Owing to the specific distribution and pathology of intracranial giant aneurysm, the parent artery must frequently be interdicted. In order to avoid cerebral ischemia, many neurosurgeons create effective techniques of extracranial intracranial artery bypass(EIAB) for the treatment of intracranial giant aneurysm. In this review, the author summarized advances in the application of EIAB for the treatment of intracranial giant aneurysm.

Objective To evaluate the effectiveness of tobacco control interventions among employees in centers for disease control and prevention (CDC) in Hebei Province. Methods Tobacoo control interventions, including health education, Quit and Win competition, and founding smokeless CDC, were carried out in CDC system in Hebei Province from May 2006 to June 2008. Surveys on smoking rate of employees and on average cigarette quantity consumed by male employee smokers were conducted at the beginning and the end of the interventions. Results In 2006, 9 931 employees in 174 centers at provincial, city, county level in Hebei Province participated in this study. The overall smoking rate was 25.69%. Male employees had a higher smoking rate (51.28%) than the females (0.68%). The smoking rate of male employees was 50.92%, 49.48% and 51.72% for provincial, city and county CDC levels, respectively. The average cigarettes consumed by one smoker in one day were 15.0. In 2008, 9 139 employees in 189 centers participated in this study. The overall current smoking rate was 25.07%. The smoking rate was 52.26% and 0.43% for males and females, respectively. The smoking rates of male employees in provincial and city CDCs were 43.93% and 46.18%, significantly lower than those in 2006. The smoking rate of male employees in county CDCs was 53.98%, much higher than that in 2006. The average cigarettes consumed by one smoker in one day in 2008 were 12.4, significantly less than that in 2006. The current smoking rate of male employees in smokeless CDCs was 48.0% , significantly lower than 56.9% in non smokeless CDCs. Conclusion Male employees in Hebei Province CDC system had a high smoking rate. Tobacco control interventions play a role in reducing smoking rate and cigarettes consumption.

Objective: To explore the effects of continuous trickle of low temperature liquids through the lateral ventricle on neural cell apoptosis after rabbit local cerebral ischemia/reperfusion. Methods:The middle cerebral artery (MCA) of New Zealand rabbit was clipped by micro aneurysm clip for 2 hours and reperfused for 24 hours. Immediately after clipping the MCA, we trickled the left lateral ventricle continuously with low temperature liquids(22℃) to decrease the brain temperature to mild hypothermia (33℃-35℃)and maintained for 2 hours. After reperfusion for 24 hours , we assessed TUNEL method to determine the apoptotic cell rate in the sham-operated group, the control group and the mild hypothermia group respectively. Results:The apoptotic cell rate of the cortex tissues accommodated by MCA in the mild hypothermia group was obviously lower than that in the control group(P0.05). Conclusion:Trickling ventricle with low temperature liquids could decrease the apoptotic cell rate and alleviate cerebral ischemia/reperfusion injury.

Objective:The aim of the current study was to investigate the expression of nuclear factor-?B(NF-?B) and metalloproteinase-9(MMP-9) in the small intestine and to explore the potential role of NF-?B and MMP-9 in the damage of gut mucosal barrier after traumatic brain injury.Methods:The trauma was produced by a free-falling weight on the exposed dura of right parietal lobe.The rats were randomly divided into control group and traumatic brain injury groups at hours 3,12,24 and 72,and on day 7.NF-?B binding activity in the small intestine was studied by electrophoretic mobility shift assay(EMSA),and the expression of MMP-9 was studied by immunohistochemistry.Results:The results showed that NF-?B binding activity and MMP-9 expression in the small intestine was progressively increased,reached the maximum at 72 h and kept at high level up to 7 d after TBI.Concomitant upregulation of NF-?B~()and MMP-9 was observed.MMP-9 positively immunostained cells were mainly located at villous interstitium,lamina propria,crypt and submucosal layer,including endothelial cells,lymphocytes and neutrophils.Conclusion:It was concluded that cortical contusion trauma could induce a concomitant and persistent upregulation of NF-?B binding activity and MMP-9 expression in the small intestine which might play a central role in the~()damage of gut mucosal barrier.

