Objective To analyze the clinical features and prognosis of patients with acute epidural hematoma in the whirlpool sign.Methods 36 cases of CT scan showed a whirlpool sign of acute subdural hematoma patients were selected as the observation group.During the same time period,50 acute epidural hematoma patients without the whirlpool sign were selected as the control group.All patients received operation treatment.The Glasgow coma score (GCS),amount of hemorrhage and prognosis were compared between the two groups.Results The preoperative GCS score of the observation group was significantly lower than that of the control group (P ＜ 0.05).In the operation,the blood loss of the observation group was significantly increased compared with the control group (t =3.232,3.164,P ＜ 0.05).Control group CT evaluation of preoperative and intraoperative measurement had no significant difference(P ＞0.05).In the observation group,11 patients died,the mortality rate was 30.5％ (11/36).In the control group,6 patients died,the mortality rate was 12.0％ (6/50),the difference between the two groups was statistically significant (x2 =4.134,P ＜ 0.05).The patients were followed up for 6 months,the excellent and good rate of ADL score in observation group was 64.0％,which was significantly lower than 84.1％ in the control group (x2 =3.989,P ＜ 0.05).Conclusion Acute epidural hematoma patients with thewhirlpool signshowed progressive disease,high mortality,poor prognosis,and active countermeasures should be taken.

Objective To analyze the volume and position of the gross tumor volumes (GTV) in primary esophageal cancer based on contrast-enhanced three-dimensional (3D),four-dimensional (4D) and cone beam (CB) computed tomography (CT).Methods A total of thirty-four patients underwent 3D-CT and 4D-CT simulation scans for computer treatment plan and contrast-enhanced CBCT scans were conducted prior to the first treatment.GTV3D,GTV4D50,internal GTVMIP (IGTVMIP) and internal GTVCBCT (IGTVCBCT) were delineated on 3D-CT,4D-CT50 (the end expiratory phase),4D-CTMIP (the maximum intensity projection),and CBCT datasets,respectively.The IGTV10 was defined as 10 respiratory phases GTVs in 4D-CT.To evaluate the difference in position,volume and the volumes encompassed characteristic.Results The significant difference was observed in the volumes [IGTV10 ＞ (IGTVCBCT or IGTVMIP) ＞ (GTV3D or GTV4D50)] regardless of the tumor location.Regarding IGTV10 as the standard volume,the underestimations or overestimations between IGTV10 and IGTVCBCT were larger than that of between IGTV10 and JGTVMIP (t =-8.294--3.192,P ＜ 0.05).However,there was no significant difference between the areas of IGTV10 which excluded in IGTVCBCT and IGTV3D (P ＞ 0.05).The GTV4D50/ IGTVCBCT ratio for upper esophageal tumors was negatively correlated to motion vector (r =-0.756,P ＜ 0.05).The centroid coordinates of IGTVCBCT in AP direction were significantly different from the test volumes (GTV3D,GTV4D50,IGTVMIP and IGTV10) (t =-3.559--2.435,P ＜ 0.05).The IGTV10/IGTVCBCT ratio was positively correlated to motion vector (r =0.695,P ＜ 0.05) for middle esophageal tumors.The centroid coordinates of IGTVCBCT were significantly different IGTV10 (t =2.201,P ＜0.05) in AP direction.For distal esophageal tumors,the significant difference was observed in the centroid coordinate between IGTVcBcT and IGTVMIP (t =-2.365,P ＜ 0.05) in LR direction.The percentage of IGTV10 excluded the IGTVcBcT were significantly correlated to the motion vector (r =0.540,0.678,P ＜ 0.05) for both middle and distal esophageal tumors.The mean MI value of IGTVCBCT to the other four test volumes ranged from 0.65 to 0.72.Conclusions CBCT has much motion information than 3D-CT but less than IGTV10.CBCT was similar to MIP images based on respiration motion.However,the target motion information encompassed in CBCT and MIP images cannot be exchanged to each other.

