Objective To summarize efficacy of surgical treatment of acute extradural hematoma. Methods The clinical data of 67 acute extradural hematoma(combined skull fracture) surgery cases were retrospectively analyzed from January 2006 to December 2009. Results Cerebral hernia and the time from the formation of cerebral hernia to operation affacted the prognosis of acute extradural hematoma severely. It was controversial that removal of skull bone or not after cerebral hernia. Conclusions The timely diagnosis and operation of acute extradural hematoma was positive correlation to the prognosis. The simple removal of skull bone impacted limitedly on the prognosis of patients with GCS 3.

ObjectiveTo investigate value of minimally invasive surgical approach in patients with hypertensive intracerebral hemorrhage in primary hospital.MethodsAccording to the operation procedure,93 cases with basal ganglia hemorrhage were divided into three groups:1.minimally invasive surgery group A (n =37 ),2.ventricular puncture and drainage,lumbar cistern drainage group B(n=10),3.usual operation group C( n =46).Estimated operation effect with computed tomography in 24 hours after operation.Case fatality rate and complication incidence were analyzed after three months of operation according to the Glasgow Outcome Scale (GOS).ResultsMinimally invasive surgery group A had the highest hematoma clearance rate (82.7 ± 8.1 ) ％,group B (78.6±6.5 ％ ),group C (50 ±10％ ).The incidence rate of rebleeding was 8.1％ in group A( n =3 ),10％ in group B ( n =1 ),34.8％ in group C (n =16).The grade Ⅳ of the GOS and the grade Ⅲ of the GOS was respectively 93.8％ and 6.5％,case fatality rate was zero.Conclusion The minimally invasive surgical operation not only lead to less tissue damage and decrease rebleeding,but also improve neurological functional recovery.

Objective To explore the significance, indicatinos and complications of emergency tracheotomy for patients with severe craniocerbral trauma. Methods The clinical data of 42 patients with severe craniocerbral trauma were retrospectively analyzed. Results Of them, 20 were basically cured (48%), 12 had improvement (29%) ,3 were released from the hospital(7 % ), 1 survived(2 % ) in a vegetative state,and 6 died(14%). Conclu- sion Emergent tracheotomy should be performed on patients with severe craniocerbral trauma to resolve respiratory tract obstruction, improve air current, prevent cerebral anoxia, prevent and treat pulmonary infection, increase the therapeutic efficacy.

Objective To explore the dynamic change and clinical signiticance of plasma D-damer level in patients with cerebral hemorrhage and acute craniocerebral injury.Methods 50 patients with cerebral hemorrhage and 40 patients with acute craniocerebral injury were selected,The enzyme-linked immunosorbent assay (ELISA) was used to measure plasma D-dimer level in two groups of patients after onset,and the results were compared with 40 healthy controls.Results The levels of plasma D-dimer in the patients with cerebral hemorrhage were 1.59mg/L,2.10mg/L,1.03 mg/L,0.82mg/L at 3 h,6h,12h,2d after onset,which in the patients with acute craniocerebral injury were 1.61mg/L,2.02mg/L,1.01mg/L and 0.67mg/L,respectively.And the plasma D-dimer levels were 0.50mg/L,0.49mg/L,0.47mg/L,0.48mg/L in the control group at 3h,6h,12h and 2d after onset.The levels of plasma D-dimer in the patients with acute craniocerebral injury were significantly higher than those in the control group,and the differences were statistically significant (t =9.35,12.17,4.03,3.05,all P ＜ O.05).At 7d after onset,the D-dimer levels in the cerebral hemorrhage group and acute craniocerebral injury group were 0.53mg/L,0.55mg/L,respectively,which of the control group was 0.47mg/L,there was no statistically significant difference among the three groups(P ＞ 0.05).Conclusion Cerebral hemorrhage patients and acute craniocerebral injury patients have high coagulation and fibrinolytic activity in brief increase trend,dynamic observation of plasma D-dimer level in patients with cerebral hemorrhage and acute craniocerebral injury is helpful to determine courses,condition and evaluate prognosis.

Objective:To study the effect of immune regulation of the rat Leydig cells in testis infection.Methods:UU was injected into the bladders of rats,which mimics the ascending infection pathway,while using culture medium injection as control.After 1,2,3 w respectively,the rats were sacrificed to observe the pathological alterations in testis by histological examination.Leydig cell were also separated from testis,the comparation of levels of IL-1,IL-6,TGF-?,Fas and FasL mRNA expression among control and UU infected groups was made by RT-PCR.Results:Compared with control,in UU infected group,the levels of IL-1,IL-6,TGF-? increased,the level of Fas decreased,the level of FasL increased.Conclusion:Leydig cell can play the role of immune regulation,with the expressing changes of IL-1,IL-6,TGF-?,Fas and FasL in the infection of testis in rat.

