0.05). The rFA2 values were higher and rFA3 were lower in high grade gliomas than that in low grade and had significant difference (respectively t=2.453, P

Objective To investigate the relationship between the grade of gliomas and the status of adjacent fiber tract with DTL Methods MRI and DTI were performed in 24 patients with histologically confirmed brain gliomas.Regions of interest were placed in the white matter adjacent to the tumor with the lowest FA(Faa) and in the white matter of the contralateral hemisphere(Fac).The values of Faa and Fac were measured.In the regions of the same slice, the values of ADCa and ADCc were measured. Relative fractional anisotropy ratios (rFA) and relative apparent diffusion coefficient ratios (rADC) were also calculated.The status of fiber tracts adjacent to the gliomas were characterized as displacement, infiltration or disruption.Fiber tracking using the Fiber Assignment by Continuous Tracking (FACT) method was performed to investigate the integrity of white matter tracts in the surrounding border zone of the gliomas.The correlation of rFA, rADC, the state of adjacent fiber tracts, and the grade of gliomas were analyzed statistically by using independent sample t test and tendency X2 test.Results Eleven of the 24 tumors were demonstrated as low grade gliomas (WHO grade Ⅰ-Ⅱ) and 13 were high grade giiomas (WHO grade Ⅲ-Ⅳ).The average rFA and rADC of the low grade gliomas were 0.65±0.19 and 1.43 ± 0.50 respectively.Most of fiber tracts in the periphery of the low grade gliomas were displaced or infiltrated.The average rFA and rADC of the high grade gliomas were 1.51 ± 0.39 and 1.70 ±0.27 respectively.Most of fiber tracts in the periphery of the high grade gliomas were infiltrated or disrupted.Significant difference was found for rFA (t =8.504,P =0.000) and but not for rADC(t = - 1.435 ,P =0.165) between low grade and high grade gliomas.Significant difference existed between the state of fiber tracts adjacent to ghomas and low and high-grade(X2 =5.882 ,P =0.015).Conclusions The malignancy of gliomas influences the state of fiber tracts in the vicinity of tumors, rFA can serve as a reference for distinguishment of high-grade and low-grade gliomas.DTI can depict the localization of gliomas and the adjacent fiber tracts.The state of fiber tracts can also be identified by DTI.It is helpful for the therapeutic plan of the tumors.

Objective To investigate the current status of overcrowding in emergency departments of Tertiary level A hospitals in order to discover and analyze key factors limiting the performance efficiency of staff to raise a suggestion of improvements.Methods The data regarding the distribution of the total number of available beds and total number of patients registered were collected from 19 tertiary level A hospitals to construct a regression model correlating variables including number of patients waiting,time of appointment and number of patients delivered by ambulances.The national grading system of crowdedness for emergency departments was used to estimate the NEDOCS_ BJ value for Beijing Friendship Hospital.Results Statistical analyses of key factors hampering the work efficiency and correlation between ESI triage and clinical decisions revealed overcrowding in the emergency department in a pattern across hospitals and time periods.The extent of overcrowding can be alleviated by way of increase in performance efficiency.Conclusions The proposed improvements regarding the hierarchical medical system,the development of treatment plans,and working procedure were recommended.

Objective:To investigate the clinical efficacy differences of stereotactic electroencephalogram (SEEG) electrode implantation in medically-refractory temporal lobe epilepsy (TLE) patients with different neuroimaging manifestations before surgery.Methods:A total of 59 patients with medically-refractory TLE who accepted SEEG electrode implantation in Department of Neurosurgery, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2018 to December 2021 were enrolled. These were divided into groups according to neuroimaging manifestations before surgery, including MRI-positive group and MRI-negative group, PET-positive group and PET-negative group, or PET&MRI concordant group (concordant group) and PET&MRI discordant group (discordant group). Modified Engel classification was used to evaluate the clinical efficacy of these patients at 12-month follow-up after surgery, and efficacy differences among different patient groups were compared.Results:Significant differences were noted in distributions of modified Engel classification between the MRI positive and negative groups, as well as the concordant and discordant groups at 12-month follow-up after surgery ( P<0.05); patients in the MRI positive group had better outcomes than those in the MRI negative group (mean rank judgment: 27.00 and 34.08), while patients in concordant group had better outcomes than those in discordant group (mean rank judgment: 23.32 and 31.19). Significant differences were noted in distributions of modified Engel classification at 12-month follow-up after surgery between different signal abnormal regions in the MRI positive group ( P<0.05); patients with hippocampal sclerosis or amygdala abnormalities had better outcomes than those with simultaneous abnormalities in the temporal lobe internal and external regions (mean rank judgment: 14.50 and 16.50). Conclusion:When the preoperative MRI of patients with medically-refractory TLE is negative, especially when results of structural imaging and functional imaging are inconsistent, SEEG electrode implantation and path planning as well as later surgical plan should be considered more carefully.