Contrast-zero ultrasound-guided transcatheter aortic valve replacement: A case report / 中国胸心血管外科临床杂志

@#Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.

Effects of exosomal miR-630 on brain microvascular endothelial cells’ function after subarachnoid hemorrhage / 西安交通大学学报(医学版)

【Objective】 To investigate the relationship between cerebrospinal fluid exosome-derived miR-630 and the function of brain microvascular endothelial cells （BMECs）. 【Methods】 The subarachnoid hemorrhage endothelial cell model was established to evaluate the effect of hemorrhagic cerebrospinal fluid （BCSF） on BMECs’ proliferation by MTT assay and cell cycle analysis. qRT-PCR and immunofluorescence staining were used to detect the expressions of endothelial cell tight junction protein （ZO-1） and adhesion molecule （ICAM-1 and VCAM-1）. Changes in NOx concentration were detected by radioimmunoassay. The cerebrospinal fluid exosomes in the experimental group （co-incubated with BCSF） and the control group （normal cerebrospinal fluid） were isolated and identified， and differences in the expressions of cerebrospinal fluid exosomal miR-630 between the two groups were compared. BMECs work changes after the intervention with miR-630 analogue were observed. 【Results】 The proliferation of BMECs was significantly inhibited in the experimental group； the mRNA and protein levels of ICAM-1， VCAM-1 and ZO-1 were significantly decreased， and the function of endothelial cells was significantly inhibited （P<0.05）. After the successful separation and identification of cerebrospinal fluid exosomes， the expression of miR-630 was significantly lower in the experimental group than in the control group （P<0.05）. The function of BMECs was significantly improved with miR-630 mimics. 【Conclusion】 The low expression of miR-630 in cerebrospinal fluid exosomes after subarachnoid hemorrhage is closely related to BMECs injury.

Feasibility Study of the Low-Cost Motion Tracking System for Assessing Endoscope Holding Skills.

BACKGROUND: The ability to hold an endoscope is an important skill for surgeons and assistants performing endoscopic neurosurgery. Motion tracking can provide an objective assessment for surgical skills and may aid in endoscopic neurosurgery. We developed a cost-effective system to study the feasibility of objectively distinguishing performance levels for operating an endoscope. METHODS: The study was divided into 2 parts. First, a video motion tracking analysis tool was built based on a printed mark and free software (Kinovea 0.8.15). Second, the tool was used to distinguish the holding endoscope performance of the robotic arm by experts (surgeon, n = 3) and novice users (residents, n = 6) under both 0' and 30' endoscopes. RESULTS: Through the printed mark and free software, we successfully built a system for video motion tracking. The data analysis showed that for both 0' and 30' endoscopes, the experts had a shorter total distance and depth, smaller average speed and maximum acceleration, and a fewer number of extreme accelerations than their novice counterparts. Compared with experts and residents, the fixed arm had better results. CONCLUSIONS: The simple low-cost video motion tracking system can provide an objective assessment of an endoscope holding skill, which allows for discrimination between an expert and a novice, and can be used by clinical neurosurgeons to select a qualified assistant.

Novel Cost-Effective Tubular Port Based on Glove and Syringe for Endoscopic Surgery of Intracerebral Hematomas.

BACKGROUND: Intracerebral hematomas (ICH) is a common disease in the developing countries, and minimally invasive transportal resection of ICH is a widely accepted surgical technique. Many port systems are available, but most are disposable and expensive. We present a safe and cost-effective glove-syringe substitute for endoscopic hematoma evacuation, suitable for developing countries such as China. METHODS: A port substitute of different sizes and lengths was constructed using sterile gloves and syringes, commonly found in a surgical environment. RESULTS: We successfully performed endoscopic hematoma removal in 7 patients including 1 cerebellar hemorrhage case and the remaining 6 supratentorial basal ganglia cases (1 patient taking oral aspirin). Bipolar electrocoagulation was used to control bleeding from the ruptured blood vessels. There were no postsurgical complications. CONCLUSIONS: The glove-syringe port is a convenient, safe, and cost-effective tubular port system for endoscopic surgery of ICH. Such ports can be used as substitutes when commercial sleeves are unavailable, especially in rural areas and developing countries.

