Objective To investigate the influence of different timing of surgery on patients with poor-grade intracranial aneurysm. Methods The clinical data of 86 patients with aneurysmal subarachnoid hemorrhage (Hunt-Hess gradeⅣ toⅤ)were analyzed retrospectively. The patients were divided into an ultra-early treatment group (the operative time within 24 h after onset;n=40),an early treatment group, (24 to 72 h after onset;n=27),and middle and late treatment group (>72 h after onset;n=19)according to the different timing of surgery. The prognosis of patients at 6 months after procedure was evaluated with the modified Rankin Scale (mRS)scores. The differences of the rate of good prognosis (mRS 0 to 2)and mortality in patients of the 3 groups were compared. Results (1 )The ratios of good prognosis in the ultra-early treatment group,early treatment group,and middle and late treatment group were 55. 0%(n=22),33. 3%(n=9),and 21. 1%(n=4),respectively. There were significant differences (P<0. 05). The mortality rate of the ultra-early treatment group (7. 5%)was lower than that of the early treatment group (25. 9%) or middle and late treatment group (42. 1%). There were significant differences (P<0. 05). (2)There were significant differences in the rate of good prognosis in different timing of surgery in patients with gradeⅣ(P<0. 05);there was no significant difference in the rate of good prognosis in patients with grade Ⅴ(P>0. 05). The mortality ratios in patients of the 3 groups were 2/18,4/11,and 6/11,respectively. There were significant differences (P<0. 05). Conclusion Ultra-early operation may benefit part of the patients with poor-grade aneurysm,particularly in patients with gradeⅣ. As for the patients with grade Ⅴ, ultra-early operation may help to reduce short-term mortality rate,however,the rate of vegetative state is high.

Objective To investigate cognitive strategies of emotion regulation in subjects with panic disorder (PD).Methods Subjects were 51 patients with PD and 54 healthy controls individually matched by age,sex and educational level.Cognitive Emotion Regulation Questionnaire (CERQ) were obtained from both panic and control group.Twenty-three panic disorder patients and 22 healthy controls completed a validated passive cognitive reappraisal task.Results (1) PD group scored significantly lower on the strategies of positive focus (4.4± 1.3 vs 5.4±1.3),positive reappraisal (4.9±2.0 vs 6.5±2.0) and putting into perspective (4.8±1.8 vs 6.2±1.9),and significantly higher on the strategies of catastrophizing (7.1 ±2.0 vs 4.5± 1.8) and rumination (6.8±2.2 vs 3.9± 1.9)than control group (P＜0.05).(2) In cognitive reappraisal task,significant picture type × group interactions were found in both valence and arousal 9-point scales (P＜0.05).Conclusion PD patients show obvious impairment of emotion regulation,and cognitive reappraisal defect may play an important role in it.

OBJECTIVETo guide doctors in precisely positioning surgical operation, a new production method of minimally invasive implant guide template was presented.

METHODSThe mandible of patient was scanned by CT scanner, and three-dimensional jaw bone model was constructed based on CT images data The professional dental implant software Simplant was used to simulate the plant based on the three-dimensional CT model to determine the location and depth of implants. In the same time, the dental plaster models were scanned by stereo vision system to build the oral mucosa model. Next, curvature registration technology was used to fuse the oral mucosa model and the CT model, then the designed position of implant in the oral mucosa could be determined. The minimally invasive implant guide template was designed in 3-Matic software according to the design position of implant and the oral mucosa model. Finally, the template was produced by rapid prototyping.

RESULTSThe three-dimensional registration technology was useful to fuse the CT data and the dental plaster data, and the template was accurate that could provide the doctors a guidance in the actual planting without cut-off mucosa.

CONCLUSIONThe guide template which fabricated by comprehensive utilization of three-dimensional registration, Simplant simulation and rapid prototyping positioning are accurate and can achieve the minimally invasive and accuracy implant surgery, this technique is worthy of clinical use.

