Objective To analyze the clinical characteristics and treatment Methods of severe com?plications after percutaneous tracheotomy( PDT) in neurosurgery patients,and to provide reference for the treat?ment and rescue of these patients. Methods A retrospective analysis of 578 cases after PDT was performed in Neurosurgery Intensive Care Unit ( NSICU ) of Xuanwu Hospital of Capital Medical University from 2005 to 2015. The types of complications,treatment method and prognosis were analyzed. Follow?up was 3 months to 1 year. Results Eighteen cases with severe complications,including bleeding,wound infection,asphyxia caused by tracheal mucosa suffocation,airway stenosis caused by granulation tissue,subcutaneous emphysema and neu?momediastinum,etc. After treatment and active rescue,most patients recovered,no patients die directly associated with surgery. Conclusion PDT plays an important role in the treatment of patients in NSICU,but it is still pos?sible to have serious complications,so physicians must understand and be prepared for complications,and pay more attention to prevent poor prognosis.

Objective To analyze the perioperative clinical character of the severe neurological complications in intracranial aneurism treated with stent-assisted coiling(SAC). Methods 203 cases of intracranial aneurysms patients treated by SAC were enrolled retrospectively(ruptured aneurysm group 45 cases and un-ruptured,aneurysm group 158 cases)and the perioperative clinical character of the serious neurological complications(11 cases)was further analyzed. Results The total rate of serious neurological complication was 5. 4%,11 cases of patients with 13 aneurysms got 13 stents. In the ruptured aneurysm group, 5 cases(11. 1%)suffered severe neurological complications,including intraoperative bleeding in one case, postoperative stent-related ischemia in one case,both 2. 2% . Postoperative bleeding 2 cases(4. 4%),and one case of bleeding during anesthesia induced stage(2. 2%). In the unruptured aneurysm group,intraoperative bleeding in three cases,and postoperative stent-related ischemia in three cases,both 1. 9% . No bleeding case during anesthesia induced stage or postoperative period. Although active rescue treatments were performed, 8 patients eventually died,and the total mortality rate was 3. 9% . Conclusion Intracranial aneurysms patients following SAC treatment may suffer from bleeding,ischemia,severe neurological complications, severe disability,and even die. So,we have to strengthen perioperative management.

Objective To evaluate the efficacy of decompression craniotomy for the treatment of patients with malignant cerebral venous thrombosis. Methods The clinical characteristics,treatment process and follow - up results of 9 patients with malignant cerebral venous thrombosis treated with decom-pression craniotomy in Beijing Xuanwu Hospital,Capital Medical University from February 2010 to August 2015 were analyzed retrospectively. Results The preoperative Glasgow coma scale (GCS)score of 9 patients was < 9,7 survived and 2 died. The conditions of 6 patients (preoperative GCS 8 in 1 case, GCS 6 in 3cases,GCS 4 in 1case,and GCS3 in 1case)were improved in combination with other control intrac ranial pressure treatment after craniotomy decompression surgery. They recovered well (Glasgow outcome scale, GOS 4 -5). One patient (preoperative GCS 4)had severe disability (GOS 3)after procedure;1 (preoperative GCS 3)was in deep comatose state at the time of discharge and died of complications after 1 month;1 patient with bilateral mydriasis (GCS 5)was treated with craniotomy decompression,and his pupils did not return,he had circulatory failure,gave up the treatment,and died. All patients did not have the complications directly related to the surgery. Seven patients survived and continued to use warfarin anticoagulation therapy for at least 6 moths after discharge. The controlled international normalized ratio (INR)was 2 -3. They were followed up for 3 months to 5 years. The head MRI re-examination did not reveal the recurrence of venous sinus thrombosis. The modified Rankin scales (mRS)score was 0 to 2 in 6 cases after 3 months. The other one (preoperative GCS 4)had ipsilateral cerebral hemorrhage on surgical site at 4 months after discharge. He was improved after withdrawing anticoagulation and using conservative treatment for 20 d (mRS score 4). Conclusions For patients with malignant cerebral venous thrombosis,when the patients have acute cerebral hernia or hernia tendency,the emergency craniotomy decompression surgery may save lives and enable patients to achieve a better quality of life.

Objective To investigate the distribution of TCR Vβ genealogy and clonal expansion in peripheral blood after infusing mesenchymal stem cells (MSC) in patients with chronic GVHD. Methods The complementarity determining region 3 (CDR3) of 24 TCR Vβ subfamily genes in peripheral blood mononuclear cell from 1 case with cGVHD after allogeneic hematopoietic stem cell transplantation (Allo-HSCT),who were treated with infusing MSC,were amplified using RT-PCR. The blood samples were taken at the first and the fifth day after 1st infusion; and the first day,the 10 th day and the 20 th day after the second infusion of MSC,as well as the MSC infused as control . The products were labelled by fluorescein and then analyzed the CDR3 size with gene scan technique to determine the clonality of T cells. Results There were no expression of TCR Vβ subfamily with the MSC infused and after the 1st day of the first infusion of MSC. Then 3,10,14,10 Vβ subfamilies clones are appeared at the other time points,of which were polyclone and oligoclone predominately. In the same time,the manifestations of cCVHD have been abated. Conclusion MSC played a certain role in reviving the immune function of the patients after Allo-HSCT and mitigating the disease of chronic GVHD. Lineage analysis of TCR Vβ subfamily showed some predominant expression.

Objective Targeted temperature management (TTM) is often used in neuro-critical care to minimize secondary neurologic injury and improve outcomes. Evidence-based implementation guideline of TTM was generated from clinical questions relevant to TTM implementation for neuro-critical care by experts recruited by the American Neuro-critical Care Society. Interpretation of this guideline would help the readers to understand the implementation of TTM, bring benefits to standardization of TTM application, and contribute to the solving of specific issues related to TTM implementation.

