Objective To explore the diagnostic performance of 64-slice spiral CT combined with exercise treadmill test for coronary artery disease ( CAD). Methods Eighty-six patients suspected of CAD were divided into low risk group, intermediate risk group and high risk group according to estimated pretest probabilities of CAD. All patients underwent coronary angiography, 64-slice spiral CT and exercise treadmill test. With coronary artery stenosis rate >50% as positive findings, the sensitivity, specificity, positive predictive value ( PPV), negative predictive value ( NPV) and accuracy of 64-slice spiral CT and 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were calculated. Results With coronary angiography as the "golden criteria", the sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT in diagnosis of CAD were 95.2% , 88.6% , 88.9% , 95.1% and 91.9% , respectively. The sensitivity of low risk group, intermediate risk group and high risk group was 100% , 100% and 92.6%, specificity was 94.4% , 94.1% and 66.7%, PPV was 80.0%, 91.7% and 89.3%, NPV was 100% , 100% and 75.0%, and accuracy was 95.5% , 96.4% and 86.1%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were 97.6%, 97.7%, 97.6%, 97.7% and 97.7%, respectively. Conclusion 64-slice spiral CT combined with exercise treadmill test works well in screening CAD, especially for those with a low or intermediate estimated pretest probability.

Objective To investigate the expression and prognostic significance of human epidermal growth factor receptor 2(EGFR 2,also called HER2 or c-ErbB2)in elderly intracranial meningio-mas.Methods A total of 52 elderly patients with intracranial meningioma who underwent surgi-cal resection in our department from February 2021 to January 2023 were consecutively recruited in this study.According to the World Health Organization(WHO)classification,40 cases were as-signed into WHO grade Ⅰ and 12 cases into WHO grade Ⅱ/Ⅲ.Based on the phosphorylation level of HER2(p-HER2),there were 39 cases with low p-HER2 expression and 13 cases with high expression.The expression of HER2 extracellular domain(ECD),intracellular domain(ICD)and phosphorylated receptor(6B12)were detected by immunohistochemistry.Double probe fluores-cence in situ hybridization(FISH)was used to detect the amplification of HER2.Time to recur-rence(TTR)and overall survival(OS)were recorded during follow-up.Cox proportional hazards regression model and Kaplan-Meier survival curve were employed to analyze the relationship of HER2 expression and recurrence and death risk in these patients.Results The positive rate of ICD-CB11 and ICD-3B5 was both 100％,while that of ECD-SP3 and 6B12(p-HER2)was 61.54％(32/52)and 25.00％(13/52),respectively in the elderly patients.In normal meningeal tissues,negative results were observed in all above four antibody immune responses.In addition,there was no significant difference in HER2 expression between WHO group 1 and WHO group Ⅱ/Ⅲ(P＞0.05).HER2 gene amplification was not detected in all elderly patients with meningioma,and the ratio of HER2 to CEP17 signals was 1.09±0.11,ranging from 0.84 to 1.35.Univariate and multivariate COX proportional hazard regression analysis showed that high expression of p-HER2 was an independent risk factor for recurrence and death in elderly patients with meningioma(P＜0.05).During follow-up,the patients with low p-HER2 expression had higher relapse-free survival rate and longer median recurrence-free survival(RFS)when compared with the patients with high p-HER2 expression(74.36％vs 30.77％,1.66 year vs 0.56 year,P log rank＜0.01).Survival analysis indicated that higher total survival rate and longer median OS were observed in the patients with low p-HER2 expression than those with high p-HER2 expression(82.05％vs 46.15％,2.27 year vs 0.58 year,Plogrank＜0.01).Conclusion HER2 is overexpressed in elderly patients with intracra-nial meningioma,and p-HER2 overexpression is associated with an increased risk of recurrence and death.HER2 may be used as a prognostic tool in elderly patients with meningioma,and is ex-pected to be a potential therapeutic target.

Objective To study the value of ultrasound in operation for traumatic brain injury (TBI) in simulation field hospitals where computed tomography (CT) equipment is unavailable.Methods The wartime conditions were simulated, and the patients at age of 18-60 years were randomly selected.According to the principles of medical ethics, all patients received CT scanning.Two neurosur-geons from the field hospital who did not know the result of CT examination cooperated with another two neurosurgeons who got the results of the CT examination to determine whether operation should be ap-plied.Forty-five patients who needed emergency craniotomy were finally selected.The operations were performed by two neurosurgeons from the field hospital, with real-time ultrasound monitoring.The results of ultrasound were compared with that of CT scanning.Results A total of 64 lesions were found by ul-trasound , and 60 of which should be treated by operation.In the meantime, 82 lesions were found by CT scanning, 64 of which should be treated operatively.Epidural hematoma and subdural hematoma had high ultrasound detection rate, followed by intracerebral hematoma, subdural effusion and brain contusion.The overall detection rate of ultrasound was 87.1%.Conclusion Ultrasound plays an important role in correctly finding the focus so as to reduce blind operation and avoid omission of the focus in field hospi-tals, where CT equipment is usually unavailable.