Objective To investigate the effects of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients. Methods Twenty patients with severe traumatic brain injury aged 18-60 yr were randomly divided into 2 groups (n=10 each):ice bay cooling group (group IBC) and endovascular cooling group (group EVC).The state of consciousness was scored on a Glasgow coma scale (GCS).The patients had GCS scores of 3-8. The patients underwent emergency surgery.A probe of intracranial pressure monitor was placed during operation.In group EVC intravascular heat exchange catheters were inserted via femoral vein and connected to intravascular heat exchange system (CoolGard 3000, Alsius, USA). In group EVC body temperature was reduced to 34℃ and maintained at this level for 48 h. MAP, HR, body temperature and intracranial pressure (ICP) were continuously monitored and cerebral perfusion pressure (CPP) was calculated. Blood samples were taken from peripheral vein for determination of serum concentrations of neuron specific enolase (NSE), myelin basic protein (MBP) and S-100B (by enzyme linked immunosorbent assay) and GCS scores were assessed at 10 min before (baseline) and 12, 24, 48 and 72 h after operation. The state of consciousness was again assessed 3 months after operation and scored on Glasgrow outcome scale(GOS). Results ICP was significantly lower and CPP was higher after operation in group EVC than in group IBC. Serum concentrations of NSE, MBP and S-100B were significantly lower after operation in group EVC than in group IBC. Conclusion Mild hypothermia induced by endovascular cooling with heating exchange catheters can effectively reduce severe traumatic brain injury in patients.

Objective To investigate the clinical effect of interbody cages combined with pedicle screw system in treatment of spondylolisthesis. Methods Of 20 patients with spondylolisthesis, interbody cages combined with 10pedicle screw system was performed in 10 patients and spinal decompression combined with intervertebral bone grafting in another 10. Results All the patients were followed up for 8-12 months (average 10 months), which showed significant improvement in the syndrome. Of 10 patients treated with interbody cages combined with pedicle screw system, seven patients were evaluated excellent, two good and one fair. Of 10 patients treated with spinal decompression combined with intervertebral bone grafting, five patients were evaluated excellent, two good and three fair. Conclusion Interbody cages combined with pedicle screw system is an safe and effective surgery for spondylolisthesis.

ObjectiveTo study the risk factors and pathogenic characteristics of ventilator associated pneumonia(YAP). MethodsRisk factors of VAP,pathogens and drug resistance in 118 patients in ICU were analyzed retrospectively. ResultsThe incidence of VAP was 44.9％, and age, the mechanical ventilation time, state of consciousness,tracheotomy,the antibiotic combination are risk factors of incidence of VAP. 53cases of VAP(68.2％ )were infected by Gram negative bacilli,25.9％ were by Gram positive cocci,and 5.9％ were by fungi. Drug resistance was observed obviously. ConclusionThe occurrence of VAP was related with multiple factors. The gram negative bacteria are the major pathogens of VAP, and the rate of drug resistance was high. The occurrence of VAP could severely affect patients' prognosis.

Objective To investigate the performance of surgical management in facial skin malignancies.Methods From January 2000 to December 2006,65 patients with facial skin malignancies,including47 cases of basal cell carcinoma.10 cases of squamous cell carcinoma,3 cases of dermatofibrosarocoma protuberans,2 cases of malignant melanomas,and one case of malignant acanthoma,hemangioendotheliosar-coma and sebaceous carcinoma,respectively,were collected and managed with wide resection followed by reconstruction.In order to achieve a thorough resection,frozen sections were prepared and subjected to pathological examination during the operation process to ensure the margins of resection were free of malignancy.Reconstruction was carried out by direct closure,or with local random flaps,extended flaps,free skin grafts.Resuits All defects were managed by one-stage reconstruction.The survival rate of skin flaps/grafts was 100%,and a satisfactory appearance and function was achieved.During the follow-up from 6 months to 5 years,local relapse was observed in one patient with basal cell carcinoma and one with squamous eell carcinoma,lymphatic metastasis in one with squamous cell carcinoma.Distant metastasis occurred in a patient with malignant melanoma.who died consequently.Conclusions Thorough resection is the key to prevent relapse of facial skin malignancies after surgery.Appropriate reconstruction may favor the restoration of facial appearance,and local random flaps appear to be the best reconstruction strategy.

