Comparison between transsylvian-transinsular approach and transcortical approach for hematoma evacuation in hypertensive basal ganglia hemorrhage / 国际脑血管病杂志

Objective To compare the efficacy of hematoma evacuation between transsylvian-transinsular approach and transcortical approach in hypertensive basal ganglia hemorrhage.Methods The patients with hypertensive basal ganglia hemorrhage who underwent hematoma evacuation via transsylviantransinsular approach and transcortical approach were enrolled retrospectively.Demographics and baseline data,as well as the outcome (the modified Rankin scale 0-3 as good outcome and ≥4 as poor outcome) and mortality at 3 months were compared in both groups.Results A total of 68 patients with hypertensive cerebral hemorrhage (40 cases via transsylvian-transinsular approach and 28 via transcortical approach) were enrolled.There were no significant differences in the demographics and baseline data between the two groups (all P＞ 0.05).The good outcome rates in the transsylvian-transinsular approach and transcortical approach at 3 months after surgery were 52.50％ (21/40) and 21.43％ (6/28),respectively.The former is significantly higher than the latter (x2 =6.642; P=0.01); the mortalities in the transsylvian-transinsular approach and transcortical approach were 2.50％ (1/40) and 21.43％ (6/28),respectively.The former is significantly lower than the latter (Fisher's exact test,P=0.017).Conclusions The clinical efficacy of hypertensive basal ganglia hemorrhage via transsylvian-transinsular approach is better than the transcortical approach.

Risk factors for development of hypotension during craniotomy in patients with severe traumatic brain injury / 中华麻醉学杂志

Objective To identify the risk factors for the development of hypotension during craniotomy in patients with severe traumatic brain injury (TBI).Methods One hundred and seventy-five patients,aged ≥ 18 yr,undergoing emergency craniotomy for TBI,were selected.According to the occurrence of intraoperative hypotension (systolic pressure ＜ 90 mm Hg or the decreased amplitude ＞ 30％ of the baseline),all the patients were divided into 2 groups:hypotension group and non-hypotension group.The data including gender,age,preoperative Glasgow Coma Scale (GCS) score,pupils,preoperative systolic pressure,application of mannitol,hyperventilation,methods for induction of anesthesia,and decrease in intracranial pressure were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the independent risk factors for intraoperative hypotension.Results Fifty patients developed intraoperative hypotension,and the incidence was 28.57％.There was significant difference in preoperative systolic pressure,GCS score and changes in pupils between hypotension group and non-hypotension group (P ＜ 0.05).Logistic regression analysis showed that preoperative systolic pressure was the independent risk factor for hypotension during craniotomy in patients with severe TBI (P ＜ 0.05),and OR value (95％ confidence interval) was 1.019 (1.005-1.033),and regression coefficient was 0.019.Conclusion Preoperative systolic pressure is the independent risk factor for hypotension during craniotomy in patients with severe TBI.

Application of homemade newly toilet stool in urination of SAH patients / 中国实用护理杂志

Objective To investigate the clinical effect of homemade toilet stool on bed urination in spontaneous subarachnoid hemorrhage (SAH) patients.Methods The newly admitted 80 SAH patients with 0～2 level of Hunt-Hess grade were randomly divided into the observation group and the control group with 40 cases in each group.The control group was taken ordinary toilet stools and regular monitoring methods,and the observation group was taken homemade toilet stools and regular monitoring methods.Then the rate of urination,time of induced urination,blood pressure changes during induced urination and residual urine volume of bladder were compared within these two groups.Results The rate of successful urination in the observation group were significantly higher than that in the control group,and time of induced urination,blood pressure changes during induced urination,residual urine volume of bladder in the observation group were all significantly lower than those in the control group.Conclusions Homemade toilet stool is effective in promoting bed urination,shortening the time of induced urination,reducing the fluctuation of blood pressure during induced urination and the residual urine volume of bladder.

The influence between managements in emergency room and outcome of severe traumatic brain injury / 中国医师进修杂志

Objective To assess the influence between managements in emergency room(ER) andoutcome of severe traumatic brain injury (TBI),in order to provide inference for treatment.Methods A retrospective analysis was performed in severe TBI patients and recorded next indexes.(1) The managements in ER,including endotracheal intubation and oxygenation,fluid resuscitation,and mannitol intake.(2) The vital signs arriving at ICU,including systolic pressure and blood oxygen saturation.(3) Prognostic indicators including inhospital mortality and days during ICU,the scores of Glasgow outcome scale (GOS) at discharge and 6 months after injury.Results In 140 severe TBI patients,65 patients (46.4％) died during ICU.The mortality of patients with endotracheal intubation [65.0％ (39/60)] was significantly higher than that without endotracheal intubation [32.5％(26/80)](P＜ 0.01).The mortality in whether fluid resuscitation and using mannitol had no significant difference [44.7％ (46/103) vs.51.4％ (19/37),49.2％ (31/63) vs.44.2％ (34/77)] (P ＞0.05).In days during ICU,there was no significant difference among the three treatment measures (P＞ 0.05).In GOS grade at discharge and 6 months after injury,the proportion of 4 and 5 grade were 8.3％ (5/60) and 25.0％ (15/60) in patients with endotracheal intubation,while 27.5％ (22/80) and 52.5％ (42/80) in patients without endotraeheal intubation (P ＜ 0.01).In fluid resuscitation and using mannitol patients,there were no significant difference(P ＞ 0.05).Conclusion Treating severe TBI patients in ER,endotracheal intubation should be carefully chosen,fluid resuscitation and mannitol may not be given.

Bone marrow-derived mesenchymal stem cells in treatment of gliomas / 国际肿瘤学杂志

Bone marrow-derived mesenchymal stem cells (MSCs) are capable of migrating and homing to brain tumors in vivo and therefore is a promising targeted-delivery vehicle in cancer gene therapy. MSCs are transfected or transducted with the therapeutic genes and achieve stable expression in vitro, then are delivered to the host to exert their therapeutic effects. The Ex Vivo gene transfer of MSCs has been studied in several types of tumors including gliomas, and results were postive. The safety of MSC-based gene delivery remains to be controversial. The interactions between MSCs and host tumor cells need to be investigated.