Purpose To explore the reason which resulted in the flow-empty area in carotid artery, establishing a logistic regression model of carotid artery by power Doppler ultrasound, screening the risk factors of the occurrence of this phenomenon and analyzing their reasons. Materials and Methods Clinical data of 172 male subjects who had undergone power Doppler ultrasound were analyzed retrospectively, whether there was flow-empty area at the edge of carotid artery lumen during diastole was observed, brachial artery systolic pressure, diastolic pressure and pressure difference, carotid artery intima media thickness, and the existence of atherosclerotic plaques was measured, the age, body mass index (BMI), blood glucose, blood lipid, history of smoking and cerebrovascular accident situation was collected to establish the logistic model to analyze the risk factors resulted in flow-empty area. Results Among the 172 patients, intima media thickened in 89 cases, systolic blood pressure increased in 97 cases, diastolic blood pressure increased in 7 cases, the pulse pressure increased in 90 cases, with the age of 65 years or older in 92 cases, atherosclerotic plaque formation in 84 cases, long smoking history in 63 cases, cerebral vascular accident history in 11 cases, diabetes mellitus in 79 cases, hyperlipidemia in 101 cases, and abnormal BMI in 13 cases. Doppler energy imaging showed flow-empty area wave type in 98 cases, no flow-empty area wave type in 74 cases. 5 statistically significant variables for the occurrence of flow-empty area in carotid artery lumen during diastole were selected using logistic regression, which were carotid artery intima media thickness, BASP, the pressure difference of brachial artery, existence of atherosclerotic plaque, and the age of patients (OR=50.643, 47.248, 29.426, 32.667 and 20.514, P<0.05). Conclusion The risk factors resulted in flow-empty area in carotid artery are increased IMT, systolic BP and pressure difference, existence of atherosclerotic plaque and the age of 65 years or older. The flow-empty area provides hemodynamic information for the diagnosis of atherosclerosis, and it also plays a helping role in evaluating the degree of arteriosclerosis.

0.05).The prevalence of strains with resistance to rifampin was lower than that of strains with resistance to clarithromycin(P

Background and purpose: Paclitaxel is believed to be efficient in treating malignant ascites in gastric cancer. However, researches are still needed to get more evidence. The aim of this study was to discuss the efficacy and safety of the treatment of malignant ascites in gastric cancer with paclitaxel. Methods: Six cases of late phase gastric cancer patients were enrolled into the study, paclitaxel 60 mg/m~2 and 1 500-2 000 mL natural solution were administered via intraperitoneal injection, qw, for a of total 2-4 weeks. Efficacy and toxicity were determined according to WHO criteria. Results: Five (5/6) had complete response, and one (1/6) with partial response. The malignant ascites recession time was 0.5-10 months, overall survival time 2-10 months, 4 cases suffered grade Ⅰ-Ⅲabdominal pain, 4 cases grade Ⅰ leucopenia, 3 cases grade Ⅰ hair loss, 1 case grade Ⅰ liver injury (with past history of hepatitis). Conclusion: Paclitaxel is effective and relatively safe to treat malignant ascites of gastric cancer.

Background and purpose:Paclitaxel is believed to be efficient in treating malignant ascites in gastric cancer. However, researches are still needed to get more evidence. The aim of this study was to discuss the efficacy and safety of the treatment of malignant ascites in gastric cancer with paclitaxel. Methods:Six cases of late phase gastric cancer patients were enrolled into the study, paclitaxel 60 mg/m2 and 1 500-2 000 mL natural solution were administered via intraperitoneal injection, qw, for a of total 2-4 weeks. Efficacy and toxicity were determined according to WHO criteria. Results:Five (5/6) had complete response, and one (1/6) with partial response. The malignant ascites recession time was 0.5-10 months, overall survival time 2-10 months, 4 cases suffered grade Ⅰ-Ⅲ abdominal pain, 4 cases grade Ⅰ leucopenia, 3 cases grade Ⅰ hair loss, 1 case gradeⅠ liver injury (with past history of hepatitis). Conclusion:Paclitaxel is effective and relatively safe to treat malignant ascites of gastric cancer.

