Objective To investigate the diagnostic value of 64-slice CT angiography (CTA) to head and neck artery pathological changes.Methods One hundred patients with clinical suspicion of head and neck vascular lesions were retrospectively analyzed.Sixty four cases of lesions were detected by 64-slice CTA,and were checked by Digital Subtraction Angiography (DSA) within a week.First,the correlation of 64-slice CTA and DSA diagnosis of head and neck artery stenosis grade was counted.Then DSA was taken as the gold standard.The sensitivity,specificity,positive predictive value,and negative predictive value of 64-slice CTA to diagnose head and neck arteries stenosis were calculated.Results Of 64 cases of patients,2 cases of congenital vascular dysplasia,including 1 case with internal carotid artery in 2 cases,the remaining 60 patients had different degree of stenosis.The sensitivity,specificity,positive predictive value,and negative predictive value of 64-slice CTA was 95.34％,99.48％,97.62％,and 98.98％,respectively.Among 60 narrow patients,the plaque number was 205,including 88 soft plaques,56 mixed plaques,and 61 calcified plaque.Conclusions The 64-silce CTA has multiple advantages including rapid,noninvasiveness,high accuracy and safety,and high application value in the diagnosis of head and neck vascular lesions.It is worth promoting.

Objective To investigate the alteration of peripheral tissue`s temperature of the coagulation zone of microwave ablation in brain tissue, and to provide experimental evidence for clinical application. Methods Twelve canines were treated by microwave ablation in brain tissue. Each was ablated for 180 s with microwave output power of 20 W, 30 W, and 40 W. During the operation the peripheral temperature at the distance of 0.5 cm, 1.0 cm, 1.5 cm and 2.0 cm from the ablation center was recorded respectively. The ultrasound was performed 1 hour after the operation, and then the animals were executed and the microscopic changes of the ablation lesion were observed. Results Eleven canines suffered well for the ablation, while 1 presented abnormal respiration during the operation and died 2 hours later. During the operation, the temperature of the area 0.5 cm from the center rose signiifcantly, with the maximum temperature was (96.40±1.46)℃at the power of 20 W, and 100℃at the power of 30 W and 40 W. The temperature of the area 1.0 cm from the center rose faster, with the maximum temperatures at different powers all above the 46℃. The temperature of the area 1.5 cm from the center rose slower, with the maximum temperature below 46℃at the power of 20 W and 30 W and above 46℃at the power of 40 W. The maximum temperatures of the area 2.0 cm from the center at different powers were all below 46℃. The difference of the maximum temperature at different distances (1.0 cm, 1.5 cm, and 2.0 cm from the center) was signiifcant (F=776.78, 2640.64 and 3025.53, all P<0.05). The length and width of the ablation lesion as well as the area of edema increased with the power. At the power of 20 W, 30 W, and 40 W, the length of the ablation lesion was (29.3±1.8) mm, (32.7±2.1) mm and (34.2±2.4) mm, the width was (22.5±1.5) mm, (23.7±1.7) mm and (27.1±2.0) mm, and the width of the edema zone was (2.3±0.4) mm, (2.6±0.4) mm and (2.7±0.5) mm. The differences of the length and width of the ablation lesion at different powers were signiifcant (F=11.46, 14.49, both P<0.01). The difference of the edema area at different powers was insigniifcant (F=1.94, P=0.169). Conclusions Microwave ablation is a safe therapeutic modality. However, the shorter distance from the ablation center and greater ablation power give rise to larger ablation lesion, higher maximum temperature, and faster temperature increase. Therefore, 2.0 cm from the ablation center is a safe area.

Objective To evaluate the vulnerability of carotid arteriosclerosis plaque by ultrasound real-time tissue elastography in patients with SSS-TOAST1 style cerebral infarction, and discussing the value of the technique in assessment of the clinical course after cerebral infarction. Methods There were 113 patients of SSS-TOAST1 style cerebral infarction who had carotid arteriosclerosis plaque and 48 patients of contrast group who had carotid arteriosclerosis plaque selected by ultrasound in Department of Ultrasound, Beijing Tiantan Hospital, Capital University of Medical Sciences. The results between two groups were compared. The cerebral infarction group was divided into two sub-groups according to the clinical course of patients after cerebral infarction, and the difference between them was compared. Results The size had no significant difference between cerebral infarction group and contrast group as well as between aggravated group and non-aggravated group (t=15.61, 10.77, 4.52, P<0.05). The real-time tissue elastography of carotid arteriosclerosis plaques were red-green in most patients of cerebral infarction group. The real-time tissue elastography of carotid arteriosclerosis plaques were green-blue in most patients of in control group. The value of elasticity of plaque, vessel wall and stiffness of carotid arteriosclerosis plaque between cerebral infarction group and control group had significant differences (t=15.61, 10.77, 4.52, P<0.05). The value of real-time tissue elastography between aggravated group and non-aggravated group had significant difference (t=6.39, 2.30, 3.80, P<0.05). Conclusion Real-time tissue elastography could evaluate the stiffness of carotid arteriosclerosis plaque, which was related with the vulnerability of carotid arteriosclerosis plaque. The values of elasticity of plaque, vessel wall and stiffness of carotid arteriosclerosis plaque in patients with SSS-TOAST1 style cerebral infarction were lower, and the vulnerability of carotid arteriosclerosis plaque was higher. Real-time tissue elastography had some worth in evaluating the clinical course of patients after cerebral infarction.

