Objective To compare the effect of difierent combinatio of mannitol, furesemide and albumin in reducing intracranial pressure in 451 patients with severe traumatic brain injury (sTBI). Methods A total of 451 patients with an admissiou Glasgow Coma Scale of or less from 5 medical centers were randomly divided into 5 groups, ie, Group A(250 ml 20% mannitol each time as control), Group B(125 ml 20% mannitol each time), Group C(alternate use of 250 ml 20% mannitol each time or 40 mg furosemide), Group D(alternate use of 125 ml 20% mannitol each time and 20 mg furosemide)and Group E(alternate use of 125 ml 20% mannitol and moderate or large dose of albumin). We monitored intracraniai pressure continuously and observed the changes of intracranial pressure, electrolytes, hemato-crit and renal function after use of 5 combinations of mannitol. Furosemide and albumin. Results Man-nitol and furosemide could independently reduce intracranial pressure after 1-3 hours (P<0. 05). Semis mannitol plus furosemide or albumin could more signifieantly reduce intracranial pressure, with statistical difference compared with full dose of mannitol. Semis mannitol and alternate use of mannitol and furose-mide in aspect of intracranial pressure reduction and persistence time(P<0. 05). Alternate use of man-nitol and furosemide begot higher incidence rate of electrolyte abnormality, compared with the other com-binations (P<0. 05). Rebound rate of intracranial pressure was higher in full dose of mannitol than other combinations (P<0. 05). Incidence of renal function abnormality was higher in combination involved al-bumin than alternative use of mannitol and furosemide as well as combination of semis mannitol and furo-semide (P<0. 05). Abnormality of electrolyte and renal function wag reversible. Conclusion The use of 125 ml 20% mannitol each time plus 20 mg furesemide is more reasonable than other combina-tions. Meanwhile, semis mannitol combined with moderate or large dose of albumin has certain advantages too.

Objective To discuss the mechanism of progesterone that soften brain water content in traumatic brain edema in rats. Methods The models of focal lobe contusion and laceration of brain were made on the male rats treated by the progesterone following injury. Immunohistochemical method was used to assess the expression of aquaporin-4 (AQP4). Evan's Blue method was used to detect the permeability of blood-brain barrier. Results Treated by the progesteron, the brain water content was significantly decreased, and the lower expression of AQP4 took place on astrocytes of the contusion and peri-contusion of the brain tissue after 24 h,72h ,and 120h . The content of EB was decreased at 6 h and 24 h post-injury. Conclusions Progesterone can soften the traumatic brain water content, which may be associated with the attenuation of AQP4 in frontal lobe contusion following traumatic brain injury ( TBI) and progesterone can protect the blood-brain barrier at early time after TBI.

Objective To reversing methicillin-resistant Staphylococcus(MRS) to methicillin-susceptible Staphylococcus(MSS) by changing nutritional conditions and continuous transfer of culture .Methods MRS trains separating from clinical specimens were cultured in different conditions ,continuous cultural transfer ,and drug sensitive test were proceeded periodically to observe the phe-notypic and chemical reaction change of MRS .The mecA gene were detected of the original and mutant strains by polymerase chain reaction(PCR) ,then the gene sequenced and compared .Results 53 MRS strains were studied .6 strains were phenotype successful-ly converted to MSS in different cultural conditions ,among them mecA gene was undetected in 2 strains ,and down expressed in 4 strains .Conclusion The MRS strains separated from clinical specimens may revert to MSS by culture under different nutritional conditions .The mecA gene of MRS may be lost or lower expressed and the MRS and mutant strains may be different in genomics .

