OBJECTIVE：To investigate the anti- hepatic fibrosis （HF）effects of Qiwei qinggan powder and explore its possible mechanism. METHODS ：Male Wistar rats were randomly divided into blank group ，HF model group ，Qiwei qinggan powder low-dose，medium-dose and high-dose groups [ 135，270，405 mg/（kg·d），by total amount of crude drugs] ，with 12 rats in each group. Except for blank group ，other groups were given 50％ CCl4-peanut oil solution intragastrically （2 mL/kg，twice a week ，for consecutive 8 weeks） to induce HF model. At same time ， blank group and model group were given constant volume of 0.5％ CMC-Na solution intragastrically ；administration groups were given relevant medicine intragastrically ，once a day ，for consecutive 8 weeks. General situation of rats were observedand liver morphology was observed after last administration and hepatic indexes were detected. The contents of liverfunction indexes （ALT，AST，ALP，HYP）in serum and the expression of α-SMA in hepatic tissue were determined ， and HE and Masson staining were performed to observe the histopathology. Using the difference multiple of expression quantity as the index ，TMT technology was used to screen the differentially expressed protein in medicine group （combining the liver tissue samples of Qiwei qinggan powder groups ）and HF model group. Uniprot-GOA database and KAAS ，KEGG mapper online tools were used to analyze GO and KEGG pathway enrichment. RESULTS ：The rats in the blank group were in good health ；the liver was bright red and smooth ，the liver lobules were intact ，no degeneration and necrosis ，inflammatory cell infiltration or fibrous tissue proliferation was found. Compared with blank group ，the rats in HF model group had poor diet ，depressed spirit ，disordered and lusterless fur ；the liver was dark red or yellow with rough surface ，hard texture ，inflammatory cell infiltration ，fiber tissue destruction ，bridge connection and so on ；the hepatic index ，the contents of liver function indexes and the expression of α-SMA were increased significantly （P＜0.05）. Compared with HF model group ，above symptoms of rats were improved to different extent in different dose groups of Qiwei qinggan powder ；hepatic index in Qiwei qinggan powder low-dose group ，the content of ALP in high-dose group ，the contents of ALT，AST and HYP and the expression of α-SMA in different dose groups were decreased significantly （P＜0.05）. A total of 42 differentially expressed proteins related to HF were screened ，of which 15 were up-regulated and 27 were down-regulated in expression，including fatty acid binding protein 4（FABP4），cholesterol 7α-hydroxylase（CYP7A1）. The results of enrichment analysis showed that the differentially expressed proteins were mainly enriched in extracellular space ，blood particles and other cell parts，involving the molecular functions of oxidoreductase activity and fatty acid binding ，the biological processes of the regulation of heterotypic cell adhesion ，protein activation cascade ，as well as retinol metabolism ，arachidonic acid metabolism ，PPAR and other signal pathway. CONCLUSIONS ：Qiwei qinggan powder can reduce the hepatic index ，ALT，AST，ALP and HYP contents in serum ，down-regulate the expression of α-SMA，improve the degree of inflammation and fibrosis of liver tissue ，and have a certain protective effect on rats. The anti-HF mechanism of it involves multiple targets and signal pathways ，such as FABP 4， CYP7A1 and PPAR.

Objective:To summarize the surgical treatment of malignant carotid body tumor (MCBT).Methods:A retrospective analysis of 14 MCBT patients admitted at our hospital from Mar 2005 to Nov 2019 was made, and the imaging data, surgical records, perioperative complications and follow-up data were collected.Results:There were 8 males and 6 females, with an average age of (40.8±11.3) years. 10 patients underwent surgical resection of CBT, with one case undergoing tumor enucleation only, nine cases underwent internal carotid artery reconstruction, and all patients underwent intraoperative lymph node biopsy.Tumors were completely removed in all 10 patients. No perioperative death or cerebral infarction occurred. The intraoperative blood loss was (955±658.5) ml. Four patients had permanent nerve injury after surgery. The follow-up time ranged 1-132 months. There were no cases of cerebral infarction or death, and the reconstructed graft remained patent. Apart from the 2 patients who developed tumor metastasis after surgery, other patients recovered uneventfully with no disease progression.Conclusions:Surgery is still the main treatment for MCBT, but MCBT is large and Shamblin class is more advanced. Therefore, complete tumor removal and reconstruction of the carotid arteries are difficult. Surgery should seek to completely remove the tumor and neck lymph node biopsy should be performed to determine the lymph node metastasis.

