It is important in Evidence-Based Medicine(EBM) that the combination of the best clinical research evidence,the doctor′s specialized skill and the patient′s desire.EBM provides a new mode for the reformation of the paediatric student teaching.Introducing EBM into the practice teaching would improve the student′s ability to analyse and solve questions.EBM adjusts the modern medical education request.It would train the ability of clinical thinking,innovation and self-education for life,develop the medical student′s general capability.

Purpose Estimation of the degree of pulmonary artery stenosis (PS) in children patients before treatment can provide an important basis for the choice of treatment.This study explores the accuracy of non-invasive continuous wave Doppler (CW) and electrocardiogram (ECG) in estimating the degree of PS in children patients.Materials and Methods Sixty consecutive cases of PS children were collected from January 2012 to August 2016 in the General Hospital of Shenyang Military.The right ventricular pressure was estimated by measuring cross-pulmonary artery pressure gradient by CW,or estimated by measuring the amplitude of the V1R wave by ECG,which was then compared with that measured by cardiac catheterization respectively.Results The right ventricular pressure estimated by measuring cross-pulmonary artery pressure gradient by CW was positively correlated with that measured by cardiac catheterization (r=0.88,P＜0.05).The right ventricular pressure estimated by measuring the amplitude of the V1R wave by ECG was also positively correlated with that measured by cardiac catheterization (r=0.83,P＜0.05).Conclusion The right ventricular pressure estimated by CW or ECG has good consistency with that measured by cardiac catheterization.Both CW and ECG can be used as noninvasive methods for estimating the degree of PS in children.

Objective To investigate the effects of a traditional Chinese medicine (TCM ) decoction on cognitive dysfunction complicated with pulmonary infection after traumatic brain injury . Methods From February 2016 to March 2017 ,80 patients with cognitive dysfunction after traumatic brain injury ,who also had lung infection at admission to our hospital ,were enrolled and randomly divided into a control group and an observation group ,with 40 cases in each. Patients in the control group received conventional treatment with antibiotics and donepezil ,and patients in the observation group were administered a TCM decoction in addition to what was given to the control group.Mini-mental state examination(MMSE)scores and pulmonary symptom scores before and after treatment as well as adverse reactions were compared between the two groups. Results After treatment ,MMSE scores were higher in the observation group than in the control group (23.88 ± 5.90 vs.20.11 ± 6.37 ,t=2.746 ,P=0.007) ,and pulmonary symptom scores were lower in the observation group than in the control group (4.39 ± 2.01 vs.6.13 ± 2.24 ,t = 3.656 ,P = 0.007 ). The total incidence of adverse reactions showed no significant difference between the two groups (P＞0.05). Conclusions The TCM decoction has clear benefits and high safety in treating cognitive impairment complicated with pulmonary infection after brain injury. It can improve cognitive ability and clinical symptoms of the lungs ,and should be recommended.

Objective To explore the clinical effects of solitaire AB stent assisted with coil embolization therapy in the treatment of wide-necked intracranial aneurysms. Methods A total of 30 patients with wide-necked intracranial a-neurysms who were admitted in our hospital and given the treatment of stent combined with coil embolization technique from August 2013 to August 2014 were selected. The patients were given the treatment of anti-coagulation and anti-platelet during perioperative period. Cerebral angiography was re-examined 3 months after the surgery and embolization effect was evaluated. Results 30 patients (30 pieces) with wide-necked intracranial aneurysms were treated with soli-taire AB stent assisted with coil embolization therapy in this study, among whom 26 patients were fully and closely em-bolised, 3 patients were embolised over 90%, and 1 patient was embolised mostly (85%-90%). Follow-up was carried out for patients 2-12 months. Modified Rankin scores (mRS) was applied for evaluation. 25 patients were scored 0, 4 were scored 1 and 1 was scored 2. One of the patients died after rescue due to severe cerebral angiospasm induced by subarachnoid hemorrhage followed by diffuse brain swelling. No rupture of aneurysms was seen in other patients during the embolization surgery, and no surgery-associated complications such as stent displacement and bleeding. Satisfactory effect was achieved for patients with wide-necked intracranial aneurysms receiving stent assisted with embolization surgery. All patients were followed-up by cerebral angiography, and no relapse of arterial aneurysm was detected. Conclusion Solitaire AB stent assisted with coil embolization technique in the treatment of wide-necked intracranial a-neurysms is safe and effective.

