Objective To investigate the effect of 23.4% hypertonic saline(HTS)on intracranial pressure(ICP), cerebral peffusion pressure(CPP), cerebral blood flow(CBF)in poor-grade patients with subarachnoid hemorrhage(SAH).Methods Sixteen patients(Glasgow coma score ≤ 8)with poor-grade SAH received 23.4% hypertonic saline intravenously for elevated ICP.ICP, mean arterial pressure(MAP), CPP and the middle cerebral artery flow velocity(FV)were observed and recorded before and at 30, 60, 90,120, 150, 180 min after the injection respectively.Results Thirty minutes postinfusion, a significant increase in MAP, CPP, FV was seen together with a decrease in ICP(P<0.05).ICP remained reduced for 180 minutes, CPP and FV remained elevated for 90 minutes(P < 0.05).Conclusions HTS can significantly decrease ICP and improve CBF in patients with poor-grade subarachnoid hemorrhage and may be used for reversal of pathophysiologic changes caused by cerebral ischemia.

Objective To observe the prognostic effects of the patients with intracranial saccular aneurysm (Hunt-Hess grade Ⅳ- Ⅴ)first treated conservatively for 12 hours and then with surgical treatment and endovascular treatment. Methods The clinical data of 32 patients with intracranial saccular aneurysm (grade Ⅳ,n = 24 and gradeⅤ,n = 8)Hunt-Hess grade Ⅳ-Ⅴadmitted from January 2012 to January 2014 were analyzed retrospectively. Sixteen of them were treated conservatively for 12 hours in hospital,and then they were treated with surgery or embolization (postpone surgery group)and 16 underwent emergency surgery or embolization (immediate surgery group). The neurological prognosis of the patients was evaluated at 1,3 and 6 months before and after treatment. Results There was no significant difference in Glasgow outcome scores between the postpone surgery group and immediate surgery group at 1 month after treatment (3. 7 ± 1. 4,3. 8 ± 1. 2;t = 1. 372,P > 0. 05);there was no significant difference in Rankin prognostic scores at 3 months after treatment (3. 7 ± 1. 7,3. 6 ± 1. 5;t = 1. 361,P > 0. 05);But there was significant difference in prognostic scores at 6 months after treatment between the two groups (3. 5 ± 1. 5, 4. 2 ± 1. 8;t = 2. 234,P < 0. 05). Conclusion Patients with high grade cystic aneurysmal subarachnoid hemorrhage can be treated with conservative treatment. After 12 hours,endovascular embolization or surgical treatment may be performed. The prognosis at 6 months is better than emergent direct surgery or embolization.

Thirteen patients with colorectal lesions underwent laparoscopic surgery from January to December 2019. Before surgery, 5.0 ml autogenous blood was injected under colonoscopy into the inferior margin and opposite sides of the lesion for localization. The operation time，success rate，complications，location efficiency and postoperative pathology were evaluated. The autologous blood tattooing was easily applied for all patients without complication. At laparoscopic surgery，the lesions of all patients were clearly visualized except one obese patients with rectal tumors, because the tumor was located below the retroperitoneal fold. No blood diffusion and leakage，and local inflammatory responses were observed. The surgical margins of all samples were tumor negative. Preoperative tattooing with autologous blood is recommended as an easy，safe and economical procedure for colonoscopic surgery in patients with colorectal lesions.

Objective To explore the treatment of paradoxical herniation after bone flap decompression surgery,and improve people's understanding of paradoxical herniation.Methods From April 2014 to July 2017,the clinical data of 12 patients with paradoxical herniation were retrospectively analyzed.The treatment efficacies of position adjusting,sufficient hydration,and cranioplasty were explored.Results Nine patients (75％) had paradoxical herniation within two weeks of surgery,two(16.67％) developed paradoxical herniation from two weeks to one month of surgery,and one (8.33％) developed paradoxical herniation at two months after operation.But no all the patients had sunken and collapsed skin flap.After position adjusting,sufficient hydration,and cranioplasty,12 patients had periodic improvement;the neurological function of 9 patients accepted cranioplasty recovered obviously.Conclusion Paradoxical herniation is reversible after effective treatments,as position adjusting,sufficient hydration,and cranioplasty,enjoying good results.

