Objective We discussed the influence of early intervention on the prognosis of patients with severe brain injury. Methods Patients with severe brain injury (300 cases) were divided into the control group and the intervention group with 150 cases in each group. The control group adopted routine therapeutic method. The observation group received early sensory pathway exercises and limbs functional exercises. The prognosis of the two groups was compared. Results Statistical difference existed in prognosis and hospitalization time between the two groups (P<0.05). Conclusion Nursing intervention had positive significance on the prognosis of patients with severe brain injury.

mTOR signaling pathway is closely related to cell proliferation,cell cycle and other pathological processes about tumor.Rapamycin plays an anti-tumor effect through inhibiting mTOR,but it prone to drug resistance,which leads to limited clinical application.Its resistant mechanism is related with the activation of PI3K-Akt,which is regulated with negative feedback.Dual inhibitors of related proteins of mTOR pathway are expected to reverse the drug resistance.

AIM: To observe the changes of VEGF expression in different subfield of brain in tree shrews during hyperglycemia and focal cerebral ischemia, in order to explore the relationship between cerebral ischemia, hyperglycemia and VEGF. METHODS: High blood glucose in tree shrews was induced by intraperitoneal injection of streptozotoctin. Focal cortical thrombotic cerebral ischemia was induced by photochemical method in tree shrews. At 4 h, 24 h and 72 h after cerebral ischemia, the histopathological changes and hippocampal neuronal density were examined. VEGF expressions in the ischemic core, penumbra and contralateral cerebral cortex were detected by immunohistochemistry technique at different times after cerebral ischemia. RESULTS: The results of histopathological study showed that there was infarction zone in the exposured cerebral cortex at 4 h after photochemical reaction, and the damage was most severe at 24 h, subsequently accompanied with the glia multiplication and rehab reaction at 72 h. The animals in hyperglycemic ischemic group suffered from greater neurological lesion than the normoglycemic stroke animals, especially at 24 h (P<0.01) and 72 h (P<0.05) after cerebral ischemia. Immunohistochemical analyses of VEGF expression revealed that it started to increase at 4 h after brain ischemia in the penumbra, reached a peak at 24 h, and weakened at 72 h. The stimulated VEGF production was also observed in hyperglycemic only group. When hyperglycemia and brain ischemia were combined, the VEGF expression was higher than that in hyperglycemic only group (P<0.05). Compared to normoglycemic ischemic group, no additivity of the effects of hyperglycemia combined with brain ischemia was observed. CONCLUSION: (1) The model of experimental hyperglycemia and cerebral ischemia is replicated successfully by applying the method combined in vivo injection of streptozotocin in the lower primate tree shrew with thrombotic focal cerebral ischemia. (2) This study shows that hyperglycemia aggravates the focal cerebral ischemia damage. (3) Cerebral ischemia and hyperglycemia both can independently up-regulate VEGF expression, but there is no additional increase in VEGF expression when hyperglycemia combined with brain ischemia is applied.

Objective.To explore the prognostic influence factors of acute subdural hematoma.Methods The clinical data of 114 patients of acute subdural hematoma were analyzed retrospectively,they were divided into good prognosis group(62 patients) and poor prognosis group(52 patients) according to prognosis,analyzed the related factors for the prognosis were gualyzed in two groups.Results The prognosis of acute subdural hematoma with sex,weight was no significant correlation(all P＞0.05),but related with age,GCS score,pupillary changes,brain shift and hematoma volume(all P＜0.05).Conclusion Patient's age,GCS score,pupillary changes,brain shift and hematoma volume were the prognostic influence factors of acute subdural hematoma.

