Objective To investigate the discussion of risk factors of severe head injury with multiple organ dysfunction syndrome.Methods The clinical data of 149 cases with severe traumatic brain injury patients were retro-spectively analyzed,and the risk factors in patients with severe traumatic brain injury were collected,which may affect MODS,such as gender,age,GCS score,associated injuries,chronic underlying diseases,infections and other details, statistically analyzed were combined with incidence of MODS.Results (1 )Univariate analysis results could be seen, age,chronic underlying diseases,admission GCS score,extensive brain parenchymal damage,merge large organ dam-age,brain herniation,concurrent infection,massive blood transfusion were risk factors of MODS severe traumatic brain injury(χ2 =12.962,11.725,11.021,13.894,11.486,12.031,12.967,13.078,P=0.023,0.025,0.027,0.017, 0.023,0.018,0.021,0.019).(2)MODS rate and the number of risk factors were positive correlation(r=0.528,P=0.021).(3)With the increase of the number of mortality in patients with MODS organ dysfunction occurred signifi-cantly increased,MODS patients in this group,the two organs mortality was 17.4%,the three organs were 46.7%, four or more mortality was 87.5%(χ2 =11.735,13.933,12.748,P=0.028,0.019,0.025).Conclusion Age, chronic underlying diseases,GCS low,extensive parenchymal injury,combined injury,the occurrence of hernia,com-plicated by infection,massive blood transfusion were independent risk factors for brain injury,which should be payed attention.

BACKGROUND:At present, scholars general y believe that the physical and chemical properties of titanium mesh are fine as easy plastic, easy cutting, good corrosion resistance and wear resistance, non-magnetic, less effect on CT or MRI results, good histocompatibility and resistance to stress. The titanium mesh is regarded as an ideal material for cranioplasty. ＜br> OBJECTIVE:To explore the clinical feasibility of primary reconstruction of comminuted and open skul fracture with titanium mesh. ＜br> METHODS:Sixty-two cases of comminuted and open skul fracture were analyzed retrospectively, including 49 males and 13 females, aged 7-69 years. Among these 62 patients, 30 patients underwent debridement and then after 6-12 months, they received titanium mesh reconstruction, serving as control group. Another 32 cases underwent debridement and titanium mesh reconstruction in the same time as observation group. Al the cases were fol owed-up for 1-2 years to observe wound healing, complications and hospitalization cost. ＜br> RESULTS AND CONCLUSION:During the fol ow-up, no wound infection and intracranial infection occurred in the two groups. The incidence of intracranial hematoma, epilepsy, and other complications was higher in the control group than the observation group (P＜0.05), and the hospitalization cost was also higher in the control group than the observation group (P＜0.05). These findings indicate that primary reconstruction with titanium mesh is feasible in the treatment of comminuted and open skul fracture and can significantly reduce the incidence of complications and hospitalization costs.

OBJECTIVE The N-methyl-D-aspartate(NMDA)receptor has been shown to be strongly associ-ated with rapid antidepressant effects.GW043 is a com-pound with a novel structure that we designed and syn-thesized to act on the NMDA receptor(NMDAR).METH-ODS In this study,we first confirmed the target of GW043 using a receptor binding assay.We observed the effect of GW043 on NMDAR currents in vivo and in vitro assays using a membrane clamp technique with a view to characterizing the function of GW043.We investi-gated the antidepressant effect of GW043 in rodent behavioral models such as FST,TST and CUMS.Fur-thermore,we explored the mechanism of GW043 onset using Western blotting,BrdU staining,Golgi staining and electrophysiological techniques.RESULTS GW043 interacts with high affinity only at the NMDAR.Electro-physiological studies have indicated that GW043 is a par-tial agonist of NMDAR.Meanwhile,behavioral experi-ments were conducted to confirm the antidepressant effect of GW043 in rodents.The mechanism study found that GW043 regulate synaptic plasticity through LTP and BDNF/mTOR pathways and increase the number of new-born neurons to cause antidepressant effects.GW043,a partial agonist of NMDAR,reversed depression-like behav-ior in rats by modulating synaptic plasticity,suggesting an antidepressant effect.CONCLUSION The results suggest that GW043 is a partial agonist of NMDA recep-tors and has significant antidepressant effects.

