Objective To discuss the opportunity of hemilateral craniotomy in treatment of a large area combined middle cerebral artery (MCA) infarction.Methods Thirty-two patients with a large area combined MCA infarction were performed by hemilateral craniotomy.Initial clinical presentation was evaluated by the Glasgow coma scale(GCS).All survivors were assessed three months after surgical decompression according to Barthel index(BI).The effects of pre-hemia decompressive surgery(before any signs of cerebral hernia,based on clinical status and CT or DWI findings)versus post-hernia surgery (after signs of hernia) on mortality,functional outcome.Results In 18 patients with pre-hernia decompressive surgery,3 patients (16.7%)were dead and average BI was (66.94±7.75)scores.The mortality was 57.1%(8/14)and average BI was (38.43±9.82)scores of post-hernia surgery with 3 cases severe aphasia.Conclusion Hemilateral craniotamy is performed before occurrence of cerebral hernia may decrease the mortality and improve outcome in these patients.

The embryo quality and endometrial receptivity is the two important factors that affects human implantation. Many patients with infertility caused by the disorder of endometrial receptivity fails in embryo implantation. Improving the receptivity of endometrium to improve clinical pregnancy rate has become a hot issue of research in recent years. In this paper, the current use of drugs and surgery on the measures to improve the receptivity of endometrium was summarized, in order to provide references for improving the success rate of assisted reproductive technology.

ObjectiveTo determine ff the cardiac index (CI) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).MethodsForty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midasolam,sufentunil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.CI was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.ResultsBland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:CI (2.8 ± 0.6 ) L· min - 1 · m- 2,bias was 0.23 L* min- 1 · m - 2 and limit of agreement was ( - 0.57,1.02)L · min- 1 · m- 2,resulting in κ ＝ 0.546 and an overall percentage error of 28.6 ％.ConclusionCI values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.

Objective:To explore the effects of omeprazole combined with somatostatin on intra-abdominal pressure and intestinal mucosal barrier function of elderly patients with severe acute pancreatitis.Methods:Selected 82 cases of elderly patients with severe acute pancreatitis from our hospital.They were divided into research group (48 cases) and control group (34 cases).The control group was treated with basic therapy,and the research group was treated with omeprazole combined with somatostatin on the basis of the control group.Analyzed and compared the clinical effects,intestinal mucosal barrier function and symptom indexes of patients in the two groups.Results:①The total effective rate of the research group was significantly better than that of the control group,and the difference was statistically significant (P=0.005).②After treatment,the D-lactose and diamine oxidase (DAO) levels of both groups were significantly lower than before treatment,and the difference was statistically significant (both P＜0.001).In addition,after treatment,the D-lactose and DAO levels were significantly lower in the research group than in the control group,and the differences were statistically significant (mean P ＜ 0.001).③After treatment,patients of the research group showed better results in abdominal pain and abdominal distension relief time,bowel recovery time,hospital stay and blood amylase index than those in the control group,and the difference was statistically significant (mean P ＜ 0.001).④After treatment,the intra-abdominal hypertension of two groups was significantly lower than before treatment,with statistical difference (P ＜ 0.001).Yet it was significantly lower in the research group than in the control group,with statistical difference (P ＜ 0.001).Conclusion:The combined treatment of omeprazole and somatostatin can effectively improve the clinical efficacy of severe acute pancreatitis in elderly patients,correct intra-abdominal hypertension and improve the intestinal mucosal barrier function of patients,so it is worthy of reference and promotion.