Objective To study the role of hemorrhagic shock in severe eraniocerebral trauma with stress ulcer.Methods The clinical data of 428 patients of sevcere craniocerebral tramna in 0111"hospital from January 2001 to January 2009 were divided into two groups according to whether or not merging with hemorrhagic shock.The incidence of stress ulcer in two groups was calculated and the PH ofgastric juice and blood in different periods were measured.Results Stress ulcerdevelopedin 56.4%(75/133)ofpatientswith hemorrhagic shockand 12.5%(37/295)of patients with hemorrhagic shock-free,with significant difference between the two groups(P＜0.01).Blood pH differed significantly(P＜0.01)on 2d,but not on 7d(P＞0.05)after injury between the two groups.There wag no significant difference in gastric juice pH on 2d and 7d after injury between the two groups(P＞0.05).Condusion Hemorrhagie shock phys an important role in severe craniocerebral trauma with stress deer.

Objective To explore the measures to prevent acute encephalocele during the decompressive craniotomy in the patients with severe brain injury.Methods The clinical data of 28 patients with severe brain injury,who were treated by extended fronto-temporo-prietal craniotomy were analyzed retrospectively.The sequential dural ineision(SDI)was performed during the operation in all the patients.Results The catastrophic encephalocele did not occur in all the cases even if very hish intracranial pressure wag caused by fulminant brain swelling in some cases.The total removal of hematomas was achieved in 19 cases,but there still was extensive hemorrhage in the operative fieId in 4 eases and secondary intracranial hematomas in the other regions in 5 cases observed on postoperative CT scan.The disappeared basal cistern and the third ventricle could be observed again in 12 eases.According to GOS,9 patienm obrained good recovery,5 was moderately disabled,4 were severely disabled,2 vegetatively survived,and 8 died.Condusion The encephalocele,which is easily produced by rapid decompression,is prevented by eontrollable decompression as early as possible and SDI in the patients with especially severe brain injury.

Objective To study the value of reverse CT scan in eliminating the respiratory motion artifacts in the thoracic CT of the patients with chronic obstructive pulmonary diseases(COPD).Methods Fourty patients with COPD were randomly selected and underwent chest CT examinations with the technique of GR-Helical including directive and reverse CT scans.The images were blindly evaluated by three experienced doctors.Results In 40 cases,the respiratory motion artifacts were present in 17 cases,among them,70.59%(12/17) artifacts was in lower lung field,and 64.7%(11/17) artifacts occurred in the people over 60 years of age.The rate of artifact was 35% at directive scan,while it was reduced to 7.5% at reverse scan,the image quality was improved at 27.5%.There was statistical significance in eliminating respiratory motion artifacts between two scanning method (P＜0.05).Conclusion Reverse CT scanning can effectively eliminating or reducing the respiratory motion artifacts in lower lung field,it is the best choice of scanning mode in elderly patients with COPD.

