Objective To evaluate the microstructural integrity of white matter (WM) in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) using voxel-based analysis (VBA), and investigate the relationship between WM abnormalities and gray matter(GM) atrophy.Methods Thirty-three cases with aMCI, 32 cases with mild AD and 31 normal aging volunteers as control subjects were scanned on a 3.0 T MR system using diffusion tensor imaging (DTI) and three-dimensional spoiled gradient-recalled(3DSPGR) sequences. Fractional anisotropy (FA) maps and morphological images were preprocessed by SPM5 and voxel-based comparisons between the 2 patient groups and the control group were performed by t test. Results Relative to the control group, patients with aMCI showed significantly reduced FA value in bilateral frontal, temporal and left occipital WM, left anterior part of cingulum, left inferior parietal lobule, and the W M adjacent to the triangular part of the right lateral ventricle(k≥20 voxels).In mild AD,significantly reduced FA value was found in bilateral hippocampal,inferior parietal lobular,frontal,temporal,and occipital WM,bilateral corpus callosum,anterior part of cingulums,the WM adjacent to the triaangular part of the bilateral lateral ventricles,left temporal stem,left thalamus,right precuneus(k≥20 voxels).Significantly reduced GM volume was found in left hippocampus,parahippocampal gyrus,lingual gyrus and superior temporal gyrus,bilateral insulae and middle temporal gyri in aMCl group whencompared with control group(k≥50 voxels).In mild AD,significantly reduced GM volume was found in bilateral hippoeampi,parahippocampal gyri,amygdalae,thalami,temporal,parietal,frontal,occipital cortex(k≥50 voxels).The pattern of areas with reduced FA differs;from that of the GM volumetric reduction.No areas with significantlv reduced FA was detected in aMCl compared with mild AD. There was no significant correlation between FA value of WM in patient groups and Mini-Mental State Examination(MMSE)scores.Conclusions Voxel-based MRI DTI analysis of whole brain white matter can objectively reveal widespread white matter abnormalities in early-stage AD.The difierence between WM FA reduction pattern and GM volumetric reduction pattern indicates that the pathological WM changes in earlyslage AD were caused by multiple mechanisms. FA did not vary significantly in patients pr0gressing from aMCI to mild AD and can hardly reflect the severitv of cognitive function damage in these patients.

Objective To investigate compliance of breast cancer patients with postoperative peripherally inserted central catheter (PICC) in terms of upper limb motion, to formulate practical plan of upper limb motion, and to improve the compliance in the patients with PICC catheter.Methods A total of 75 patients after breast cancer operation with PICC for chemotherapy were selected from Department of Thyroid and Breast Surgery for upper limb activity instructions.Plan-Do-Check-Act method was used to evaluate the feasibility and effectiveness.Two cycles were performed in two weeks.Patients' compliance was assessed by the inquiry method.Results After practicing and refining nursing process, perfecting the risk assessment table, adjusting the education time, etc., the cognition and acceptance of the significance of upper limb motion were improved in the patients.The compliance of the patients to the upper limb motion instructions was satisfactory.Conclusions The upper limb motion scheme in this study was modified and perfected through application, research, and practice.This scheme could enhance the compliance of patients in terms of upper limb motion.

Objective To compare the efficacies and prognoses of stereotactic radiosurgery and fractionated stereotactic radiosurgery in treatment of brain metastases of lung cancer with diameter of 3-7 cm.Methods A retrospective study of 80 patients with brain metastases from lung cancer with diameter of 3-7 cm treated with gamma knife in our hospital from April 2010 to November 2016 was performed.There were 46 patients in stereotactic radiosurgery group and 34 in fractionated stereotactic radiosurgery group.The local tumor rate,incidence of complications,changes ofperitumoral edema,and Kamofsky Performance Status (KPS) scale scores at 3 months after operation were compared between the two groups.Multi-factor Cox regression model was used to analyze the factors influencing the short-term efficacy of patients.Kaplan-Meier survival analysis was used to evaluate the survival rate of patients.Results Three months after operation,the local tumor control rate and incidence of complications were 73.9％ and 21.7％ in the stereotactic radiosurgery group,and 94.1％ and 2.94％ in the fractionated stereotactic radiosurgery group,with significant differences (P＜0.05).As compared with those in the stereotactic radiosurgery group,the percentage of patients with increased grading ofperitumoral edema was significantly decreased and percentage of patients with increased KPS scores was significantly increased in fractionated stereotactic radiosurgery group (P＜0.05).Multivariate Cox analysis showed that tumor diameter was the only statistically significant risk factor for prognosis (P＜0.05).The median survival time was 13.6 months in the stereotactic radiosurgery group and 16 months in the fractionated stereotactic radiosurgery group.The one-year survival rate and accumulate survival rate showed no significant differences between the two groups (P＞0.05).Conclusion As compared with stereotactic radiosurgery therapy,fractionated stereotactic radiosurgery has more advantages in the treatment of lung cancer brain metastases with diameter of 3-7 cm.