Objective To investigate the optimal trajectory of posterior occipital condyle screw fixation via radiological and anatomical study.Methods Twelve adult craniocervical junction complete specimens were selected.The length,width and height of occipital condyle and the inclination angle of the longest axis were measured by CT scanning and reconstruction.Subsequently,occipital condyle screws were inserted with reference to CT measurements.After screw fixation,accuracy and safety of the placement of occipital condyle screw were verified by gross observation and CT scanning.Results Preoperative measurements of height and width of the occipital condyles indicated the placement of 4.0 mm bicortical screws was secure.Left vertebral artery horizontal sections of 2 specimens were slightly pressed without damage.CT scanning identified no damage to the inner or outer wall of the occipital condyle and the hypoglossal canal.Trajectory parameters between the right and left sides were slightly different,but no significant difference was observed (P ＞ 0.05).Average screw channel length and inclination angle were (20.8 ±2.6)mm and (37.1 ± 4.7)°respectively.Angle between screw and skull base tangent was observed as (8.5 ± 1.7) °.Distance between screw axis and hypoglossal canal was observed as (3.1 ± 1.1) mm.And the distance averaged (4.6 ± 1.4) mm between occipital condyle screw entry point and skull base and (6.1 ± 1.5) mm between entry point and inside edge of the occipital condyle.Conclusion Occipital condyle can be used as a new alternative fixed point in occipitocervical fusion.

Objective To investigate the feasibility and effectiveness of fast track surgery (FTS) in neurosurgery. Methods One hundred fifteen patients who underwent neurosurgery surgery in Henan Province People's Hospital from June 2012 to March 2014 were enrolled in this study. All the patients were divided into FTS group (62 cases) and the tra?ditional operation group (53 cases). The clinical index, postoperative hospital stay and hospitalization cost were compared between the two groups. Results The clinical index were significantly lower in FTS group than in traditional operation group (P<0.05). Length of hospital stay (days) and hospitalization cost of FTS group were significantly shorter and lower in FTS group compared with traditonal operation group (8±1 vs. 11±2 days and RMB 4.58 ±0.75 vs. 5.78 ±0.64 ten thou?sand, respectively) (P<0.05). Conclusion FTS in neurosurgery operation is an all-new concept for surgery which can ef?fectively reduce postoperative complications, shorten length of hospital stay, decrease hospitalization cost and promote postoperative recovery.

Objective To construct in the extracellular matrix metalloproteinase inducer (EMMPRIN)glycosylation single point mutation plasmid,and to explore its relationship with tumor cell proliferation.Methods PCR point mutantion technology was used to construct the mutantion plasimid of EMMPRIN glycosylation single point.After successful mutation, the function of mutantion plasmids were detected. Western blotting was used to detect the expression of EMMPRIN protein,immunofluorescence method was used to detemine the morphological changes of the cells,and MTT assay was performed to detect the relationship between mutantion pasmid and tumor cell proliferation.Results Confirmed by restriction enzyme digestion and sequencing,the 44th,the 152th,and the 186th Asn were successfully mutated to Gln in the sequence of EMMPRIN;EMMPRIN/GFP (N44Q), EMMPRIN/GFP(N152Q),and EMMPRIN/ GFP (N186Q)glycosylation single point mutation plasmids were constructed.Compared with wild-type,thel morphology of the cells was significantly changed,the core division of mutant-type cells was significantly reduced, the number of filopodia was reduced. The results of MTT assay showed that the survival rate of the cells in wild-type group were significantly increased compared with control group (P<0.05 );the survival rates of the cells in EMMPRIN (N44Q) group, EMMPRIN (N152Q) group and EMMPRIN(N186Q)were significantly decreased compared with wild-type group(P<0.05).Conclusion Mutant-type EMMPRIN can inhibit the proliferation of tumor cells;with the duration increasing, the inhibitory effect is weakened.There is a correlation between EMMPRIN glycosylation and proliferation of tumor cells.

Objective To evaluate the clinical effect of postural reduction combined with miniincision screw-rod system and percutaneous kyphoplasty (PKP) in treating osteoporotic thoracolumbar burst fractures.Methods A retrospective case series study was performed for data of 35 patients with osteoporotic thoracolumbar burst fractures without neurological deficits undergone mini-incision screw-rod system fixation and PKP between January 2012 and January 2014.There were 14 males and 21 females,with a mean age of 63.2 years (range,50-72 years).Operation time,intraoperative blood loss,complications,visual analogue score (VAS),height of fractured vertebrae and kyphosis Cobb angle were recorded.Results Operation time was (49.6 ± 6.8) min,and intraoperative blood loss was (45.6 ±7.8)ml.All patients were followed up for 9-18 months (mean,13.5 months).No intraoperative or postoperative serious complications occurred,including intracanal cement leakage,breakage or loosening of the screws.VAS of back pain was decreased from (8.4 ± 1.1)points preoperatively to (3.5 ± 0.6)points postoperatively (P ＜ 0.05).Height of the fractured vertebrae was improved from (49.62％ ± 5.68)％ preoperatively to (86.64 ± 6.63) ％ postoperatively (P ＜ 0.05).Kyphosis Cobb angle was improved from (28.12 ± 1.06) °preoperatively to (5.15 ± 1.08) °postoperatively (P ＜0.05).At the final follow-up,VAS was further decrease and vertebral height and Cobb’ s showed a slight loss of correction.Conclusion Postural reduction combined with mini-incision screw-rod system and PKP can relieve back pain,restore the height of injured vertebrae,correct kyphotic deformity and reduce operation time and blood loss,indicating a minimally invasive,safe and effective procedure for treatment of osteoporotic thoracolumbar burst fractures.