Objective To evaluate the effect ofcytochrome P450 isoenzyme subfamily 2C19 (CYP2C19)gene polymorphism on the clopidogrel antiplatelet therapy in cirrhosis patients after receiving transjugular intrahepatic portosystemic shunt (TIPS).Methods The clinical data of 171 cirrhosis patients,who were treated with TIPS during the period from January 2013 to December 2014,were retrospectively analyzed.During operation both the portal vein and the elbow vein blood samples were collected and sent for CYP2C19 gene testing.After TIPS,clinical follow-up checkup was made once every 3 months.The gene detection results and clinical follow-up findings were comparatively analyzed.Results A total of 110 patients,who had not received blood transfusion before TIPS and who had regularly taken clopidogrel antiplatelet therapy after TIPS were enrolled in the study.The mean time to take clopidogrel was 192.4 days (31-517 days),and the gene detection results of portal vein and elbow vein were quite consistent.CYP2C19 genotype of *1/*1 was found in 49 patients (44.5％),CYP2C19 genotype of *1/*2 in 27 patients (24.6％),CYP2C19 genotype of *1/*3 in 18patients (16.4％),CYP2C19 genotype of *2/*2 in 11 patients (10.0％),CYP2C19 genotype of *2/*3 in 3patients (2.7％),and CYP2C 19 genotype of *3/*3 in 2 patients (1.8％).Following-up examinations showed that the incidence of shunt dysfunction in patients carrying slow metabolic gene was 87.5％ (14/16),which was significantly higher than that in patients carrying moderate metabolic gene (20.0％,9/45;x2=22.9,P=0.006)as well as in patients carrying fast metabolic gene (8.2％,4/49;x2=37.91,P=O.O00 1).Multivariate analysis of Cox regression model indicated that CYP2C19 slow metabolic gene variation was an important predictive factor for shunt dysfunction (95％CI:1.80-9.03,P=O.O00 7).Conclusion CYP2C19 slow metabolic gene variation,including genotype of *2/*2,*2/*3 and *3/*3,is an important factor that can influence the efficacy of clopidogrel treatment after TIPS.Preoperative CYP2C19 gene detection results can provide useful information,which is very helpful in making an effective and reliable anti-platelet treatment plan for patients after TIPS.

Objective To summarize the experience of assisted reproductive technology concurrent deep vein thrombosis, improve the level of nursing. Methods The clinical data of 5 cases of assisted reproductive technology concurrent deep vein thrombosis in Reproductive Medical Center of Peking University Third Hospital were retrospectively analyzed and the related literature was retrieved,the nursing experience and preventive measures were summarized. Results Through treatment and careful, all the patient were cured. Conclusions Strengthen the nursing care of patients with assisted reproductive technology concurrent deep vein thrombosis, actively prevent ovarian hyperstimulation syndrome occurred is the key to reduce thrombosis. Those patients with risks factors should be paid more attention, strengthen health education, reduce or alleviate complications.

Objective To determine if the cardiac index (Cl) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midazolam,sufentanil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.Cl was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:Cl (2.8 ± 0.6) L·min-1 ·m-2,bias was 0.23 L·min-1 ·m-2 and limit of agreement was (-0.57,1.02) L·min-1 ·m-2,resulting in κ =0.546 and an overall percentage error of 28.6％.Conclusion Cl values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.

Objective To investigate the efficiency of transjugular intrahepatic portosystemic shunt (TIPS) with Fluency stent in improving the hepatic and renal function and survival rate in patients with decompensated cirrhosis.Methods The decompensated cirrhosis patients who were treated in our hospital from May 2008 to September 2011 were retrospectively analyzed.One group of patients (n =48) undergoing TIPS was randomly selected as treatment group,while another group of patients (n =48) treated by medicine and therapeutic endoscope was randomly chosen as control group.Clinical data and fellow-up data were retrospectively reviewed.There was no significant deviation in baseline characteristics (age,gender composition,etiology,renal function,hepatic function et al) among all the patients before the operations; The laboratory results of hepatic and renal function in 2 groups before and after operation (1 week,20 days,3 months,6 months,1 year,2 years,3 years) were recorded and compared with independent samples t-test or Wilcoxon rank sum test.The survival rates of two groups in 3 years were analyzed using Kaplan-Meier survival curve and compared with Chi-square test.Results Three years after the operation,there were significant differences between the treatment group and the control group in AST(70.8 vs.108.7 U/L,Z =-2.958,P ＜ 0.05) and TBIL (51.2 vs.76.2 μmol/L,Z =-2.004,P ＜ 0.05).The Cr value of the 3rd year after the treatment were (9928.2 ± 2363.8) in the the control group and (7742.1 ± 2845.6) μmol/L in the treatment group(t =-2.074,P ＜ 0.05).BUN of the 1st,2nd and 3rd years after the treatment were (2.0 ± 1.1),(2.3 ± 1.5),(2.5 ± 1.3) mmol/L in the treatment group,while it was (2.6 ± 1.1),(3.8 ±1.2),(5.4 ± 1.1)mmol/L in the control group.There was significant difference between the 2 groups (t =-2.222,-3.940 and-6.110,P ＜ 0.05).Comparing the survival rate in the 2 groups with Kaplan-Meier survival curve,the 3 year survival rate in the treatment group was 46.2％,while in the control group it was only 30.0％ (x2 =6.341,P ＜ 0.05).Conclusions Compared with medicine therapy and therapeutic endoscopy,TIPS with Fluency stent may improve the hepatic function,renal function and survival rate in liver cirrhosis patients.It is a safe and effective therapy choice for patients with decompensated cirrhosis.

