Objective To investigate the major risk factors of posterior circulation infarction.Methods Clinical data from 216 patients with posterior circulation infarction were analyzed retrospectively. The patients were divided into follow groups (proxima1,middle, dista1 and combination group,or single , multiple, or unilateral, bilateral, or lacune infarct, non lacune infarct ) according to the infarcts locations on MRI.The risk factors in each group were analysed. Also,the major risk factors were compared with that from patients with anterior circulation infarction. Results In 216 patients with posterior circulation infarction, hypertension was the most common risk factor (76.9%), followed by diabetes mellitus (36.6% ),hyperlipedemia (30.1%), previous stroke history(26%), and heart disease(22.2%). The most common location of infarcts was distal territory (49%),followed by middle(24.5%) ,proxima1(6%). The average age of proximal group [(57.92?12.81) years] was significant lower than that of other groups(P

Objective To investigate the positioning errors of head and neck during intensity-modulated radiation therapy of nasopharyngeal carcinoma.Methods Nineteen patients with middle-advanced nasopharyngeal carcinoma (T2-4N1-3M0), treated by intensity-modulated radiation therapy, underwent repeated CT during their 6-week treatment course.All the patients were immobilized by head-neck-shoulder thermoplastic mask.We evaluated their anatomic landmark coordinated in a total of 66 repeated CT data sets and respective x, y, z shifts relative to their position in the planning CT.ResultsThe positioning error of the neck was 2.44 mm±2.24 mm,2.05 mm±1.42 mm,1.83 mm±1.53 mm in x, y, z respectively.And that of the head was 1.05 mm±0.87 mm,1.23 mm±1.05 mm,1.17 mm±1.55 mm respectively.The positioning error between neck and head have respectively statistical difference (t=-6.58,-5.28,-3.42,P=0.000,0.000,0.001).The system error of the neck was 2.33,1.67 and 1.56 higher than that of the head, respectively in left-right, vertical and head-foot directions;and the random error of neck was 2.57,1.34 and 0.99 higher than that of head respectively.Conclusions In the process of the intensity-modulated radiation therapy of nasopharyngeal carcinoma, with the immobilization by head-neck-shoulder thermoplastic mask, the positioning error of neck is higher than that of head.

objective To describe the clinical features of patients with posterior circulation ischemic stroke.Methods 216 patients with posterior circulation ischemic stroke admitted in our department during 2004-2006 were analyzed retrospectively.All patients were undertaken MRI on admission and responsble lesions were identified at the posterior circulation territories.The patients'clinical symptoms and signs were evaluated and the relationships between lesion locations and clinical characteristics were analyzed.Results The common symptoms of posterior circulation ischemic stroke were unilateral limb Weakness(81.9%),speech difficulty(46.3%),dizziness(33.8%),and unilateral limb numbness (31.O%).The common signs of posterior circulation ischemic stroke were unilateral limb weakness (81.9%),central facial or lingual palsy(61.1%),dysarthria(46.3%),unilateral limb sensory loss (31.0%),and ataxia(30.1%).The incidence of crossed paralysis was low(2.8%).Isolated vertigo was rare (1.4%).Predominant clinical features such as bulbar paralysis,unconsciousness,visual disorder and amnesia can help to localize the lesions.Typical brainstem syndromes had topographic meanings.Conclusions The clinical features of patients with posterior circulation ischemic stroke were complex.Predominant symptoms can help to diagnose the posterior circulation ischemic stroke.

Objective To evaluate the efficacy of donepezil for post-stroke aphasia. Methods Sixty patients with acute post-stroke aphasia were divided into treatment group and a control group. All patients had been treated for secondary prevention according to the guideline. The treatment group received donepezil hydrochloride (5 mg/d) for 12 weeks. The efficacy of treatment was measured by comparing the changes of scores of Western Aphasia Battery ( WAB) between baseline and 12 weeks later. Results Compared with the baseline, the changes of scores of all items of WAB and Aphasia Quotient ( AQ) in both group after 12 weeks follow-up were great, however, the change of AQ was significantly greater in donepezil group (34. 14 ± 17. 70) than that in control group (20. 69± 17. 26) (P =0. 004). The patients in donepezil group also showed significant recovery in spontaneous speech, comprehension, repetition, and naming than those in control group (P <0. 05 ). The rate of significant improving in donepezil group was 60. 0% which was significantly greater than that in control group ( 26. 7% ) ( P = 0. 009 ). Conclusion There are spontaneous recovery of post-stroke aphasia within 3 months. Donepezil may facilitate the recovery in spontaneous speech, comprehension,repetition,and naming functions.