BACKGROUND: Neuroprotective role of hypothermia on cerebral ischemic-reperfusional impairment has been long acknowledged. Since general hypothermia is complicated and unfit for observing postoperative consciousness and neurological function, it is of important significance to explore novel methods of focal cerebral hypothermia.OBJECTIVE: To study the neuroprotective effect of lateral ventricle infusion of low-temperature fluid on ischemic neurons of middle cerebral artery (MAC) occlusion models established on New Zealand rabbits.DESIGN: A randomized case-control study based on experimental animal models.SETTING: Neurosurgical department and pathological department of a general military hospital of Chinese PLA.MATERIALS: This study was carried out at Neurosurgical Laboratory of Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Altogether 18 healthy New Zealand male rabbits, weighing from 2. 8 to 3.2 kg, were selected 4 - 6 months after birth, and randomly divided into occlusion group, hypothermia group and control group.INTERVENTIONS: Cerebral focal ischemic-reperfusional model was established on the New Zealand rabbits through MCA occlusion for 2 hours followed by reperfusion for 24 hours.MAIN OUTCOME MEASURES: Scores for neurological function, water content in the left and right brain, pathological changes of nerve cells in the left MCA supplying region.pothermia group, significantly higher than that in occlusion group(7.58 ± 0.58 )( P ＜ 0.01 ), but no significant difference could be observed in contrast with brain was(81.64 ± 0.82)% and (79.26 ± 1.30)% in occlusion and hypothermia groups with significant difference between them( P ＜ 0.05), and it was significantly different between the left side [ (81.64 ± 0. 82 )% ] and opyknosis and deep staining could be observed in nerve ganglion cells in occlusion group under optical microscope, but no obvious pathological changes were observed in MCA supplying brain regions in hypothermia group.CONCLUSION: Permanent infusion of low-temperature fluid into the lateral ventricle plays an important neuroprotective role by attenuating cerebral ischemic-reperfusional impairment and improving post-ischemic neurological functions.

Objective To analyze the total cost and clinical effectiveness of internal fixation and hemiar-throplasty in the treatment of femoral neck fracture for the elderly. Methods From October 2013 to May 2015,85 patients above 60-year old who were diagnosed as displaced femoral neck fracture and received operation in our hospital. All the patients were divided into internal fixation(IF)group and hemiarthroplasty(HA)group respec-tively. There were 40 cases in the IF group and 45 cases in the HA group. The total cost associated with fracture in a year was collected by medical record ,telephone interview and standard methods. At the last follow-up ,we ap-plied Harris scores to evaluate the clinical outcome for each group. Results All the patients completed the operation successfully. During 1 year follow-up the total cost in the IF group was less than that in the HA group including higher primary hospitalization cost and less post-discharge cost. The total cost was 44,556.1 Yuan in the IF group and 72,198.0 Yuan in the HA group respectively. The data showed that the total cost of HA was 1.6 times higher than that of IF. At the last follow-up the mean Harris scores was 71.1 ± 12.1 in the IF group and 74.3 ± 10.3 in the HA group while the EQ-5D index was 0.74 ± 0.15 and 0.76 ± 0.13 respectively which showed no significant differ-ence(P > 0.05). Conclusions Both internal fixation and hemiarthroplasty have effective treatment for elderly pa-tients with femoral neck fracture. Compared to hemiarthroplasty IF can provide similar clinical effectiveness with less total cost. Therefore IF may contribute to decrease the economic burden for elderly patients in China.

Objectives: The aim of the current study was to explore the alterations of intestinal mucosa morphology and barrier function, and to determine how rapidly impairment of gut barrier function occurs and how long it persists following traumatic brain injury. Methods: Male Wistar rats were randomly divided into six groups (6 rats each group) including controls without brain injury and traumatic brain injury groups at hours 3, 12, 24, 72 and days 7. The intestinal mucosa structure was detected by histopathological examination and electron microscopy. Gut barrier dysfunction was evaluated by detecting serum endotoxin and intestinal permeability. The level of serum endotoxin and intestinal permeability were measured by using chromogenic limulus amebocyte lysate and lactulose/mannitol (L/M) ratio, respectively. Results: After traumatic brain injury, the histopathological alterations of gut mucosa occurred rapidly as early as 3 hours and progressed to a serious state, including shedding of epithelial cells, fracture of villi, focal ulcer, fusion of adjacent villi, dilation of central chyle duct, mucosal atrophy, and vascular dilation, congestion and edema in the villous interstitium and lamina propria. Apoptosis of epithelial cells, fracture and sparseness of microvilli, loss of tight junction between enterocytes, and damage of mitochondria and endoplasm were found by electron microscope. The villous height, crypt depth and surface area in jejunum decreased progressively with the time of brain injury. The level of serum endotoxin and L/M ratio were significantly higher in traumatic brain injury groups than that in control (P