Objective:To explore the risk factors for misdiagnosis of ruptured intracranial aneurysm.Methods:A total of 606 patients with ruptured intracranial aneurysms, admitted to our hospital from October 2014 to October 2020, were enrolled in our study; these patients were divided into two groups according to whether they were initially misdiagnosed: misdiagnosis group ( n=35) and non-misdiagnosis group ( n=571). The general clinical data of patients from the two groups were compared; multivariate Logistic regression was used to identify the independent influencing factors for misdiagnosis. Receiver operating characteristic (ROC) curve was drawn according to the regression model to evaluate the predictive value of different factors for misdiagnosis. The re-rupture of aneurysms and different prognoses were compared between the two groups. Results:There were significant differences in Fisher grading, primarily visited departments, aneurysm diameters, hospital levels, and propaganda and education situation of the first visited doctors between the 2 groups ( P<0.05). Multivariate Logistic regression analysis showed that the independent factors for misdiagnosis of ruptured intracranial aneurysms were as follows: modified Fisher grading 0-II ( OR=12.284, 95%CI: 5.397-27.958, P=0.000); aneurysm diameter ≥10 mm ( OR=2.871, 95%CI: 1.276-6.456, P=0.011), not neurology or neurosurgery as primarily visited departments ( OR=9.279, 95%CI: 4.019-21.420, P=0.001), and first visited doctor not receiving propaganda and education ( OR=2.907, 95%CI: 1.258-6.721, P=0.013); area under the ROC curve of not neurology or neurosurgery as primarily visited departments and modified Fisher grading 0-II were 0.747 and 0.754, which had good predictive value in the misdiagnosis of ruptured intracranial aneurysm. Re-ruptured aneurysms occurred in 37.1% patients from the misdiagnosis group and 5.3% patients from the non-misdiagnosis group, with significant difference ( P<0.05); and the proportion of patients with poor prognosis at discharge (modified Rankin scale scores>2) was 42.9% in the misdiagnosis group and 22.6% in the non-misdiagnosis group, with significant difference ( P<0.05). Conclusion:Patients with modified Fisher grading 0-II, without neurology or neurosurgery as primarily visited departments and with aneurysm≥ 10 mm, and patients whose first visited doctor not receiving professional education of spontaneous subarachnoid hemorrhage have high risks of misdiagnosis of ruptured intracranial aneurysm; strengthening the professional education of spontaneous subarachnoid hemorrhage for doctors from non-neurology or neurosurgery departments of hospital at different levels may reduce the misdiagnosis rate.

Objective:To investigate the influencing factors for unfavorable outcome of low-grade aneurysmal subarachnoid hemorrhage (aSAH).Methods:A retrospective study was performed. The clinical data of 273 patients with aSAH of World Federation of Neurosurgery (WNFS) grading I and II, admitted to our hospital from April 2017 to March 2021, were collected. According to modified Rankin scale (mRS) scores 3 months after treatment, these patients were divided into favorable outcome group (mRS scores of 0-2) and unfavorable outcome group (mRS scores of 3-6). Statistical methods were used to analyze the clinical and imaging data differences between the two groups and identify the independent influencing factors for unfavorable outcome. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive values of different independent factors in unfavorable outcome.Results:Among the 273 patients with low-grade aSAH, 45 patients had unfavorable outcome and 228 patients had favorable outcome. Univariate analysis showed that there was significant difference between the 2 groups in age, Fisher grading distribution, proportions of patients complicated with shunt dependent hydrocephalus, with delayed cerebral ischemia, or with intracranial hemorrhage, and WNFS grading ( P<0.05). Multivariate Logistic regression analysis showed that concurrent shunt dependent hydrocephalus ( OR=5.075, 95%CI: 1.705-15.102, P=0.004), age ( OR=1.090, 95%CI: 1.036-1.147, P=0.004), delayed cerebral ischemia ( OR=8.282, 95%CI: 3.447-19.896, P=0.000), and postoperative intracranial hemorrhage ( OR=8.603, 95%CI: 2.332-31.745, P=0.001) were independent influencing factors for unfavorable outcome. ROC curve analysis showed that the optimal diagnostic threshold of age was 65 years, and the areas under ROC curve for delayed cerebral ischemia and age in predicting unfavorable outcome were 0.733 ( 95%CI: 0.653-0.813, P=0.000) and 0.709 ( 95%CI: 0.622-0.796, P=0.000). Conclusion:Low-grade aSAH patients with age≥65, postoperative shunt dependent hydrocephalus, delayed cerebral ischemia, and intracranial hemorrhage are more likely to have unfavorable outcome; age and complicated delayed cerebral ischemia have certain diagnostic value in low-grade aSAH patients.