Objective To evaluate the value of percutaneous transhepatic angioplasty in treatment of portal vein stenosis (PVS) after pediatric liver transplantation.Methods The data of 8 pediatric patients with PVS after liver transplantation were retrospectively evaluated.All cases were confirmed by portal vein angiography,and were treated with percutaneous transluminal angioplasty and/or percutaneous transluminal stent angioplasty.The effect of endovascular interventional therapy in 8 cases was analyzed.Results A total of 12 times of 8 patients received endovascular interventional therapy.The success rate was 66.67％ (8/12).The clinical success rate of the first treatment was 62.50％ (5/8).Three cases were treated with balloon dilation after the first balloon dilation,and there was no recurrence of PVS after operation in 2 cases.After the treatment of balloon dilation,stent angioplasty was performed in 1 case.There were no complications related to treatment in 8 cases.Conclusion Endovascular interventional treatment is a safe and effective way for PVS after pediatric liver transplantation.

Objective To respectively analyze the patterns and possible predictors of recurrent strokes among patients with initial ischemic stroke.Methods Three hundred and sixty-one patients with recurrent strokes (acute ischemic stroke or intracerebral hemorrhage) after initial ischemic strokes were collected from Jan 2004 to Dec 2009.The data about conventional risk factors such as smoking,heavy alcohol drinking,hypertension,diabetes,hyperlipidemia,heart diseases,head trauma,migraine,family history of cardiovascular disease,and the use of preventive medications were collected and analyzed among patients with different types of recurrent strokes.Results Patients (n =361) were divided into ischemic stroke group (n =321) and hemorrhagic stroke group (n =40) according to the recurrent stroke type.The ischemic stroke group was further divided into the anterior circulation stroke subgroup (n =234),the posterior circulation stroke subgroup (n =75) and watershed cerebral infarction or multiple infarction subgroup (n =12).Multivariate logistic regression analysis revealed that older age at initial stroke onset (OR =1.036,95 ％ CI 1.006-1.067,P =0.02) and hyperlipidemia (OR =2.253,95 ％ CI 1.092-4.647,P =0.028) were both the independent risk factors for the recurrent ischemic stroke.Comparing the subgroups,multivariate logistic regression analysis showed that atrial fibrillation (OR =4.217,95％ CI 1.489-11.942,P =0.007) was the independent risk factor for the recurrent ischemic stroke in the posterior circulation territory.Conclusion Aging and hyperlipidemia are possible predictors of recurrent ischemic stroke after the initial ischemic stroke which would be useful for individualized secondary prevention of stroke.

Background and purpose:It has been demonstrated that radical prostatectomy for patients with oligometastatic prostate cancer may contribute to improving local control of prostate cancer and overall survival by several retrospective studies. Perioperative complications play an important role in determining whether radical prostatectomy is appropriate for patients with oligometastatic prostate cancer. This study aimed to discuss the recurrence rate and the sever-ity of perioperative complications, and the primary curative effect of radical prostatectomy on oligometastatic prostate can-cer patients.Methods:A total number of 247 patients who received radical prostatectomy were recruited in the study from Jul. 2015 to Jan. 2016, including 25 patients with oligometastatic prostate cancer and 222 patients with localized prostate cancer. Patients with perioperative complications in both groups were graded with the Clavien-Dindo grading system. The proportion of PSA decline and the rates and severity of perioperative complications were analyzed in both groups.Results:The cases of prostate specific antigen (PSA) decline in the oligometastatic group were 21 (84.0%), lower than the localized group with 212 cases (95.5%). There were 6 cases (24.0%) with postoperative complications in the oligometastatic group, including serious complications (Ⅲ or above) 1 case (4.0%), and 49 cases (22.1%) with postoperative complications in the localized group, including serious complications (Ⅲ or above) 7 cases (3.2%). The differences between the groups reached no statistical significance (P>0.05).Conclusion:Radical prostatectomy for patients with oligometastatic prostate cancer could be safe, effective, and appropriate, the risk of perioperative complications should not be one of the limiting factors.