Objective To observe effect of intra-and post-operative mild hypothermia using an ice blanket on patients with severe traumatic brain injury (sTBI).Methods Twenty sTBI patients with Glasgow Coma Scale (GCS) of 3-8 points were included and were assigned to either ice bag cooling (Bag group) or ice blanket cooling (Blanket group) (n =10 each) according to random number table.Patients in Bag group had temperature reduction by placing ice bag over great vessels,whereas in Blanket group an ice blanket (temperature was set as the nasopharyngeal temperature of 33℃-34℃) was employed to have temperature reduction.Hypothermia therapy in the two group groups was initiated from the beginning of operation and continued for 48 hours after operation.Intracranial pressure,cerebral perfusion pressure (CPP) and GCS in both groups were recorded respectively at 10 minutes before operation (T0) and at 8,12,24,48 and 72 hours after operation (T1,T2,T3,T4 and T5).Venous blood of the two groups was harvested to assay the serum concentration of neuronspecific enolase (NSE),myelin basic protein (MBP)and S-100β at T0,T3,T4,-Ts and at 96 hours after operation (T6) by ELISA method.Glasgow Outcome Scale (GOS) was evaluated at postoperative six months.Results In Bag group,body temperature (T1-T5) of the patients had no significant decrease (P ＞ 0.05) and NSE (T3-T6),S-100β (T3-T6) and MBP (T4-T6) were increased (P ＜ 0.05 or 0.01) when compared with those in T0 ; intracranial pressure (T2-T5) was increased (P ＜ 0.05) and CPP (T3-T5) was lowered (P ＜ 0.05) when compared with those in T1.In Blanket group,body temperature (T1-T6) of the patients presented was decreased significantly (P ＜ 0.01) and NSE (T3-T6),MBP (T5-T6) and S-100β (T4-T6) were increased (P ＜ 0.05 or 0.01) when compared those in T0 ; intracranial pressure (T2-T6) was increased (P ＜ 0.05) and CPP had no significant changes (P ＞0.05) when compared with those in T1.By contrast with those in the same time points in Bag group,lower body temperature (T1-T5) (P ＜ 0.001),lower intracranial pressure (T2-T5),higher CPP (T3-T5) as well as lower NSE (T4-T6),MBP (T4-T6) and S-100β(T6)were observed in Blanket group (P ＜0.05 or 0.01).Changes of GCS and GOS in the two groups were no significance (P ＞0.05).Conclusion Intraoperative and postoperative mild hypothermia therapy using an ice blanket may alleviate the degree of brain injury in sTBI patients.

Objective:To establish and validate the rat model of syndrome of stagnation of liver qi,followed by a primary study on this model with 1H NMR based on metabonomics to explore the essence of syndrome of stagnation of liver qi. Methods:Twelve Wistar male rats were randomly divided into two groups(model group and control group).The rats of model group were restrained by special equipment for 21 days to get into stagnation of liver qi.The behavior,fluid consumption test and plasma CORT of rats were recorded.At 22th day,animals were sacrificed and biopsies of gastric mucosa and adrenal gland were collected for pathological check,and serum samples for 1H NMR spectroscopy.The NMR data were analyzed using principal component analysis.Results:There were abnormal behaviors,such as decrease of elusion,slackness,looser stools,and matte fur were observed among model group rats.After one week the body weight of model group was significantly lower than that of control group(P

Objective To study the rehabilitation effect of Bellidifolin for injuried sciatic nerve,and to explore whether ciliary neurotro-phic factor ( CNTF) is involved in this mechanism. Methods The right sciatic nerver of 225 male wistar rats was cut and sewed under mi-croscopy. Rats were devided into 5 groups,as control group,Bellidifolin 25 mg group,50 mg group、75 mg group and Mecobalamin group. The control group were injected sodium chloride,other groups were injected different dose of Bellidifolin and Mecobalamin. 1,3 and 5 weeks later, the motor nerve conduction velocity( MNVC) and gastrocnemius muscle cross-sectional area were detected,CNTF positive area were analysed by immunohistochemical method. Results There were differences among bellidifolin groups,control group and mecobalamin group in Nerve conduction velocity. Within Bellidifolin groups,50 mg group compared with 25 mg and 75 mg groups,there were statistically differences( P=0. 025). Three weeks after operation,gastrocnemius muscle cross-sectional area of control group,mecobalaming grop and Bellidifolin 25 mg group,50 mg group,and 75 mg group were(455. 06 ± 29. 38),(679. 03 ± 81. 48),(465. 31 ± 71. 55),(670. 24 ± 91. 26) and (669. 28 ± 78. 54) respectively,compared with control group and Bellidifolin 25 mg group,others had a significant difference(P<0. 05). CNTF expres-sion showed billidifolin 50 mg group are higher than others(P<0. 05). Conclusion Bellidifolin can improve the rehabilitation of injured sciatic nerve. CNTF is involved in this mechnism.

