Objective:To explore the application value of intraoperative awake combined with neuronavigation in surgery for eloquent area gliomas.Methods:Twenty patients with eloquent area gliomas, admitted to our hospital from October 2017 to June 2019, were chosen in our study. Preoperative blood oxygenation level dependent-functional MR imaging (BOLT-fMRI) was used to display the functional cortex in all patients, and diffusion tensor imaging (DTI) was used to reconstruct the peripheral fibrous tracts of the gliomas; after imaging fusion of above function structures, the data were imported into the neuronavigation system; intraoperative microscope was used to determine the functional areas in the cortex and the fiber bundle, and intraoperative awake combined with cortical stimulus was employed to determine the functional areas in the cortex again before removal of the tumors. Changes in patients' quality of life (Karnofsky performance scale, [KPS] scores) before surgery, 2 weeks after surgery, and 3 months after surgery were compared, and surgical-related complications or death were recorded.Results:Intraoperative awake combined with neuronavigation were successfully applied with the addition of cortical electrical stimulation in all 20 patients; 16 (80%) accepted total resection and 4 (20%) accepted subtotal resection. Follow-up for 2 weeks after surgery and 3 months after surgery showed that only one patient with high-grade glioma had decreased KPS scores than those before surgery, and there were no postoperative deaths or severe disabilities. As compared with KPS scores before surgery(83.02±4.76), those at 2 weeks after surgery (90.15±6.72) and 3 months after surgery (96.86±6.18) were significantly higher ( P<0.05). Conclusion:Intraoperative awake combined with neuronavigation can locate the eloquent area and fibers accurately, help neurosurgeons to resect gliomas totally in the surgery and protect patients' neuro-function.

OBJECTIVETo assess the relationship between myocardial regional perfusion using second harmonic myocardial contrast echocardiography (MCE) by venous injection of Levovist and coronary artery stenosis detected by coronary angiography to determine whe ther MCE can be used to detect coronary artery disease (CAD) and its sensitivity and specificity for detecting CAD.

METHODSThirty-six patients who underwent coronary artery angiography and MCE formed the study groups. Ten myocardial segments (5 each in the apical two- and four-chamber views) from the images were scored for detecting myocardial perfusion as follows: 1, normal perfusion; 2, decreased perfusion; and 3, perfusion defect. The arteries were classified as normal or diseased. The diseased arteries were classified into three groups according to the perfusion scores.

RESULTSThere were significant differences in coronary diameter stenosis among the different perfusion score groups (P < 0.001). There were 10 total occluded arteries, and the myocardial perfusion scores were different because of different collateral circulation. In the normal perfusion group (Group A), the coronary diameter stenosis was 65% +/- 12%, and the myocardial perfusion score index was 1 +/- 0.00. In the decreased perfusion group (Group B), the average coronary diameter stenosis was 82% +/- 8%, and the myocardial perfusion score was 1.93 +/- 0.16. The diameter stenosis was less than 85% in 63% of the coronary arteries (including diameter stenosis < or = 75% in 12% of the vessels). The diameter stenosis was 85%-90% in 22% of the coronary arteries and > 90% in 15% of the arteries. In the perfusion defect group (Group C), the average diameter stenosis was 90% +/- 6%, and the myocardial perfusion score index was 2.89 +/- 0.24. The diameter stenosis was > or = 85% in 94% of the coronary arteries, and the diameter stenosis was < 85% and > 75% only in 6% of the coronary arteries. The overall sensitivity and specificity of MCE in identifying angiographic coronary diameter stenosis was 67% and 100%, respectively. The false negative rate was 32.6% for the 108 coronary arteries. Further subdivided analysis showed the sensitivities in Groups A, B and C were 0, 100%, and 100%, respectively. The sensitivity increased with increased lumen diameter stenosis of coronary arteries.

CONCLUSIONSThere is a close relationship between coronary artery stenosis and MCE perfusion scores. MCE with venous injection of new generation contrast can define the presence of CAD and lesion graded classifications. Some disagreements between perfusion score and coronary diameter of stenosis may indicate other factors such as different collateral circulation, which should be further investigated. As artery stenosis increases, the sensitivity of MCE is increased.

Adult ; Aged ; Coronary Circulation ; Coronary Disease ; diagnostic imaging ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity

Objective To investigate the expression of glucose transporters 1 (GLUT-1) in gastric cancer and its relation with clinicopathological characteristics and prognosis. Methods PubMed, Web of Science,EMbase,Cochrane Library,WanFang Databases and China National Knowledge Internet(CNKI)were used to search literatures about GLUT-1 and gastric cancer. From the day of establishment to May 15, 2017, according to the inclusion and exclusion criteria, 2 researchers independently screened studies, extracted data and assessed quality of the included studies. Effect value and 95 % CI was calculated respectively. Then Meta-analysis was conducted by using RevMan5.3 software. Results A total of 11 articles were enrolled, including 1 714 cases in the gastric cancer group and 431 cases in the normal gastric mucosa group. The results of Meta-analysis showed that GLUT-1 expression was higher in the gastric cancer group than that in the normal group, and there was a significant difference (OR= 24.23, 95 % CI 11.86-49.51, P< 0.000 01). The expression of GLUT-1 was not related with age, gender, tumor size and invasion depth (all P> 0.05), but related with differentiated degree (OR= 0.41, 95 % CI 0.25-0.67, P= 0.000 4), lymphatic metastasis (OR=5.11, 95 % CI 2.73-9.56, P<0.000 1), and TNM staging (OR= 0.32, 95 % CI 0.20-0.51, P< 0.000 01). Moreover, GLUT-1 had a correlation with the overall survival rate of gastric cancer (HR= 1.61, 95 % CI 1.30-1.99, P < 0.000 1). Conclusions GLUT-1 protein expression is higher in gastric cancer tissues than that in normal gastric mucosa, and it is related to tumor differentiation degree, lymph node metastasis, TNM staging.Besides,GLUT-1 may be correlated with poor prognosis of patients with gastric cancer.

Objective To explore the application of new neuronavigation in microsurgery for intracranial tumors. Methods Thirty-six patients with intracranial tumors, admitted to our hospital from November 2016 to April 2017, were treated with brain LAB KICK neuronavigational system-assisted micro-neurosurgery. Preoperative MRI or CT thin-layer scanning were performed, and the images were input to the Brain LAB Vector Vision neural system for three-dimensional reconstruction. The tumors and the important structures were marked. Intraoperative guidance in the neuronavigation system was performed to find the important nerves, vascular and bone signs and other structures. The clinical data and therapeutic effect of these patients were retrospectively analyzed. Results All the 36 patients were successfully guided by neuronavigation to reach the tumor sites, with the registration error of 0.10-0.25 mm. Total resection was achieved in 31 patients, subtotal resection in 3, and most resection in 2. Symptoms improved significantly in 34 patients after the surgery. No surgical complications caused by neuronavigation errors were found, and no asymptomatic deterioration or death were noted. Conclusion Brain LAB neuronavigation system in neurosurgery is accurate and safe, enjoying high total resection rate and minimized operation complications.