Objective To study the surgical treatment and defect repair of the former skull base comminuted fracture.MethodsClinical data of 47 patients were retrospectively analyzed and emergency treatment,surgical debridement and defect repair were discussed consulting the literature..Results Restore score was determined according to international standards after surgical treatment for 3 months,in all cases,36 cases restored good,6 cases with light disability,3 cases with severe disability,2 cases died.Subsequent following-up revealed 31 cases completely recovered for normal work and life,14 patients survived in varying degrees of neurological function obstacles without encephalomeningocele.Conclusion The successful surgery is determined by thorough debridement,closing the damaged local subarachnoid,repairing reconstruct former dural skull base and defective bones.

Objective To investigate the clinical effect of cisplatin combined with cisplatin and radiotherapy in the treatment of glioblastomas patients receiving surgery.Methods 68 cases of glioblastomas patients with surgery were divided into control group (n=36) and treatment group (n=32).The control group was treated with temozolomide and radiotherapy;the treatment group was treated with cisplatin combined with temozolomide and radiotherapy.Short-term efficacy,adverse reactions,and survival time were documented during following up in both groups.Results The efficiency in the treatment group (87.5％) was significantly higher than that in the control group (66.67％),P＜0.05.There were no significant difference of adverse reaction including bone marrow inhibition,digestive tract symptoms,and psychiatric symptoms among the two groups,P＞0.05.The medium survival time of the treatment group (26.0 month) was significantly longer than that of the control group (17.5 month),P ＜0.05.There was no significant difference of 1-year survival rate between the treatment group (81.25％) with control group (63.89％),P＞0.05;however,2-and 3-year survival rate in treatment group (52.13％,31.25％) were significantly higher than that in the control group (27.78％,11.11％),P＜0.05.1-year progression free survival (PFS) rate of treatment group (68.75％) was significantly higher that of control group (41.67％),P＜0.05.Conclusion Cisplatin combined with temozolomide and radiotherapy can significantly improve the treatment efficiency without leading to higher rate of adverse reactions and significantly improve the 2-,3-year survival rate as well as 1-year progression free survival (PFS) rate in patients with glioblastomas,it is worth being promoted in clinical application.

Objective Set up a new performance management system with JCI standard that designed for improvement of nursing research.Methods Based on JCI standard,the new system was designed to be performed separately.Re-design a performance appraisal plan that will take account into nursing workload,care quality,nursing risk,nursing research,personal comprehensive quality etc.Results The average performance of the nurses in 42 wards had increased by 24.64％.In this system,research project application,and paper publishing was significantly improved.Projects Standardization was also improved.Enthusiasm of continuing education increased.Conclusions The system is helpful to improve the quality of nursing research.It can also help to assure the occupational stability of the clinical nurses and enthusiasm of nursing research.

This study was aimed to observe the influence on angiogenesis factor and expression of its receptor protein on estrogen-induced uterine fibroids rat models with Y i-Qi Xiao-Zheng (YQXZ) method, in order to explore the mechanism of this method in the inhibition of angiogenesis in the treatment of uterine fibroids. Castration and estro-gen-induced method were used in the establishment of guinea pig uterine fibroids rat model. And then, different doses of Chinese medicine of YQXZ method were given. The immunohistochemical method was used in the detection of microvessel density (MVD) and vascular endothelial growth factor (VEGF) protein expression of the uterine tissues. The RT-PCR method was used to detect the expression of VEGFR1 mRNA and VEGFR2 mRNA. Then, statistical analysis was given on indexes mentioned above. The results showed that compared with the normal control group, ex-pression of MVD, VEGF and VEGFR of uterine muscle tissues in the model group was significantly higher (P <0.01). Compared with the model group, Chinese medicine group of different doses showed different reducing. Among them, the high-dose group was the most obvious one. It showed that the high-dose Chinese medicine of YQXZ group was able to significantly inhibit the expression of MVD, VEGF and theirs receptors. It was concluded that YQXZ method can antagonize proliferation of the leiomyoma cell by inhibiting angiogenesis. Therefore, it may be one of the mechanisms of this method in the treatment of uterine fibroids.

The ultrastructural changes of atrial myocardial cells during hemorrhagic shock and after autotransfusion with the shedded blood were observed in rats,which were divided into control,hemorrhagic shock and auspeto-transfusion groups.It was found that there was a marked increase of atrial specific granules in the atrial myocardial cells during hemorrhagic shock.Striking ultrastructural changes of atrial myocardial cells were noted after transfusion of the shedded blood.Reduction in the number of atrial specific granules,in addition to mitochondrial swelling,reduction of the cristae,focal emptying of mitochondria,myelin-like figure in mitochondrial matrix,expansion of sar-coplasmic reticulum,dilatation of Golgi complexes and perinuclear space,and dissociation of myocardial disk,were remarkable.The findings suggest that atrial myocardila cells participate in the patho-physiological changes of hemorrhagic shock and autotransfusion.

