Objective:To explore the application value of neurovascular three-dimensional (3D) reconstruction with 3D-slicer software in the preoperative diagnosis of neurovascular relations and offending arteries in patients with vertebrobasilar dilatation (VBD) complicated with facial muscle spasm (HFS).Methods:The clinical data of 42 patients with VBD complicated with HFS accepted microvascular decompression (MVD) in our hospital from January 2016 to February 2019 were retrospectively analyzed. The data of skull 3D-TOF MR angiography and 3D-FiESTA MR imaging were imported into 3D-slicer software to establish 3D models of the blood vessels, brain stem and facial auditory nerves of the patients before surgery. The neurovascular relations and offending arteries found during surgery were compared with those diagnosed by 3D-TOF MR angiography combined with 3D-FiESTA MR imaging and 3D models.Results:The consistencies of neurovascular relations and offending arteries found during surgery and those showed by 3D models were good ( Kappa=0.889, P=0.000; Kappa=0.869, P=0.000). The consistency of neurovascular relations showed by 3D models and those diagnosed by 3D-TOF MR angiography combined with 3D-FiESTA MR imaging was good( Kappa=0.809, P=0.000); there was no significant difference between the two methods in diagnosing neurovascular relations ( McNemar-Bowker=5.000, P=0.082). The consistency of offending arteries showed by 3D models and those diagnosed by 3D-TOF MR angiography combined with 3D-FiESTA MR imaging was poor ( Kappa=0.336, P=0.000); there was significant difference between the two methods in diagnosing offending arteries ( McNemar-Bowker=23.000, P=0.000). Conclusion:The 3D-slicer software is used to perform 3D simultaneous reconstruction of blood vessels, nerves and brain stem in the cerebellopontine angle, and the results are highly consistent with surgical findings; 3D-slicer software is more helpful than 3D-TOF MR angiography combined with 3D-FiESTA MR imaging in identification of offending arteries, surgical risk assessment and surgical strategy formulation in patients with VBD complicated with HFS.

Objective:To investigate the efficacy of percutaneous balloon compression (PBC) in the treatment of trigeminal neuralgia (TN) and the risk factors of postoperative recurrence.Methods:A retrospective case-control study was conducted to collect the clinical data of 200 TN patients admitted to Hebei General Hospital from February 2018 to February 2019. According to different treatment methods, the patients were divided into operation group ( n=150) and conservative group ( n=50). The operation group received PBC treatment, and the conservative group received conservative treatment. The clinical efficacy of the two groups was recorded, including total effective rate, VAS, quality of life score (physical function, health status, social function, mental health). Patients treated with PBC were followed up for 4 years, and were divided into relapse group ( n=23) and non-recurrence group ( n=127) according to postoperative recurrence. The baseline data and laboratory indexes of the two groups were recorded, including fasting blood glucose, procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α). Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups. Chi-square test was used for comparison between count data groups. The factors related to postoperative recurrence of TN patients were first analyzed by univariate analysis, and then by multivariate Logistic regression analysis. A nomogram prediction model was constructed to predict postoperative recurrence, and its prediction efficiency was evaluated. The model was stratified by X-tile software to discuss its clinical application value. Results:The total effective rate, VAS of the operation group were 94.00%, 2.14±0.57, the conservative group were 78.00%, 3.87±1.16, and the difference between the two groups was statistically significant ( P< 0.05). The scores of physical function, health status, social function and mental health of quality of life in the operation group after treatment were 89.75±4.67, 90.36±5.68, 87.68±4.16, 88.79±5.09, the conservative group were 82.54±4.03, 84.67±4.28, 81.45±4.09, 80.69±4.89, and the difference between the two groups was statistically significant ( P< 0.05). Of 150 patients treated with PBC, 23 (15.33%) relapsed. Hypertension( OR=2.537, 95% CI: 1.069-6.019), diabetes( OR=5.179, 95% CI: 1.492-17.970), hyperlipidemia( OR=2.447, 95% CI: 1.227-4.883), CRP≥6.62 mg/L( OR=6.386, 95% CI: 1.738-9.854), IL-6≥19.55 ng/L( OR=8.028, 95% CI: 1.279-12.214), procalcitonin ≥1.13 ng/mL ( OR=7.615, 95% CI: 5.020-14.559), TNF-α≥4.56 ng/L( OR=6.226, 95% CI: 4.950-13.337) were independent risk factors for postoperative recurrence of PBC ( P<0.05). Based on the nomogram constructed by the above 7 risk factors, the decision curve showed that the net benefit rate was greater than 0 when the threshold probability was between 0.01 and 0.91. The X-tile software was used to divide the model into three levels of low (>21.6), medium (13.8-21.6) and high (<13.8) risk according to the Logistic risk score, and the postoperative recurrence probability of PBC was 10.87%, 20.74% and 64.04%, respectively. The recurrence rate of PBC in the high-risk group was significantly higher than that in the medium-risk group and the low-risk group ( χ2=5.136, P=0.015). Conclusions:Percutaneous balloon compression of trigeminal nerve in the treatment of patients with trigeminal neuralgia has the advantages of high total effective rate, fewer postoperative complications, good clinical efficacy, quick effect and so on. The construction of percutaneous balloon compression of trigeminal nerve in patients with trigeminal neuralgia postoperative recurrence risk prediction model to provide reference for clinical improvement of patient rehabilitation.

