Objective To explore the effects of modified balloon dilatation therapy for treating upper esophageal sphincter dysfunction after a brainstem stroke.Methods Ten healthy adult volunteers and 20 dysphagic patients with upper esophageal sphincter dysfunction after a brainstem stroke were recruited.The 20 patients were divided into a balloon dilatation therapy group of ten who were treated with catheter balloon dilatation therapy, and a control group of ten who received conventional therapy.All were given block-designed task fMRI scans guided by a matched visual presentation system before and after the treatment.Results Widespread activation was observed in both hemispheres, including the bilateral cerebral cortex, the brainstem and the cerebellum, but the activated areas were significantly smaller in the stroke patients before treatment.After the treatment, seven patients in the balloon dilatation group were totally orally fed, while only three patients in the control group recovered totally oral intake.After dilatation, significantly more regions were activated, including the anterior cingulate, insula, supplementary motor area, precuneus and the frontal lobe.They were activated with relatively low voxels in the treatment group, while in the control group significant activation was observed only in the precuneus after treatment.Conclusion Modified balloon dilatation therapy can increase activation of the cortex and subcortical structures related to swallowing, promoting better swallowing function.

Objective To review the indications,surgical methods,and matters which need attention in partial right diaphragmatic resection,and to summarize our experience of surgical therapy for hepatocellular carcinoma with right diaphragmatic invasion.Methods The clinical data of 27 patients with hepatocellular carcinoma which had invaded the diaphragm and had received partial right diaphragmatic resection and partial hepatectomy in our hospital from September 2008 to September 2012 were retrospectively analyzed.Results The operations were all performed successfully.The tumor diameter ranged from 5.0 to 15.0 cm (average 8.5 cm).The area of right diaphragm which was resected ranged from 9.0 to 50.0 cm2 (average 28.5 cm2).The operation time was 110～250 min (average 165 min),and blood loss was 450～2600 ml (average 870 ml).Diaphragmatic invasion was confirmed by postoperative histopathology in 9 patients (33.3％).A small quantity of right thoracic effusion was detected in all the cases postoperatively.Other complications included hepatic insufficiency in 4 patients and early postoperative bleeding,upper gastrointestinal bleeding,biliary fistula,and infection under the diaphragm in 1 case each.All patients recovered after conservative treatment.There was no perioperative death.19 patients received other postoperative adjuvant treatment while 6 patients refused further treatment and 2 patients were lost to follow-up.The 0.5-,1-,2,and 3 year survival rates after operation were 92.6％,81.5％,51.9％ and 33.3％ respectively.Conclusions Right diaphragmatic invasion is not a contraindication to surgery.Right diaphragmatic resection was safe and feasible,and postoperative long-term survival was satisfactory.

Objective To investigate regional activity abnormalities of patients with liver cirrhosis before and after liver transplantation using resting-state fMRI and amplitude of low frequency fluctuations (ALFF)method.Methods Totally 11 patients preparing to accept liver transplantation were adopted into liver cirrhosis group and 11 healthy volunteers in the health examination were adopted into the control group. The liver cirrhosis group was investigated at a week before operation and repeatedly a month after liver trans-plantation.Healthy volunteers were investigated at the same time.MR imaging data were obtained from a Phil-ips Achieva 1.5-T MR imager.The imaging data were mainly preprocessed with a MATLAB toolbox called DPARSF.REST software was used to calculate the ALFF value of each subject.A second-level random-effect two-sample t-test was performed on the individual ALFF.Significant differences were set at the standard of a corrected cluster level of P<0.05,and software Xjview 8.1 was adopted to express the outcome.Results (1)Compared with control group,decreased ALFF were found in bilateral middle occipital gyrus(MOG) (MNI:x=36,y=-72,z=9),bilateral precuneus/cuneus(PCu/Cu)/posterior cingulated(PCC)(MNI:x=15,y=-66,z=24),left inferior parietal lobule(LIPL)(MNI:x=-39,y=-54,z=42),and bilateral para-central lobule/cingulate gyrus(MNI:x=3,y=-36,z=45)of cirrhosis patients,no increased ALFF were found.(2)Compared with cirrhosis patients,no increased or decreased ALFF were found in postoperative group.After relaxing standards of statistics,increased ALFF were found in left inferior parietal lobule(IPL) (MNI:x=-39,y=-51,z=42),cingulate gyrus(MNI:x=3,y=-33,z=42),and right middle frontal gyrus (MNI:x=35,y=57,z=0)of postoperative group,no decreased ALFF were found.(3)Compared with control group,decreased ALFF were found in bilateral precuneus/posterior cingulated(PCC),and left middle occipi-tal gyrus(MOG)of postoperative group,no increased ALFF were found.Conclusions Significant decreased ALFF is found in visual cortex(PCu),DMN((PCu/Cu/PCC),and LIPL of cirrrhosis patients,and those ab-normalities reflect the weakness of local neurons spontaneous low-frequency.Compared with beforeoperative group,ALFF of LIPL,in cingulate gyrus,and right middle frontal gyrus have a tendency of rising.One month after liver transplantation,decreased ALFF is found in BA7 and BA 31,suggesting that the spontaneous low-frequency of local neurons haven't recoverd to normal level.

