Objective To investigate the clinical efficacy of pre-hospital mild hypothermia in patients with severe craniocerebral injury,and to explore the possible mechanism by the changes of serum Malondialdehyde (MDA).Methods 120 cases of severe craniocerebral injury were divided into pre-hospital mild hypothermia group (group A,65 cases) and control group(group B,55 cases) by random number table.Patients in group A were gave pre-hospital mild hypothermia treatment,and patients in group B were gave mild hypothermia therapy only after hospitalization.Comparison of the change of serum MDA at admission,the 7th and 14th day between two groups,and the functional outcomes were evaluated by GOS score in 6 months after treatment.Results The MDA levels of two group at seventh days and 14 days were higher than that at admission [(10.4 ± 1.5)nmol/L and (8.2 ± 1.2)nmol/L in group A,(12.6 ± 1.9)nmol/L and (10.0 ± 1.4)nmol/L in group B,P ＜0.05],and it was the highest at 7th day,and its in group A was significantly lower than that in group B at 7th,14th day [(6.9 ± 1.1) nmol/L in group A,(6.6 ±1.0) nmol/L in group B,P ＜ 0.05].The good prognosis rate was 47.7％ (31 cases) in group A,higher than the 38.2％ (21 cases) in group B;The mortality rate was 12.1％ (8 cases) in group A,lower than the 21.4％ (12 cases)the group B,and the difference was statistically significant (Z =-2.132,P ＜ 0.05).Conclusion Pre-hospital mild hypothermia treatment can improve the prognosis of patients with severe craniocerebral injury and alleviate the damage of brain tissues.

Objective To investigate the gradient changes of bilateral cerebral hemisphere pressure after lateral hemisphere injury and observe their effects on craniotomy. Methods Twenty-four patients with cerebral contusion and subdural intracerebral hematoma were included in this study. All patients received brain parenehyma pressure (BPP) monitoring by introducing optic fibro sensor into each cerebral hemisphere via the frontal lobe. All patients underwent surgical craniotomy for evacuation of space occupying lesions such as cerebral hemisphere contusion, subdural and/or intracerebral hematoma.Preoperative and postoperative BPP data at different time points were recorded and analyzed. Results Preoperative BPP value of the injured hemispheres was significantly higher than that of the other hemisphere (P ＜ 0. 01 ). There was no significant statistical difference upon BPP value at 0, 24 and 48 hours after operation between both hemispheres ( P ＞ 0.05 ). The postoperative BPP value of bilateral hemispheres was lower than the preoperative one. Conclusions BPP monitoring sensors should be introduced into the injured hemisphere so that the valuable information can be timely showed. When the cerebral hemisphere has lesions after brain injury, such lesion becomes the source of elevated intracranial pressure and can result in bilateral hemisphere pressure gradient. Craniotomy can not only effectively lower the intracranial pressure, but also eliminate the BPP gradient, which contritbutes to reposition of the oppressed brain tissue.

Objective To investigate the clinical effects of standard large trauma craniectomy in patients with acute posttraumatic brain swelling. Methods A cohort study was performed in 74 patients of acute posttraumatic brain swelling with midline shifting more than 5 mm, who were divided randomly into two groups: standard large trauma craniectomy group (n =37) and routine temporoparietal craniectomy group as control group (n =37). The vital sign, the intracranial pressure (ICP) and complications were observed during the treatment. The Glasgow outcome scale (GOS) and mortality rate as well as the complications were evaluated after treatment. Results The mean ICP in the large trauma craniectomy group at 24, 48, 72 and 96 hours was much lower than those of the control group ( P

Objective To investigate the role of Heme oxygenase-1 in the effect of hyperbaric oxygen preconditioning (HBOP) against the brain edema formation after experimental intracerebral hemorrhage in rats.Methods The study was carried out by animal experiment in two steps by using 54 Spradgue-Dawley rats weighting from 300-350 g.In the first step,rats were treated with HBOP (HBOP group,n =3) or with sham pre-conditioning (Sham pre-conditioning group,n =3).All the rats were sacrificed 24 h after the preconditioning,and basal ganglion of brain tissue was taken for detect HO-1 level by using western blot analysis.In the second step,rats were divided into 4 groups (n =12 in each group):HBOP +ZnPP group,in which rats had a micro-pump intra-peritoneally implanted containing a specific HO-1 inhibitor ZnPPⅨ (Zinc protoporphyrin IX,0.01 mg/kg),Sham pre-conditioning + Znpp group,HBOP + DMSO group,in which rats with a intra-peritoneal micro-pump containing 2 mL Dimethyl sulfoxide (DMSO,a solvent vehicle) and Sham pre-conditioning + DMSO group before HBOP.At 24 hours after the pre-conditioning,rats received an infusion of 100 μL autologous blood into the caudate nucleus to form a simulated intracerebrum hemorrhage (ICH),and were sacrificed 72 h later for brain water content measurements.All data were analyzed by using Stata 7.0 software and statistical analyses were carried out by two-tailed Student t test.Results Compared with the Sham pre-conditioning group,the HBOP group had significant higher level of HO-1.Compared with the Sham pre-conditioning + DMSO group,the HBOP + DMSO group had a significant lower level of water content in the ipsilateral basal ganglion [(81.4 ± 0.9) ％ vs.(82.6 ± 0.8) ％ (P ＜ 0.05)],however,peritoneal infusion of ZnPP Ⅸ before HBOP abolished HBOP-induced protection against brain edema formation after experimental ICH [(82.8 ± 0.9) ％ vs.(82.6 ± 0.7) ％ (P ＞ 0.05)].Conclusions Hyperbaric oxygen preconditioning attenuate brain edema formation after experimental ICH in rats,and this protection is attributed to the activation of HO-1.