Objective To investigate the safety of the occipital condylar screw with vertical position and evaluate the selection strategy of the posterior approach of the posterior occipital condylar screw in Chinese people.Methods The clinical imaging data of 60 outpatients from September 2013 to September 2015 were retrospectively analyzed,36 male and 24 female,the average age was 41.6±9.2 (range from 25-58),Excluded occipitocervical injury,tumor and deformity patients.We built a three-dimensional digital model and simulated placing screw by utilizing CT data on Mimics software,after that we took the occipital condyle posterior medial and lateral midpoint as the entry point,then made 2 points equidistantly to the midpoint in vertical direction.We put 3.5 mm diameter virtual screws in 4 different conditions:largest cranial angle,smallest cranial angle,longest screw path and shortest screw path.Then we assessed the anatomical relationship between the screw and the hypoglossal canal or the atlanto-occipital joint by a three-dimensional window and measured the cranial angle,medial angle and length of screw path,then calculated the safety angle of the cranial angle,the successful rate of setting screw,and compared the safety of different screw points by 3-Matic software.Results 120 occipital condyles were obtained from the CT data of 60 patients by Mimics software.There was no significant difference in the data of the cranial angle,medial angle,safety range and length between both left and right sides.The obtained safe cranial angle of each point respectively was 20.9°±6.0° (lowest point),17.0°±6.2° (middle point),and 11.6°±7.1°(top point),obviously the largest angle was in the lower point and the smallest was in the top point.The difference was statistically significant.We then acquired the successful rates of different cranial angle of each point,the highest successful rate was 99.17％,96.67％,74.17％ in lowest,middle and top point when cranial angle were 3°or 4°,3°and 0°respectively.The successful rates of lower point and niddle point were significantly higher than the top point,and the difference was statistically significant.The medial angle parameters obtained were 34.41°±2.59°on left and 34.06°±2.44°on right,and there was no significant difference.The length parameters of the longest screw path acquired were 23.09± 1.47 mm,22.84± 1.40 mm and 23.15± 1.45 mm at top,middle and lowest entry point.The average value of shortest screw path of each point was 21 mm,and there was no significant difference among every entry point.Conclusion Among the occipital condyle posterior screw entering points,selecting the lower point can improve the success rate and safety;the change of nail enter point in the vertical direction has little effect on the length of the nail.We can increase the safety and reduce the risk of occipital condylar screw placement as far as possible through the three-dimensional digital technology.

