Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective:To evaluate the effect of hydrogen on lipopolysaccharide (LPS)-caused inflammatory responses in BV-2 microglia and the role of autophagy.Methods:The BV-2 microglial cells cultured in vitro were seeded in 6- or 96-well plates and were divided into 4 groups ( n=24 each) using a random number table method: control group (group C), group LPS, hydrogen-rich medium group (group H) and autophagy inhibitor 3-methylpurine group (group 3-MA). In group C, cells were cultured in MEM culture medium supplemented with 15% fetal bovine serum for 24 h. In group LPS, LPS was added at a final concentration of 1 μg/ml, and cells were incubated for 24 h. In group H, LPS was added at a final concentration of 1 μg/ml, the culture medium was replaced with a hydrogen-rich medium at a final concentration of 0.6 mmol/L, and cells were incubated for 24 h. In group 3-MA, 3-methylpurine was added at a final concentration of 2 mmol/L, and the subsequent treatment was similar to those previously described in group H. The cell survival rate was detected by CCK-8 assay.The concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-10 and transforming growth factor-β (TGF-β) in supernatant were detected by enzyme-linked immunosorbent assay.The percentage of ionized calcium binding adaptor molecule-1 (Iba-1) +, Iba-1 + CD86 + and Iba-1 + CD206 + cells was detected by flow cytometry.The expression of microtubule-associated protein 1 light chain 3 Ⅰ (LC3 Ⅰ), LC3Ⅱ, Beclin-1 and p62 was detected by Western blot, and the ratio of LC3Ⅱ/LC3Ⅰ was calculated. Results:There was no significant difference in the cell survival rate among the four groups ( P>0.05). Compared with group C, the concentrations of TNF-α, IL-6, IL-10 and TGF-β and percentage of Iba-1 +, Iba-1 + CD86 + and Iba-1 + CD206 + cells were significantly increased in LPS, H and 3-MA groups, the LC3Ⅱ/LC3Ⅰ ratio and Beclin-1 expression was significantly down-regulated, and p62 expression was up-regulated in LPS and 3-MA groups, and the ratio of LC3LC3Ⅱ/LC3Ⅰ and Beclin-1 expression was significantly up-regulated, and p62 expression was down-regulated in group H ( P<0.05). Compared with group LPS, the concentrations of TNF-α and IL-6 were significantly decreased, the concentrations of IL-10 and TGF-β were increased, the percentage of Iba-1 + and Iba-1 + CD86 + cells were decreased, the percentage of Iba-1 + CD206 + cells was increased, the LC3Ⅱ/LC3Ⅰ ratio and Beclin-1 expression was up-regulated, and p62 expression was down-regulated in group H ( P<0.05), and no significant change was found in the above indexes in group 3-MA ( P>0.05). Compared with group H, the concentrations of TNF-α and IL-6 were significantly increased, the concentrations of IL-10 and TGF-β were decreased, the percentage of Iba-1 + and Iba-1 + CD86 + cells was increased, the percentage of Iba-1 + CD206 + cells was decreased, the LC3Ⅱ/LC3Ⅰ ratio and Beclin-1 expression was down-regulated, and p62 expression was up-regulated in group 3-MA ( P<0.05). Conclusion:The mechanism by which hydrogen reduces LPS-caused inflammatory responses in BV-2 microglia is related to enhancing autophagy and inhibiting microglial activation.

Objective To determine the median effective dose(ED50)of dezocine inhibiting re-sponses to insertion of laryngeal mask airway(LMA)when combined with propofol in the elderly pa-tients.Methods American Society of Anesthesiologists physical statusⅠorⅡ patients, aged 66-75 yr, with body mass index of 20-25 kg∕m2, were included in this study.Anesthesia was induced with dezocine at the initial dose of 0.2 mg∕kg and propofol which was simultaneously administered by target-controlled infu-sion.The initial target plasma concentration of propofol was 1 μg∕ml, and the concentration was increased in increments of 0.5 μg∕ml every 3 min until the target concentration 3 μg∕ml was achieved.LMA was inserted when bispectral index value reached 50-60.The dose of dezocine was determined using the up-and-down method.The response to insertion of LMA was defined as positive when patients developed coughing, laryn-gospasm and∕or body movement during insertion or within 3 min after insertion.The dose of dezocine was in-creased∕decreased in the next patient if the insertion response was positive or negative.The ratio between the two successive doses was 0.8.The ED50and 95% confidence interval of dezocine inhibiting responses to in-sertion of LMA were calculated.Results When combined with propofol, the ED50of dezocine inhibiting re-sponses to insertion of LMA was 0.126 mg∕kg, and the 95% confidence interval was 0.110-0.143 mg∕kg.Conclusion The ED50of dezocine inhibiting responses to insertion of LMA is 0.126 mg∕kg when combined with propofol in the elderly patients.