Objective To explore the value of texture analysis on ADC maps in the preoperative prediction of histological grade of tongue and mouth floor squamous cell carcinoma (SCC). Methods Forty?nine pathologically confirmed tongue and mouth floor SCC with definite grading from May 2015 to June 2018 were retrospectively analyzed, including 21 cases of gradeⅠ, 21 cases of gradeⅡand 7 cases of gradeⅢ. All subjects underwent preoperative MRI examination with DWI included. Two doctors delineated whole tumor region of interest and extracted texture parameters by the 3D Slicer software, including 8 histogram parameters, 11 grey?level co?occurrence matrix (GLCM) parameters and 7 gray?level run?length matrix (GLRLM) parameters. Intraclass correlation coefficient (ICC) was used to evaluate the inter?observer delineation agreement, and the texture parameters with excellent reproducibility (ICC>0.8) were used for analysis only. Mann?Whitney U test was used to compare the differences of ADC texture parameters between grade Ⅰ and grade Ⅱ?Ⅲ SCCs. Stepwise logistic regression was used to determine the independent predictors and to build combined model. ROC analysis was used to explore the performance of texture parameter and model in predicting histological grade of tongue and mouth floor SCCs. Pearson correlation coefficient was used to evaluate the correlation between texture parameters with statistical significance. Results (1) Excellent inter?observer delineation agreement (ICC: 0.81-0.98) was observed in 69.23% (18/26) texture parameters, including 6 histogram parameters, 7 GLCM parameters and 5 GLRLM parameters. (2) Among histogram parameters, significantly higher 10 percentile ADC value (ADC10) and significantly lower energy and entropy were shown in gradeⅠcompared with gradeⅡandⅢSCCs (all P<0.05). Among GLCM parameters, significantly lower joint entropy, difference entropy, sum entropy, difference variance, difference average and contrast were shown in grade Ⅰ SCCs (all P<0.05). Among GLRLM parameters, significantly lower gray?level nonuniformity and run?length nonuniformity were shown in gradeⅠSCCs (all P<0.05). ADC10 and entropy were identified as independent predictors. The ADC10 and entropy were 960(913, 1 178)×10?6mm2/s and 4.32(4.06, 4.76) in gradeⅠSCCs, and 888(816, 987)×10?6mm2/s and 4.88(4.57, 5.29) in gradeⅡ?ⅢSCCs respectively. The area under ROC curve (AUC) of ADC10, entropy and combined model were 0.72, 0.75, 0.81. (3) Significant correlation (|r|≥0.5) was observed among 52.73% (29/55)texture parameters with statistical significance. Conclusion Texture analysis on ADC maps can provide more quantitative information, which can be more accurately in discriminating grade Ⅰfrom gradeⅡ?Ⅲtongue and mouth floor SCCs.

Objective To research the proliferation and apoptosis of glioma stem cells after Gamma knife treatment.Methods The glioma stem cells were cultured in serum-free suspension; real time-PCR was used to detect the CD133 expression; fluorescence staining was employed to observe the expressions of nestin,glial fibrillary acidic protein (GFAP) and [3-tubulin after stem cell differentiation.After 10 Gy Gamma knife treatment for 48 h,the glioma U87 cell and stem cell survival was detected under microscope; after 15 Gy Gamma knife treatments for 8-10 h,immunofluorescent staining was performed to detect the 5-bromodeoxyuridine (BrdU)-positive cells; flow cytometry was employed to compare the changes of cell apoptosis before and after 10 and 15 Gy Gamma knife treatment.Results Under the culture conditions of serum-free medium,glioma stem cells became spherical suspended growth and had proliferation and self-renewal capacity,expressing CD133 and nestin,and containing the ability to differentiate into astrocytes and neural elements.After 10 Gy gamma knife treatments,the cell survival in the glioma stem cells was significantly higher than that in the U87 cells (86±3 vs.22±2,P＜0.05).About 35％ glioma stem cells showed positive BrdU staining before 15 Gy gamma knife treatment and it was about 22％ after treatment with statistical difference (P＜0.05).The apoptosis rate in the glioma stem cells was low; that in cells with 15 Gy gamma knife treatment (0.312±0.011) was significantly higher than that in cells with 10 Gy gamma knife treatment (0.112±0.014,P＜0.05).Conclusions Under the culture conditions of serum-free medium,glioma stem cells can be derived from human glioma tissue.Treatment of gamma knife could inhibit the proliferation of glioma stem cells,causing their apoptosis.As compared with glioma cells,glioma stem cells are not sensitive to gamma knife radiotherapy and radio-resistant.