Objective To compare the clinical features and surgical outcomes of hepatocellular carcinoma (HCC) combined with portal venous tumor thrombus (PVTT) and hepatic venous tumor thrombus (HVTT) or bile duct tumor thrombi (BDTT),and analyze the effects of different tumor thrombus (TT) types and different surgical methods for TT on prognosis.Methods The retrospective cross-sectional study was conducted.The clinical data of 220 HCC patients with lymphovascular invasion (LVI) who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University between January 2004 and December 2014 were collected.Of 220 patients,140 were combined with PVTT,36 with HVTT and 44 with BDTT.According to patients' conditions,they underwent tumor and TT resection,and tumor resection + TT removal or single TT removal.Observation indicators:(1) comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT;(2) surgical and postoperative situations;(3) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 2015.Measurement data with normal distribution were represented as (x)±s.Comparisons among 3 indicators were analyzed using the one-way ANOVA,and comparisons between 2 indicators were analyzed using the t test.Comparisons of count data were analyzed using the chi-square test.The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT:number of patients with Child-pugh A,Child-pugh B and peritoneal effusion,tumor diameter and cases with tumor capsule were respectively detected in 133,7,23,(10±4)cm,91 in HCC patients with PVTT and 35,1,4,(9±4)cm,27 in HCC patients with HVTT and 35,9,16,(6±4)cm,15 in HCC patients with BDTT,with statistically significant differences (x2 =12.693,10.408,F=11.300,x2 =17.188,P＜ 0.05).(2) Surgical and postoperative situations:of 140 HCC patients with PVTT,51 underwent tumor and PVTT resection,89 underwent tumor resection + PVTT removal through incising portal vein;68 received postoperative transcatheter arterial chemoembolization (TACE).Thirty-six HCC patients with HVTT underwent tumor and HVTT resection;24 received postoperative TACE.Of 44 HCC patients with BDTT,23 underwent tumor and BDTT resection,21 underwent tumor resection + BDTT removal through incising common bile duct;29 received postoperative TACE.(3) Follow-up and survival:① 220 patients were followed up for 1-73 months,with a median time of 12 months.The median survival time,1-,3-and 5-year survival rates were respectively 12 months,48.2％,25.0％,15.4％ in 140 HCC patients with PVTT and 28 months,77.1％,45.6％,24.5％ in 36 HCC patients with HVTT and 36 months,88.6％,48.3％,24.6％ in 44 HCC patients with BDTT,with a statistically significant difference in survival (x2 =13.316,P＜0.05).② Of 140 HCC patients with PVTT,49 were in type Ⅰ PVTT,and median survival time,1-,3-and 5-year survival rates were respectively 20 months,60.3％,32.6％ and 17.1％;70 were in type Ⅱ PVTT,and median survival time,1-,3-and 5-year survival rates were respectively 13 months,51.4％,26.0％ and 17.3％;21 were in type Ⅲ PVTT,and median survival time,1-,3-and 5-year survival rates were respectively 7 months,9.5％,4.8％ and 0,showing a statistically significant difference in survival (x2=18.102,P＜0.05).The median survival time,1-,3-and 5-year survival rates were respectively 21 months,72.5％,42.5％,26.2％ in 51 patients undergoing tumor and TT resection and 9 months,40％,14.4％,0 in 89 patients undergoing tumor resection + PVTT removal through incising portal vein,showing a statistically significant difference in survival (x2=24.098,P＜0.05).③ Of 36 HCC patients with HVTT,17 were detected in right HVTT,and median survival time,1-,3-and 5-year survival rates were respectively 14 months,64.7％,20.2％ and 0;10 were detected in left HVTT,and median survival time,1-,3-and 5-year survival rates were respectively 53 months,80.0％,70.0％ and 38.9％;9 were detected in middle HVTT,and median survival time,1-,3-and 5-year survival rates were respectively 40 months,88.9％,61.0％ and 30.5％;showing no statistically significant difference in survival (x2 =5.951,P＞0.05).④ Of 44 HCC patients with BDTT,24,6 and 14 were respectively detected in type Ⅰ,Ⅱ and Ⅲ BDTTs,and median survival time,1-,3-and 5-year survival rates were respectively 38 months,87.5％,60.4％,34.9％ in type Ⅰ BDTT patients and 26 months,83.3％,16.7％,0 in type Ⅱ BDTT patients and 35 months,78.6％,50.0％,21.4％ in type Ⅲ BDTT patients,showing no statistically significant difference in survival (x2 =5.312,P＞0.05).Of 44 patients,median survival time,1-,3-and 5-year survival rates were respectively 38 months,91.3％,59.5％,34.3％ in 23 patients undergoing tumor and TT resection and 26 months,85.7％,35.7％,15.3％ in 21 patients undergoing tumor resection + TT removal through incising common bile duct,showing no statistically significant difference in survival (x2 =2.071,P＞0.05).Conclusions HCC patients with PVTT have larger tumor diameter and worse liver dysfunction,and are prone to peritoneal effusion.HCC patients with different LVI undergo surgery.There is better prognosis in HCC patients with BDTT,and good prognosis in patients with HVTT,while poorer prognosis in patients with PVTT.The postoperative survival of HCC patients with PVTT is associated with TT type,and patients will have better prognosis after tumor resection + TT removal if TT type is confirmed earlier.The postoperative survival of HCC patients with BDTT is not associated with TT type,tumor resection + TT removal maybe prolong postoperative survival time.

Non-invasive mechanical ventilation(NIV)is increasingly being used as a respiratory support technique in clinical practice.However,the pressure-related injuries should not be overlooked.In order to prevent local pressure injuries caused by NIV technology,a series of preventive measures have been adopted in clinical work.These measures include the use of dressings to provide pressure relief to the local skin.Currently,in clinical practice,when using preventive dressings,nurses need to cut them themselves based on the physiological structure of the patient's nose,forehead,or face.However,precise cutting can be challenging.If the dressing is cut too small,it may not provide adequate prevention,and if it's cut too large,it can cover too much skin,affecting the nurse's observation and the patient's comfort.Additionally,during NIV treatment,the preventive dressings used may become curled or displaced,requiring nurses to re-cut and replace them.This process inevitably leads to material wastage,increasing the cost of dressing use for patients.Moreover,the cutting tools used must meet infection control requirements,adding to the nursing workload and reducing the compliance of nurses in changing dressings.Our research team has designed a ready-made pressure injury prevention dressing component for use with NIV masks to prevent pressure injuries to the nasal and facial areas.It is precisely designed,flexible in composition,easy to use,and can provide multiple usage modes.It effectively combines emergency care with pressure relief measures,reducing the occurrence of pressure injuries to the patient's nasal and facial areas.This improves patient comfort and treatment compliance,facilitates technology-based nursing,and enhances clinical efficiency.It has significant clinical application value and has been granted a National Utility Model Patent(ZL 202020529121.6).