Progress of long non-coding RNA in pituitary adenoma / 肿瘤研究与临床

Pituitary adenoma is a common neuroendocrine tumor, and its complex pathogenesis makes its treatment a clinical problem. Recently, studies have shown that long non-coding RNA (LncRNA), as a class of endogenous RNA with a length of more than 200 nucleotides and basically no protein-coding function, plays an important regulatory role in various forms in multiple tumors including pituitary adenoma, and is closely related to the proliferation, invasion and metastasis of pituitary adenoma. Based on the latest research status at home and abroad, this paper summarizes the research progress of LncRNA in pituitary adenoma, hoping to provide new ideas for the diagnosis, treatment and prognosis of pituitary adenoma.

Recent advance in interventional embolization for chronic subdural hematoma / 中华神经医学杂志

Chronic subdural hematoma (cSDH) occurs in acute subdural hemorrhage after head trauma or converts from effusion. Traditional treatment is based on conservative treatment and surgical drainage. The effective rate of conservative treatment is only 3%-18%; even with drilling drainage treatment, the recurrence rate is as high as 33%. Recently, the middle meningeal artery embolization technique based on pathological analysis can greatly reduce the recurrence rate, and the operation is simple and curative effect is exact. This article reviews the pathogenesis of cSDH and progress of interventional therapy.

Progress of long non-coding RNA in pituitary adenoma / 肿瘤研究与临床

Pituitary adenoma is a common neuroendocrine tumor, and its complex pathogenesis makes its treatment a clinical problem. Recently, studies have shown that long non-coding RNA (LncRNA), as a class of endogenous RNA with a length of more than 200 nucleotides and basically no protein-coding function, plays an important regulatory role in various forms in multiple tumors including pituitary adenoma, and is closely related to the proliferation, invasion and metastasis of pituitary adenoma. Based on the latest research status at home and abroad, this paper summarizes the research progress of LncRNA in pituitary adenoma, hoping to provide new ideas for the diagnosis, treatment and prognosis of pituitary adenoma.

Effect of subcutaneous negative pressure drainage and absorbable suture on prevention of postoperative complications of cranioplasty / 中国基层医药

Objective To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty.Methods The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods,97 cases were treated with thread suture to the galea aponeurotica combined with general drainage (the general drainage group),and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group).The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture,and the drainage tube was placed outside the metal titanium plate under the skin,and removed after 48-72 hours.The postoperative complications of the two groups were compared.Results The incidence rates of subcutaneous hemorrhage,knotting reaction,infection of incision in the negative pressure drainage group were 1.3％ (1/78),0.0％ (0/78),and 0.0％ (0/78),respectively,which were significantly lower than those in the average drainage group [11.3％ (11/97),20.6％ (20/97),7.2％ (7/97)],the differences were statistically significant (x2 =6.85,18.16,4.13,all P ＜ 0.05).Conclusion The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty.

Effect of subcutaneous negative pressure drainage and absorbable suture on prevention of postoperative complications of cranioplasty / 中国基层医药

Objective@#To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty.@*Methods@#The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods, 97 cases were treated with thread suture to the galea aponeurotica combined with general drainage(the general drainage group), and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group). The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture, and the drainage tube was placed outside the metal titanium plate under the skin, and removed after 48-72 hours.The postoperative complications of the two groups were compared.@*Results@#The incidence rates of subcutaneous hemorrhage, knotting reaction, infection of incision in the negative pressure drainage group were 1.3%(1/78), 0.0%(0/78), and 0.0%(0/78), respectively, which were significantly lower than those in the average drainage group[11.3%(11/97), 20.6%(20/97), 7.2%(7/97)], the differences were statistically significant(χ2=6.85, 18.16, 4.13, all P<0.05).@*Conclusion@#The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty.

Recent advance in correlation between toll-like receptor 2 and glioma / 中华神经医学杂志

Glioma is a serious health threat for humans,so we urgently need to develop a more accurate,efficient and durable method to fight it.Immunotherapy is a fashionable treatment,which can stimulate the body's own immune system stimulation.And finding a reliable therapeutic target becomes the essential for glioma immunotherapy.The toll-like receptor 2 is form Ⅰ transmembrane receptor,which can be highly expressed in a variety of tumors and is closely linked to the aggressiveness and prognosis of the tumors.This article aims to explore the TLR2 expression and its association with tumors to provide new therapeutic targets for glioma immunotherapy.

