Objective To investigate the effect of butylphthalide on cerebrovascular reactivity (CVR) in patients with severe intracranial internal carotid stenosis.Methods The patients with severe intracranial internal carotid stenosis diagnosed by cerebral angiography in Nanjing Stroke Registry Program from January 2010 to November 2010 were randomly divided into either the butylphthalide group or the control group.All patients received the oral drugs for ischemic cerebrovascular disease that met the guideline criteria,and butylphthalide 20 mg,3 times a day orally was added in the butylphthalide group.The CVR was evaluated by transcranial Doppler and CO2 inhalation challenge test,and reexamined 3 months after treatment.Results A total of 81 patients met the inclusion criteria,11 (13.6％) were lost to follow-up,and finally 70 (n =35 in each group) were included in the analysis.The mean age of the patients was 55.2 ± 9.0 years,47 of them were male and 23 were female.The degree of vascular stenosis was 72％ to 99％ (mean 79.4％ ± 9.5％).The CVR was improved significantly after 3 months of treatment in the butylphthalide group than that in the control group (P =0.007),but it was not improvedsignificantly in the control group (P =0.330).All the patients did not have ischemic stroke events during the medication.No serious adverse reactions occurred in the butylphthalide group.Conclusions Butylphthalide may improve the CVR in patients with severe intracranial internal carotid stenosis.

Objective To evaluate the safety and efficacy of early carotid artery stenting in treating cerebral watershed infarction patients with carotid artery stenosis. Methods A total of 33 patients with acute cerebral watershed infarction complicated by carotid artery stenosis received carotid artery stenting within one week after the onset of the disease. The clinical safety and efficacy were evaluated. Results The carotid artery stenting was successfully accomplished in all 33 patients with a success rate of 100%. After the procedure, different degree of bradycardia and hypotension was seen in 23 patients, which restored to normal after prompt medication with atropine, dopamine, etc. During the procedure, one patients developed cerebral embolism due to dislodgment of emboli, resulting in contralateral hemiparalysis, and the contralateral limb muscle strength returned to preoperative status after proper treatment. After the treatment, no ipsilateral hemisphere excessive perfusion or cerebral hemorrhage occurred. Thirty days after the treatment, NHISS scores of the patients were obviously improved, which were significantly different from those determined before the treatment (P<0.05). Conclusion For the treatment of acute cerebral watershed infarction, early carotid artery stenting to relieve carotid artery stenosis is quite safe and it may improve the prognosis as well.

Objective:To investigate the safety of intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel in patients with unruptured intracranial aneurysms accepted stent-assisted coil embolization, and explore the effect of tirofiban on perioperative thrombotic events.Methods:The clinical data of 275 patients with unruptured intracranial aneurysms who underwent stent assisted coil embolization in our hospital from January 2016 to December 2019 were retrospectively collected. Among them, 110 patients admitted to our hospital from January 2016 to December 2017 only received preoperative oral administration of aspirin and clopidogrel combined with antiplatelet treatment (classic group), and 165 patients admitted to out hospital from January 2018 to December 2019 received intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel (improved group). The differences of perioperative safety and thrombotic events between the two groups were compared and analyzed.Results:The incidence of intraoperative visual thrombotic events in the classic group and the improved group were 6.4% (7/110) and 1.2% (2/165), respectively, with significant difference ( P<0.05); the incidence of postoperative thrombotic events was 4.5% (5/110) and 2.4% (4/165), respectively, without significant difference ( P>0.05); the incidence of urethrorrhagia was 9.1% (10/110) and 21.2% (35/165), respectively, with significant difference ( P<0.05); and the incidence of gingival hemorrhage was 13.6% (15/110) and 19.4% (32/165), respectively, without significant difference ( P>0.05). No acute gastrointestinal hemorrhage or cerebral hemorrhage occurred in both groups; urethrorrhagia and gingival hemorrhage were transient and relieved spontaneously. Conclusion:Intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel can reduce the incidence of intraoperative visual thrombotic events without increasing the risk of hemorrhage in stent-assisted coil embolization of unruptured intracranial aneurysms.

Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1％ and 71.0％,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.