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.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

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 analyze the indication and status of early use of analgesic, sedative and antiepileptic drugs of patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU).Methods:A questionnaire covering hospital basic characteristics, prehospital and emergency care, inpatient treatment, neurocritical care and rehabilitation were used to survey NICU of 37 hospitals in 18 municipalities or provinces from the Chinese registry of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) by Web or Email. The indications for admission to the NICU, categories and frequency of early use of analgesic and sedative drugs, and categories, frequency and indications of early use of antiepileptic drugs were analyzed.Results:Glasgow coma scale (GCS)≤8 points in patients with TBI and post-operation of TBI were the main indications for admission in 30 NICU (81.1%) and 24 NICU (64.9%), respectively. When admitting patients with a GCS of 9-12 points or 13-15 points, most NICU gave more considerations to the combined other risk factors. In terms of the early use of analgesics and sedatives, fentanyl was routinely used for analgesia (i.e., use frequency for 70%-100%) in 13 NICU (35.1%), and midazolam and alpha-2 agonists were routinely used for sedation in 24 NICU (64.9%) and 18 NICU (48.6%), respectively. Regarding the early use of antiepileptic drugs, sodium valproate was routinely used in 35 NICU (94.6%). Moreover, seizures within 2 hours after injury, penetrating TBI and cortical contusion were indications for routine application of antiepileptic drugs in 35 NICU (94.6%), 21 NICU (56.8%) and 20 NICU (54.1%), respectively.Conclusions:Severe TBI and post-operation of TBI are the main indications for admission to the NICU, while the combination of other risk factors will be considered when admitting patients with moderate or mild TBI. For TBI patients admitted to NICU, fentanyl, midazolam and sodium valproate are the most commonly used analgesic, sedative, and antiepileptic drugs in the early stage. Seizures within 2 hours after injury, penetrating TBI and cortical contusion are the main indications for antiepileptic drug use.

Objective? To understand the current situation of mobile phone dependence and procrastination among medical students, and to explore the correlation between them. Methods? We selected 220 university students in a medical school as research objects by the random stratified sampling. All of the students were investigated with the Dependency Scale with Telephone for Undergraduate Student and the General Procrastination Scale (GPS). A total of 220 questionnaires were sent out and 209 valid questionnaires were collected. Results? Among 209 medical students, 74.6% of them had mobile phone dependence; the total score from the Dependency Scale with Telephone was (66.67±12.39); there were statistical differences in the total scores of the Dependency Scale with Telephone among students whether they were in love and whether they thought mobile phones were essential (P＜0.05). Among 209 medical students, there were 92.3% of medical students with procrastination; the total score of GPS was (54.21±10.75);there were statistical differences in the total scores of GPS among medical students in different grades (P＜0.05). The scores of the Dependency Scale with Telephone were positively correlated with the scores of GPS among medical students (r=0.240, P＜0.01). Conclusions? The mobile phone dependence and procrastination are common in medical students. Students who are in higher levels of mobile phone dependence are more likely to have procrastination. Guiding medical students to reasonably used mobile phone is recommended to reduce the incidence of procrastination.

Objective To investigate the feasibility and clinical effect of tranexamic acid in prehospital emergency care of patients with craniocerebral trauma.Methods A randomized,placebo controlled trial was carried out on 77 craniocerebral trauma patients [Glasgow Coma Scale (GCS) ≤12 points]enrolled between May 2015 and December 2016.There were 45 males and 32 females,with an average age of 36.5 years (range,19-73 years).Among the patients,37 cases were caused by traffic accidents,19 falling from high places,11 falling when walking,and ten by being hit.According to the random number table method,they were divided into control group (39 cases) and treatment group (38 cases).The treatment group received 1 g of tranexamic acid by intravenous injection within ten minutes on the scene and another 1 g of tranexamic acid within eight hours at the hospital.The control group received 0.9％ isotonic saline.The operation and medication followed the routine process.The arrival time of ambulance and the time of first medication use were recorded.The plasma fibrin degradation products (FDP) and D-dimer at admission and 1 d post-trauma,the percentage of cranitomy operation,case fatality rate,red blood cell transfusion,length of stay in the neurosurgical intensive care unit (NICU),and the Glasgow Outcome Scale (GOS) at day 28 were all recorded and analyzed.Results No significant differences were found between the two groups in gender,age,injury causes,GCS,arrival time of ambulance,and the time of first medication use (P ＞ 0.05).The FDP and D-dimer at admission of the two groups were similar (P ＞ 0.05).One day after admission,the expression of plasma FDP was significantly lower in treatment group than that in control group [6758 (4732,13661) μg/L vs.11740 (8516,21756) μg/L] (P ＜ 0.01).The expression of D-dimer was significantly lower in treatment group than that in control group [1074 (849,1414) μg/L vs.1722 (1389,2330) μg/L] (P ＜ 0.01).Between group differences were insignificant in the percentage of craniotomy operation,case fatality rate,and red blood cell transfusion (P ＞ 0.05).However,treatment group showed shorter stay in NICU [4 (1,12)days vs.2 (0,4)days] and higher GOS [4 (3,5)points vs.5 (4,5)points]than control group (both P ＜ 0.01).Conclusions Tranexamic acid can be applied conveniently in pre-hospital emergency care of craniocerebral trauma patients.It can effectively realize the synchronization of pre hospital transport and treatment,eventually reducing the time of NICU treatment as well as improving the prognosis.