Objective To assess the effect of alprostadil on accelerating early recovery of renal transplant patients with delayed graft function.Methods A randomized control clinical trial was designed in renal recipients with delayed graft function(DGF)who were administered with 50μg alprostadil each day after the operation.The effects of alprostadil were compared with the control group which included 14 recipients with DGF to determine the influences of alprostadil on urine,serum creatinine(SCr).Under Doppler ultrasound,the renal blood flow resistance-indexes(RI)were measured.The rates of acute renal graft rejection(AR)were also calculated in both groups,and the 1year patient/graft survival rates were compared between the two groups.Results Urine was significantly higher in alprostadil-treated group than in control group(P ＜ 0.05).On the contrary,SCr and RI were significantly lower in alprostadil-treated group than in control group(P ＜ 0.05).No significant differences were found between the two groups in AR rate(6.25％ vs 7.14％)and the 1-year patient/graft survival rates(P ＞ 0.05).Conclusion The application of alprostadil in renal recipients with DGF had beneficial effects on accelerating recovery of renal graft function.

Objective To explore the cerebral protective effect of edaravone combined with mild hypothermia in patients with severe craniocerebral injury. Methods 64 patients with severe craniocerebral injury were divided into control groups ( n =21 ) , mild hypothermia groups ( n =22 ) and combination groups ( n =21 ) according to the random number table method. All patients were treated with symptomatic supportive therapy and surgical decompression,and the patients in the mild hypothermia group accepted physical cooling and drugs to maintain a low body temperature, and the patients in the combination group accepted edaravone 30mg on the basis of the mild hypothermia group,1 time every 12 hours,and the course of treatment was lasted for two weeks. The Glasgow coma score(GCS),the degree of brain edema and the Glasgow prognostic score( GOS) were observed in the three groups. Results The GCS scores of the mild hypothermia group and combination group at 7d after admission were (9. 54 ± 1. 26) points and (10. 15 ± 1. 56)points,respectively,which were higher than (7. 58 ± 1. 12) points of the control group,the differences were statistically significant(t=7. 867,12. 232,all P<0. 05),and the GCS score of the combination group was higher than that of the mild hypothermia group(t =7. 986,P <0. 05). The GCS scores of the mild hypothermia group and combination group were (12. 21 ± 1. 47)points and (12. 35 ± 1. 12)points at 14d after admission,which were higher than (10.28 ±2.28)points of the control group,the differences were statistically significant(t=8. 823,9. 066,all P<0. 05). The proportions of mild edema patients in the mild hypothermia group and combination group were 69. 09%,71. 43%,respectively,which were higher than 19. 05% of the control group,the differences were statistically significant(χ2 =9. 019,7. 563,all P<0. 05). The GOS scores of the mild hypothermia group and combination group at discharge were (4. 15 ± 0. 51) points and (4. 51 ± 0. 37) points,respectively,which were higher than (3. 69 ± 0. 61)points of the control group,the differences were statistically significant(t=5. 328,6. 228,all P<0. 05),and the GOS score of the combination group was higher than that of the mild hypothermia group(t=4. 251,P<0. 05). Conclusion The curative effect of edaravone combined with mild hypothermia in the treatment of patients with severe craniocerebral injury is significantly better than conventional therapy and mild hypothermia treatment, and it is conducive to promote the recovery of the nerve function.

Objective To investigate the value of cerebrospinal fluid drainage after aneurysm clipping in patients with intracranial aneurysm complicated with subarachnoid hemorrhage .Methods 84 intracranial aneurysms patients with subarachnoid hemorrhage were selected ,and they were randomly divided into study group (n =42) and control group (n =42).The control group used simple suture after aneurysm clipping ,the study group was given lumbar cistern drainage by implementation of the dural suture tube after aneurysm clipping .Before and after hydro-cephalus and cerebral vasospasm ,treatment changes of serum insulin-like growth factor 1 (IGF-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels were compared between the two groups .Results The incidence rate of hydrocephalus of the study gruop was 4.8%,which was significantly lower than the 14.3% of the control group (χ2 =9.743,P <0.05).The incidence rate of cerebral vasospasm of the study group was 7.1%,which was significantly lower than 19.0% of the control group (χ2 =11.802,P <0.05).The incidence rates of intracranial infection,cerebrospinal fluid leakage and other complications between the two groups had no statistically significant differences (χ2 =2.074,2.125,all P >0.05).The serum levels of IGF-1 and sVCAM-1 between the two groups had no statistically significant differences before operation (t =0.417,0.603,all P >0.05).At the 8th day after oper-ation,the serum levels of sVCAM-1 and IGF-1 of the study group were significantly lower than those of the control group (t =7.335,6.856,all P <0.05).Conclusion After aneurysm clipping,the lumbar cistern drainage tube drainage is beneficial to reduce hydrocephalus and cerebral vasospasm incidence ,inhibit the expression of serum IGF-1,sVCAM-1,with less adverse reactions,it is worthy of application.