Computer-Aided Design ; Dental Implantation, Endosseous ; Dental Implants ; Dental Models ; Humans ; Jaw, Edentulous ; Mandible ; Patient Care Planning ; Surgery, Computer-Assisted

Objective To investigate the application value of digital subtraction angiography ( DSA) combined with volume rendering technique ( VRT) in intracranial aneurysm clipping. Methods From January to July 2016,19 consecutive patients with intracranial aneurysm admitted to the Department of Neurosurgery,Northern Jiangsu People′s Hospital were enrolled retrospectively. All patients underwent craniotomy clipping immediately after clipping,DSA was performed and VRT was use to process the related images. For those with poor clipping effect, angiography was performed again after the adjustment of the aneurysm clips,until angiography confirmed that the clipping was satisfactory. Good treatment was defined as no recurrence of aneurysms and the Glasgow outcome scale of 4-5 . Results Nineteen patients had 26 aneurysms. They were all clipped completely observed under the microscope. Confirmed by angiography, 18 aneurysms were clipped completely for the first time,1 apical aneurysm of basilar artery and its contralateral posterior cerebral artery were clipped with a residual aneurysm neck,the contralateral A2 artery was clipped in 1 anterior communicating artery aneurysm, an anterior choroidal artery was clipped completetly in 1 posterior communicating aneurysm,3 aneurysms had residual necks, the upper stem artery was stenosis after 1 middle cerebral artery bifurcation aneurysm was clipped,the anterior communicating artery and the origin of contralateral A2 was stenotic after one anterior communicating artery aneurysm being clipped.Except for 2 aneurysms ruptured without adjustment during the operation,the clipping of other aneurysms was ideal after adjustment. In 2 patients with severe cerebral vasospasm,1 was relieved after a slow transcatheter injection of papaverine,1 was relieved after putting papaverine-wetted cotton piece on the site of vasospasm. The intraoperative DSA and VRT image processing time was 30-100 min. No complications associated with angiography occurred. The patients were followed up for 3-16 months,computed tomography angiography was showed no aneurysm recurrence and vascular stenosis,there were 1 case with hemiplegia and 18 cases with good recovery. Conclusions Intraoperative DSA combined with VRT can help to observe the clipping effect in real time and adjust the aneurysm clips. It can reduce the residual aneurysm neck,parent artery,and peritumoral vascular occlusion,thus improving the operation effect and reducing the disability and mortality.

Atrial fibrillation, also known as atrial fibrillation, is a common cardiac arrhythmia, and its incidence increases with age. Catheter ablation is considered to be an effective means to treat atrial fibrillation and maintain sinus rhythm. The common ablation technologies are radiofrequency ablation and cryoablation. However, the existing catheter ablation technology has a "zero-sum effect", and it is difficult to control the optimal dose clinically. In this study, a new method of pulsed electric field ablation for atrial fibrillation was proposed, which effectively solved the "zero-sum effect" problem of temperature ablation. The clinical application results show that the proposed technology effectively overcomes the shortcomings of existing temperature ablation, and can form durable pulmonary vein isolation.

Objective:To investigate the value of 3D printing technology in sphenoid ridge meningioma dissection. Methods:By using craniocerebral spiral enhanced CT scan DICOM images, the skull, vessels, and tumor were extracted, reconstructed, and assembled and integrated in the same coordinate system. Then, we constructed a 3D virtual model and a 3D-printed entity model, which was ap-plied for preoperation and postoperation. Results:Virtual models of the brains of five patients were reconstructed successfully and 3D entity models were produced. The models expressed the relationship among tumors, adjacent blood vessels, and the important posi-tion of the nerve tissue. Then, the models were applied to the reference before surgery planning and after surgery. Five cases were successfully performed. Conclusion:The use of the entity model of sphenoid ridge meningioma is important in optimizing operation plans, improving tumor resection, and reducing intraoperative bleeding.