Objective To preliminarily investigate the safety and feasibility of intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion. Methods From March 2016 to March 2018, consecutive acute ischemic stroke patients with large artery occlusion within 8 h after onset admitted to the Department of Neurology, the People's Hospital of Longhua District, Shenzhen and recanalized successfully after endovascular treatment were enrolled. After recanalization, cold saline was infused through the guiding catheter via the ipsilateral guilty vessel (10 ℃, 33 ml/min for 30 min). Results A total of 20 patients were enrolled, including 15 males. Their median age was 67 years (interquartile range, 53-80 years). Fifteen patients were treated with thrombolysis. A median onset-to-needle time was 300 min (interquartile range, 260-360 min). During the infusion of cold saline, the lowest rectal temperature was only decreased 0. 1 ℃, but within 5 min after completion of perfusion, it returned to the temperature before perfusion. Complications associated with intra-arterial hypothermia were not observed. The median National Institutes of Health Stroke Scale score was significantly decreased from 21 (interquartile range 15-55) before needle to 15 (interquartile range 10-16; Z = -4. 549, P < 0. 001) at discharge. Conclusion Selective intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion is safe and feasible.

Objective To evaluate euthyphoria reduction combined with percutaneous iliosacral screw fixation in the treatment of irreducible sacroiliac dislocation.Methods From March 2012 to May 2015,29 patients with irreducible sacroiliac dislocation were treated using euthyphoria reduction followed by percutaneous iliosacral screw fixation.They were 18 men and 11 women,aged from 25 to 68 years (average,37.9 years).According to the Tile classification,there were 7 cases of type Cl,9 cases of type C2,and 13 cases of type C3.The intervals from injury to surgery ranged from 6 to 32 days (average,11.3 days).Results The operation time for this cohort ranged from 40 to 125 minutes (average,76.2 minutes).The intraoperative bleeding ranged from 50 to 360 mL (average,148.6 mL).Their follow-ups ranged from 24 to 41 months (average,28.9 months).According to the Matta criteria for reduction,20 cases were rated as excellent and 9 as good,yielding an excellent to good rate of 100％.Their Majeed scores at the final follow-up averaged 90.1 points (range,from 67 to 100 points),giving 20 excellent,7 good and 2 fair cases (with an excellent to good rate of 93.1％).No screw loosening or lameness of the affected limb was observed during follow-ups.Conclusions Euthyphoria reduction combined with percutaneous iliosacral screw fixation can lead to satisfactory outcomes in the treatment of irreducible sacroiliac dislocation.Additionally it may improve operative safety.

【Objective】 To explore the recruitment and retention strategy of blood donors by investigating the age composition of blood donors in some areas of China, so as to promote blood donation and enhance clinical blood supply. 【Methods】 Through the working platform of Practice Comparison Working Group of China’s Mainland Blood Collection and Supply Institutions, the average age and age composition of blood donors from 22 blood centers were collected, and statistical analysis was conducted after eliminating invalid data. 【Results】 The median average age of blood donors during the survey year was 30.02.The median age in 2.89% of the blood centers was lower than 25. The average age of different genders was statistically significant only in 2018(P<0.05). Fot first-time blood donors, the median constituent ratio of donors <25 and ≥25 years old was 54.53% and 44.28%, with median retention rate at 10.30% and 9.61%, respectively. The median overall participation rate of blood donors was 2.7%, with median participation rate of blood donors <25 years old at 5.1%. 【Conclusion】 The recruitment and retention of blood donor is crucial to enhance clinical blood supply. Blood donors <25 years old, with a longer period for future donation, should be the main target of blood donation recruitment. Meanwhile, the revision of upper age limit for blood donation is another important initiative to grow the blood donor pool.