CCL18 is highly expressed in glioma tissues and promotes activity of glioblastoma cells / 中华神经医学杂志

Objective To explore the expression levels of chemokine (C-C motif) ligand 18 (CCL18) in human glioma tissues and its effects on the invasion,migration and proliferation ofglioma cells.Methods (1) Sixty samples were harvested from the glioma which was excised surgically and confirmed pathologically from the patients at the Department of Neurosurgery,Affiliated Hospital to Binzhou Medical College from January 2012 to December 2017.Of the samples,by the WHO grading,26 belonged to grade Ⅱ,18 to grade Ⅲ and 16 to grade Ⅳ.Ten samples of normal brain tissue were harvested as controls from the contemporary patients who underwent intracranial decompression and excision due to brain injury.CCL18 mRNA expression was determined by real-time RT-PCR and CCL18 protein expression in tumor cells by immunochemically histological staining.(2) U251 glioma cells cultured in vitro were incubated with CCL18 serum-free culture media (0 ng/mL,5 ng/mL and 10 ng/mL) for 24 h before they were subjected to Transwell,scarification and CCK-8 assays to measure cellular invasion,migration and proliferation.Results (1) The expression of CCL18 mRNA was significantly increased in the order from normal brain,glioma of grade Ⅱ,glioma of grade Ⅲ to glioma of grade Ⅳ (P＜0.05);the expression of CCL18 protein was significantly increased in the order from glioma of grade Ⅱ,glioma of grade Ⅲ to glioma of grade Ⅳ (P＜0.05).(2) The 24 h Transwell assay for invasion showed that the number of transmembrane cells was significantly increased in the order from 0 ng/mL group to 5 ng/mL group to 10 ng/mL group (43.5±8.3,202.0±18.5 and 279.7±18.6 cells) (P＜0.05).The widths of scratch (pixels) in the scarification assay for migration were 498.4±75.3,381.3±21.4 and 347.7±14.2 at 12 h,and 299.5±15.3,284.6±7.8 and 237.3±20.6 at 24 h,respectively,showing significant differences between the groups of 0 ng/mL,5 ng/mL and 10 ng/mL recombinant CCL18 (P＜0.05).The cell growth in CCK-8 assay for proliferation was 1.000±0.019,1.260±0.094 and 2.070±0.138 fold at 24 h,respectively,also showing significant differences between the groups of 0 ng/mL,5 ng/mL and 10 ng/mL recombinant CCL18 (P＜0.05).Conclusions Expression of CCL18 in glioma is associated with the malignancy of the tumor.As CCL 18 promotes invasion,migration and proliferation of glioma cells,it may be a potential biomarker for detecting and grading human glioma.

Diagnostic value of transcranial doppler ultrasonography for middle cerebral artery stenosis:a Meta-analysis / 中华神经医学杂志

Objective To evaluate the diagnostic value of transcranial doppler ultrasonography (TCD) for middle cerebral artery stenosis.Methods A comprehensive electronic search was performed in PubMed,EMBase,The Cochrane Library,CNKI,Wanfang Database and VIP Database to retrieve relevant studies on TCD in diagnosis of middle cerebral artery stenosis from initiation of the databases to January 2017.The general information and diagnostic parameters were documented from the retrieved studies.The quality of the prepared studies was evaluated by QUADAS-2 and the risk assessment maps brought by RevMan 5.3 statistical software.Pooled sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio (NLR) and the heterogeneity of the included studies were analyzed using the Stata 13.0 software.Summary receiver operating characteristic curve (SROC) was drawn and the area under the curve (AUC) was calculated.The publication bias was assessed with funnel plotting.Results A total of 11 studies were included for this Meta analysis,involving 2 550 patients.Heterogeneity test showed that the heterogeneity was established between studies in sensitivity,specificity,NLR and diagnostic odds ratio (DOR),resulting from disparity in study design and TCD test criteria (P＜0.05).Meta analysis revealed a pooled sensitivity of 0.88 (95％ CI:0.84～0.91),a specificity of 0.93 (95％ CI:0.91～0.95),a PLR of 12.93 (95％ CI:9.90～16.90),a NLR of 0.13 (95％ CI:0.09～0.17),a diagnostic score (SCORE) of 4.63 (95％ CI:4.32～4.94),a diagnostic odds ratio (DOR) of 102.64 (95％ CI:75.44～139.65),and an AUC of SROC of 0.96 (95％ CI:0.94～0.98).The sensitivity analysis after removing studies with sample capacity ＜100 showed that the confidence interval of the diagnostic parameters mostly overlapped with that of the original data.Conclusion As TCD shows good accuracy in diagnosing middle cerebral artery stenosis,it can be used in diagnostic screening of the disease.