Objective? To investigate the therapeutic hypothermia related knowledge and training demands of neurosurgery nurses at a hospital. Methods? From January to April 2018, we selected 139 neurosurgery nurses at a ClassⅢ Grade A hospital by cluster sampling. All of the nurses were investigated with the self-designed therapeutic hypothermia knowledge questionnaire and therapeutic hypothermia knowledge demands questionnaire of nurses. Results? A total of 59.7% of nurses mastered therapeutic hypothermia related knowledge and 11.5% of them mastered the knowledge well. Three terms of therapeutic hypothermia related knowledge were with the highest accuracy rate including the necessity of calm assessment, need of sedation and analgesia as well as mechanical ventilation support at low temperature. Three terms of them were with the lowest accuracy rate including the duration of the cooling, duration of holding phase and recommended temperature of therapeutic hypothermia monitoring. Neurosurgery nurses were willing to learn therapeutic hypothermia related knowledge by various ways. Conclusions? Neurosurgery nurses' mastery of therapeutic hypothermia knowledge needs to be improved. Mastery of knowledge and demands should be taken into account in contents and ways of inservice training.

Objective To determine the incidence and clinical features of headache after carotid endarterectomy (CEA).Methods A retrospective analysis was made on the data of patients undergoing CEA in the Department of Vascular Surgery,Peking Union Medical College Hospital from Jan 2014 to Jan 2015.There were 119 males and 24 females,including 97 cases of symptomatic carotid stenosis and 110 cases of severe carotid stenosis.Results The incidence of newly emergent headache after surgery was 44％ (63/143).The earliest time of headache was 30 minutes after surgery and the latest was 6 days after surgery.95％ of headache occurred within 48 hours after surgery (60/63).79.4％ (50/63) of the headache lay ipsilaterally with CEA,and bilateral headache accounted for 20.6％ (13/63).Severe headache accounted for 4.8％ (3/63),all were ipsilaterally frontal and temporal headache,complicating central nervous system symptoms.Conclusions After CEA headache is a common clinical symptom.Most were mild to moderate and unilateral,which can be relieved spontaneously.Cerebral hemodynamics need to be further examined to differentiate the different pathological states of severe headache on the operative side after CEA because of the high risk of developing hyperperfusion syndrome or cerebral infarction.History of TIA or stroke is the risk factor of post-CEA headache.

Objective Targeted temperature management (TTM) is often used in neuro-critical care to minimize secondary neurologic injury and improve outcomes. Evidence-based implementation guideline of TTM was generated from clinical questions relevant to TTM implementation for neuro-critical care by experts recruited by the American Neuro-critical Care Society. Interpretation of this guideline would help the readers to understand the implementation of TTM, bring benefits to standardization of TTM application, and contribute to the solving of specific issues related to TTM implementation.

Objective To investigate the guidelines implementation status of preventing gastric aspiration by Neurosurgery Intensive Care Unit (NSICU) nurses, and analyze its effects on gastric aspiration outcomes. Methods Using convenient sampling method, two NSICU of Class Ⅲ hospitals in Beijing from June 2016 to January 2017 were selected to investigate the nursing status of preventing gastric aspiration and analyze its relationship with gastric aspiration outcomes. SPSS 21.0 software was used to analyze the data. Results NSICU nursing routine included assessing the nasal feeding tube position, using the compound chlorhexidine in oral care, and assessing gastric residual volumes (GRVs) per 6 hours. However, only a quarter of bedside elevation angle met the guidelines requirements; 55.9% of the cuff pressure was at a low level. There were statistically significant differences in bedside elevation angle, cuff pressure and enteral nutrition velocity in the comparison of aspiration and non-aspiration patients (χ2=13.848,41.093,33.011;P< 0.001). Conclusions Although guidelines for the prevention of gastric aspiration are being constantly added and updated, a gap between the clinical practice and the guidelines exists. This study suggests that the recommended measures should be more rigorous and detailed in practical clinical work to reduce the incidence of gastric aspiration.

