74 cases of the aged severe craniocerebral injury were presented in this paper, which accounts for 11.9% of the severe craniocerebral injury for the period. Among them, 28 cases died with a morta-lity of 37.8%. The mortality amounts to 51.4% in intracranial hematoma cases. 5 cases over 70 years all died. The reaction capacity becomes lower in old people, so that in craniocerebral injury the early clinical manifestations are difficult to represent the truth.Close observation and the early accurate diag-nosis are rather important. Attention should be paid to the multiple injuries and severe medical con-ditions. Some factors such as early clearance of the intracranial hematoma and prevention of com-plications and hypotension during an operation may reduce the mortality.Prognosis may be affected by such factors as the severity of the primary, injury, the compound injuty, complications, age and the deficiency in cerebral blood supply after cranio-cerebral injury.

The experience in the management of 108 cases of deeply situated meningiomas is presented. Complete removal of the tumor has been possible in 83 cases (76.9%), partial resection in 22 cases (20.3%). The surgical results were excellent in 72.2% and fair in 16.7%. Early diagnosis and an attempt to remove completely of such tumors should always be considered as the treatment of choice. In order to reach this goal, we propose:(a)wide exposure, induced hypotension, hypothermia, interruption of the blood supply at the base of the tumor, and careful hemos-tasis are essential; (b) in addition, microsurgical dissection to avoid injury of the neighbouring important structures as well as vital areas of the brain are mandatory. The removal of an unusual giant mening-ioma arising in the medial aspect of the sphenoid ridge illustrated these points well. The tumor was13?10?8cm in size and 864g in weight. The patient recovered uneventfully and his general condition has remained good for years. Recent CT scan showed no recurrence.

Purpose To prepare a novel fusion protein of CREKA and tTF as a universal carrier targeting to cancer,and to analyze its activities.Methods CREKA and tTF gene were acquired by PCR,and inserted into plasmid pET22b(+)to construct recombinant plasmid CREKA/tTF/pET22b(+),and the fusion gene was expressed in E.coli BL21.The fusion protein Wag purified through Nickel-affinity chromatography column.After purifying,the fusion protein was refold by subsequent dialysis.The activities of the fusion proteins were measured by coagulation timing and quantitative fluorescence test in vitro.Results The recombinant plasmid CREKA/tTF/pET22b(+)with correct sequence was obtained.The fusion protein was highly expressed in E.coli BL21.The coagulation of the fusion protein Was determined by the coagulation test.And the capability of the fusion protein effectively binding to clotted plasma proteins is identified in quantitative fluorescence test.Conclusion The recombinant plasmid CREKA/tTF/pET22b(+)with correct sequence was built.The fusion protein CREKA/tTF with both TF and CREKA activity was successfully obtained.

BACKGROUND:Recently, periprosthetic femoral fractures have been a common complication after total hip replacement. Vancouver type B1 periprosthetic femoral fractures commonly received internal fixation due to stable femoral prosthesis and less bone defects.
OBJECTIVE:To evaluate the effect of the application of Synthes cable system in the treatment of Vancouver type B1 periprosthetic femoral fractures after total hip replacement.
METHODS:From May 2009 to October 2012, 18 patients with Vancouver type B1 periprosthetic femoral fractures were treated with Synthes cable system in the Department of Orthopedics, Nantong First People’s Hospital. There were 8 males and 10 females with an average age of (62.67±8.67) years ranging 45 to 80 years. They received a further consultation at 1, 3 and 6 months after treatment. The function of hip joint was evaluated by Harrris evaluation standard:ful marks, 100 points, ≥ 90 points, excellent;80-89 points, better;70-79 points, good;<70 points, poor.
RESULTS AND CONCLUSION:Al 18 patients were fol owed up for 6 to 43 months. Mean healing period was (19.06±4.04) weeks. Harris score was (22.3±3.6) points before treatment in 18 cases. Harris score was higher significantly at 1, 3 and 6 months after treatment compared with that before treatment (P<0.01), and the recovery of hip function was good. Results indicated that Synthes cable system could help to restore the normal anatomic structure of femur in the greatest extent, showing simple operation, little injury, high stability and high safety. It is an ideal method for treating Vancouver type B1 periprosthetic femoral fractures.