Objective To evaluate the clinical efficacy of local intra-arterial thrombolysis (LIT) with urokinase in patients with acute ischemic stroke.Methods One hundred and sixty two patients with acute ischemic stroke were treated with LIT by using urokinase and relationship of reconalization for different occluded arteries with the Glasgow outcome scale (GOS) scores three months later was analyzed. Results Angiography showed occlusion of the cerebral artery in 162 patients, among which 119(73.5%) patients showed the sites in the internal carotid artery system, with 27 occlusions in the internal carotid artery (ICA)trunk, 63(38.89%) in the middle cerebral artery (MCA)and 29(17.9%) in the anterior cerebral artery (ACA), and the remaining 43(26.5%)patients of vertebrobasilar artery (VBA); successful recanalization was achieved in 103 (63.58%)patients, including 11 (40.7%), 49(77.8%), 20(69.0%) and 23(53.3%), respectively, after intraarterial infusion of urokinase. Unsuccessful recanalization occurred in 59patients (36.42%). Followed up for 90 days, 90 (55.6%) patients obtained a good outcome; 72(44.44%) had poor prognosis including 20(12.35%) deaths. 8 patients associated with hemorrhage (4.9%) 73 with reperfusion injury (45.1%) and 5 arterial re-occlusion (3.1%). Based on statistic analysis, ICA trunk and VBA had low ratio of successful recanalization with poor clinic prognosis MCA and ACA possessed high ratio of successful recanalization and good clinic outcomes. There was a significant relationship between arterial recanalization rate and clinic prognosis (r=0.86).Conclusions Successful recanalization of cerebral occlusive artery by using intra-arterial thrombolysis could improve clinic prognosis in patients with acute ischemic stroke. Clinical prognosis has a significant relationship with both initial treatment time and arterial recanalization rate.

Objective To explore the causes and preventive measures of symptomatic intracranial hemorrhage in 217 patients with acute cerebral ischemic stroke treated with local intra-arterial urokinase. Methods From February1999 to June 2004, 217 patients were treated for acute ischemic stroke with local intra-arterial urokinase in our hospital. Factors associated with symptomatic intracranial hemorrhage of intra-arterial thrombolysis were analyzed by Stepwise logistic regression to identify some factors relating the prediction symptomatic intracranial hemorrhage. Results Symptomatic intracranial hemorrhage occurred in 8 cases (3.7%). Predictors of the symptomatic intracranial hemorrhage were the elevated systolic blood pressure before therapy (odds ratio, 1.096; 95% CI, 1.006 to 1.194) and urokinase (UK) treatment (odds ratio , 1.068; 95% CL, 1.053 to 1.247). Risk of secondary symptomatic intracranial hemorrhage was increased with elevated systolic blood pressure. Other factors like age, initial treating time, NIHSS, diabetes and collateral circulation did not predict the symptomatic intracranial hemorrhage respectively. Conclusions Predictors of symptomatic intracranial hemorrhage after local intra-arterial infusion of urokinase for acute ischemic stroke were the elevated systolic blood pressure before therapy and urokinase (UK) treatment.