Objective To explore the expression and its clinical significance of serum procalcitonin (PCT)level in ventilator-associated pneumonia( VAP)in newborns. Methods One hundred and fifty-five children with suspected VAP in Shajing Hospital of Shenzhen Affiliated to Medical University of Guangzhou from June 2013 to December 2014 who were in intensive care kiunit(NICU)were selected as our subjects. According to whether they had VAP or not could be divided into VAP group(80 cases)and non-VAP group(75 cases). Immunoluminometric method was used to detect PCT level at 1st day. According to the different medicine,VAP group was divided into 40 cases of two groups. The control group was according to the situation of children which was used empirical antibiotic by clinicians. The observation group was given antibiotics according to the level of PCT(the antibiotics were used when PCT > 0. 25 μg/ L). After treatment,if PCT did not decrease,the antibiotics was replaced. If PCT decreased,the antibiotics was continued to use the same kind of antibiotics. While the PCT< 0. 25 μg/ L,the antibiotics were stopped using. The change of the PCT level at 1st,4th,7th,10th day of two groups were observed. Results Serum PCT level of VAP group was(1. 68 ± 0. 83)μg/ L,significantly higher than that of non-VAP((0. 10 ± 0. 02)μg/ L),and there was statistically significant difference( t = 52. 614,P< 0. 05). Clinical effective rate of observation group was 87. 5%(35 / 40),which was higher than that of the control group(80. 0%(32 / 40),P = 2. 067). At 4th,7th and 10th day after treatment,PCT expressions of the observation group were all significantly lower than those of the control group. The medical costs and antibiotic using time were significantly lower than those of the control group((3 525. 8 ± 1 162. 9)yuan vs.(4 706. 7 ± 803. 4),(10. 3 ± 2. 7)d vs.(13. 5 ± 1. 4)d;t = 5. 28,6. 65;P < 0. 05). Conclusion The serum PCT levels of newborns of VAP significantly increase,and monitoring the PCT can guide reasonably the use of antibiotics in clinic.

Objective To explore the effect of keratinocyte growth factor(KGF)on the lung tissue and expres-sion of transforming growth factor - β1(TGF - β1 )in newborn rats with hyperoxia. Methods The 108 newborn SD rats were randomly divided into air group,hyperoxia group and KGF intervention group,and each group had 36 rats. The rats in every group were randomly divided into the 3,7,14 days subgroups,and each group had 12 rats. The rats in the hy-peroxia group and KGF intervention group were continually exposed to more than 950 mL/ L of oxygen box until the end of the experiment. KGF intervention group simultaneously undertook oxygen inhalation,hypodermic injection of 1 mg/ d recombinant human KGF(rhKGF)on the back on the first 3 days and 0. 5 mg/ d 3 days later till the end of the experi-ment. Air group and hyperoxia group were offered equivalent 9 g/ L saline. The rats in the air group took air. The sub -groups of the 3,7 and 14 days were cut for lung tissue in the corresponding time,observing lung tissue by light micro-scope for pathological changes and TGF - β1 protein expressed in the lungs was determined by immunohistochemistry. Results Air group sprout pulmonary alveolus on the 7th day,and the alveolaration finished on the 14th day,while hy-peroxia group had alveolar growth retardation and pulmonary fibrosis,but pulmonary fibrosis was not obvious in KGF in-tervention group. There was a significant difference on 7th day and 14th day between hyperoxia group and air group in TGF - β1(9. 43 ± 0. 64 vs 8. 62 ± 0. 52,P ﹤ 0. 05;9. 97 ± 0. 49 vs 8. 66 ± 0. 48,P ﹤ 0. 01). There was no significant difference between KGF intervention group and air group in TGF - β1(8. 67 ± 0. 55 vs 8. 56 ± 0. 43,8. 77 ± 0. 52 vs 8. 62 ± 0. 52,8. 81 ± 0. 47 vs 8. 66 ± 0. 48,all P ﹥ 0. 05). There's a significant difference on 7th day and 14th day be-tween hyperoxia group and KGF intervention group in TGF - β1(all P ﹤ 0. 05). Conclusions KGF can inhibit the pro-tein expression of TGF - β1 ,and this may be one of the possible mechanism underlying the protective effect of KGF a-gainst lung injury.

Objective To investigate the expression of PI3K, AKT and PTEN in gliomas. Methods The pathological specimens of 66 glioma patients who underwent surgery in our hospital and Huashan Hospital from January to December 2017 were analyzed, and another 50 normal pathological specimens were selected as reference group. Immunohisto-chemistry was used to detect the expressions of phosphatidylinositol 3-kinase, protein kinase B and homologous phos-phatase-tensin. The expression of three indicators between glioma tissues and normal brain tissues was compared to analyze the correlation between the three positive expressions in glioma tissues. Results The positive expression rates of PI3K and AKT in normal brain tissue were significantly lower than those in low-grade gliomas and high-grade gliomas, and the difference was significant (P＜0. 05). And the positive expression rates of PI3K and AKT in the low-grade gliomas were significantly lower than those in high-grade gliomas, and the difference was statistically significant (P＜ 0. 05). The positive rate of PTEN protein in normal brain tissue was 100. 0％, which was significantly higher than that in low-grade glioma and high-grade glioma, with significant difference (P＜0. 05). And the positive rate of PTEN protein in the low malignant glioma was significantly higher than that in high grade glioma, and the difference was statistically significant (P＜0. 05). Conclusion PI3K and AKT are highly expressed and PTEN is low-expressed in gliomas, which is related to the degree of malignancy.