Objective:To investigate the predictive value of Charlson comorbidity index (CCI) in the operative prognosis of colorectal cancer (CRC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 337 CRC patients who underwent surgery in the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to February 2019 were collected. There were 774 males and 563 females, aged 62(range, 22?80)years. All patients were evaluated by CCI. Observation indicators: (1) clinicopathological characteristics of CRC patients undergoing operation; (2) follow-up and survival; (3) prognostic factors analysis of CRC patients undergoing operation; (4) establishment and evaluation of a nomogram prediction model based on CCI. Follow-up was conducted using the telephone interview or outpatient examination to detect the survival of patients up to March 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M(range) or M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Non-para-meter rank sum test was used for comparison of ordinal data. The Kaplan‐Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used for survival analysis. Univariate and multivariate analyses were performed using the COX proportional hazard regression model. The independent risk factors were included into R4.0.4 software to construct a nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn, and the area under curve (AUC) was used to evaluate discrimination of the nomogram prediction model. The C-index and calibration chart were used to evaluate consistency of the nomogram prediction model. Results:(1) Clinicopathological characteristics of CRC patients undergoing operation. Of the 1 337 patients, there were 1 041 cases with CCI ≤3 and 296 cases with CCI ≥4. Age, cases with non-smoking history, smoking cessation or smoking history, cases without or with R 0 resection, cases with low, moderate, well differentiated tumor, cases in stage Ⅰ?Ⅱ or Ⅲ?Ⅳ of clinical TNM staging, preoperative carcinoembryonic antigen (CEA) were 61(53,68)years, 717, 43, 281, 12, 1 029, 123, 859, 59, 666, 375, 3.22(1.84,7.75)μg/L for the 1 041 patients with CCI ≤3, versus 70(61,75)years, 217, 19, 60, 43, 253, 48, 237, 11, 102, 194, 5.55(2.43,17.64)μg/L for the 296 patients with CCI ≥4, showing significant differences in the above indicators between them ( Z=?10.50, χ2=7.34, 104.51, Z=?2.31, χ2=82.14, Z=?5.78, P<0.05). (2) Follow-up and survival. All the 1 337 patients were followed up for 31(range, 1?84)months. Of the 1 337 patients, 1 024 cases survived and 313 cases died. The 1-, 3-, 5-year survival rates were 94.8%, 85.5%, 80.1% for the 1 041 patients with CCI ≤3, versus 73.6%, 46.9%, 34.0% for the 296 patients with CCI ≥4, showing significant differences between them ( χ2=181.93, P<0.05). (3) Prognostic factors analysis of CRC patients undergoing operation. Results of univariate analysis showed that age, smoking history (having a history of smoking), tumor location (decending colon-sigmoid colon, recto-sigmoid junction-rectum), R 0 resection, tumor differentiation degree (moderate differentiation, well differentiation), clinical TNM staging, postoperative radio-therapy and chemotherapy, preoperational CEA and CCI were related factors for operative prognosis of CRC patients ( odds ratios=1.76, 0.71, 0.72, 0.61, 0.08, 0.39, 0.13, 3.02, 0.60, 2.41, 4.96, 95% confidence intervals as 1.39?2.23, 0.53?0.93, 0.52?0.99, 0.47?0.78, 0.06?0.11, 0.30?0.50, 0.05?0.31, 2.39?3.81, 0.48?0.76, 1.92?3.01, 3.97?6.20, P<0.05). Results of multivariate analysis showed that age >60 years, clinical TNM staging as stage Ⅲ?