BACKGROUND: Cervical orthosis is one of the non-surgical therapeutic methods for the remedy of cervical deformities. The introduction of cervical orthosis into the clinical remedy of cervical deformities resulted by burn can maximally restore the cervical function of the patients.OBJECTIVE: To analyse the clinical applicative mode and the effects of moulded cervical orthosis (MCO) on cervical burn.DESIGN: A before-and-after verification study by employing pateitns as subjects.SETTING: Prosthetics and orthotic department in a provincial artificial limb center.PARTICIPANTS: Totally 19 cases including 13 males and 6 females after skin-transplantation due to serious burn in head, neck and chest admitted by the outpatient department of prosthetics center between January and September 2003.METHODS: Nineteen patients with cervical burn wore MCO. Return visits were made afterwards for the evaluation of the treatment effects of MCO.MAIN OUTCOME MEASURES: Resutls of therapeutic effectiveness evaluation.RESULTS: All nineteen patients with cervical deformities due to burn reached the effects of correcting cervical flexion and restoring cervical functions through wearing orthosis. The cervical functions restored entirely in seven cases, almost restored in eight cases and improved in four cases.CONCLUSION: MCO can be clinically used on cervical deformities resulted by burn and provide good effects on remedy and rehabilitation.

Objective To study the operating approaches of laparoscopic resection of ovarian benign cystic teratomas. Methods 67 patients underwent operative laparoscopy for ovarian cystic teratomas(23 ovarian cystectomies,44 oophorectomies or adnexectomies),including 27 patients who had cysts more than 8cm in diameter.In operation, a plastic bag was used and the abdominal cavity was abundantly flushed with warm physiologic saline.The larger cysts were aspirated to reduce the cysts and extracted through abdominal wall incision. Results Cyst rupture occurred in 17 cases (17/44) when cystectomy was performed. No cyst spillage occurred in all the oophorectomies and adexectomies.The mean operating time was (34?19)min.Blood loss was 3ml～7ml.No complications occurred and none of the patients needed conversion from laparoscopy to laparotomy.chemical peritonitis wes not seen in any of the patiants. Conclusions Laparoscopic surgery is safe and feasible for ovarian benign cystic teratomas and allows the removal of larger ovarian cysts.

Objective To explore the feasibitity of endoscopic thyroidectomy through armpit or breast approach. Methods 14 patients aged from 21 to 36 years.There were 11 cases of thyroid adenoma(9 cases of single side and 2 cases of double sides)and 3 cases of nodular goiter (1 case of single side and 2 cases of double sides).The mini-mcision was made at armpit or breast.A percutaneous chennel into thyroid gland was performed and the focus was removed with ultrasonic scalpel wnder endoscopy. Results All cases were operated on under endoscopy,in cluding 11 cases through armpit approach and 3 ones through breast approach.The mean operative time was 135(105～335)min.The average blood loss was 65ml through armpit approach and 135ml through breast approach respectively.There was no operative complications. Conclusions Thyroidectomy under endoscopy is a new secure method.

Objective To explore the feasibility of laparoscopic splenectomy and cholecysterctomy in the treatment of patients with congenital hemolytic anemia and cholecystolithiasis. Methods 8 patients with congenital hemolytic anemia and cholecystolithiasis were operated on by single-stage splenectomy and cholecysterctomy. Results The procedures were successfully accomplished in all patients. The average hospitalization was 7.5 days. No intraoperative and postoperative complications occurred in all of the 8 patients. Conclusions Single-stage laparoscopic splenectomy and cholecysterctomy is the therapy of choice for patients with congenital hemolytic anemia and cholecystolithiasis. The kind of operation is a minimally invasive approach and has the advantages of less injury and short hospital stay.

Objective To explore the feasibility of laparoscope combined with cholangioscope in the management of bile duct calculus. Methods 100 cases of extra- and/or intrahepatic bile duct underwent laparoscopic choledocholithotomy and T-tube drainage or intra- or postoperative cholangioscope was performed from July 1997 to December 2000. Results 42 out of 100 cases obtained intraoperative complete clearance of the bile duct calculus and other 58 cases achieved thorough clearance of calculus postoperatively once to six times. No residual calculus was found in 3 years of follow-up. Conclusions Laparoscopic and cholangioscopic surgery is an effective method for the treatment of bile duct calculus.

Alogliptin is a class of highly selective dipeptidyl peptidase-IV (DPP-IV) inhibitors.It can reduce the glucose level mainly through inhibiting the decomposition of dipeptidyl peptidase of glucagon peptide-1 (GLP-1), therefor promote insulin secretion.A large number of clinical trials have been conducted before and after algliptin get approved by Food and Drug Administration form different countries , which proves that alogliptin can remarkably reduce blood glucose without causing any serious risks.This article is mean to introduce most of the important clinical trials that has been conducted, from Phase I to Phase IV.