Objective:To explore a simple and effective method of local hypothermia, and to testify its neuroprotective effects . Methods:This experiment adopts twelve adult and healthy New Zealand rabbits as experimental animals. These rabbits were randomly assigned to two groups : ① MCAO (n=6),② MCAO and hypothermia (n=6). The middle cerebral artery (MCA) was exposed through the left orbital approach, and was clipped 2 hours by a 3 mm straight aneurysm clip to establish the MCAO model. We assign 2 cavities ventricle tube to puncture the frontal angle of the lateral ventricle, then 22℃ physiological brine was dropped into the lateral ventricle to reduce the brain temperature in MCAO and hypothermia group. Temperature thermister probes were inserted for measuring the brain and rectal temperatures. The neurological deficits and histological changes of brain tissue were evaluated in all experimental animals.Results: Brain temperature below cortex was descend to 35℃within 20 minutes after hypothermia in MCAO and hypothermia group while rectal temperature has maintained normal. The neurological deficits and histological changes of brain tissue of MCAO and hypothermia group were better than those in MCAO group. Conclusion: The local intra-ventricle hypothermia model is a reliable, cooling rapidly and useful method for selective brain cooling.

Objectives:To explore the protective effects of continuous trickle of low temperature liquids through the lateral ventricle on neurons after rabbit local cerebral ischemia reperfusion. Methods: The middle cerebral artery (MCA) of New Zealand rabbit was clipped with micro aneurysm clip for 2 hours and reperfused for 24 hours. Immediately after clipping the MCA, we trickled the left lateral ventricle continuously with low temperature liquids to decrease the brain temperature to mild hypothermia(32-35℃) and maintained for 2 hours. After reperfusion for 24 hours, we assessed the animal's neural deficits, observe the pathology of the ischemic brain tissues dyed by HE and determined the dry wet ratio for brain edema in the sham operated group, the control group and the mild hypothermia group respectively.Results:①The grades of neural deficits in mild hypothermia group were obviously lower than that in the clipping group( P 0.05 );②The dry wet ratios were obviously different in the mild hypothermia group and clipping group;③ Pyknosis and dense dying by HE were observed in the neural nuclei of ischemic cortex tissues of the clipping group, but no obvious changes were observed in the mild hypothermia group. Conclusions:Trickling ventricle with low temperature liquids could alleviate cerebral ischemia reperfusion injury, ameliorated neural deficit after ischemia reperfusion and were protective on the brain.

Objective To investigate the effect of parent artery occlusion with liquid embolic agents (Onyx)for the treatment of distal intracranial aneurysms. Methods The clinical data of 27 patients with 29 ruptured distal intracranial aneurysms were analyzed retrospectively.Seventeen aneurysms located in the posterior inferior cerebellar artery,3 in the anterior inferior cerebellar artery,2 in the superior cerebellar artery,2 in the posterior cerebral artery,1 in the anterior cerebral artery,and 4 in the middle cerebral artery.Twenty-eight aneurysms were treated with Onyx to occlude proximal parent arteries and aneurysms, and 1 distal middle cerebral artery aneurysm was occluded spontaneously. Results All the aneurysms treated were occluded completely.One patient died of intraoperative hemorrhage.The remaining patients were followed up for 8 to 67 months.The final Glasgow outcome scale (GOS)scores were 5 in 23 patients and 4 in 3 patients. 17 patients were followed up with digital subtraction angiography (DSA)and 5 were followed up with computed tomography angiography (CTA)after procedure.There was no recurrence of the aneurysm. Four patients were followed up clinically.No new neurological disturbance or rebleeding was found in all the survived patients. Conclusion Medium-long term follow-up results have shown that the clinical efficacy of proximal parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms is satisfactory,and the recurrence rate is low.