Objective: To investigate the value of ultrasound in the localization of peripherally inserted central catheter (PICC) in neonates. Methods: A retrospective analysis of the PICC catheterization was conducted at Department of Neonatology, Beijing Chaoyang District Maternal and Child Healthcare Hospital from June 2017 to December 2018.The ultrasound monitoring was performed immediately after PICC catheterization.The probe was placed into the midline position of the lower xiphoid or the subclavian parasternal line for scanning, and it would be the PICC if a high-echo " equal sign" was observed by ultrasound.It was believed that the PICC was successfully placed when ultrasound detected that the PICC tip was located in the junction of inferior vena cava or superior vena cava in the right atrium. Results: (1)Among 112 infants with PICC catheterization, 103 cases (92.0%) were accurately placed, 9 cases (8.0%) were not placed in the ideal site, among them, 2 cases were too deep, 4 cases were too shallow and 3 cases were catheter heterotopia.The tip position was accurate after the readjustment under ultrasound monitoring in those patients whose the first ultrasound showed the tip position was not ideal.(2)The PICC indwelling time was as short as 2 days (removed due to severe arrhythmia) and as long as 56 days with an average of (15.1±10.7) days.(3)The catheter-related complications occurred in 3 cases with an incidence of 2.7%. Conclusions Using ultrasound to determine the PICC tips position is accurate and reliable, which is worthy of extensive application in the neonatal wards.

Based on clinical training and practice experience of the authors in recent years, the training practice of critical ultrasonography in standardized training of neurosurgical specialists were summarized in the study. The study also discussed the appropriate training mode and training requirements of critical ultrasonography in standardized training of neurosurgical specialists, from the aspects of basic theory training, clinical application training of critical ultrasonography and special training of craniocerebral ultrasound, training precautions and training assessment, so as to provide comprehensive evaluation and treatment strategies for neurological intensive patients.

Objective To explore the clinical characteristics of drug-induced liver injury(DILI),and provide reference for early clinical recognition,diagnosis and treatment of DILI.Methods Clinical datas of 65 patients with DILI hospitalized in the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2019 to December 2023 were retrospectively analyzed,and their general conditions,using drugs,distribution type of liver injury,traditional Chinese medicine treatment and outcome were statistically analyzed.Results A total of 65 patients were included,including 27 males and 38 females,with an average age of(46.40±19.19)years old.The majority of patients were 41 to 60 years old.Chinese herbal medicine and Chinese patent medicine accounted for the highest proportion of drugs inducing DILI(30.8％).Hepatocyte injury was the most common type of DILI,with 39 cases.The main clinical manifestations of DILI patients were fatigue,abdominal discomfort,aversion to oil,yellow eyes,yellow urine and so on.In the treatment of traditional Chinese medicine,liquorice root was the most frequently used,with a frequency of 60.7％.After active treatment,59 patients were cured and discharged from hospital.Conclusion Hepatocyte injury is the main type of DILI.Clinical monitoring of hepatotoxicity of traditional Chinese herbal medicine and Chinese patent medicine should be strengthened to reduce the damage to liver caused by adverse drug reactions.

Objective To investigate the influencing factors and demand of clinical frontline nurses' thesis writing in He'nan Province providing a theoretical basis for improving the clinical nurses' thesis writing willingness and level.Methods From May 2015 to May 2016, a self-designed questionnaire was used to survey 1200 clinical nursing staff from 12 hospitals in He'nan Province by Lottery method and random number table method for general information, hinder factors of thesis writing, and the assist and guidance needed in thesis writing. The descriptive analysis, Kruskal-Wallis rank sum test, independent sample t-test, single factor analysis of variance, linear correlation analysis, multiple linear regression analysis were used to analyze the influencing factors of nurses' paper writing.Results A total of 1086 effective questionnaires were recycled. The differences of number of papers wrote by nurses who were different in hospital level, marital status, age, nursing age, work intensity, professional title, and final education were statistically significant (H=16.293, 206.350, 31.775, 56.393, 136.605, 484.600, 48.913;P<0.05). Hospital level, age, nursing age, marital status, professional title, and final education were all positively correlated with the number of papers (r=0.119, 0.161, 0.215, 0.410, 0.639, 0.093;P<0.01), while work intensity was negatively correlated (r= -0.367,P<0.01). The scores of five dimensions of factor hindering the thesis writing from high to low were lack of thesis writing skills (16.16±2.37), literature search obstacles (15.14±2.47), lack of statistical software operation (15.49±1.72), clinical sensitivity of problems identifying (14.63±2.74) and poor data collection methods (13.27±2.14). Multiple linear regression analysis showed that hospital level, professional title, nursing age and final education level were the main factors that impeded the writing of clinical nurses, which explained 93.1％ of the total variation. The main thesis writing training needs were research topic selection and project design, paper writing methods and skill training, and hospital policy support.Conclusions Thesis writing number by Class Ⅲ hospital nursing staff was higher than that by Class Ⅱ hospital in He'nan Province. Nursing age, title and final education level were the main factors hindering the clinical nurses from thesis writing. Hospital managers needs to train clinical nurses on paper writing according to the medical system of our country.

The training of neurocritical care is an important component in standardized training of neurosurgical specialists. As a subspeciality of neurosurgery, as well as with the characteristics of critical care medicine, neurocritical care carries its own discipline features. Based on clinical training and practice experiences, the training mode and practice experience were summarized, including basic requirement, theory training, skill training, research training, humanity accomplishment improvement and evaluation stan-dard, in order to discuss the appropriate training mode of neurocritical care in standardized training of neurosurgical specialists, improve the training methods and advance the training effectiveness, and provide reference for cultivating qualified and comprehensively developed neurosurgical specialists.