Objective To determine the median effective concentration (EC50) of lidocaine for obturator nerve block (ONB) guided by a nerve stimulator in patients undergoing transurethral resection of bladder tumor (TURBT).Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients with bladder tumor,scheduled for elective TURBT,required ONB according to the results of cystoscopy or CT examination performed before operation,with body mass index of 19-30 kg/m2,aged 18-64 yr,were enrolled in the study.ONB was performed with lidocaine using the suprainguinal approach under the guidance of a nerve stimulator.The concentration of lidocaine was determined by up-and-down sequential trial.The initial concentration of lidocaine was 1.5％,and the ratio between the two successive concentrations was 1.2.Successful ONB was considered to be positive response.The EC50 and 95％ confidence interval of lidocaine for ONB guided by a nerve stimulator was calculated.Results The EC50 of lidocaine was 0.57％,and the 95％ confidence interval was 0.55％-0.59％ when used for ONB guided by a nerve stimulator.Conclusion The EC50 of lidocaine is 0.57％ when used for ONB guided by a nerve stimulator in the patients undergoing TURBT.

The oxidative stress, inflammatory cytokines and apoptosis have been strongly implicated in the pathogenesis of multiple diseases. Recently, more and more research findings have demonstrated that hydrogen-rich saline (HRS) has the anti-oxidant, anti-inflammatory and anti-apoptotic effects in vivo and in vitro, and can be used to treat multiple diseases, such as ischemia/reperfusion injury, stroke, neurodegeneration, sepsis, neuropathic pain and multiple organ dysfunction syn-drome diseases. This article reviews the possible mechanism of HRS for the treatment of diseases.

Objective To compare butorphanol or midazolam alone and combination of the two drugs in preventing etomidate-induced myoclonus during anesthesia induction.Methods One hundred sixty patients, aged 40-64 yr, with body mass index of 20-25 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective operations under general anesthesia, were randomly allocated into 4 groups with 40 patients in each group: control group (group C), butorphanol group (group B) , midazolam group (group M) , and butorphanol combined with midazolam group (group BM).Before induction of anesthesia, butorphanol 15.0 μg/kg, midazolam 50 μg/kg, and butorphanol 7.5 μg/kg combined with midazolam 25 μg/kg were injected intravenously over 30 s in B, M and BM groups, respectively.The equal volume of normal saline was given in group C.And 2 min later, etomidate 0.3 mg/kg was injected intravenously over 1 min.The occurrence of myoclonus was recorded within 2 min after administration of etomidate, and the severity of myoclonus was assessed.Results Compared with group C, the incidence and severity of myoclonus were significantly decreased in B, M and BM groups (P＜0.05).Compared with B and M groups, the incidence and severity of myoclonus were significantly decreased in group BM (P＜0.05).There was no significant difference in the incidence and severity of myoclonus between group B and group M (P ＞ 0.05).Conclusion Butorphanol or midazolam alone produces similar efficacy in preventing etomidate-induced myoclonus during anesthesia induction, and the combination of the two drugs provides better efficacy than either alone in the patients.

Objective To evaluate the effect of hydrogen-rich saline on Toll-like receptor 4 (TLR4) /nuclear factor kappa B (NF-κB) signaling pathway in the sciatic nerve of rats with diabetic neuropathic pain (DNP).Methods Pathogen-free male Sprague-Dawley rats, aged 8 weeks, weighing 180-210 g, were used in the study.DPN model was established by intraperitoneal injection of 1％ streptozocin (STZ) 65 mg/kg.Twenty-four diabetic rats were randomly divided into 2 groups (n =12 each) using a random number table: DPN group and hydrogen-rich saline group (HRS group).Another 12 normal rats were randomly selected and served as control group (group C).At 14 days after STZ injection, hydrogenrich saline 5 ml/kg was injected intraperitoneally once a day for 14 consecutive days in group HRS, while the equal volume of normal saline was given in C and DNP groups.Mechanical paw withdrawal threshold to yon Frey stimuli (MWT) and thermal paw withdrawal latency (TWL) were measured at 2 days before STZ injection (T0) , and 7, 14, 21 and 28 days after STZ injection (T1-4).The motor nerve conduction velocity (MNCV) of the right hindlimb was measured after pain threshold was measured at T4.After measurement of neurological function was completed, the expression of TLR4 and NF-κB was detected in the sciatic nerve (by Western blot) , the tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) contents in sciatic nerves were measured by enzyme-linked immunosorbent assay, and the neuronal apoptosis was detected by TUNEL.The apoptosis index was calculated.Results Compared with group C, the MWT was significantly decreased at T1-4, TWL was shortened at T2-4, and MNCV was decreased at T4, the expression of TLR4 and NF-κB, contents of TNF-α and IL-6, and apoptosis index were increased in HRS and DNP groups (P＜0.05).Compared with group DNP, the MWT was significantly increased, and TWL was prolonged at T3,4 MNCV was increased T4, and the expression of TLR4 and NF-κB, contents of TNF-α and IL-6, and apoptosis index were decreased in group HRS (P＜ 0.05).Conclusion Hydrogen-rich saline can mitigate DNP through blocking TLR4/NF-κB signaling pathway in the sciatic nerve of rats.