Objective To obtain better insights into transmission dynamics of macrolide resistance genes between human and animal Enterococcus strains.Methods The antimicrobial susceptibility to 8 anti-bioties of 52 Enterococci isolated from animal and 55 Enterococci isolated from human was determined.PCR was used to detect the macrolide resistance genes ermB and mefA,tetracycline resistance genes tetM,and the integrase gene int of Tnl545 of the total 107 strains.Forty-nine ermB positive strains were chosen to be se-quenced.Filter mating experiments were taken.Results The resistance rate to erythromycin were 89.09% and 80.77%for isolates from human and animal:and resistance rate to tetracycline were 80.00%and 67.3l%for isolates from human and animal.respectively.All isolated Enterococci strains were found sensi-tive to vancomycin ermB was detected in 61.82% human Enterococci and 53.85% porcine ones.Identical er-mB gene sequences were found in animal and human Enterococci.Transfer of the ermB gene from porcine E.faecalis to human E.feacalis was successful.and the transfer frequency is 1.2×10-5.Conclusion En-terococci have a high resistance rate to erythromycin and some other antibio tics,especially in pediatric iso-lates:but still very sensitive to glycopeptide.ermB was the predominant genes for macrolide and tetracy-cline.Identical ermB gene sequences were present in animal and human Enterococci and that transfer of the ermB gene from porcine E.faecalis to human E.faecalis and vice versa is possible.but probably occurs at a low frequency.

Objective To evaluate the role of c-Jun N-terminal kinase (JNK) signaling pathway in the protective effect of isoflurane preconditioning and sevoflurane preconditioning against oxygen-glucose deprivation (OGD) injury in rat hippocampal slices. Methods Male adult SD rats weighing 270-290 g were anesthetized with ether and decapitated. The hippocampi were removed and sagittally sliced (400 μm thick) and placed in artificial cerebral spinal fluid aerated with 95% O2-5% CO2 . Ninety-six hippocampal slices were randomly divided into 8 groups (n = 12 each): control group (group C), OGD group, isoflurane preconditioning group (group Iso),sevoflurane preconditioning group (group Sevo) , SP600125 + isoflurane preconditioning group (group SP + Iso),SP600125 +sevoflurane preconditioning group (group SP + Sevo), DMSO + isoflurane preconditioning group (group DMSO + Iso) and DMSO + sevoflurane preconditioning group (group DMSO + Sevo). Electrophysiological technique was used to record the amplitude of population spike ( PS) in the stratum pyramidale of CA1 region and the degree of recovery of PS was calculated. The cell viability was determined by propidium iodide staining. Results Compared with group C, the degree of recovery of PS and cell viability were significantly decreased in the other groups ( P ＜ 0.01) . Compared with group OGD, the degree of recovery of PS and cell viability were significantly increased in groups Iso, Sevo, SP+Iso, SP+Sevo, DMSO+ Iso and DMSO + Sevo (P＜ 0.01). Compared with group Iso, the degree of recovery of PS and cell viability were significantly increased in group SP+Iso ( P ＜ 0.01) , while no significant change was found in group DMSO + Iso ( P ＞ 0.05) . Compared with group Sevo, the degree of recovery of PS and cell viability were significantly increased in group SP + Sevo ( P ＜ 0.01) , while no significant change was found in group DMSO + Sevo ( P ＞ 0.05). Conclusion Isoflurane preconditioning and sevoflurane preconditioning can attenuate the OGD injury to rat hippocampal slices through inhibiting JNK signaling pathway.

Objective To investigate the correlation of spinal canal stricture and intramedullary increased signal intensity (ISI) in patients with ossification of the posterior longitudinal ligament (OPLL). Methods 92 patients with OPLL were divided into 3 groups, those with the sagittal diameter remained ≥66.7% were as group A, 33.3%~66.7% as group B, and <33.3% as group C. The incidence of intramedullary ISI was recorded, and their neurological condition was assessed with the Japanese Orthopedics Association Assessment (JOA). Results ISI were found in 6 cases in the group A (20.7%), 17 cases in the group B (47.2%) and 19 cases in the group C (70.4%) (P<0.05). The score of JOA was (7.1±2.1) in the group A, (6.0±1.8) in the group B and (5.6±2.0) in the group C (P<0.05). Conclusion The incidence of intramedullary ISI increased with the severity of spinal canal stricture, and with more severe nerve damage in OPLL patients.

Objective:To evaluate the short-type single balloon enteroscope (SBE) to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis.Methods:Data of 10 patients with Roux-en-Y anastomosis who received short-type SBE assisting ERCP (14 times of ERCP, the short-type SBE group) from May 2019 to September 2019 and 55 patients who received conventional SBE assisting ERCP (87 times of ERCP, the conventional SBE group) from March 2016 to April 2019 were collected in Nanjing Drum Tower Hospital. Success rates and mean time of reaching the blind loop, diagnosis and treatment success rates, procedure time and complication incidence in the two groups were compared.Results:The mean time to reach the blind loop was significantly shorter in short-type SBE group than that in the conventional SBE group (17.1 min VS 23.4 min, P = 0.04). There were no significant differences in success rates of reaching the blind loop[100.0%(14/14) VS 95.4%(83/87)], the success rates of diagnosis and treatment[both 100.0% (14/14) VS 100.0% (83/83)], the mean procedure time (62.6 min VS 64.3 min) or complication incidence [21.4%(3/14) VS 16.1% (14/83) ] between the two groups (all P>0.05). Conclusion:ERCP assisted by either type of SBE is safe and effective in patients with Roux-en-Y anastomosis. However, short-type SBE is faster to reach the blind loop because of its unique design and easier manipulation.