Objective To observe the anatomical course of occipital artery through far lateral approach and make preparation for posterior circulation vascular bypass operation.Methods Far lateral approach was performed to observe the 20 occipital arteries in 10 cadaveric heads with color silicon glue perfusion.The origin,course branches,adjacent structure and diameter of related segments were observed and measured.The distance from the adjacent structures and the diameter of vertebral arteries were measured at the same time.The anatomical structures were recorded by taking photos.Results The occipital artery originated from posterior wall of external carotid artery at the level of mandibular angle and raised up between medial to external carotid artery and lateral to Jugular vein.Then it coursed to posteriorlateral direction,raising up between digastric posterior belly and rectus capitis lateralis,going up digastric posterior belly and superior oblique muscle.And then,it crossed longus scapitis on or beneath its surface and coursed medially on the surface of superior oblique muscle and semispinalis capitis muscle below the superior nuchal line.The occipital artery crossed up the superior nuchal line where trapezius muscle and semispinalis capitis muscle attached,accompanied with greater occipital nerve.And then,it outgrew 1 or 2 branches distributing the distal scalp beneath the superficial fascia of scalp.The diameter of occipital artery was (2.4±0.4) mm,(2.0±0.2) mm,(1.7±0.1) mm at the original point,superior border of transverse process and superior nuchal line,respectively.The length of occipital artery fiom point of superior border of transverse process to the point of superior nuchal line was (93.3±2.4) mm,from the point of superior nuchal line to external occipital protuberance was (21.6±0.8)mm.Diameter of the midpoint of V3 segment of vertebral artery was (3.3±1.3) mm.Conclusions The far lateral approach focusing on the vertebral artery could expose the course of occipital artery,vertebral artery,and atlas-occipital junction widely.The occipital artery could locate the position by mastoidale,digastric posterior belly,and transverse process of atlas.Its diameter and length are suitable for vessel bypass of posterior circulation.

Objective To explore the value of decompressive craniotomy with bilateral integrated frontotemporal bone flap in treatment of severe craniocerebral injury.Methods Nineteen patients with severe craniocerebral injury,admitted to our hospital from September 2015 to February 2017,were chosen in our study.These patients were applied decompressive craniotomy with bilateral integrated frontotemporal bone flap.The clinical data and treatment efficacy were retrospectively analyzed.Results Contralateral brain tissues were detected in 2 patients with unilateral lesions during the operation due to brain tissue swelling,and no other patients were forced to close the skull because of malignant brain swelling.Within 10 d of surgery,the average fluctuation of intracranial pressure was about 20 mmHg.Three months after operation,Glasgow outcome scale (GOS) indicated 10 patients (52.6％) with good recovery,4 (21％) with mild disability,2 (10.5％) with severe disability,2 (10.5％) with plant survival,and one (5.26％) death.There were 4 with mild subdural effusion,and 3 of them got recovery after craniotomy.Five patients were complicated with epilepsy,2 with cerebrospinal fluid leakage and 3 with intracranial infection.Conclusion Decompressive craniotomy with bilateral integrated frontotemporal bone flap can achieve effective decompression,effectively prevent related complications,reduce damage of nerve function,and improve overall clinical prognosis at the same time for suitable cases.

Objective To evaluate the clinical value of Headway duo microcatheter combined with Onyx glue in embolization ofmeningiomas.Methods A retrospective analysis on clinical data of 12 patients with meningiomas,admitted to our hospital from December 2015 to March 2017,was performed.According to the blood supply typing ofManelfe meningiomas,5 were type Ⅰ,3 were type Ⅱ,2 were type Ⅲ,and 2 were type Ⅳ.The degrees of embolization were compared by DSA tumor staining before and after embolization;and complications of embolization were recorded.Results Cerebral angiography after embolization demonstrated complete embolization in 5 patients,subtotal embolization in 5,partial embolization in 2,and small amount of embolization in 0.Only 2 had head and face pain in the process of embolization,and these syndromes disappeared once the operation stopped.The mean average blood loss in the surgery was 685 mL and the mean surgical time was 4.45 h.Conclusion Headway duo microcatheter combined with Onyx glue in the embolization of intracranial meningiomas can play a good role in blocking blood flow,and results suggest that this method is safe and effective,worth of clinical promotion.

Objective To explore the safety and efficacy of meningiomas in atrium of lateral ventricle with contralateral transfalcine transprecuneus approach.Methods Four patients with meningiomas in the atrium of the lateral ventricle,admitted to our hospital from August 2015 to February 2017,were chosen in our study;two of the meningiomas were at the left side and two of them were at the right side;the diameters of meningiomas were of 2-4 cm.Resection via contralateral transfalcine transprecuneus approach was performed on these meningiomas in the atrium of the lateral ventricle.A retrospective study on their clinical data and efficacies was performed.Results Complete resection was achieved in all patients enjoying Simpson grading I.Postoperative pathology revealed 3 with meningiomas of fiber type and one with meningioma of mixed type.No postoperative visual field damage or sensory aphasia was noted.One patient with dizziness before operation was completely relieved after operation.No recurrence of postoperative epilepsy after half a year of antiepileptic treatment was noted in one patient with preoperative epilepsy.All the 4 patients had no recurrence and no new symptom during the 2-18 months of follow-up.Conclusion The contralateral transfalcine transprecuneus approach is appropriate for most lesions of 2-4 cm in the atrium of the lateral ventricle,enjoying good safety and efficacy.