Objective To compare the normal thickness of the esophageal wall measured by contrast?enhanced three?dimensional ( 3DCT ) , four?dimensional ( 4DCT ) , and cone beam computed tomography ( CBCT) ,and to provide a basis for target volume delineation in esophageal cancer. Methods From 2009 to 2016,thoracic contrast?enhanced 3DCT and 4DCT simulations were performed in 50 patients with lung cancer or metastatic lung cancer. Contrast?enhanced CBCT scans were acquired during the first three?dimensional conformal radiotherapy. The normal esophageal wall was contoured on 3DCT images, the end?exhalation phase of 4DCT images ( 4DCT50 ) , the maximum intensity projection of 4DCT images (4DCTMIP),and CBCT images. The wall thickness was measured on each segment and the average thickness of esophageal wall was obtained. Comparison of the thickness of a fixed segment of esophageal wall between different CT images was made by paired t test. Comparison of thickness on the same type of CT images between different segments of esophageal wall was made by one?way analysis of variance. Results For the thoracic and intra?abdominal segments,there was no significant difference in the thickness of esophageal wall between 3DCT and 4DCT50 images ( P= 0?056?0?550 );however, the thickness of esophageal wall was significantly smaller on 3DCT images than on 4DCTMIP or CBCT images (P=0?000?0?004).For the upper and middle thoracic segments,the thickness of esophageal wall was significantly larger on CBCT images than on 4DCTMIP images ( P= 0?008, P= 0?001 ) . On 3DCT, 4DCT50 , and 4DCTMIP images, the thickness of esophageal wall was significantly larger in the lower thoracic segment than in the upper or middle thoracic segments ( P=0.008~0?041);the intra?abdominal segment had a significantly larger thickness of esophageal wall than the thoracic segments ( all P=0?000 ) . There was no significant difference in wall thickness on CBCT images between three thoracic segments ( P=0.088~0?945) . Conclusions A uniform criterion can be adopted to judge the normal thickness of esophageal wall in gross tumor volume ( GTV ) delineation on 3DCT and 4DCT50 images for thoracic esophageal cancer. However,caution should be taken when 5 mm is used as a criterion for normal thickness of esophageal wall in GTV delineation on 4DCTMIP and CBCT images.

Objective:To explore the effect and mechanism of lncRNA SBF2-AS1 on glioma cell proliferation, apoptosis and radiosensitivity.Methods:Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the mRNA expression levels of SBF2-AS1, miR-1287-5p and FSCN1 in normal human brain glial cell HEB and glioma cell lines, including LN18, SW1088, Hs683, and western blot method was used to detect the expression level of FSCN1 protein in cells. Glioma cells including LN18 and SW1088 were taken as the research object. After SBF2-AS1 small interfering RNA, miR-1287-5p mimics, FSCN1 small interfering RNA were transfected into LN18 cells, CCK-8 was used to detect cell proliferation, flow cytometry was used to detect cell apoptosis, clone formation experiment was used to detect cell radiosensitivity, Western blot was used to detect the protein expressions of cyclin D1, cleaved-caspase 3 and phosphorylated histone 2A variant phosphorylated histone (γ-H2AX). Dual luciferase reporter gene experiments verified the regulatory relationship between SBF2-AS1 and miR-1287-5p, as well as miR-1287-5p and FSCN1.Results:Compared with HEB cells, the expression level of SBF2-AS1 and the expression levels of FSCN1 mRNA and protein in glioma cell line LN18, SW1088 and Hs683 were significantly increased ( P<0.05), and the expression level of miR-1287-5p was significantly reduced ( P<0.05). After down-regulating SBF2-AS1, up-regulating miR-1287-5p or down-regulating FSCN1 expression, LN18 and SW1088 cells activity and cyclin D1 protein expression were significantly reduced ( P<0.05), the apoptosis rate and cleared-caspase-3 protein expression were significantly increased ( P<0.05), the survival score was significantly reduced ( P<0.05), and the expression ofγ-H2AX protein was significantly increased ( P<0.05). The results of dual luciferase reporter gene assay showed that the luciferase activity of LN18 and SW1088 cells co-transfected with miR-1287-5p mimics and SBF2-AS1-WT or FSCN1-WT was lower than that of co-transfected miR-NC and SBF2-AS1-WT or FSCN1-WT in LN18 and SW1088 cells ( P<0.001), while the luciferase activity of LN18 and SW1088 cells co-transfected with miR-1287-5p mimics and SBF2-AS1-MUT or FSCN1-MUT was not significantly different from that of miR-NC transfected with SBF2-AS1-MUT or FSCN1-MUT ( P>0.05). The expression level of miR-1287-5p in LN18 and SW1088 cells in si-SBF2-AS1 group was higher than that in si-NC group ( P<0.05), and the expression level of miR-1287-5p in LN18 and SW1088 cells in pcDNA-SBF2-AS1 group was higher than that in si-NC group ( P<0.05), but lower than that of pcDNA-NC group ( P<0.05). The protein expression level of FSCN1 in LN18 and SW1088 cells in the miR-1287-5p group was significantly lower than that in the miR-NC group ( P<0.05), and the protein expression level of FSCN1 in LN18 and SW1088 cells in the anti-miR-1287-5p group was significantly higher than that in the anti-miR-NC group ( P<0.05). When miR-1287-5p and SBF2-AS1 were down-regulated simultaneously or FSCN1 was up-regulated while SBF2-AS1 was down-regulated simultaneously, the proliferation and cyclin D1 protein expression of LN18 and SW1088cells were significantly increased ( P<0.001), the apoptosis rate and cleared-caspase-3 protein expression were significantly reduced ( P<0.001), the survival score was significantly increased ( P<0.001), and the expression of γ-H2AX protein was significantly reduced ( P<0.001). Conclusion:SBF2-AS1 highly expresses in glioma cells, down-regulation of SBF2-AS1 expression can inhibit the proliferation of glioma cells, promote apoptosis, and enhance cell radiosensitivity by regulating the miR-1287-5p/FSCN1 axis.

