Objective To investigate the clinicial significance of continuous glucose monitoring(CGM)of patients with severe traumatic brain injury(sTBI). Methods By glucose monitoring method,80 patients with sTBI〔Glasgow coma score(GCS)3-8〕in Department of Critical Care Medicine of Qingyuan People's Hospital in Guangdong Province from January 2012 to December 2012 were divided into two groups:41 patients in CGM group and 39 in regular glucose monitoring(RGM)group. The continuous glucose monitoring system(CGMS)was applied to monitor glucose level in the CGM group,and the finger blood was taken by portable blood glucose meter in the RGM group. The two groups were treated with insulin on the basis of glucose level,respectively. The relationships between the condition of glycemic excursions and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score or prognosis and between the incidence of hypoglycemia and prognosis were seen in the two groups. Results The close linear correlations between APACHEⅡ score and glycemic excursion in two groups,i.e. mean amplitude of glycemic excursions(MAGE)and coefficient of variation of glucose(GluCV),were documented(both P<0.05). The MAGE of the especially severe patients(GCS 3-5)was obviously higher than that of severe ones(GCS 6-8),and with the increase of APACHEⅡ score,the MAGE of patients was gradually elevated,the difference being statistically significant(both P<0.05). The incidence of hypoglycemia(7.32%vs. 23.08%)and fatality rate of 30 days(12.20%vs. 30.77%)in CGM group were lower than those of RGM group(both P<0.05). The MAGE and fatality rate of 30 days were positively correlated in CGM group(r=0.597,P=0.007),and the GLuCV and fatality rate of 30 days were positively correlated in RGM group(r=0.622,P=0.019). Conclusion CGM is beneficial to timely observe condition of glycemic excursions in sTBI patients and avoid occurrence of hypoglycemia or hyperglycemia,guiding the treatment of insulin and improving patients' prognosis.

Objective To study an effective treatment of severe thoracic and abdominal injury accompanied with acute respiratory distress syndromes (ARDS).Methods Emergency treatments of 32 patients with severe thoracic and abdominal trauma accompanied with ARDS were retrospectively analyzed.Results All of the 32 patients had severe thoracic and abdominal injury,ribs fracture or pulmonary contuson.Anti-shock treatment,reasonable supplemental blood volume,rational mechanical ventilation and emergency operation were performed.Twenty-six patients were cured,and 6 died,with mortality 18.75%.Conclusions Early diagnosis,timely anti-shock treatment,early treatment for thoracic and abdominal injury and correct mechanical ventilation are essential for treating thoracic and abdominal trauma accompanied by ARDS,and is also an effective method for reducing mortality.

AIM:To investigate the autophagy induced by sepsis and acute kidney injury , and the regulation of phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in this process.METHODS: The rats were subjected to cecal ligation and puncture ( CLP) or sham operation .Histopathologic changes of the renal tissues were examined by HE staining .Blood urea nitrogen ( BUN) and serum creatinine ( SCr) were measured by chemical colorime-try.The protein expression of microtubule-associated protein light chain 3 I/II (LC3 I/II), beclin-1 and p-Akt at different time points after CLP was detected by Western blotting .In vitro, human proximal tubular epithelial cell line HK-2 were treated with LPS to induce autophagy .The protein expression of LC 3 I/II and p-Akt in the HK-2 cells after LPS treatment at different time points and different concentrations was detected by Western blotting .These molecules in HK-2 cells and apoptosis of HK-2 cells treated with LPS plus PI3K inhibitor or Akt inhibitor were also detected .RESULTS: Compared with sham group , the severe changes of renal histopathological injuries in CLP groups were observed , the levels of BUN and SCr in CLP groups were significantly increased .LC3 I/II, beclin-1 and phosphorylation of Akt gradually increased after CLP.After treatment with LPS, the expression of p-Akt (308) in the HK-2 cells gradually increased in a dose-and time-dependent fashion.The expression of beclin-1 and p-Akt (472) reached a peak at 8 h or 10 mg/L LPS treatment.Treat-ment with PI3K or Akt inhibitor down-regulated the expression of LC3 and promoted the apoptosis of HK-2 cells.CON-CLUSION:Autophagy in the kidney is induced by sepsis and acute kidney injury .PI3/Akt signaling pathway may be in-volved in this process .

Objective To observe the therapeutic effects of end-to-side and side-to-side portal vein-hepatic artery shunts (P-H shunt) in pigs with liver cirrhosis and portal hypertension.Methods There were 15 pigs in each group (control and experimental),and the P-H shunt was made in each animal to observe the process of blood flow into the liver and the reduction of portal vein blood pressure.Results The portal vein pressures before the P-H shunt of pigs in the control and experimental group were (20.51±0.74) cm H2O (1 cm H2O=0.098 kPa) and (30.82±2.53) cm H2O respectively (P＜0.05).Portal vein pressures 30 days after the P-H shunt were(19.75±0.84) cm H2O and (20.84± 1.36) cm H2 O respectively (P＞0.05).The portal vein pressure differences of pigs in the control and experimental group before P-H shunt were (7.20±0.34) cm H2O and (17.34±0.62) cm H2O respectively (P＜0.05).Pressures differences 30 days after the P-H shunt were (6.40±0.21) cm H2O and (7.84 ± 1.32) cm H2O respectively (P＜0.05).Splenic vein injection of methylene blue after the P-H shunt operation stained the liver well.No necrosis and hepatic encephalopathy occurred for 30 days after the P-H shunt,and the splenomegaly gradually returned to normal.Liver function was most affected after the operation and other biochemical markers were least affected.Conclusions The P-H shunt changed the channel of blood flow into the liver,the portal hemodynamic was not affected,and a new balanced mechanism was established to maintain the portal hemodynamic stability.However,further treatment was needed for liver function recovery.