Objective To validate the Memorial Sloan-Kettering Cancer Center(MSKCC)score model and evaluate the clinical efficacy of vascular endothelial growth factor(VEGF)-targeted agents in the treatment of advanced renal cell carcinoma(RCC)in China.Methods Three hundred and forty-five patients with advanced RCC and average age of 57(17-90)years were treated with VEGF-targeted agents.There were 306 cases of clear cell RCC,20 cases of papillary RCC,4 cases of chromophobe RCC,5 cases of renal collecting duct carcinoma,3 cases of medullary carcinoma and 7 cases of unclassified RCC.The main metastatic lesions were located at lung,bone and lymph nodes.Of them,205 cases were given the treatment of sorafenib 400 mg bid without off treatment,while 140 cases received sunitinib treatment in repeated six week cycles consisting of four weeks of sunitinib 50 mg daily followed by two weeks off treatment.Overall survival(OS)was estimated by the Kaplan-Meier method.Log-rank test and Harrell concordance index analysis were used to validate the MSKCC score model.Results The median follow-up period were 23(1-68)months in the whole group.The OS was 33 months,and survival rates at 1,2,3 year were 77.6％,59.3％,46.6％,respectively.According to the MSKCC score model,the patients were segregated into three risk categories: the favorable-risk group(no prognostic factors;n =169;49.0％),in which median OS(mOS)was 46 months and 2 year OS was 75.8％;the imtermediate-risk group(one or two prognostic factors;n =150;43.5％),in which mOS was 24 months and 2 year OS was 47.7％;and the poorrisk group(three to five prognostic factors;n =26;7.5％),in which mOS was 8 months and 2 year OS was 10.1％(log-rank P ＜ 0.01).The concordance index was 0.687.Conclusions VEGF-targeted agents are effective in Chinese advanced RCC patients.The MSKCC score model can be incorporated into judging individualizing tumor prognosis and communicating about the treatment options with patients who are using VEGF-targeted agents.

Background and purpose: Platelet to lymphocyte ratio (PLR) is an important factor reflected systematic inflammation. The clinical value of PLR has not been confirmed. The present study was to explore the value of preoperative PLR in predicting clinical stage and prognosis in upper tract urothelial carcinoma. Methods:Patients who underwent surgical therapy with postoperative pathology upper tract urothelial carcinoma without metastasis from Jan. 2007 to Mar. 2012, were collected. Following up was done by telephone and clinic work, 150 vs 1 was taken as the threshold value of PLR, and the association of PLR with tumor stage, whether suffered bladder cancer as comorbidity, recurrent or metastasis, overall survival, tumor lesion, preoperative hematuria, gender and age was analyzed. We further analyzed the association difference of disease free survival (DFS) time and overall survival (OS) time between different PLR groups. Results:Fifty-one cases of UTUC were collected, and the postoperative mean following up time is 21 (9–51) months. Twenty cases recurred or metastasis and 9 cases died. The mean DFS time was 15 (2–51) months,and the mean OS time was 21 (9–51) months. One-factor analysis of variance showed that preoperative PLR was associated with tumor stage, overall survival rate, hematuria and gender, and the P value were 0.028, 0.008, 0.045, 0.036 respectively. High PLR group was intended to be non-organ confined disease, the sensitivity was 57%and the specificity was 74%. Survival analysis by Kaplan-Meier method showed there is no statistical difference in DFS between high and low PLR groups (P=0.155). But OS time in high PLR group was significantly less than that in low PLR group (P=0.006). Cox regression confirmed that only tumor stage is an independent prognostic factor of OS (P=0.029). Conclusion:PLR has potential clinical value in predicting advanced stage disease and Cox regression confirmed that only tumor stage is an independent prognostic factor of OS.

Objective To discuss the application of pelvic lymph node dissection during radical prostatectomy.Methods The data of 239 patients with prostate cancer which had been done radical prostatectomy and pelvic lymph node dissection were retrospectively reviewed,with the patients'median age of 68 (48-79) years.148 patients(61.9%) had either a Gleason score of>7 or a PSA of>20 ng/ml.All patients were diagnosed as clinical localized prostate cancer preoperatively.The extent of pelvic lymph node dissection included bilateral obturator fossa and region of the external iliac artery.Patients with positive lymph nodes were advised to receive maximal androgen blockade therapy and were followed up until biochemical recurrence.Results It took an average operation time of 20(15-35)min with the average blood loss of 20(5-45) ml for bilateral lymphadenectomy. There was no injury of big vessels and nerves. The total number of lymph node dissected was 1-23 with a median of 7.The median postoperative hospital stay was 16 days.The time of drainage was 4-36 days with a median of 7 days.74.5%(178 cases)of patients had drainage less than 8 days and 9.4%(20 cases)patients were more than 14 days. Positive nodes were found in 29 cases with the positive rate of 12.1%. The median number of positive lymph nodes was 1.Early postoperative complications related to pelvic lymphadenectomy included deep venous thrombosis,lymphocele,lymph leakage,pelvic infection. Patients with positive lymph nodes had a median progression free time of 10 months.Conclusions Pelvic lymph node dissection could detect lymph node metastasis which might be difficult to find through other means. It could facilitate the accurate staging of prostate cancer and bring potential benefits to patients. It does not significantly prolong the operation time and the incidence of complications should decrease gradually with the improvement of the surgeons'experience and surgical techniques.