Objective To explore the clinical effect of tumescent anaesthesia in laparoscopic cholecystectomy(LC). Methods We analyzed the data of 71 patients who underwent LC for gallbladder benign disease. Anesthesia swelling fluid was injected in 37 cases before the operation in the gallbladder triangle( group D)and another 34 cases received no injection(group C). SBP,DBP,HR and Spo2 were monitored at 4 min before gallbladder traction(T1),1 min(T2),6 min(T3)and 11 min after gallbladder traction(T4),and when the gallbladder was dissected from gallbladder bed completely(T5). The operation time,intraoperative blood loss,postoperative exhaust time,time of getting out of bed after the surgery and length of stay were recorded. The gallbladder rupture, vascular injury ,bile duct injury ,intestinal injury ,placement of drainage tube ,intra-abdominal hemorrhage , intraoperative use of atropine or ephedrine and nausea and vomiting 24 hours after the operation were recorded. Results In group C,SBP,DBP and HR were significantly decreased at T2-T4 when compared with those at T1, and were significantly lower when compared with those in group D(P < 0.05). There was no significant difference in oxygen saturation between the two groups(P > 0.05). There were shorter operation time and less intraoperative blood loss in group D when compared with those in group C and the difference was statistically significant (P <0.05). The anus exhaust time,time of getting out of bed after the surgery,length of stay,intraoperative intra-abdominal hemorrhage and nausea and vomiting in the two groups indicated no statistical significance (P > 0.05). Gallbladder damage,vascular injury,placement of drainage tube and the incidence of adverse event were less in group D than those in group C. Conclusion Swelling anesthesia in LC can shorten the operation time ,induce less postoperative complications and maintain blood circulation stability.

OBJECTIVETo evaluate the collateral flow in patients with ischemic stroke due to acute basilar artery occlusion by dynamic CT angiography and to predict the outcome after reperfusion therapy.

METHODSForty-five patients with stroke due to acute basilar artery occlusion undergoing reperfusion treatment in the Second Affiliated Hospital of Zhejiang University School of Medicine during January 2012 and August 2016 were retrospectively reviewed. Univariate and binary logistic regression model were used to identify the independent predictors of patient's outcome, and the receiver operating characteristic (ROC) curve was used to determine the optimal threshold of the posterior circulation collateral score (PC-CS) in predicting the prognosis of the patients.

RESULTSBinary logistic regression analysis indicated that the baseline National Institutes of Health Stroke Scale (NIHSS) score (=0.886, 95%:0.802-0.979,<0.05) and PC-CS (=1.962, 95%:1.026-3.752,<0.05) were independent predictors of patient's outcome, and PC-CS 4.5 was the optimal threshold (AUC:0.837, sensitivity of 68.2%, specificity of 87.0%).

CONCLUSIONSDynamic CT angiography based on CT perfusion imaging can be used to evaluate collaterals in posterior circulation, and to predict clinical outcome after reperfusion therapy in patients with acute basilar artery occlusion.

OBJECTIVETo investigate the association of serum folate level with the severity of white matter hyperintensity (WMH) and presence of cerebral microbleeds (CMB).

METHODSClinical data of WMH patients from the second affiliated Hospital, Zhejiang University school of Medicine during July 2011 and February 2016 were retrospectively reviewed. According to Fazekas score based on T2-Flair images, patients were classified into mild WMH (0-3) and severe WMH (4-6). The presence of CMB was assessed on susceptibility weighted imaging (SWI). Binary logistic analysis was conducted to identify the independent predictors for severe WMH and the presence of CMB.

RESULTSTwo hundred and twenty eight patients with WMH were included, among whom 149(65.35%)had severe WMH. In patients with high folate (≥ 15.68 nmol/L), low folate (6.8-15.67 nmol/L) and folate deficiency (<6.8 nmol/L), the proportions of severe WMH were 52.88%, 73.33% and 89.47%, respectively. Binary logistic regression analysis revealed that compared with high folate group, severe WMH was more common in groups with low folate (=2.109, 95%:1.112-4.001,<0.05) and folate deficiency (=6.383, 95%:1.168-34.866,<0.05). Eighty-eight(48.09%) of 183 patients receiving SWI scan presented with CMB. Although the subjects with CMB had lower serum folate level than those without CMB(13.42 vs 16.51 nmol/L,<0.01), binary logistic regression analysis did not reveal the independent association between serum folate level and the presence of CMB after adjusting for hyperhomocysteinemia (>0.05).

CONCLUSIONSLower serum folate level is independently associated with severe WMH, but not with the CMB concurrence.