Expression and correlation of Toll-like receptor 2, LC3B and Beclin1 in glioma / 中国医师进修杂志

Objective To explore the relationship between Toll-like receptor 2(TLR2) and autophagy marker protein in glioma. Methods Glioma tumors of a total of 74 patients from June 2012 to December 2017 were surgically resected, including WHO gradeⅠtoⅡ32 cases, grade Ⅲ 20 cases, gradeⅣ22 cases. Immunohistochemistry and Western blot were used to detect the expression of TLR2, autophagy related protein LC3B, Beclin 1 and apoptosis related protein Bax and Bcl-2. The correlation between TLR2 and autophagy related protein LC3B and Beclin 1 were analyzed. Results In high grade glioma (HGG) tissue and low grade glioma (LGG) tissue, the TLR2 positive expression rates were 92.9％(39/42) and 75.0％(24/32), and there was significant difference (P<0.05). In HGG tissue, autophagy related protein LC3B, Beclin1 protein was strongly positive and the positive expression rates were 45.2％(19/42) and 52.4％(22/42). In LGG tissue, LC3B and Beclin1 protein positive expression rates were 18.8％(6/32) and 15.6％(5/32), and there were significant differences (P<0.05). Spearman correlation analysis showed that TLR2 protein was closely related to autophagy related protein LC3B (r=0.5638, P<0.05) and Beclin1 (r=0.6101, P<0.05). Conclusions TLR2 is highly expressed in HGG tissue, and its expression level may be related to autophagy, which has potential value as a targeted therapy.

Progress of exosomes in tumor immune escape / 肿瘤研究与临床

Exosomes are a type of nanoscale vesicles that are actively secreted by various type of cells, and are considered as a new way of cell communication. The exosomes can shuttle bioactive molecules including proteins, lipids, miRNAs and mRNAs from one cell to another, resulting in the exchange of genetic information between cells and the reprogramming of recipient cells. Many evidences show that tumor cells can secrete a large amount of exosomes and regulate tumor progression,metastasis,immune escape, resistance and many other aspects through a variety of ways. In the tumor microenvironment, exosomes transmit between tumor cells,immune cells,and stromal cells,contributing to the escape from immune surveillance.This review summarizes recent advances in exosomes in tumor immune escape.

Expression of Toll-like receptor 2 in glioma and its correlation / 中国医师进修杂志

Objective To investigate the expression of Toll like receptor 2 (TLR2) in glioma and its relationship with the malignant biological behavior of glioma, so as to provide a new therapeutic target for glioma immunotherapy. Methods The tumor tissues of 90 glioma patients undergoing surgical excision were collected, of which WHO gradingⅠ-Ⅱgrade 39 cases,Ⅲgrade 24 cases,Ⅳgrade 24 cases. In addition, the normal brain tissues of 12 patients undergoing routine intracranial decompression were selected. The human glioma cell lines U87-MG, U251-MG and human astrocyte cell line HA were cultured. The expression levels of TLR2 mRNA and protein were detected by reverse transcriptase polymerase chain reaction (RT-PCR) and Western Blot test. The correlation between TLR2 protein and different clinical pathological parameters was analyzed. Results The expression levels of TLR2 mRNA and protein in the glioma tissuesⅠ-Ⅱgrade,Ⅲgrade andⅣgrade were significantly higher than those in normal brain tissues (0.27 ± 0.09, 0.57 ± 0.12 and 0.96 ± 0.18 vs. 0.11 ± 0.05; 0.31 ± 0.05, 0.44 ± 0.05 and 0.71 ± 0.09 vs. 0.02 ± 0.01), there were statistical differences (P0.05), but was related to tumor diameter and WHO grading (P < 0.01). Conclusions TLR2 in different grade glioma tissues and glioma cell lines are expressed, and its expression level is associated with the malignant degree of glioma; TLR2 protein not only can be used as a biomarker of gliomas and prognosis, but also provide a new target for the treatment of glioma.