Objective:To establish a HPLC method for determinating 9 components simultaneously in Swertia chirayita. Methods:By useing water Sunfire C18 column (4.6 mm× 250 mm,5 μm); Gradient elution was carried out with methanol-0.05% phosphoric acid solution as mobile phase. Setting the column temperature at 30 ℃, the flow rate at 1.0 ml/min, and the detection wavelength at 254 nm.Results:9 components showed good linear relationship within the injection quality range. The recovery rates of wertiamarin, Gentiopicroside, Angelica glycosides,Mangiferin, Isolysine, Gentianoside, Diol glycoside, 8-hydroxy-1,3,5 trimethoxyketone, and Daisy leaf gentinone were 95.38%, 92.41%, 95.14%, 91.87%, 92.24%, 92.51%, 95.08%, 91.72%, 95.74% ( n=6). Conclusion:The method is simple, efficient, sensitive, accurate, economical and practical, with repeatability and stability. It could provide reference for the quality control and comprehensive utilization of Swertia chirayita.

Objective To investigate the clinical efficacy of intracranial pressure monitoring in ventricular puncture for patients with posttraumatic diffuse brain swelling under guidance of real-time intraoperative ultrasound. Methods Sixty-seven patients with posttraumatic diffuse brain swelling, admitted to and accepted intracranial pressure monitoring in ventricular puncture under real-time intraoperative ultrasound in our hospital from January 2015 to December 2017, were chosen as experimental group; and other 71 patients with posttraumatic diffuse brain swelling, admitted to and accepted traditional intracranial pressure monitoring in ventricular puncture in our hospital from January 2012 to June 2014, were chosen as control group. The clinical data were retrospectively analyzed, and the success rate of primary puncture and complications were compared between the two groups. Results The success rate of primary puncture in the experimental group was 100％ (67/67), and that in the control group was 77.5％ (55/71), with significant difference (P<0.05). No catheter-related infection was noted in either group. Only one patient in study group had puncture tract bleeding, while 9 patients in the control group had puncture tract bleeding; abnormal puncture location was noted in 8 patients of the control group, including 5 failing to be punctured in the ventricle, one puncturing to the contralateral ventricle, and two having excessive puncture depth; occurrence of postoperative complications in study group was significantly lower than that in control group (P<0.05). Conclusion Real-time intraoperative ultrasound-guided puncture ventricle drainage is superior to conventional bind-puncture in traumatic patients with diffuse brain swelling, and can be widely used in clinical practice.