Objective:To explore the effect and mechanism of lncRNA SBF2-AS1 on glioma cell proliferation, apoptosis and radiosensitivity.Methods:Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the mRNA expression levels of SBF2-AS1, miR-1287-5p and FSCN1 in normal human brain glial cell HEB and glioma cell lines, including LN18, SW1088, Hs683, and western blot method was used to detect the expression level of FSCN1 protein in cells. Glioma cells including LN18 and SW1088 were taken as the research object. After SBF2-AS1 small interfering RNA, miR-1287-5p mimics, FSCN1 small interfering RNA were transfected into LN18 cells, CCK-8 was used to detect cell proliferation, flow cytometry was used to detect cell apoptosis, clone formation experiment was used to detect cell radiosensitivity, Western blot was used to detect the protein expressions of cyclin D1, cleaved-caspase 3 and phosphorylated histone 2A variant phosphorylated histone (γ-H2AX). Dual luciferase reporter gene experiments verified the regulatory relationship between SBF2-AS1 and miR-1287-5p, as well as miR-1287-5p and FSCN1.Results:Compared with HEB cells, the expression level of SBF2-AS1 and the expression levels of FSCN1 mRNA and protein in glioma cell line LN18, SW1088 and Hs683 were significantly increased ( P<0.05), and the expression level of miR-1287-5p was significantly reduced ( P<0.05). After down-regulating SBF2-AS1, up-regulating miR-1287-5p or down-regulating FSCN1 expression, LN18 and SW1088 cells activity and cyclin D1 protein expression were significantly reduced ( P<0.05), the apoptosis rate and cleared-caspase-3 protein expression were significantly increased ( P<0.05), the survival score was significantly reduced ( P<0.05), and the expression ofγ-H2AX protein was significantly increased ( P<0.05). The results of dual luciferase reporter gene assay showed that the luciferase activity of LN18 and SW1088 cells co-transfected with miR-1287-5p mimics and SBF2-AS1-WT or FSCN1-WT was lower than that of co-transfected miR-NC and SBF2-AS1-WT or FSCN1-WT in LN18 and SW1088 cells ( P<0.001), while the luciferase activity of LN18 and SW1088 cells co-transfected with miR-1287-5p mimics and SBF2-AS1-MUT or FSCN1-MUT was not significantly different from that of miR-NC transfected with SBF2-AS1-MUT or FSCN1-MUT ( P>0.05). The expression level of miR-1287-5p in LN18 and SW1088 cells in si-SBF2-AS1 group was higher than that in si-NC group ( P<0.05), and the expression level of miR-1287-5p in LN18 and SW1088 cells in pcDNA-SBF2-AS1 group was higher than that in si-NC group ( P<0.05), but lower than that of pcDNA-NC group ( P<0.05). The protein expression level of FSCN1 in LN18 and SW1088 cells in the miR-1287-5p group was significantly lower than that in the miR-NC group ( P<0.05), and the protein expression level of FSCN1 in LN18 and SW1088 cells in the anti-miR-1287-5p group was significantly higher than that in the anti-miR-NC group ( P<0.05). When miR-1287-5p and SBF2-AS1 were down-regulated simultaneously or FSCN1 was up-regulated while SBF2-AS1 was down-regulated simultaneously, the proliferation and cyclin D1 protein expression of LN18 and SW1088cells were significantly increased ( P<0.001), the apoptosis rate and cleared-caspase-3 protein expression were significantly reduced ( P<0.001), the survival score was significantly increased ( P<0.001), and the expression of γ-H2AX protein was significantly reduced ( P<0.001). Conclusion:SBF2-AS1 highly expresses in glioma cells, down-regulation of SBF2-AS1 expression can inhibit the proliferation of glioma cells, promote apoptosis, and enhance cell radiosensitivity by regulating the miR-1287-5p/FSCN1 axis.