Ⅳ, preoperational CEA >5 μg/L and CCI ≥4 were independent risk factors for operative prognosis of CRC patients ( odds ratios=1.29, 1.88, 1.77, 2.84, 95% confidence intervals as 1.00?1.65, 1.45?2.44, 1.40?2.23, 2.20?3.67, P<0.05);tumor located in descending colon to sigmoid colon and recto-sigmoid junction to rectum, R 0 resection,tumor differen-tiation degree as moderate and well differentiation, postoperative radiotherapy and chemotherapy were independent protect factors for operative prognosis of CRC patients ( odds ratios=0.71, 0.72, 0.27, 0.50, 0.25, 0.56, 95% confidence intervals as 0.51?0.98, 0.56?0.93, 0.19?0.37, 0.38?0.65, 0.10?0.62, 0.44?0.70, P<0.05) (4) Establishment and evaluation of a nomogram prediction model based on CCI. Based on age, tumor location, R 0 resection, tumor differentiation degree, clinical TNM staging, postoperative radiotherapy and chemotherapy, preoperational CEA and CCI of multivariate analysis results, a nomogram prediction model for operative prognosis of CRC patients was established. The nomogram score was 1.0 for age >60 years, 18.0 for tumor located in proximal colon, 9.0 for tumor located in distal colon, 53.0 for non-R 0 resection, 62.0 for low differentiated tumor, 31.0 for morderate differentiated tumor, 32.0 for stage Ⅲ?Ⅳ of clinical TNM staging, 26.0 for no postoperative radiotherapy and chemotherapy, 4.6 for each increase of 100 μg/L in preoperative CEA and 12.6 for each increase of 1 score in CCI respectively. The total of different scores for risk factors was used to evaluate total 1, 3, 5-year survival rates. The ROC curve was drawn to evaluate the predictive ability for prognosis of nomogram model, with the AUC as 0.75 (95% confidence interval as 0.71?0.79, P<0.05). The C-index was 0.80 (95% confidence interval as 0.77?0.72). The calibration chart showed a good consistency between the probability of survival predicted by nomogram and the actual probability of survival. Conclusions:Age >60 years, stage Ⅲ?Ⅳ of clinical TNM staging, preoperational CEA >5 μg/L and CCI ≥4 are independent risk factors for operative prognosis of CRC patients. Tumor located in descending colon to sigmoid colon and recto-sigmoid junction to rectum, R 0 resection, tumor differentiation degree as moderate and well differentiation, postoperative radiotherapy and chemotherapy are independent protective factors for operative prognosis of CRC patients. The nomogram prediction model contributes to prediction of the survival of CRC patients.

Objective:To investigate the distribution characteristics of cognition-related lifestyles of elderly in communities and explore the integrated effects on early cognitive decline.Methods:The participants were from the Project of Prevention and Intervention of Neurodegenerative Disease for Elderly in China. A total of 2 537 older adults aged ≥60 years without dementia in the 2015 baseline survey and the 2017 follow-up survey were included. The information about their cognition-related lifestyles, including physical exercise, social interaction, leisure activity, sleep quality, smoking status, and alcohol consumption, were collected through questionnaire survey and the integrated scores were calculated. Multivariate logistic regression analysis was used to assess the association between integrated cognition-related lifestyle score and early cognitive decline.Results:In the 2 537 older adults surveyed, 28.7% had score of 5-6, while only 4.8% had high scores for all 6 healthy lifestyles. Significant differences in healthy lifestyle factor distributions were observed between men and women. Multivariate logistic regression model showed that the risks for early cognitive decline in the older adults who had lifestyle score of 4 and 5-6 were lower than that in those with lifestyle score of 0-3 ( OR=0.683, 95% CI: 0.457-1.019; OR=0.623, 95% CI: 0.398-0.976; trend P=0.030). In the women, the risks for early cognitive decline was lower in groups with score of 4 and 5-6 than in group with score of 0-3 ( OR=0.491, 95% CI: 0.297-0.812; OR=0.556, 95% CI: 0.332-0.929; trend P=0.024). Conclusion:Cognition-related healthy lifestyles are associated with significantly lower risk for early cognitive decline in the elderly, especially in women.