Objective To explore the risk and prognosis factor of cranial nerve injury in non acquired immune deficiency syndrome(AIDS)-related cryptococcal meningitis.Methods The clinical data of 115 patients with non-AIDS-related cryptococcal meningitis were reviewed retrospectively.Clinical characteristics,initial antifungal therapies and outcome of these patients were analyzed.The risk and prognosis factor was performed by multivariate Logistic regression.Results The incidence of cranial nerve injury was 35.7％(41/115).Among of them,the involved ratio was 48.8％ (20/41),39.0％ (16/41),24.4％ (10/41),12.2％ (5/41),7.3％ (3/41),4.9％ (2/41) in optic nerve,oculomotor nerve,acoustic nerve,abducent nerve,olfactory nerve,facial nerve.Predictive risk factor for cranial nerve injury was duration of diagnosis (OR =1.057,95％ CI 1.003-1.112),low cerebrospinal fluid cell count and intracranial hypertension were also the independent predictive factors (both P ＜ 0.05).In the follow-up peried,72.2％ (26/36) patients who had cranial nerve injury were fully recovered,with a median time of 0.5-24.0 (3.8 ±1.7) months.The independent predictors of recovery were numbers of nerve involved (OR =0.241,95 ％ CI 0.067-0.801,P =0.023) and combination therapy (OR =10.328,95 ％ CI 2.087-51.026,P =0.006).Condusions Cranial nerve injury is common in non-AIDS-related cryptococcal meningitis.Delay in diagnosis,intracranial hypertension and low cerebrospinal fluid cell count are independent predictive factors.Less cranial nerve involvement and combination therapy predicts recovery.

Objective To explore the effect of multiparameter electroencephalogram(EEG)-guided anesthesia management on EEG burst suppression(BS)and postoperative delirium(POD)in elderly patients undergoing lower abdominal laparoscopic surgery.Methods A total of 100 elderly patients,48 males and 52 females,aged 65-85 years,BMI 18.5-28.0 kg/m2,and ASA physical status Ⅱ or Ⅲ,were enrolled for lower abdominal surgery under general anesthesia.Patients were randomly divided into two groups:multiparameter group and single parameter group,50 patients in each group.In multiparameter group,multiparameter EEG monitoring with patient statu index(PSI),spectral edge frequency(SEF),burst suppression ratio(BSR)and density spectral array(DSA)were used to guide the depth management of anesthesia.In single parameter group,single parameter PSI was used to guide the depth management of anesthesia.The total area under the hypotensive threshold of MAP(AUTMAP)was calculated,and the amount of anesthetic used during the operation and the use of vasoactive drugs,duration of anesthesia,extu-bation time,duration of PACU stay,and postoperative hospitalisation days were recorded.HR,MAP,PSI,and SEF were recorded before the induction of anesthesia,5 minutes after induction of anesthesia,5,30,and 60 minutes after incision,and at the end of surgery.The incidence,duration,and maximum BSR of in-traoperative BS,as well as the incidence of POD 1,2,and 3 days after surgery were recorded.Results There was no significant difference in AUTMAP values between the two groups.Compared with single parame-ter group,intraoperative propofol and remifentanil dosage were significantly decreased(P＜0.05),awak-ening time,PACU stay,and postoperative hospitalization time were significantly shorter in multiparameter group(P＜0.05),the PSI was significantly increased 5,30,and 60 minutes after incision and at the end of surgery,and the SEF was significantly increased 5 minutes after induction of anesthesia,5,30,and 60 minutes after induction and the end of surgery(P＜0.05).Compared with single parameter group,inci-dence of intraoperative BS was significantly decreased,duration of BS was significantly shorter,smaller maximum BSR was significantly decreased,and incidence of POD on 1 day after surgery in multiparameter group(P＜0.05).Conclusion Anesthesia management guided by multiparameter EEG can inhibit the oc-currence of BS,mitigate the degree of BS,and reduce the incidence of POD in elderly patients undergoing abdominal surgery.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.