Objective To investigate the changes in intrapulmonary shunting during controlled hypotension induced by sodium nitroprusside(SNP)in patients undergoing naso-endoscopic operation.Methods Forty ASAⅠorⅡpatients of both sexes(23 male,17 female)aged 16-50 yrs weighing 50-75 kg undergoing naso-endoscopic operation under general anesthesia with muscle relaxation and mechanical ventilation were studied.Radial artery was cannulated for direct BP monitoring and blood sampling.Right internal jugular vein was cannulated and the catheter was advanced into right ventricle.Blood sample taken from right ventricle was used as mixed venous blood instead of blood from pulmonary artery.ECG,MAP,HR and P_(ET) CO_2 were continuously monitored during operation Cardiac output was monitored with noninvasive cardiac function monitor(NC-COM.)based on impedance principle.SNP infusion was started at the beginning of operation at 1-3?g?kg~(-1)?min~(-1) and was then adjusted.MAP was reduced by 30%-40% and maintained at this level until the end of operation.Blood samples were taken from artery and right ventricle simultaneously before SNP infusion(T_1,baseline)at 30 and 60 min of hypotension(T_2,T_3)and at 20 min after BP returned to the baseline level(T_4)for blood gas analysis.Qs/Qt was calculated.Results Qs/Qt was significantly increased during controlled hypotension at T_2 and T_3 as compared to the baseline value(P＜0.01)and returned to the baseline level at T_4.HR was increased and cardiac output and stroke volume was significantly reduced during hypotension as compared to the baseline value.Conclusion The intrapulmonary shunting is increased and the hemodynamics is depressed during SNP-induced controlled hypotension and they return rapidly to baseline level after SNP is discontinued.No hypoxemia develops during SNP- induced hypotension.

Objective To explore the characteristic of transcranial color-coded sonography(TCCS)and contrast-enhanced transcranial color-coded sonography (CE-TCCS) in patients with intracerebral hemorrhage and thiers clinical value.Methods 66 patients were randomly selected,whose preliminary clinical diagnosis were intracerebral hemorrhage (ICH).The patients were followed up by TCCS in acute phase,subacute phase and chronic phase.The changes of the echo,boundary and the hematoma volume were recorded in different stages.In acute phase,patients' complications of intracerebral structure were observed.32 patients were selected randomly to underwent CE-TCCS examination in the subacute phase.The size,shape and the perfusion situation of hematoma were observed.The results of CE-TCCS were compared with the results of TCCS.Correlation analysis was made between the results of ultrasound and CT scan.Results (1) CT results:61 patients (61/66) were confirmed ICH through CT scan.(2) TCCS results:50 patients (50/61) with ICH could show the bleeding site.TCCS showed that 33 patients with ICH accompanied by intraventricular pressure,haematoma defeats ventricle and midline shift in acute phase.The echo became lower and the boundary became more clear with time.The long diameter,wide diameter,thickness diameter and volume of hematoma in different stages on TCCS had a good correlation with that on CT scan.(3)CE-TCCS results:30 cases of intracerebral hematoma could be clearly displayed the situation of hematoma through the ipsilateral temporal window.Compared with TCCS,CE TCCS had a better correlation with CT scan on the measurement of the hematoma length,width.The images of 2 cases observed through contralateral temporal window failded to be clearly shown.In 7 cases of ICH,visible low-enhanced edema area could be seen around the hematoma.The width of the edema area had a good correlation with the CTP result.Conclusions TCCS could clearly show the bleeding sites,hematoma volume and complications and the features of ICH in different stages of disease.TCCS could be used to monitor the condition of patients with ICH and recognized the disease progression initially.CE-TCCS had a much more clear display of intracerebral hematoma location,shape,boundary.At the same time,CE-TCCS could provide blood perfusion information of surrounding tissue in hematoma so that it could observe the change of peripheral edema more convenient.