Objective To explore the anatomic positional relationship of bronchial artery(BA)with esophagus and main bronchus on 320-detector CTA.Methods Original and post-processed images of 142 patients were observed.Type,origin,opening direction of BA as well as its concomitant relationship with esophagus were recorded.The positional relationship of BA with main bronchus was also recorded by fusing the images of BA and bronchial tree together.Results In 122 patients,273 BA were identified (146 on the right and 127 on the left).Right BA mainly ran simultaneously along the right and posterior edge of the esophagus (49.3%),while left BA mainly ran far gradually on the left side of the esophagus (82.7%).The left and right BA mainly ran along the middle thoracic esophagus, accounting for 58.3% and 42.5% respectively.45.2% of the right BA ran across the posterior edge of the right main bronchus and 60.6% of left BA ran simultaneously on the posterior and up edge of the esophagus.The most dividing direction of BA from the tho-racic aorta was 9 to 12 o’clock with a frequency of 74.2%.Conclusion The concomitant relationship with esophagus of the BA and the positional relationship with main bronchus of the BA could clearly be demonstrated on 320-detector CTA,thus providing availa-ble information and help for pulmonary and mediastinal sugery.

Objective:To investigate the clinical efficacy of extreme lateral interbody fusion (XLIF) in comparison with traditional posterior lumbar fusion in the treatment of lumbar infectious diseases.Methods:A retrospective study was conducted to analyze the clinical data of 30 patients with lumbar infectious disease who had been treated at Department of Spinal Surgery, The Third Hospital of Hebei Medical University from May 2017 to November 2019. There were 18 males and 12 females with an age of (53.3 ± 12.5) years. According to surgical procedures, the patients were divided into group A of 13 cases subjected to XLIF and group B of 17 cases subjected to posterior radical debridement plus lumbar fusion plus internal fixation. The 2 groups were compared in terms of demographic data like age and gender, intraoperative indexes, intervertebral fusion rate, and complications, as well as visual analogue scale (VAS) and Oswestry disability index (ODI) at 3, 6, and 12 months after operation.Results:There was no statistically significant difference between the 2 groups in the general clinical data before operation, showing comparability ( P>0.05). The operation time in group A was significantly shorter than that in group B [(88.5 ± 13.6) min versus (124.1 ± 15.4) min], and the intraoperative blood loss in group A significantly less than that in group B [(66.9 ± 18.4) mL versus (461.8 ± 150.6) mL] ( P<0.05). The VAS and ODI at 3, 6, and 12 months after operation in both groups were significantly lower than those before operation ( P<0.05). The VAS and ODI at 3 months after surgery in group A [2 (2, 2) points and 15.2% ± 5.0%] were significantly lower than those in group B [3 (2, 3) points and 19.5% ± 6.2%] ( P<0.05). There was no significant difference in the fusion rate between groups A and B at 12 months after operation (13 versus 16) ( P>0.05). Postoperatively, left thigh numbness and weakness was reported in 1 case in group A while 2 cases of cerebrospinal fluid fistula and 1 case of poor wound healing were observed in group B, showing no significant difference in the incidence of complications between the 2 groups ( P>0.05). Conclusion:Compared with the traditional posterior lumbar surgery, XLIF demonstrates advantages of less intraoperative blood loss, less tissue damage, shorter operation time, faster postoperative recovery in the treatment of lumbar infectious diseases with no obvious intraspinal abscess or nerve compression.

Objective:To analyze the clinical characteristics of adult-onset patients with familial neuronal intranuclear inclusion disease (NIID).Methods:The clinical data of 3 patients with familial NIID genetically diagnosed in Department of Neurology, Sixth Affiliated Hospital of Guangzhou Medical University in August 2021, January 2022, and August 2022 were collected. Their clinical manifestations, imaging features, pathological features, Notch2 N-terminal-like C ( NOTCH2NLC) gene mutation characteristics, treatment methods and prognoses were summarized retrospectively. Results:The age of these 3 patients was 73, 67, and 65 years, and the onset age was 68, 64, and 56 years, respectively. The clinical manifestations are highly heterogeneous. In patient 1, the nervous centralis, peripheral nerves and autonomic nerves were involved, appearing dementia, epilepsy, Parkinson's syndrome, muscle weakness and uremia; in patient 2, only the nervous centralis were involved, presenting symptoms of Parkinson's syndrome; in patient 3, peripheral nerves and autonomic nerves were involved, prominently presenting with repeated vomiting. Skull diffusion weighted imaging (DWI) showed asymmetric high signal at the dermo-medullary junction in 3 patients. Acidophilic inclusion bodies in some sudoriferous duct epithelial cells, and vascular endothelial nucleus were found in the skin biopsy of 2 patients. All 3 patients completed NOTCH2NL gene test, and all had GGC repeat amplification mutations with mutation frequency>134. These 3 patients were mainly treated symptomatically, and the disease was still progressed gradually. Conclusion:The clinical manifestations of familial NIID are highly heterogeneous; skull MRI characteristic changes and skin biopsy can help to diagnose NIID and NOTCH2NL gene detection can diagnose NIID.

Ablation Techniques ; adverse effects ; methods ; Humans ; Lung Neoplasms ; diagnostic imaging ; radiotherapy ; surgery ; Postoperative Complications ; prevention & control ; therapy ; Radio Waves ; therapeutic use ; Radiotherapy, Image-Guided ; adverse effects ; methods ; Treatment Outcome