Objective:To investigate the safety and effectiveness of emergency one-stop hybrid operation in ruptured and hemorrhagic high-grade brain arteriovenous malformations (BAVMs).Methods:Twelve patients with ruptured and hemorrhagic high-grade BAVMs who underwent emergency one-stop hybrid operation were chosen. The clinical data and efficacy of these patients were analyzed retrospectively.Results:All patients completed surgery successfully. Embolization combined with BAVMs resection was performed in 4 patients, BAVMs resection under digital subtraction angiography (DSA) was performed in 4 patients, embolization combined with balloon-assisted BAVMs resection was performed in 1 patient, balloon-assisted BAVMs resection under DSA was performed in 1 patient, embolization combined with BAVMs resection and aneurysm clipping was performed in 1 patient, and BAVMs resection combined with aneurysm clipping under DSA was performed in 1 patient. Intraoperative DSA showed residual vascular malformation in 1 patient and complete resection in other 11 patients. No surgical complications occurred. Two patients presented symptoms of delayed epilepsy after discharge. Six months after operation, 8 patients had good prognosis (Glasgow Outcome Scale [GOS] scores≥4), 4 had poor prognosis (GOS scores of 1-3), and no death occurred. CTA or DSA in all patients 6 months after operation found no residual or recurrent vascular lesions.Conclusion:Emergency one-stop hybrid operation has high complete occlusion rate and low surgical complication incidence in ruptured and hemorrhagic high-grade BAVMs, which is worthy of clinical application.

OBJECTIVETo explore the effects of electroacupuncture (EA) combined with motor imagery therapy on motor function and activity of daily living in patients with hemiplegic cerebral infarction.

METHODSNinety patients with hemiplegic cerebral infarction were randomly divided into a rehabilitation group, an EA group and a comprehensive group, 30 patients in each one. The patients in the rehabilitation group were treated with regular care, medication and rehabilitation training; based on the rehabilitation group, the patients in the EA group were treated mainly with electroacupuncture at Baihui (GV 20), Dingnieqianxiexian (MS 6), Dingniehouxiexian (MS 7), Jianyu (LI 15), Waiguan (TE 5), Fengshi (GB 31) and Sanyinjiao (SP 6); with the arrival of. EA device was connected for 30 min. The patients in the comprehensive group were treated with EA as the EA group and motor imagery therapy, 20 min per treatment. The treatment was given once a day, five treatments per week, and totally 4-week treatment was performed. The Barthel index and Brunnstrom score before and after treatment were observed in the three groups.

RESULTSThree cases did not finish the trial and finally 87 cases were included into analysis, including 30 cases in the rehabilitation group, 29 cases in the EA group and 28 cases in the comprehensive group. Compared before treatment, the Barthel index and Brunnstrom score were significantly improved after treatment in the three groups (all<0.01); after treatment, the Barthel index in the EA group and comprehensive group was significantly higher than that in the rehabilitation group (both<0.01); the lower extremity score of Brunnstrom score in the comprehensive group was better than those in the EA group and rehabilitation group (both<0.05).

CONCLUSIONEA combined with motor imagery therapy and rehabilitation can significantly improve the motor function and activity of daily living in patients with hemiplegic cerebral infarction, which is superior to rehabilitation alone or EA alone.

The 15th Syposium on Chinese Burn Medicine and the 2nd Congress of Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare (CPAM) was successfully held in Suzhou, from June 20th to 22th in 2019. A total of 400 specialists and scholars across the country attended the meeting. Focusing on the theme of " Guide and consensus: exploration and consideration " , with form of one main meeting place and two branch meeting places, the related hot and difficult problems were discussed warmly. During the conference, Working Conference of Editorial Committee of Chinese Journal of Burns, Standing Committee of the Chinese Burn Association, and the Congress of Burn Medicine Branch of CPAM were held.