Objective To investigate the clinical,neuroradiologic characteristics and possible causes in 3 patients with combined developmental venous anomalies (DVAs) and cerebral cavernous malformations (CCM).Methods The clinical examination,magnetic resonance imaging (MRI) T1-weighted (T1 WI),T2-weighted (T2WI),susceptibility-weighted imaging (SWI) or T2 fast field echo (T2 FFE),contrast-enhanced MRI at 1.5 T field strength and digital substrate angiography were performed in 3 patients.Results Three patients presented with the seizure,vertigo,and dizziness respectively.MRI findings of reticulated “popcorn like” lesion with complete hemosiden rim showed typical sign of CCM.DSA,contrast-enhanced MRI and MRI-SWI revealed the caput medusae of the medullary veins and collected veins which was drained into subcortical and deep venous system,which indicated DVAs in 3 patients.The angulated medullary veins and collected veins in approaching distal zone of CCM were observed.Conclusion DVAs can be combined with CCM.The angulated medullary veins and collected veins combined with CCM in same territory reveals that the angioarchitectural factors is a key factor in pathogenesis of cavernous malformation.

Objective To summarize the clinical experience of surgical treatment for the congenital coronary artery anomaly.Methods 15 patients with coronary artery anomaly,congenital coronary artery fis-tulas were 11 patients,including 1 patient associated with Fallot,5 patients underwent ligation of isolated fistula and 1 patient's fistula was performed tangent suture though off-pump cardiopulmonary bypass,4 pa-tients'fistulas were repaired by endocardiac way and 1 patient was mended through dissection of fistula under Oil-pump cardiopulmonary bypass.Anomalous origin of the left coronary artery from pulmonary artery were 4 patients and 1 patient associated with rheumatoid valve disease.Operative methods included ligation of left circumflex (1 case),anastomosis of left subclavian artery-left artery-left main (1 case) and transplantation of left main(2 cases).Results There was 1 death becaused severe low cardiac output syndrome,and the there was good prognosis and no clinical symptoms found in 14 patients during follow-up.Conclusion The feasible operation for the coronary artery anomaly should be performed as early as possible once diagnosed correctly.

BACKGROUND:Serious patel ar comminuted fractures can be treated by a number of methods such as cerclage with tension band steel wire or steel wire, or fixation with the nickel titanium patel a concentrator and absorption lines, or cerclage with 10# double-loop wire plus fixation with split-type patel a claws or with the memory al oy patel a concentrator. But it is difficult to achieve strongly fixed effect on patel a fractures by these methods.
OBJECTIVE:To investigate the clinical effects of suture with polyester braided wire and cerclage with belt lock cable on serious comminuted patel ar fractures.
METHODS:A retrospective analysis was performed on the clinical data of 57 patients with serious comminuted patel ar fractures who received suture with polyester braided wire and cerclage with belt lock cable from January 2007 to October 2012. According to AO classification of fractures, there were nine cases of type B3, 22 cases of type C2 and 26 cases of type C3. After satisfactory reduction of comminuted patel ar fractures during the operation, firstly we sewed up both sides of the expansion region of quadriceps muscle and stitched on periosteum and prepatel ar tissue with thick polyester braided wire fol owed by patel ar cerclage with belt lock cable. According to the stability of fracture blocks, tension band fixation with polyester braided wire was partial y added. After the operation, the clinical effects were assessed based on the Bostman score system.
RESULTS AND CONCLUSION:Total y 46 out of 57 cases were fol owed up with an average of 8 months (4-18 months). Al patients obtained bone union within 3-5 months. Wounds healed in the first stage without any infections, and fractures in al patients healed without complications such as implant loosening and skin irritation. According to the Bostman score system, 33 cases were scored excellent, 10 good and three fair. The excellent and good rate was 93.5%. It suggests that treatment of serious patel ar comminuted fracture by the combination of polyester braided wire and belt lock cable leads to closely contact fracture sites and reliably fix bone fragments. It can facilitate early postoperative range of motion exercises.