Objective To investigate Danhong in improving the movement function of reperfused rat after stroke. Methods Rats to make middle cerebral artery occlusion model,after 24 hours of reperfusion were divided into control group,high dose and low dose of Danhong groups and Venorruton group randomly. Rats in Control group were injected saline. High and low dose group were injected DanHong according to their weight,high dose as 14. 4 mg/kg,low dose as 3. 6 mg/kg. Venorruton group were injected Venorruton as 0. 04 g/kg. The infarcted square of rat brain was measured,the rats were tested with walking wood bar and two fore limb grasp strength. Results Rat infarcted squre in 24 hours and 3 days,control groups is the biggest,compared with others,there are statistically difference(P<0. 05). Score in each group of walking wood bar in 3rd days are (1. 30 ± 0. 91),(3. 78 ± 1. 72),(4. 18 ± 2. 05),(4. 63 ± 2. 45). Compared between control and other druge groups,there are statistically differnec(P<0. 05). There are statistically differences between control and other groups in two fore limb grasp testing(P<0. 05). Conclusion Danhong has the same effect which can improve the movement function to stroke rat as Venorruton.

A sensitive, rapid, simple and economical ultra-performance liquid chromatography–tandem mass spectro-metric method (UPLC–MS/MS) was developed and validated for simultaneous determination of imatinib, dasatinib and nilotinib in human plasma using gliquidone as internal standard (IS). Liquid-liquid extraction method with ethyl acetate was used for sample pre-treatment. The separation was performed on an Xtimate Phenyl column using isocratic mobile phase consisting of A (aqueous phase: 0.15% formic acid and 0.05% ammonium acetate)and B(organic phase:acetonitrile)(A:B=40:60,v/v).The flow rate was 0.25 mL/min and the total run time was 6 min. The multiple reaction monitoring (MRM) transitions, m/z 494.5→394.5 for imatinib, 488.7→401.5 for dasatinib, 530.7→289.5 for nilotinib and 528.5→403.4 for IS, were chosen to achieve high selectivity in the simultaneous analyses. The method exhibited great improvement in sensitivity and good linearity over the concentration range of 2.6–5250.0 ng/mL for imatinib, 2.0–490.0 ng/mL for dasatinib,and 2.4–4700.0 ng/mL for nilotinib.The method showed acceptable results on sensitivity,specificity, recovery, precision, accuracy and stability tests. This UPLC–MS/MS assay was successfully used for human plasma samples analysis and no significant differences were found in imatinib steady-state trough concentra-tions among the SLC22A5?1889T>C or SLCO1B3 699G>A genotypes(P>0.05).This validated method can provide support for clinical therapeutic drug monitoring and pharmacokinetic investigations of these three tyrosine kinase inhibitors(TKIs).

One hundred and seventy six consecutive patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator ( rt-PA ) in 4.5 hours from symptom onset during February 2009 to July 2013 were included in the study.Modified Rankin Scale was used to evaluate the recovery of neurological functions.Patients were divided into good ( 0 -1 ) or poor ( 2 -6 ) outcome groups according modified Rankin Scale score.Univariate analysis and multivariate logistic regression analysis were used to determine the differences of clinical data between the two groups.The age of patients with good outcome was significantly lower than that of poor outcome group [ ( 61.4 ±11.5 ) vs.( 69.0 ± 13.2) years,P =0.000].Compared to patients with poor outcomes, patients with good outcome group showed lower rate of diabetes [ 13%( 12/93 ) vs.29%( 24/83 ) , P =0.009 ] , lower blood glucose level [(5.05 ±0.97) vs.(5.83 ±1.72) mmol/L,P=0.020], higher uric acid level[(404.4 ±151.7) vs.(345.6 ±107.5) μmol/L,P=0.028],shorter onset to treatment time [(1.92 ±0.94) vs.(2.30 ±1.01) h, P=0.019],lower baseline National Institute of Health Stroke Scale score [(14.0 ±5.2) vs.(16.0 ± 6.2),P=0.025],lower systolic blood pressure level at 2 h[(140.8 ±18.3) vs.(149.0 ±18.9) mmHg (1 mmHg=0.133 kPa),P=0.005]and 24 h [(137.6 ±21.9) vs.(147.1 ±17.4) mmHg,P=0.009] after thrombolysis.Logistic regression analysis showed that uric acid levels were not related to hemorrhagic transformation independently (P =0.172,OR =0.965,95%CI:0.917 -1.016), but were related to outcome independently (P=0.047,OR=0.957,95%CI:0.916-0.999).