Prospective studies have indicated that the incidence of recurrent stroke in patients with symptomatic intracranial arterial stenosis is approximately 15-20％ per year,and the mortality rate is significantly higher.Although the strict control of the risk factors for atherosclerosis and antithrombotic drugs,especially the use of anti-platelet drugs,is the main basis treatment for these patients,some patients may have drug resistance.These high-riskpatients showed severe stenosis ( ＞ 70％ ) of the recent clinical symptoms of ischemia and theclinical and imaging evidence of distal hemodynamic irnpairment accompanying arterial stenosis.The advances in balloon and stenting have made people begun to consider the possibility ofusing angioplasty and stenting for the treatment of these high-risk patients.However,becausethe relative efficacy of these invasive therapy and drug therapy is not very clear,furtherrandomized clinical trial is still needed.This article reviews the available drug treatment optionsfor symptomatic intracranial arteriosclerotic disease and the current status of endovascudartreatment.

Stroke-associated pneumonia (SAP) refers to the stroke patients suffering from infectious lung parenchyma (including the alveolar wall,i.e.the general pulmonary interstitial) inflammation without previous pulmonary infection.It is one of the most common major complications resulting in death and affecting functional recovery in patients with stroke.Dysphagia resulting in aspiration is the main reason of SAP.Therefore,avoiding aspiration and preventing SAP have important significance for patients with stroke through early correct tube feeding.This article reviews the tube feeding methods of preventing SAP.

The annual incidence of aneurysmal subarachnoid hemorrhage (aSAH) is 9.0/100000.Although it only accounts for 5％ of all strokes,its prognosis is poor.Among the aSAH survivors,46％ of them do not completely recover within 1 year,50％ have progessive memory impairment,14％ have language disorders,and 39％ have emotional disorders.Because the social and family responsibilities shouldered by the relatively young patients,the demand for quality of life,as well as the lack of about the prognostic data of aSAH in China,all these are particularly important for the study of the prognosis of cognitive function,quality of life,and the ability of returning to work in patients with aSAH.

Objective To evaluate the value of dual Doppler ultrasonography in the diagnosis of fetal atrial extrasystoles.Methods Seven thousands and thirteen fetuses were examined by fetal echocardiography.If fetal arrhythmias were found,information of pulsed wave Doppler signals in hepatic vein (HV) and descending aorta (DAo) using dual Doppler were colleted simultaneously.The detected times were compared between using general Doppler and dual Doppler in 20 cases.Results On dual Doppler examination,28 of the fetuses showed signals of atrial extrasystoles,14 fetuses atrial extrasystoles conducted to ventricle,8 fetuses atrial extrasystoles non-conducted to ventricle,6 fetuses with part of the extrasystoles conducted to ventricle and part of the extrasystoles non-conducted to ventricle.No case had congenital heart disease.Twenty-six fetuses with atrial extrasystole were converted to normal rhythm within the third trimester of pregnancy,and the others' were converted to normal rhythm during the first 3 days postnatally.The detected time of dual Doppler was shorter than that of general Doppler(P ＜0.05).Conclusions Dual Doppler ultrasonography of simultaneous recordings in HV and DAo is an easy,rapid method of assessing fetal atrial extrasystoles,which should allow precise diagnosis of atrial extrasystole.

Ischemic stroke is closely associated with carotid atherosclerosis.Detecting carotid plaque components (including fibrous Cap,lipid core,hemorrhage,and calcification) using high-resolution 3.0T magnetic resonance imaging contributes to evaluate the risk of ischemic stroke and guide treatment.This article reviews the research status of magnetic resonance imaging of carotid atherosclerotic plaque components.

Atrial fibrillation is an important cause of ischemic stroke.Studies have shown that the acute ischemic stroke patients with atrial fibrillation may have more severe neurological deficits and higher mortality compared with those without atrial fibrillation.In addition,atrial fibrillation is also an independent risk factor for the failure of recanalization after iotravenous thrombolysis,and it is associated with poor outcome.Mechanical thrombectomy treatment provides a new therapeutic regimen for acute ischemic stroke patients with atrial fibrillation.This article reviews the intravenous thrombolysis and mechanical thrombectomy for acute ischemic patients with atrial fibrillation.

Objective To investigate the intracranial vascular stenosis and risk factors in different types of ischemic stroke. Methods 525 patients with ischemic stroke were assessed by a transcranial Doppler. Lipids including total cholesterol (CHO),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were examined. Results Intracranial vascular stenosis in diabetic and non-diabetic groups of patients,hypertension and non-hypertension groups of patients showed significantly difference (P

Objective To compare the value of ultrasound International Ovarian of Tumor Analysis (IOTA) simple rules and gynecologic imaging reporting and data system (GI-RADS) ultrasonographie stratification in the diagnosis of adnexal masses.Methods A total of 463 patients with adnexal masses were classified according to IOTA simple rules by senior doctor.The benign and malignant masses were enrolled in the study.Then the masses were judged according to GI-RADS classification and IOTA simple rules by senior and junior doctors.And junior doctorn in diagnosis of adnexal masses with IOTA was group A1,senior doctor in diagnosis of adnexal masses with IOTA was group B1,junior doctor in diagnosis of adnexal masses with GI-RADS was A2,senior doctor in diagnosis of adnexal masses with GI-RADS was B2.The efficacy of the two methods were compared.Results Among the 463 cases,there were 411 cases (411/463,88.77％) of benign mass and malignant mass by IOTA and 52 cases (52/463,11.23 ％) of uncertain mass.The specificity,positive predictive value,diagnostic accuracy had statistical differences between groups A2 and B2,A1 and A2 (all P＜0.05),and sensitivity and negative predictive value had no statistical differences (all P＞0.05).Diagnostic efficacy index had no statistial signifi cance between group A1 and B1,B1 and B2 (all P＞0.05).Conclusion The diagnostic efficacy of IOTA simple rules and GI-RADS is high and similar in diagnosis of benign and malignant adnexal masse.IOTA simple rules do not depend on experience,but they are not suitable for the diagnosis of all adnexal masses.

Objective　To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. Methods　Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm×5.0 cm to 4.5 cm ×11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm ×8 cm to 12 cm×25 cm. Results　All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. Conclusion　The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.

Objective To detect the normal values of fetal cerebellar vermis using transabdominal ultrasonography and assess its clinical significance in the diagnosis of vermal hypoplasia(agenesis). Methods A total of 111 fetuses were evaluated by transabdominal sonography between 20 and 40 weeks of gestation.The mid-sagittal antero-posterior(AP) and cranio-caudal(CC) vermian diameters were measured. A second group of 15 fetuses with cisterns magna were assessed and compared with the value of normal fetuses.0.05) and correlated linearly with gestational age ( AP = - 5.406 + 0. 761 GA, r = 0.97 ; CC = - 5.795 +fissure, second fissure and fastigium may help identify developmental anomalies. Conclusions Transabdominal ultrasonography is a valuable tool in the study of fetal vermis during the second half of pregnancy.