Objective:Small cell lung cancer (SCLC) is a highly malignant tumor with a high risk of brain metastasis (BMs). The purpose of this study was to evaluate the clinical factors affecting the occurrence of BMs in patients with stage IIB-IIIB SCLC who achieved complete remission (CR) after thoracic radio-chemotherapy.Methods:Clinical data of 191 patients with stage IIB-IIIB SCLC who achieved CR after thoracic radio-chemotherapy in Zhejiang Cancer Hospital from January 2009 to April 2016 were retrospectively analyzed. Common clinical factors related to the risk of BMs, including gender, age, thoracic radiotherapy dose, combined mode of radiotherapy and chemotherapy, pretreatment serum NSE and LDH, whether PCI was performed, TMN stage and PS score, were analyzed using log-rank method for univariate analysis, COX regression method for multivariate analysis and Kaplan-Meier method to plot the survival curve.Results:Univariate analysis showed that pretreatment LDH level≥240IU, pretreatment NSE ≥17 ng/ml and no PCI were positively correlated with the risk of BMs (all P＜0.05). Multivariate analysis showed that the risk of BMs was only positively correlated with pretreatment LDH≥240IU [HR: 1.90, 95%CI(1.07-3.37), P=0.029], and no PCI [HR:2.08, 95%CI(1.17-3.72), P=0.013]. Conclusion:Pretreatment serum LDH levels provide important value for predicting the risk of BMs in patients with stage IIB-IIIB SCLC who achieve CR after thoracic radio-chemotherapy.

Objective:To investigate the effect of microsurgery by modified pterional approach in the treatment of temporal lobe epilepsy under intraoperative cortical encephalon electricity graph (EEG) monitoring.Methods:The clinical data of 32 patients with temporal lobe epilepsy who were admitted to the Department of Neurosurgery of Shangqiu First People's Hospital from January 2012 to June 2021 were retrospectively analyzed, all patients underwent microsurgical resection of epileptogenic foci by modified pterional approach under cortical EEG monitoring.Results:The postoperative follow-up was from half a year to 6 years. According to the Tan's classification, 25 cases (78.1%(25/32)) of seizures disappeared completely, 3 cases (9.4%(3/32)) of seizures decreased by more than 75%, and 4 cases (12.5%(4/32)) of seizures decreased by more than 50%. Isotropic hemianopia occurred in 1 case (3.1%) after operation, and there was no operative death.Conclusion:Microsurgical resection of epileptogenic foci through modified pterional approach under intraoperative cortical EEG monitoring was a safe and effective method for the treatment of temporal lobe epilepsy.

Adaptation, Psychological ; Adolescent ; COVID-19 ; Child ; China ; Cross-Sectional Studies ; Female ; Humans ; Male ; SARS-CoV-2

Objective　To evaluate the role of ultrasound in evaluating hemodynamic parameters for post-operative patients with ocular ischemia syndrome.Methods　 to direction of ophthalmic artery blood flow，68 cases of OIS patients were divided into forward blood flow group（n=41） and reverse blood flow group（n=27）. The carotid stenosis rate and PSV using ultrasound and BCVA were detected.Results　Before operation，carotid artery stenosis rate of forward blood flow group was significantly lower than reverse blood flow group（P<0.05） Before and after operation，posterior ciliary artery PSV and BCVA of forward blood flow group was obviously higher than reverse blood flow group（P<0.05）. The ophthalmic artery，posterior ciliary artery and central retinal artery PSV after operation in the two groups were significantly higher than those before operation（P<0.05）. BCVA after operation in forward blood flow group was significantly higher than before operation（P<0.05）.Conclusion　Ultrasound can accurately evaluate carotid artery stenosis，PSV，and provide reference value for evaluating hemodynamic changes.

Objective To systematically evaluate the efficacy and safety of craniotomy and decompressive craniectomy in the treatment of acute subdural hematoma.Methods A systematic search was performed in PubMed,EMbase,the Cochrane Library,Web of science,China National Knowledge Infrastructure (CNKI),WanFang Data,and CBM databases up to June 2018 for the studies that provided comparisons between craniotomy hematoma evacuation and decompressive craniectomy for acute subdural hematoma.For the two categorical variables,the Odds Ratio (OR) and its 95％ Confidence Interval (95％ CI) are used.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias of the included studies.The meta analysis was performed using Stata/SE 12.0 software.Results A total of 8 studies were included in the meta analysis,of which 828 patients underwent craniotomy,and 663 patients underwent decompressive craniectomy.Meta analysis results showed that patients receiving decompressive craniectomy had a significantly lower Glasgow Coma Scale (GCS) when they first had symptoms.The residual rate of acute subdural hematoma in the decompressive craniectomy group was significantly lower than that in the craniotomy group (P =0.015),but there was no significant difference in the rate of reoperation.The incidence of poor outcome at following was lower in the craniotomy group compared with decompressive craniectomy group (50.1％ vs 60.1％;P =0.003).Similarly,the mortality of the craniotomy group was lower than that of the decompressive craniectomy group (P =0.002).Conclusions Decompressive craniectomy may be the first choice for acute subdural hematoma,but the study is influenced by many factors and is not sufficient to provide definitive evidence.