Objective: To study the toxicological effects of Nao-de-kang on rats. Methods: According to the digital table, SD rats were randomly divided into blank group and Nao-de-kang small dose group(3.85g/kg), high dose group(7.71g/kg) and maximum tolerated dose group(77.14g/kg), 20 rats in each group, half male and half female.All groups were treated for 12 weeks, and the maximum tolerated dose group was treated for 1 week.The animal activity during treatment, the blood routine indicators, blood biochemical index and the organs for pathological examination were recorded and compared. Results: There was no mortality in the dose group of rats in the experimental period.The weights of 4 groups had no statistically significant differences during treatment(F=0.688, 0.540, 0.121, 0.065, 0.128, 0.239, 0.199, 0.378, 0.127, 0.446, 0.906 and 0.665, P=0.562, 0.585, 0.886, 0.937, 0.880, 0.788, 0.820, 0.687, 0.881, 0.642, 0.410 and 0.518), male and femal′s red blood cell(RBC)(♀: F=0.178, P=0.910, ♂: F=0.119, P=0.948), hemoglobin(HGB)(♀: F=0.046, P=0.987, ♂: F=0.072, P=0.975), hematokrit(HCT)(♀: F=0.126, P=0.944, ♂: F=0.054, P=0.983), platelet(PLT)(♀: F=0.515, P=0.675, ♂: F=0.500, P=0.685), white blood cell(WBC)(♀: F=0.078, P=0.972, ♂: F=0.057, P=0.982), eosnophils(Eos)(♀: F=0.078, P=0.972, ♂: F=0.057, P=0.982), lymphocyte(Lym)(♀: F=0.078, P=0.972, ♂: F=0.057, P=0.982), neutrophilic granulocyte(Neu)(♀: F=0.134, P=0.939, ♂: F=0.090, P=0.999), alanine aminotransfease (ALT)(♀: F=0.572, P=0.637, ♂: F=0.200, P=0.896), aspartate aminotransferase(AST)(♀: F=0.572, P=0.637, ♂: F=0.200, P=0.896), total protein(TP)(♀: F=0.665, P=0.579, ♂: F=0.343, P=0.795), albumin(ALB)(♀: F=0.533, P=0.663, ♂: F=0.668, P=0.577), triglyceride(TG)(♀: F=0.843, P=0.480, ♂: F=0.561, P=0.644), cholesterol(CHOL)(♀: F=0.245, P=0.864, ♂: F=0.046, P=0.987), glucose(GLU)(♀: F=0.216, P=0.884, ♂: F=0.095, P=0.963), urea nitrogen(BUN)(♀: F=0.172, P=0.914, ♂: F=0.203, P=0.894)and creatinine(Cr)(♀: F=0.172, P=0.914, ♂: F=0.203, P=0.894) had no statistically significant differences. Conclusion Nao-de-kang has no obvious side effect.

【Objective】 To explore the effects of nerve growth factor （NGF） on bladder function and axon injury repair in rats with traumatic spinal cord injury （t-SCI） so as to explore its molecular mechanism. 【Methods】 Traumatic spinal cord injury model was constructed in 30 male SD rats by modified Allen’s beating method. The rats were randomly divided into sham-operation group， injury group and NGF group， with 10 rats in each group. We used the BBB score to observe the motor function of the rats’ hind limbs before and after the operation. The BL-420 biometer experimental system detected the urodynamics. Six anterior roots of the left lumbar taken from the distal end of the anastomosis were stained with toluidine blue， and the number of myelinated axons was counted. We used HE to stain rat bladder tissue， TUNEL to stain the rats’ severely injured spinal cord， and observed the spinal cord apoptosis rate. Western blotting was used to detect the protein expressions of Raf-1， p-MEK-2， MEK-2， ERK1/2， and p-ERK1/2 in spinal cord tissue. 【Results】 The BBB score results showed that there was no difference in the scores of the sham-operation group， the injury group and the NGF group before the operation. After the operation， the scores of the injury group and the NGF group were significantly lower than those in the sham-operation group （P<0.05）. The maximum detrusive pressure and the number of axons were significantly lower in the injury group than in the sham-operation group and the NGF group （P<0.05）， but the residual urine volume and bladder cell apoptosis rate in the injury group were notablely higher than those in the other two groups （P<0.05）. HE staining results showed that bladder edema in the injury group was severe and the detrusor muscle structure was loose， while the NGF group had reduced bladder injury. Western blot results showed that the protein ratio of p-ERK1/2/ERK1/2 and p-MEK-2/MEK-2 and the expression of Raf-1 in the injury group were significantly higher than those in the sham operation group and NGF group （P<0.05）. However， there was no significant difference between the sham operation group and the NGF group in maximum detrusive pressure， the number of myelin axons， residual urine volume， bladder cell apoptosis rate， or protein （P>0.05）. 【Conclusion】 NGF may hinder the conduction of MAPK/ERK pathway， thereby affecting the repair of axon damage and improving the bladder function of t-SCI rats.