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in classifying lesions,measuring the range of lesions,and the ability of manifesting the boundary and the severity of lesions after traumatic brain injury.Methods 83 patients with traumatic brain injury underwent the emergency surgery operations were enrolled in this study.Intraoperative ultrasound was applied in detecting the echo characteristics of lesions and classifying.Traumatic brain injuries which were classified indefinitely by conventional ultrasound were examined by CEUS to observe enhanced features of trauma lesions and the surrounding tissue,confirm the types of lesions,identify the border of lesions,measure the range of lesions,and compare with conventional ultrasound,preoperative CT and operative results.The severity of lesions was judged according to the parameter of time intensity curve (TIC).The results which would help the operators to adjust the method of treatment timely was informed.Results 148 lesions were detected by intraoperative ultrasound among 83 patients in this study.Thirty-two lesions which were classified indefinitely by conventional ultrasound were examined by CEUS.The results of classifying were confirmed by CT and operations,the diagnostic accuracy rate was 100％.The absolute peak intensity was changed with the injury severity,the more serious of the tissue,the lower absolute peak intensity was displayed.The boundary of lesions was manifested clearly after CEUS.Compare to the conventional ultrasonography,the range of lesions was larger.The difference between them was meaningful significally(P =0.01).Based on the results of CEUS,the way of operation was adjusted in 21 lesions.Conclusions Using the contrastenhanced ultrasound and intraoperative ultrasound,various traumatic brain injuries can be diagnosed accurately.By CEUS,the perfusion of lesions would be displayed,which would hint the severity of the brain tissue and help the operators adjust the methods of treatment timely,and provide the reliable evidence for the operation precisely.

Abstract: Objective　To investigate the pollution of paralytic shellfish poisons (PSP) in shellfish sold in Hainan Province from 2018 to 2021. Methods　From 2018 to 2021, the content of 10 paralytic shellfish poisons including saxitoxin (STX), neosaxitoxin (neoSTX), gonyautoxins 1 (GTX1), gonyautoxins 2 (GTX2), gonyautoxins 3 (GTX3), gonyautoxins 4 (GTX4), gonyautoxins 5 (GTX5), decarbamoylsaxitoxin (dcSTX), decarbamoylgonyau toxins 2 (dcGTX2) and decarbamoylgonyau toxins 3 (dcGTX3) in 7 kinds of shellfish commonly sold in 13 cities and counties in Hainan province was analyzed. Results　The detection rate of PSP in 360 shellfish samples was 10.3%. Among them, the highest detection rate of STX was 5.83%, followed by GTX2 detection rate of 4.17%; the detection rate of neoSTX and GTX3 were both 1.67%; the detection rate of GTX1 was 1.39%. None of the five PSP, GTX4, GTX5, dcSTX, dcGTX2 and dcGTX3, were detected. Four types of PSP were detected in fanscallops, two were detected in oysters, mussels and Scapharca subcrenata, only one was detected in scallops, and no toxin contamination was detected in clams and razor clams. A single sample of fanscallops detected a maximum of 4 PSP, and a single sample of oysters, scallops, mussels and Scapharca subcrenata detected a maximum of 1 PSP. The equivalence of PSP in all samples was ND-155.6 μg/kg.The annual detection rate of PSP from high to low was: 20.0% in 2020, 15.6% in 2019, 5.3% in 2018, and 2.0% in 2021, and none of the samples tested exceeded the standard. Continuously detectable STX in 2018-2020, all PSP that could be detected in 2018 were STX. In 2019, in addition to STX detected in scallops and Scapharca subcrenata, neoSTX was also detected in oysters, mussels and Scapharca subcrenata. In 2020, PSP was only detected from scallops, and GTX2 could be detected in all positive specimens, while 5 STX, 5 GTX1 and 6 GTX3 were detected. Only GTX2 detected from scallops in 2021. STX was detected in shellfish sold in 12 cities and counties, GTX2 can be detected in 10 cities and counties, neoSTX can be detected in 5 cities and counties, GTX1 and GTX2 were detected in 4 cities and counties respectively. Shellfish sold in Wenchang and Lingshui markets can detect 5 types of PSP. Conclusion　Some types of shellfish on the market in Hainan are contaminated with some kind of PSP pollution risks, and it is necessary to strengthen the supervision of PSP in marketed shellfish.