BACKGROUND: Traditional open surgery will do great damage to the patients with thoracolumbar fractures, and easily induces local degeneration. In contrast, the novel method is minimally invasive, which contributes to the functional recovery of the spine.OBJECTIVE: To discuss the essential procedures and precautions in the treatment of thoracolumbar fractures with percutaneous pedicle screw fixation.METHODS: Twenty-seven cases of single-level thoracolumbar fractures without spinal neurological deficits treated with percutaneous pedicle screw fixation were selected. The operation time and intraoperative blood loss were observed. The Visual Analogue Scale scores during axial turning at baseline and 3 days postoperatively, and the Visual Analogue Scale scores of the operation region at 1 and 3 days postoperatively were detected, respectively.RESULTS AND CONCLUSION: (1) Twenty-seven patients with 108 vertebrae underwent percutaneous pedicle screw fixation under the guidance of the needle, the puncture was smooth, 98 vertebrae was punctured successfully once, and 10 vertebrae were punctured successfully twice. (2) The Visual Analogue Scale scores during axial turning at 3 days postoperatively were significantly lower than those at baseline, and the scores of the operation region at 3 days postoperatively were significantly lower than those at 1 day postoperatively (P < 0.001). (3) The mean operation time was (109±18) minutes, and the mean intraoperative blood loss was (60±16) mL. (4) There were no nerve root injury and other complications. (5) Our results indicate that percutaneou pedicle screw fixation is a minimally invasive and safe method to treat the patients suffering single-level thoracolumbar fractures without spinal neurological deficits.

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.

OBJECTIVETo study the dynamics of the reinfection of Schistosoma japonicum and related risk factors among the people in schistosomiasis endemic areas in China.

METHODSLiterature retrieval was conducted by using databases of PubMed, CNKI,VIP and Wanfang to collected all the data about the human re-infection of Schistosoma japonicum and related risk factors in the endemic areas in China. And a Mata-analysis was conducted on the literatures met the inclusion standards.

RESULTSEighteen studies involving 12 604 people for infection survey and 3 128 people for re-infection survey were included in the analysis. The overall infection rate was 20.8%, and the overall re-infection rate was 21.0% . The difference had no statistical significance (Z = 1.12, P = 0.26). The re-infection related factors included baseline infection intensity (OR = 3.58, 95% CI: 1.56-8.22); the index of contaminated water OR = 2.37, 95% CI: 1.08-5.22); distance from house to river-side (OR = 1.72, 95% CI: 0.41-7.30) and age (OR = 0.48, 95% CI: 0.19-1.23).

CONCLUSIONThe baseline infection intensity, the index of contaminated water and distance from house to river-side were the risk factors related to the re-infection of Schistosoma japonicum and age was a protective factor.

Objective To investigate the effect of dexmedetomidine on the expression of hypoxia-inducible factor-1α (HIF-1α) during hypoxia/reoxygenation (H/R) in human renal tubular epithelial cells.Methods Human renal tubular epithelial cells (HK-2 cells) cultured in vitro were randomly divided into 4 groups (n =24 each) using a random number table:control group (group C),dexmedetomidine group (group DEX),H/R group and H/R+ dexmedetomidine group (group H/R + DEX).In group C,the cells were incubated for 28 h in an incubator filled with normoxia at 37 ℃.In group DEX,dexmedetomidine 0.1 nmol/L (final concentration) was added to the culture medium and the cells were incubated for 2 h,and then incubated for 28 h in an incubator filled with normoxia at 37 ℃.In group H/R,the cells were incubated in an anaerobic chamber for 24 h at 37 ℃,and then incubated for 4 h in an incubator filled with normoxia at 37 ℃.In group H/R + DEX,the cells were incubated for 2 h in the culture medium containing dexmedetomidine 0.1 nmol/L (final concentration),incubated in an anaerobic chamber for 24 h at 37 ℃,and then incubated for 4 h in an incubator filled with normoxia at 37 ℃.After treatment in each group,the cell viability was measured by MTT assay,cell apoptosis was measured using flow cytometry,the expression of HIF-1α mRNA was detected using RT-PCR,the expression of HIF-1α and activated caspase-3 protein was detected by Western blot,and the cell growth was observed.The apoptosis rate was calculated.Results Compared with group C,the cell viability was significantly decreased,the apoptosis rate was increased,and the expression of HIF-1α mRNA and protein and activated caspase-3 protein was up-regulated in H/.R and H/R + DEX groups,and no significant change was found in group DEX.Compared with group H/R,the cell viability was significantly increased,the apoptosis rate was decreased,the expression of HIF-1α mRNA and protein was up-regulated,the expression of activated caspase-3 protein was down-regulated,and the cell status was significantly improved in group H/R + DEX.Conclusion The mechanism by which dexmedetomidine attenuates H/ R-induced damage to human renal tubular epithelial cells may be related to up-regulated expression of HIF-1 α and inhibited cell apoptosis.