ~ 10 days, without complications, such as anastomotic leakage and intraperitoneal infection. One case was failed in recurrent rectal carcinoma after resection, one case with widespread metastatic sigmoid colon carcinoma occurred colon perforation and received immediate Hartmann operation. Recurrent obstruction was detected in one patient with distal stent migration within 6 weeks, and second stent were placed to solve the problems. Stent occlusion from stool impaction was found in one patient 1 month after stent insertion, and was solved by endoscpic interventions. Conclusion Endoscopic decompression with metal stent and colorectal tube can alleviate the acute malignant colorectal obstructive sympotoms with high success rate. It is a simple, safe, effective and well tolerated method, and can obviate colostomy, prominently reduce trauma and agony, and increase the living quality of patients.

Glioma remains the most common malignant tumor in the brain and is also the most difficult to treat. Immunotherapy achieving long-lasting tumor remission in multiple cancer types has received considerable attention due to its potential to improve the treatment outcomes of patients with glioma. However, clinical trials have not yet demonstrated major improvements in prognoses, which might be attributable to the extrinsic components and intrinsic mechanisms involved in the tumor microenvironment and immune system. It is particularly noteworthy that there is emerging evidence that current routine treatment modalities and the physical and psychological characteristics of patients have different impacts on the efficacy of glioma immunotherapy. This article addresses how these factors interact with the host immune system and tumor microenvironment, and highlights their potential roles in glioma immunotherapy, with the ultimate goal of developing better immunotherapybased personalized medicine strategies.

Objective To research the application of rapid dura-mater reticular incision in the evacuation of acute severe subduml hematoma.Methods The clinical data of 30 patients performed evacuation of acute severe subdural hematoma in our hospital were retrospectively analyzed; the dumra maters was rapidly incised after the first bore hole being drilled,and then the dura mater was incised in reticular shape after the bone flap was formed.The subdural hematoma could effuse slowly and uniformly,and intmcranial hypertension would reduce effectively.Results The subdural hematoma of all patients was removed totally.Based on the Glasgow outcome scale (GOS) scores three months after surgery,8 patients got recovered,13 were referred to moderate maim,5 were severe disability and 4 died.By using this modified method,the acute cenencephalocele rate decreased to 23.3％,which was more effective as compared with that using traditional method (48.2％).Conclusion In acute severe subdural hematoma operation,reticular incision of dura mater may achieve rapid hematoma evacuation and controllable and balanceable decompression,increase curative rate and decrease mortality.

Objective To evaluate the effectiveness of endovascular intervention in treating acute cerebral stroke.Methods Thirty-two patients with acute cerebral stroke (22 with middle cerebral artery occlusion and 10 with internal carotid artery occlusion),admitted to and treated with endovascular intervention in our hospital from January 2010 to October 2013,were chosen in our study;14 were performed arterial thrombolysis+mechanical fragrnengation and 18 were performed mechanical fragrnengation+ solitaireAB stent thrombectomy.Retrospective analysis was performed on the clinical data and treatment efficacy,and the prevention experience of complications was concluded.Results CTA showed that complete recanalization was noted in 18 patients and partial recanalization in 5,with a recanalization rate reaching 7 1％.Postoperative symptomatic intracerebral hemorrhage was noted in 2 patients (6％) and 1 (3.1％) had large area of cerebral infarction.One month after the treatment,MRI indicated decreased areas of infarction in all patients.NIHSS scores were 4-6 points of all patients;favorable prognosis was noted in 23 patients (72％).Nine patients had heavy neurological dysfunction,with limb muscle strength less than grade Ⅲ.Conclusion Endovascular intervention in treating acute cerebral stroke can get high recanalization rate,and achieve good clinical outcome.

OBJECTIVETo assess the feasibility superselective embolization using microcatheters in treatment of intravertebral canal vascular malformation.

METHODSIn 128 patients with intravertebral canals vascular malformation, their AVMS or fistulae were treated with silk thread, Ivalon microspheres or tungsten microcoils.

RESULTSIn the 128 patients, 120 fistulae disappeared completely, but 8 were embolized 60% - 80%. Symptoms were improved in 113 patients. Improved muscular strength from grade I to IV was obtained in 8 patients, from grade II to III in 32, from grade III to IV in 32, and from grade IV to V in 41. The symptoms did not change in 15 patients.

CONCLUSIONSuperselective embolization through microcatheter is effective in the treatment of intraspinal canal vascular malformations.

Adolescent ; Adult ; Arteriovenous Malformations ; diagnosis ; therapy ; Child ; Child, Preschool ; Embolization, Therapeutic ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Canal ; blood supply