Objective To investigate the diffusion changes in ipsilateral substantia nigra after a chronic striatum infarction with diffusion tensor imaging ( DTI ) and its connotation for clinical lecture.Methods Participators underwent a DTI scan and were divided into three groups. The striatum infarction (SI) group consisted of twenty patients with chronic basal ganglia infarction with striatum involved, while the non striatum infarction (NSI) group consisted of another twenty patients with chronic basal ganglia infarctions without striatum involved. The control group consisted of twenty healthy volunteers. Before the DTI scan all patients underwent a clinical evaluation with Modified Rankin Scale (mRS) and Barthol Index,and the four patients of SI group with symptoms like Parkinson disease underwent an additional evaluation with the third subscale of Unified Parkinson' s Disease Rating Scale ( UPDRS Ⅲ ). Results Compared with NSI and control groups, the infarct side substantia nigra MD of SI group increased by 30. 86 percent (t =40.07,P=0.000) and 31.42 percent (t =42. 64,P =0.000). The FA values from the three groups were not different. There were four patients with some symptoms like Parkinson disease in SI group. Compared with those patients without symptom like Parkinson disease in SI group, the infarct side substantia nigra MD of these four patients increased by 22 percent(t = 18.03, P =0. 01 ). Moreover, the infarct side substantia nigra MD of these four patients was correlated with their UPDRS Ⅲ positively ( r = 0. 97, P = 0. 03 ).Conclusions The secondary degeneration in the ipsilateral side substantia nigra after striatum infarction could be detested quantitatively with diffusion tensor imaging. The secondary degeneration in substantia nigra may be responsible for the symptoms like Parkinson disease in striatum infarction patients.

OBJECTIVE: To improve the outcome of treatment in patients with craniocerebral firearm wound. METHODS: Prospectively and retrospectively reviewed a series of 93 patients presented to the Xi-Jing Hospital of Fourth Military Medical University with a diagnosis of craniocerebral firearm wound during a period of 27 years from July 1970 to July 1997. All the patients had acute craniocerebral firearm wound. Of these, it consisted of 81 males (87.1%) and 12 females (12.9%) ranging from 3 months to 58 years in age (median 24.6 years). The lesion included 16 tangential wounds, 58 tubular wounds and 19 through-and-through wounds. The cases were urgent and in serious and unstable condition. All the patients underwent surgical intervention and aggressive perioperative management in the neurosurgical intensive care, including resuscitative protocols. RESULTS: After emergency treatment and operation, 9 cases died (9.7%). Follow-up studies at three months postoperative showed that 56 cases (66.7%) had made good recovery. Rates of moderate disability, severe disability or vegetative state in this series were 19.0%, 10.7% and 3.6%, respectively. Long term follow-up studies (median 5.5 years) found that 42 (50.0%) were capable of resuming their occupation. CONCLUSIONS: Craniocerebral firearm wounds are often severe, needing urgent treatment for the patients. Timely, proper and thorough initial debridement are crucial for avoiding rapid neurological deterioration.

OBJECTIVE: To study the changes of brain TXA(2) and PGI(2) levels in a new rodent model of impact acceleration diffuse brain injury with hypotention and hypoxia and the effect of diaspirin cross linked hemoglobin solution (DCLHb) on brain TXA(2) and PGI(2) levels. METHODS: Thirty-two male SD rats were randomized into sham, head injury alone, head injury with secondary insults and injury with insults followed by DCLHb administration groups. Animals were physiologically monitored throughout the experiment and the prostanoids were measured via radioimmunoassay (RIA). RESULTS: There were no changes in TXB(2) and 6-keto-PGF1alpha (stable metabolites of TXA(2) and PGI(2)) levels in injury alone group while TXB(2) level in secondary insults group elevated significantly and both TXB(2) and 6-keto-PGF1alpha levels in injury with insults followed by DCLHb administration augmented significantly in comparison with the corresponding value of sham at 4 h postimpact. CONCLUSIONS: The only increase in TXA(2) level in secondary insults rats suggests that there may be both thrombotic episodes and vasoconstriction leading to focal increase in micro-circulatory resistance which contributes to a decreased focal cerebral blood flow (CBF). And it is hypothesed that DCLHb may exert its protective properties through increasing PGI(2) production in injured brain by affecting CBF and cerebral perfusion pressure (CPP).