Objective To investigate the application of temporal and frontotemporal puncture or frontotemporal craniotomy for hypertensive intracerebral hemorrhage in basal ganglia region .Methods From January 2013 to April 2017,eighty patients with basal ganglia region hypertensive intracerebral hemorrhage in Shanxi Da Hospital were divided into observation group and control group according to random number table method ,with 40 cases in each group.The two groups were respectively given puncture of temporal and frontal temporal region and craniotomy with frontal and temporal bone flap for evacuation of hematoma and decompression of bone flap .The complications and treatment effect after surgery of the two groups were compared.Results Compared with the control group , the emptying rate of postoperative hematoma 1 day in the observation group was decreased [(60.1 ±9.7)%vs.(81.0 ± 9.9)%,t＝-9.537,P＜0.05];the operation time was shortened [(68.5 ±7.7) min vs.(110.2 ±9.1) min,t＝-22.124,P＜0.05];the use of postoperative mannitol decreased [(672.1 ±84.2) g vs.(1427.2 ±99.6) g,t＝-36.617,P＜0.05];the incidence rate of intracranial pneumatosis in the observation group was increased (7.5%vs. 30.0%,χ2＝6.646,P＜0.05).Conclusion Monitoring of intracranial pressure in lateral ventricles combined with puncture of temporal and frontal temporal region used in hypertensive intracerebral hemorrhage in basal ganglia region is helpful to reduce the surgical trauma and accelerate the recovery of postoperative patients ,and can be widely used.

ObjectiveAn increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections,including valve repair,and valve replacement with mechanical or bioprosthetic valves.The operative and peri-operative management of these patients has been varied.MethodsA retrospective study of VADs between Jan 1994 and June 2008 revealed 10 patients with previous prosthetic valves requiring management during and after VAD placement.Three patients were supported post-cardiotomy after valve surgery.Two patients were supported due to cardiogenic shock postopera-tively.Four patients were supported as a bridge to transplantation.One patient was supported as a destination therapy.ResultsThe mitral valve was left untreated during VAD implantation regardless of valve repair or replacement.For aortic valves,the mechanical aortic valve was replaced with tissue valve in two patients and left untreated in one case.One patient had tricuspid valve repair previously and was left untouched.All patients with prosthetic valves in aortic,mitral and tricuspid position during VAD support received anticoagulation therapy.There were 4 deaths,and 4 went on to transplantation.One patient weaned from VAD and discharge from hospital.One patient received HeartMate Ⅰ as destination therapy.The most common causes of death were multisystem organ failure and sepsis.One patient had a thromboembolic event.ConclusionThe survival rate of 60% is encouraging when compared to overall survival rates.The most common cause of death was multisystem organ failure.Patients with prosthetic valves may be safely managed during VAD support.

Objective To explore the efficacy and safety of mechanical thrombectomy with Solitaire device in patients with acute basilar artery occlusion (ABAO).Methods The clinical data of 5 patients with ABAO,underwent mechanical thrombectomy with Solitaire stent in our hospital from May 2016 to November 2018,were analyzed retrospectively.The clinical treatment efficacy and safety were recorded.Results All these 5 patients accepted endovascular mechanical thrombectomy successfully;successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grading 2b or 3) was achieved in 4 patients;the embolus was detached to the distal arteriole in one patient.There was no symptomatic intracranial hemorrhage;one patient accepted decompressive craniectomy resulting from massive infarction of cerebellum.Follow up results 90 d after treatment indicated that 4 patients enjoyed good prognosis (modified Rankin Scale scores:0-3).Conclusion Mechanical thrombectomy with Solitaire device is suggested to be safe and efficient in ABAO patients complying with appropriate operative indications.