Objective:To investigate the distribution of respiratory pathogens and risk factors of death in patients with pulmonary infection in neurosurgical intensive care unit (NICU).Methods:A total of 87 patients with pulmonary infection in the NICU of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2018 to December 2019 were collected, and the pathogens of their respiratory tract were analyzed to understand the types and distribution of bacteria in the lung infection. Univariate statistical analysis was used to analyze the relationship between the patient′s clinical outcome with age, diabetes, hypertension, renal insufficiency, hypoproteinemia, anemia, chronic respiratory disease, surgery, tracheotomy, and bacterial multi-resistance. Binary logistic regression analysis was used to analyze the influencing factors of death in NICU patients with pulmonary infection.Results:A total of 112 pathogenic bacteria were isolated in this research group, including 83 Gram-negative bacteria (74.11%), 22 Gram-positive bacteria (19.64%), and 7 Fungi (5.25%). Imipenem was highly sensitive to Gram-negative bacteria, vancomycin was highly sensitive to Gram-positive bacteria, and other drugs were highly resistant. 41 patients died (47.13%). Age≥60 ( OR=3.501, 95% CI: 1.152-10.638), renal insufficiency ( OR=3.872, 95% CI: 1.336-11.224), tracheotomy ( OR=0.317, 95% CI: 0.114-0.882), bacteria multi-drug resistance ( OR=3.480, 95% CI: 1.162-10.422) were independent risk factors for death in NICU patients with pulmonary infection. Conclusions:Patients with severe neurological diseases are in critical condition, and there are many patients with pulmonary infection, with poor prognosis and high mortality. Gram-negative bacteria are the most common respiratory pathogens. Carbapenems account for the highest proportion of antibiotics in clinic. Advanced age, renal insufficiency and bacterial multidrug resistance increase the mortality of patients, while early tracheotomy can reduce the mortality of patients.

Objective:To explore the clinical efficacy and safety analysis of a novel laser localization technology assisted percutaneous puncture of trigeminal nerve microsphere capsule compression surgery for the treatment of primary trigeminal neuralgia.Methods:A retrospective selection was conducted on 63 patients with primary trigeminal neuralgia who underwent percutaneous puncture of the trigeminal nerve microsphere capsule compression surgery at the First Hospital of Hunan University of Chinese Medicine from January 2020 to December 2021. According to different surgical methods, they were divided into a new laser localization assisted puncture group (observation group) of 32 cases and a traditional barehanded localization puncture group (control group) of 31 cases. An analysis was conducted on the surgical time, puncture time, puncture frequency, intraoperative exposure to radiation, number of cases of poor balloon formation, and clinical efficacy within 6 months after surgery for two groups of patients. The prognosis of the patients was followed up at 6 months after surgery.Results:The surgical time, puncture time, puncture frequency, and intraoperative exposure of the observation group were all less than those of the control group, and the differences were statistically significant (all P<0.05). There was no statistically significant difference ( P>0.05) in the number of cases of poor balloon angioplasty between the observation group and the control group, as well as the pain score grading of the Barlow Neurological Institute (BNI) on the first day after surgery. Within 6 months after surgery, there was no statistically significant difference in the incidence of facial numbness, diplopia, masseter weakness, perilabial herpes, and recurrent pain between the two groups of patients (all P>0.05). Conclusions:Laser positioning technology can assist in precise puncture of the foramen ovale and accurate placement of balloons based on surgical experience, which helps to improve surgical safety, reduce postoperative complications and intraoperative radiation dose, and achieve satisfactory short-term follow-up results.