Objective To evaluate the effect of hydrogen?rich saline on nuclear factor erythroid 2?related factor 2 ( Nrf2)∕antioxidant response element ( ARE) pathway in the peripheral nerve in a rat model of diabetic neuropathic pain ( DNP ) . Methods Thirty?six healthy male Sprague?Dawley rats, aged 8 weeks, weighing 180-200 g, were randomly divided into 3 groups ( n=12 each) using a random number table: control group ( C group) , DNP group and hydrogen?rich saline group ( HRS group) . Diabetes melli?tus was produced by intraperitoneal 1% streptozocin ( STZ) 65 mg∕kg and confirmed by fasting blood glucose concentration>16?67 mmol∕L. Hydrogen?rich saline 5 ml∕kg was injected intraperitoneally once a day for 14 consecutive days starting from 14 days after STZ injection in group HRS, and the equal volume of normal saline was given in C and DNP groups. The mechanical paw withdrawal threshold ( MWT) and thermal paw withdrawal latency ( TWL) were measured at 2 days before STZ injection ( T0 ) , and 7, 14, 21 and 28 days after STZ injection ( T1?4 ) . After measurement of the pain threshold at T4 , the motor nerve conduction velocity ( MNCV) of the right hindlimb and distal motor latency were measured. The expression of Nrf2 in nucleoprotein and HO?1 and NQO1 in total protein was detected in the sciatic nerve by Western blot. Re?sults Compared with group C, the MWT was significantly decreased, and the TWL was shortened at T1?4 , and the expression of Nrf2 in nucleoprotein and HO?1 and NQO1 in total protein was up?regulated in DNP and HRS groups (P<0?05). Compared with group DNP, the MWT was significantly increased, and the TWL was prolonged at T3 and T4 , and the expression of Nrf2 in nucleoprotein and HO?1 and NQO1 in total protein was up?regulated in group HRS ( P<0?05) . Conclusion The mechanism by which hydrogen?rich saline mitigates DNP is related to activated Nrf2∕ARE pathway in the peripheral nerve of rats.

Objective To compare the inhibitory effects of Butorphanol and Dezocine on Etomidate-induced myoclo?nus. Methods A total of 150 patients with ASA physical statusⅠorⅡ, aged 40-65 yr, with body mass index (BMI) of 20-25 kg/m2, scheduled for elective operations under general anesthesia, were included in this study. Patients were randomly al?located into three groups (A, B and C) with 50 patients in each group. Group A was given intravenous Butorphanol 15 μg/kg for 30 s, group B was given Dezocine 0.1 mg/kg and group C was given equal volume of saline. After 2 min, etomidate 0.3 mg/kg was administrated to three groups. The occurrence and severity of myoclonus were recorded for 2 min after administration of Etomidate. The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and Bispectral index (BIS) were recorded at the time points before induction (T0), 2 min after the experimental drug treatment (T1), and 2 min after Etomi?date treatment (T2). At the same time, the concentration of serum potassium was determined at T0 and 5 min after endotrache?al intubation (T3) respectively. Results The positive incidences of myoclonus were 12%in group A, 22%in group B and 74%in group C, respectively. Compared with group C, the positive incidence rates of myoclonus and myoclonus scales were significantly lower in group A and group B (P<0.05), but no significant difference between group A and group B (P>0.05). Compared with T0, there was no significant difference in the potassium concentration between patients without myoclonus (grade 0) and patients with myoclonus (grade 1 and grade 2) at T3 (P>0.05). There was a significant increase in potassium concentration in patients with grade 3 (P<0.05). There were no significant differences in MAP, HR, SpO2 and BIS values at T0, T1 and T2 between three groups of patients (P>0.05). Conclusion Pre-treatment of Butorphanol (15μg/kg) or Dezocine (0.1 mg/kg) can reduce the Etomidate-induced myoclonus. At the same time, both therapies show no different effects on cir?culation and respiration system.