Bromocriptine induces autophagy-dependent cell death in pituitary adenomas / 中华神经医学杂志

Objective To study the mechanism of bromocriptine (BRC) inducing autophagy-dependent cell death in pituitary adenomas and to explore its significance.Methods Thirty pituitary adenomas excised in our hospital from June 2013 to December 2015 were collected;the expressions of LC3 and Bcl-2 in these pituitary adenomas and normal brain tissues were examined by immunohistochemical staining.The rat hypophysoma MMQ cells were conventionally cultured in vitro;after 24 h of treatment with 60 μmol/L BRC,cytometry was performed to detect the variation of these cell cycle;the protein expressions of microtubule-associated protein light chain 3-Ⅰ (LC3-Ⅰ) and light chain 3-1Ⅱ (LC3-1Ⅱ) and the ratio of Bcl-2/Bax were measured by Western blotting after 24 h of treatment with various concentrations BRC (0,30 and 60 μ moi/L) for the MMQ cells.Results The LC3 protein expression rate in the pituitary adenomas was 80％ (24/30) and that in the normal brain tissues was 0％ (0/30);Bcl-2 protein expression rate in the pituitary adenomas was 83.33％ (25/30) and that in the normal brain tissues was 0％ (0/30).The high expression rates of LC3 and Bcl-2 in pituitary adenomas were significantly higher than those of the normal brain tissues (P＜0.05).Patients with increased prolactin after BRC treatment had significantly higher expression rates of LC3 and Bcl-2 than those with decreased prolactin after BRC treatment (P＜0.05).After treatment with 60 μmol/L BRC for 24 h,the number of MMQ cells in G0-G1 phase was significantly larger than controls (P＜0.05).After 24 h of induction with various concentrations BRC,Western blotting showed that the conversion ratio of LC3-Ⅰ to LC3-Ⅱ in MMQ cells was significantly increased following the increase of BRC concentration (P＜0.05);the ratio of Bcl-2 and Bax showed no significant difference among the 0,30 and 60 μ mol/L BRC treatment groups (P＞0.05).Conclusion The death manner of BRC-treated pituitary adenoma cells is mainly autophagic cell death rather than apoptosis.

Microscopic and neuroendoscopy assisted microvascular decompression: a Meta-analysis / 中华神经医学杂志

Objective To compare the clinical efficacies of endoscopy-assisted microvascular decompression and microscopic microvascular decompression.Methods PubMed,Cochrane Library,Embase,VIP,CNKI and Wanfang database were retrieved.The randomized controlled trials comparing trigeminal neuralgia and hemifacial spasm treated with endoscopy-assisted microvascular decompression and microscopic microvascular decompression were chosen.The retrieval time was from the establishment of the database to April 1st,2017.After the detected literatures being screened,extracted and evaluated,a Meta-analysis was performed using RevMan 5.3 software.Results Finally,a total of 10 trials with 1010 patients were enrolled.The results of Meta-analysis showed:(1) in the aspect of effectiveness,patients from the neuroendoscope group had significantly better prognosis (RR=1.110,95％CI:1.060-1.160,P=0.000) and statistically lower relapse rate (RR=0.100,95％CI:0.020-0.530,P=0.007) as compared with the microsurgery group;(2) in the aspect of safety,patients from the neuroendoscope group had fewer postoperative complications (RR=0.650,95％CI:0.530-0.800,P=0.000) and lower postoperative paralysis incidence rate (RR=0.580,95％CI:0.360-0.930,P=0.020) as compared with the microscope group.There were no significant differences in the operation time,incidence of cerebrospinal fluid leakage,hearing loss or intracranial infections between the 2 groups (P＞0.05).Conclusion As compared with those in patients accepted microscopic microvascular decompression,the prognosis of patients accepted endoscopy-assisted microvascular decompression is better,the relapse rate is lower,and safety is higher.