Objective To determine the factors influencing the results of open reduction and internal fixation for displaced intra-articular calcaneal fracture (DIACF).Methods From May 2009 to June 2013, 80 patients with DIACF involving in 91 feet were treated by open reduction and internal fixation.Mean age was 38.7 years (range, 18-72 years).Patients were grouped according to the possible factors related to the operative results, including the Sanders classification of fracture, quality of fracture reduction, postoperative B(o)hler angle, width of postoperative calcaneus, and time to surgery after injury.Clinical result was evaluated and compared within each group.Results Mean duration of follow-up was 18.3 months (range, 14-26 months).The clinical results were excellent for 67 feet (74％), good for 12 feet (13％), fair for 7 feet (8％) and poor for 5 feet (5％), which yielded 87％ good to excellent results.Good to excellent results in Sanders Ⅱ , Ⅲ and Ⅳ groups reached 94％, 85％ and 53％ respectively, in quality of fracture reduction ≤ 2 mm and ＞ 2 mm groups reached 93％ and 30％ respectively, in postoperative B(o)hler angle ＜ 15° and ≥15° groups reached 33％ and 90％ respectively;in broadening of postoperative calcaneus ＜ 1 cm and ≥ 1 cm groups reached 92％ and 17％ respectively, in time to surgery after injury ≤14 days and ＞ 14 days groups reached 91％ and 43％ respectively, in age ≤60 years old and ＞ 60 years old groups reached 85％ and 88％ respectively.Except for the age group, the clinical result differed significantly within group (P ＜ 0.05).Conclusions Fracture type, reduction quality, postoperative B(o)hler angle, width of postoperative calcaneus, time to surgery after injury are the factors influencing on the operative results of patients with displaced intra-articular calcaneal fracture.Thereupon the unfavorable influences should be avoided to improve the operative results.

Objective To discuss the surgical treatment of spinal injury, and provide insights on key points and related issues for operations. Methods Two hundred and five cases of spinal fracture were treated through posterior surgical treatment. Under C-arm X-ray monitoring, surgeries had been operated on pedicle screws insertion, vertebral canal decompression, over-extending reduction position, and placed the connecting rod, knocked in the bone graft and finally transplanted the paraspinal bone. Results After operations , the height and morphology of vertebral bodies and spinal physiological curvature were basically recovered analyzed by X ray examination. The follow-up results (in the average of 14 to 36 months) indicated that there were 4 cases of delayed infection, 7 cases of loosen screw, 6 cases of broken screw (14 screws)and 1 case of broken stick, with no secondary nerve injury or other syndromes. Conclusion The vertebral pedicle screw internal fixation manipulated easily, which could sufficiently enlarge vertebral canal in order to decompression. In addition, during the operation, together with over-extending reduction position is beneficial to regain the height of fractured vertebral bodies.

Objective To explore the ultrasonographic characteristics of internal jugular vein(IJV) valve insufficiency and reflux.Methods 40 healthy volunteers' bilateral IJVs were study subjects.The inner diameter,valve morphological feature,reflux distance and hemodynamic parameters in IJV were detected by color Doppler ultrasound (CDU),the contrast agents transvalvular regurgitation in IJV was monitored by contrast-enhanced ultrasound (CEUS) (with low mechanical index,MI 0.10),then analyse the results of two methods.Results Of 80 investigated IJVs,1 vein was excluded due to absence of its left valve,so 79 veins were evaluated in the study.The IJV's inner diameter on the right side was larger than on the left side,but there was no significant difference (P ＞0.05).The detection rate of IJV valve insufficiency was 31.6％ (25/79),which was higher on the right than that on the left,but without significant difference (P ＞ 0.05).The detection rate of IJV valve insufficiency was significantly higher in the group of greater than or equal to 50 years old than that in less than 50 years old(P ＜0.05).The reflux distance in IJV displayed by CDU was associated with IJV valve's function.Compaired with sufficient valves,the reflux duration time in insufficient valves during quiet respiration showed no significant difference (P ＞0.05).During Valsalvalike manoeuvres and quiet respiration,the reflux duration time in sufficient valves showed no significant difference (P ＞ 0.05).The reflux duration time in insufficient valves during Valsalva-like manoeuvres showed significantly higher than that during quiet respiration (P ＜0.01).Compaired with sufficient valves,the peak flow velocity of reflux flow in insufficient valves was significantly prolonged during quiet respiration and Valsalva-like manoeuvres (P ＜0.05,P ＜0.01,respectively).Conclusions The incidence rate of IJV valve insufficiency and reflux is high in healthy individuals.During quiet respiration and/or Valsalva-like manoeuvres,detecting the reflux distance,reflux duration time and peak flow velocity of reflux flow by CDU are valuable in evaluating IJV valve insufficiency and the degree of IJV reflux.