Objective To assess the effect of statin therapy on serum inflammatory cytokines in patients with abdominal aortic aneurysm (AAA).Methods The clinical data of 126 AAA patients who were hospitalized in the Department of Vascular Surgery,Peking Union Medical College Hospital,from September 2014 to September 2017 were retrospectively analyzed.Patients were divided into treatment group and control group according to whether statins were used or not.The levels of serum lipids and serum inflammatory factors were compared between these two groups.Results There was no significant difference in gender,age,body height,body weight,smoking ratio,and AAA diameter between these two groups (all P ＞ 0.05).While the levels of total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were not significantly different before treatment (all P ＞ 0.05),the treatment group had significantly lower TC (t =2.868,P =0.009),TG (t =3.472,P =0.006),and LDL-C (t =3.924,P =0.005) and significantly higher HDL-C level (t =3.322,P =0.007) after treatment.In addition,the concentrations of interleukin (IL)-1β,IL-6,high-sensitivity C-reactive protein (hs-CRP),and tumor necrosis factor-α (TNF-α) were not significantly different between these two groups before treatment (all P ＞0.05);after treatment,the serum levels of IL-1β and IL-6 in the treatment group were (224.32 ± 78.54) and (116.49 ± 19.64) ng/L,respectively,which were lower than those in the control group [(254.68 ±96.77)ng/L (t=1.765,P=0.058) and (126.71 ±23.59) ng/L (t=1.692,P=0.063)],although the differences were not statistically significant.The serum levels of hs-CRP and TNF-α in the treatment group were (6.46 ± 1.24) mg/L and (0.77 ± 0.21) μg/L,respectively,which were significantly lower than those in the control group [(10.93 ± 4.18) mg/L (t =2.007,P =0.012) and (1.28 ± 0.49) μg/L (t =2.144,P =0.016)].Conclusion Statin treatment reduces the levels of hs-CRP and TNF-α in AAA patients.

Objective To compare the clinical efficacy of Rivaroxaban and Warfarin in the treatment of lower extremity deep vein thrombosis.Methods From January to December 2015,51 patients of deep vein thrombosis of the lower limb divided into.Warfarin group (21 cases) and Rivaroxaban group (30 cases).The time of each therapy lasted for 3 months or longer.The characteristics and the change of lower limb venous patency rate in two groups of patients were analyzed to evaluate the curative effect.Results Rivaroxaban group had shorter therapy time than Warfarin group.The lower limb venous patency rate in Rivaroxaban group were higher than that in Warfarin group (85.7％ vs.60％,P ＜0.05).Ultrasonography showed partial patency in 5 mixed thrombus patients of Warfarin group,while complete patency in 2 and partial patency in 3 of Rivaroxaban group.Normalized rate in peripheral venous thrombosis patients of Rivaroxaban group were higher than Warfarin group (84％ vs.25 ％ P ＜ 0.001).Conclusions Rivaraxaban is superior to Warfarin in the complete recanalization of DVT,while safe and reliable.

Objective To study the effect of CBT resection on blood pressure in essential hypertensive subjects.Methods Clinical data of 24 essential hypertensive patients (BP ＞ 140/90 mmHg or was using anti-hypertensive drugs) with CBT resection from May 2005 to March 2016 was analyzed,retrospectively.The heart rate,blood pressure were recorded continuously during the peri-operative and follow-up period.All of the patients were followed-up for at least 1 year.Results The systolic blood pressure(SBP) and pulse pressure (PP) decreased 1-3 months after the operation,and the difference was significant (P ＜ 0.001),while the diastolic blood pressure (DBP) and heart rate (HR) did not change significantly (P ＞ 0.05).Postoperative patients used less amount of antihypertensive drugs,but the difference was statistically not significant (P ＞ 0.05).Conclusions Unilateral CBT resection is associated with short-term to intermediate-term lowering of BP in hypertensive patients (P ＞ 0.05).

Objective To investigate the standard rate and common types of mistakes in ventricular intracranial pressure monitoring in neurosurgery intensive care unit ( NICU ) . Methods A total of 45 nurses were enrolled by convenience sampling method and investigated with assessment criteria developed by Department of Neurosurgery. Results There were 75. 6% nurses conformed to the operation standard, while 24. 4% nurses didn′t. The common types of mistakes were ventricular drainage unclosed before measuring pressure (37. 5%), measuring pressure without zero correction (25. 0%), incorrect zero position (16. 7%), measuring pressure immediately after nursing operations (8. 3%), measuring pressure without patients′head at median position (8. 3%), and tubes obstruction (4. 2%), etc. The different ages, professional (technical) titles and working years of nurses in ICU were the influencing factors of standardized ventricular intracranial pressure monitoring. Conclusions Nurses have some non-standard operation and multiple practice during ventricular intracranial pressure monitoring. More attentions should be paid to provide standardized ventricular intracranial pressure monitoring training for nurses who are young, low occupational title and short of working experience in ICU.