Effect analysis of pterional approach combined with partial orbital roof and zygomatic process resection for the treatment of ruptured anterior communicating artery aneurysms / 中国脑血管病杂志

Objective To investigate the effect of using pterional approach combined with partial orbital roof and zygomatic process resection (modified orbitopterional approach)for the management of ruptured anterior communicating artery aneurysms. Methods From October 2013 to October 2016,36 consecutive patients with ruptured anterior communicating artery aneurysm admitted to the Department of Neurosurgery,Binzhou Medical University Hospital were enrolled retrospectively. They were all confirmed by DSA or CT angiography. The orbitopterional approach was used,only part of the orbital roof was removed and the structures of lateral orbital wall and the wings of sphenoid bone were not removed. The clinical manifestations,imaging data,surgical methods,and surgical results of ruptured anterior communicating artery aneurysms were summarized. Results All 36 patients with anterior communicating artery aneurysm in this group were treated with the modified orbitopterional approach. There was no obvious brain retraction injury on CT scan after procedure. At the time of discharge,the Glasgow outcome scale score was 5 in 25 cases, 4 in 8 cases,and 3 in 3 cases. No patients died. The patients were followed up for 3 to 24 months;no rebleeding and recurrence were observed. No complications occurred,such as enophthalmos,damage to the eyeballs, and cranial nerve injury. Conclusion The modified orbitopterional approach increased the operation space,avoided the distraction of brain tissue,significantly shortened the operation distance,and increased the deep observation angle through the removal of part of the orbital roof and the zygomatic process. It is suitable for the treatment of anterior communicating artery aneurysms,especially the rear direction,upper direction and high positioned aneurysms. There was no bone loss in the procedure,no need for orbital roof reconstruction. The gyri rectus was retained anatomically,and it may be helpful to protect the postoperative cognitive function of the patients.

Application of 3D printing guide system in minimally invasive puncture and drainage of cerebral hemorrhage surgery / 中华神经医学杂志

Objective To study the design and application of customized navigation module manufactured by digital modeling and 3D-printing technology in the minimal-invasive-puncture surgery for cerebral hemorrhage. Methods Eight patients with cerebral hemorrhage, admitted to our hospital from October 2015 to December 2015 and aged from 33-80 years old (with an average age of 55.7), including 6 male and 2 female, were chosen as study objects. The 3-dimensional image was obtained by three dimensional reconstruction technique. A perfectly personal navigation module included puncturing-guidance-channel was designed and printed by 3D-printing technology. The printing module was tested in surgery. The module was tightly attached to the puncturing area, and the puncturing was performed following the guide system during the surgery. Post-operation cerebral CT scan was performed to evaluate the surgery effect. Results All the 8 patients successfully received surgery. Post-operation cerebral CT scan showed satisfied results which were classified based on accuracy: 6 enjoyed highly accurate results, one qualified result and one acceptable result. The actual puncture direction was the same with that in the pre-operation mimic process. No puncture failure, blood vessel or nervous injury symptoms were found. Conclusion Pre-operation personal 3D printing navigation is an accurate, safe and effective novel method to treat cerebral hematoma.

The effect of oral care on the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury by aspiration of subglottic secretion combined with 2%acetic acid chloride solution / 中国实用护理杂志

Objective To explore the effect of oral care on the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury by aspiration of subglottic secretion combined with 2% acetic acid chloride solution. Methods A total of 100 cases of ICU patients with mechanical ventilation for longer than 48 hours were divided into group B and group C using a random number table method according to tracheotomy mechanical ventilation time sequence number from January 2014 to June 2015. Another 50 ICU patients in group A (as the case for retrospective analysis, from April to November , 2013) were treated by routine tracheal suction, normal saline cotton for oral care, group B were treated with aspiration of subglottic secretion, normal saline cotton for oral care, group C were treated with aspiration of subglottic secretion combined with 2% acetic acid chloride solution for oral cleaning. And then VAP occurrence rate, plaque index, plaque clearance were evaluated. Results The incidence rates of early onset VAP in three groups were 14% (7/50), 8% (4/50), 4% (2/50), and incidence rates of late onset VAP were 22% (11/50),12% (6/50), 8% (4/50) respectively, the differences were significant (χ2=3.65, 3.88,P<0.01). The plaque index and plaque clearance rates of the three groups on the third day were 2.14± 0.35, (40.12 ± 13.11)%, 2.10 ± 0.33, (39.17 ± 14.21)%, 1.03 ± 0.24, (60.12 ± 15.07 )%(F=12.21,χ2=3.82,P<0.01);while on the 7th day, they were 1.76 ± 0.47, (41.12 ± 13.34)%, 1.80 ± 0.32, (39.37 ± 12.21)%, 0.99 ± 0.15, (60.33 ± 14.25)%(F=13.14,χ2=4.20,P<0.01). Conclusions The incidence rate of VAP can be decreased by the combination of aspiration of subglottic secretion and oral cleaning with 2%acetic acid chloride solution.