Objective To discuss the application of deep hypothermic circulatory arrest in surgical treatment of complex thoracoabdominal aortic aneurysms and its near-midterm effect.Methods The clinical data of 34 cases of thoracoabdominal aortic aneurysm in the center from August 2009 to June 2018 were analyzed retrospectively.All the patients underwent surgery under deep hypothermic circulatory arrest.There were 23 males and 11 females; aged 23 -67 years, mean(42.26 ±10.96) years old; Crawford type Ⅰ in 12 cases and Crawford type Ⅱ in 22 cases; aneurysms with a maximum diameter of 50 -120 mm, mean(65.26 ±16.09) mm;Marfan syndrome 15 cases, atherosclerosis 14 cases, aortic coarctation in 5 cases;22 cases of hypertension;28 cases of first aortic surgery, 6 cases of re-aortic surgery.Surgical transthoracic and abdominal incision, ext-racapsular approach, femoral artery and inferior vena cava intubation, deep hypothermic circulatory arrest technique to complete proximal anastomosis, arterial tube reconstruction of intercostal artery, abdominal organ blood supply artery and four The bifur-cated vessels were anastomosed, and the bifurcated vessels were anastomosed with the "Y"type artificial blood vessel trunk. The bilateral radial arteries were end-to-end anastomosis in the 10 mm artificial blood vessels of the "Y"type artificial blood vessels.Results There were no complications of cranial nerve system in the whole group , deep hypothermic circulatory arrest (17.68 ±4.88) min, ventilator assist time(34.88 ±16.04) hours, postoperative renal failure in 5 cases, after CRRT treat-ment After recovery, 1 case of paraplegia after operation, muscle strength recovered after cerebrospinal fluid drainage and de-compression, and 1 case died in the whole group, and died of multiple organ failure.The patients were followed up for 3 months to 5 years, and the results were satisfactory.The survivors did not die.The survivors did not die.However, 5 patients underwent thoracic aortic replacement under deep hypothermic circulatory arrest for the first time , and 4 patients underwent reo-peration because of distal vasodilation.The reconstructed intercostal artery occlusion occurred in 4 patients, but no paraplegia occurred.Conclusion When cross clamping the aorta is not feasible,it is safe to perform proximal anastomosis with deep hy-pothermic circulatory arrest.

Objective To evaluate the results of a hybrid procedure for treating Stanford type B1C aortic dissection. Methods In our center, 49 patients with Stanford type B1C aortic dissection underwent supra-arch branch vessel bypass and thoracic endovascular aortic repair (TEVAR) from December 2013 to December 2017. There were 33 males and 16 females with an average age of 60.4±5.5 years. Left common carotid artery to left subclavian artery bypass (n=29), right common carotid artery to left common carotid artery and left subclavian artery bypass (n=18), left common carotid artery to left subclavian artery and right common carotid artery to right subclavian artery bypass (n=2) were performed. Results Early mortality rate was 2.0% (1/49). Forty-eight patients survived postoperatively. The follow-up rate was 100.0% (48/48). The patients were followed up for 6 to 47 (26.8±11.9) months postoperatively. Chest pain relapsed in one patient 8 months after the operation. The whole aorta CTA showed type A1S aortic dissection in one patient 6 months after the operation, and the re-operation was satisfactory. There was no endoleak or paraplegia. Conclusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for type B1C aortic dissection.

OBJECTIVE:To improve community pharmaceutical care so as to promote the rational drug use of community resi-dent and improve the quality of life. METHODS:By analyzing the situation of community pharmaceutical care,the pharmaceutical care of community pharmacists was improved by changing pharmaceutical care mode,actively developing the propaganda of ratio-nal drug use,strengthening retraining of clinical pharmacists. RESULTS:With the help of Hongkou district quality control group, many hospitals of the district signed thepharmaceutical linkage assistance agreement. Through the efforts of Hongkou district quality control group and many hospitals,community pharmaceutical care was improved and the propaganda of rational drug use has achieved certain results. CONCLUSIONS:Through exploration and practice,the pharmaceutical care levels of community phar-macists have been improved and the rational drug use of community residents has been promoted.

Objective To explore the current status of healthcare-associated infection (HAI)and antimicrobial use in a children’s hospital.Methods Prevalence rates of HAI and antimicrobial use among hospitalized patients at 0∶00—24∶00 of May 1 ,2014 were investigated by combination of bedside visiting and medical record reviewing. Results A total of 1 027 patients were investigated,8 patients developed 10 times of infection,prevalence rate of HAI was 0.78%,prevalence case rate was 0.97%.HAI mainly occurred in patients in blood center (n =4),the main infection site was respiratory tract(upper respiratory tract,n=2;lower respiratory tract,n=2),antimicrobial usage rate was 62.12%.Antimicrobial usage rate,purpose of antimicrobial use,and combination use of antimicro-bial agents among different departments were all significantly different(all P <0.05).The departments with top 3 antimicrobial usage rates were neonatal center(89.69%),emergency center(76.00%),and comprehensive depart-ment(73.91 %);except department of ophthalmology-otorhinolaryngology-stomatology (preventive antimicrobial use accounted for 57.89%)and department of surgery(therapeutic antimicrobial use accounted for 26.32%),the other departments mainly used therapeutic antimicrobial agents;department of ophthalmology-otorhinolaryngology-stoma-tology,heart center,and neurological rehabilitation center mainly adopted single medication treatment (all >95%), two-drug combination rate in neonatal center accounted for 48.28%,three-drug combination rate in blood center ac-counted for 30.30%.Conclusion Routine surveillance on departments and sites of high HAI incidence should be in-tensified in children’s hospitals,training on knowledge of HAI among health care workers should be strengthened, and antimicrobial should be used rationally.

The realizing of standard service under the present status of medical moral depends on the construction of medical moral engineering in every level and in diversified forms, Strengthening of management, and arising of the interest and efficience of construction medical moral. Therefore, standard service is the object of medical moral construction engineering under market economy,Meanwhile, the deepening of standrd service also depends on medical moral construction engineering.