Objective To observe the anatomy status of the anterior clinoid process (ACP)and the anterior clinoid segment of in-ternal carotid artery (ICA)respectively by multisliced computed tomography (MSCT),and to provide useful imaging information for ACP removal surgery.Methods A total of 100 patients (200 sides)had volume rendering reconstruction of skull.Cranium was removed along cranio-orbital bone in simulation.Then the anatomical structures of the ACP and its surrounding were observed in cephalad direction.The total length,medium length,basic width,medium width of the ACP and the sagittal view curve length of anterior clinoid segment of the ICA from both sides were measured.Results Total length of left ACP was (9.82±2.48)mm,basal width was (9.47±1.88)mm,medium length was (5.03±1.55)mm,medium width was (6.1 9 ±1.75)mm;for right side total length was (10.41±2.1 6)mm,basal width was (9.66 ±2.21)mm,medium length was (5.86 ±2.48)mm,medium width was (6.66±1.5 1)mm.Left anterior clinoid segment of ICA curve length was (6.74±2.25)mm;right was (8.54±3.00)mm.Paired sample t test showed no significant difference in total length,basal width and medium width of ACP in both sides (P >0.05);while the difference in medium length and curve length of the anterior clinoid segment of ICA were statistically significant respectively (P <0.05).Conclusion MSCT can clearly display the vivisection and variation status of the ACP and the anterior clinoid segment of the ICA and can provide useful imaging information for removal of ACP in operation.

Purpose To study the exposure extent of internal carotid artery siphon (ICAS) before and after removing anterior clinoid process (ACP) using multislice spiral CT (MSCT) simulation, and to improve the tumor resection rate and ensure the operation effect. Materials and Methods MSCT three-dimensional images reconstruction simulating supraorbital keyhole approach of 100 patients (200 sides) were observed, the distance between the crotch of anterior cerebral artery and middle cerebral artery and ICAS before and after removing ACP (exposure extent) was measured. Results In 100 patients (200 sides ACP), the exposure extent before and after removing ACP were (14.3±3.9) mm and (30.5±4.2) mm, respectively on the left side with statistical difference (t=45.278, P<0.001), and were (15.9±3.8) mm and (31.8±3.9) mm, respectively on the right side with statistical difference (t=40.513, P<0.001). The exposure extent increased (16.3±3.6) mm and (15.8±3.9) mm, respectively on the left and right side with no statistical difference (t=0.251, P>0.05). Conclusion MSCT simulating supraorbital keyhole approach in removing ACP can effectively increase the exposure length of ICA, and enlarge the exposure extent of sella region, thus provide reliable imaging information for removing tumor and selecting surgical project in this region.

Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo-rotic thoracolumbar fracture.Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob-served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi-sual analogue scale (VAS) and neurological function score (ASIA) of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured.Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P<0.05), but no significant differences existed on these parameters between 1 week post-operation and last follow-up (P>0.05).Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo-porosis, restore the height of fractured vertebra and reduce the compression of spinal canal, which will help the correction of spinal kyphosis and neurological function recovery. This method can well maintain long-term stability of internal fixation in osteoporosis and height of fractured vertebra, and significantly reduce the risks of long-term screw loosening and vertebral collapse.

Objective:To investigate the relationship between double mutations of myosin heavy chain gene (MYH6) p.Gly743Arg and p.Glu1389Lys and the cardiac phenotype.Methods:Patients carrying double mutations in the MYH6 gene p.Gly743Arg and p.Glu1389Lys were screened from 52 unrelated left ventricular hypertrophy (LVH) who were admitted to the Second Hospital of Chongqing Medical University from 2015 to 2020, and the genetic testing of peripheral blood of patients by second-generation whole-exome sequencing assay technology and genomic DNA of their family members Sanger sequencing was performed to validate the genomic DNA of the family members. The cardiac phenotype was evaluated by electrocardiogram, coronary computed tomography angiography (CTA), echocardiography, and cardiac magnetic resonance imaging (MRI) as adjuncts.Results:All whole-exome gene were detected in 52 unrelated patients with LVH, of which 1 patient (1.9%) had double mutations in MYH6 gene p.Gly743Arg and p.Glu1389Lys (proband). Two members of the maternal line of this patient carried p.Glu1389Lys mutation, but there was no obvious clinical phenotype. Two members of the paternal line carried p.Gly743Arg mutation and had obvious clinical phenotype of bradycardia, but there was no LVH. The male proband, aged 21 years old, presented with LVH and sinus bradycardia but no coronary artery stenosis on CTA before treatment, MRI showed that the left ventricular end diastolic diameter was 58 mm. After treatment with angiotensin receptor-enkephalinase inhibitor (ARNI), electrocardiogram showed that the heart rate increased significantly (from 43 bpm to 72 bpm). Echocardiography showed that the left ventricular end diastolic diameter decreased significantly (from 60 mm to 49 mm).Conclusions:The p.Glu1389Lys mutation of the MYH6 gene may not manifest the phenotype of heart disease. MYH6 gene p.Gly743Arg mutation may be manifested asymptomatic sinus bradycardia, but there is no LVH phenotype. The cardiac disease phenotype caused by the double mutations of p.Gly743Arg and p.Glu1389Lys in the MYH6 gene is more obvious. Asymptomatic LVH and sinus bradycardia can appear in adolescence, but the LVH phenotype can be reversed in a short period of time after ARNI treatment.

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