Objective To investigate the diagnostic values of transcranial Doppler ultrasonography (TCD) for vertebral artery hypoplasia (VAH) and focal vertebral artery stenosis (fVAS) with CT angiography (CTA) finding as a standard.Methods Consecutive patient who underwent TCD and CTA were included.According to the findings of CTA,they were divided into 3 groups:a normal group,a VAH group,and a fVAS group.The TCD parameters included the mean flow velocity (MFV),peak systolic velocity (PSV),pulsatility index (PI),resistance index (RI) and asymmetry index (AI),and they were compared among the groups,respectively.The receiver operator characteristic (ROC) curves were used to evaluate the sensitivity and specificity of TCD parameters for diagnosis of VAH and fVAS.Results A total of 405 patients were enrolled,including 278 (68.6％) in the normal group,75 (18.5％) in the VAH group,and 52 (12.8％) in the fVAS group.There were significant differences in MFV,PSV,PI,and RI on the affected sides among different groups (the affected side in the normal group was defined as the right side).The blood flow velocity in the VAH group was the slowest,and that in the fVAS group was the fastest.Other parameters had the same trend.There were significant differences in MFV and PSV on the unaffected side among different groups.The blood flow velocity in the VAH group was significantly faster,the fVAS group was slightly faster,and the fVAS group was less than the VAH group.There were significant differences in AI among different groups,and it could be used as an indicator for diagnosis of VAH (the area under the curve 0.78,95％ confidence interval 0.72-0.84;P＜0.001).With the AI ＞33.7％ as a cut-off value,the sensitivity and specificity of VAH diagnosis were 74.7％ and 68.7％.Conclusions Attention should be paid to identifying VAH and fVAS when using TCD for evaluation of vertebral artery.AI ＞33.7％ can be used as a reference index for diagnosis of VAH.

Objective To investigate the safety and feasibility of multiple overlapping stents combined with coils in treating intracranial fusiform aneurysms, and to evaluate its therapeutic efficacy. Methods During the period from Aug. 2012 to Aug. 2013, three patients with intracranial fusiform aneurysm were admitted to authors’ hospital. The diagnosis was confirmed by CT angiography and whole cerebral angiography. Multiple overlapping stents combined with coils was carried out in all the three patients. All the patients were followed up and the clinical results were analyzed. Results Multiple overlapping stents combined with coils was successfully accomplished in all the three patients. Greater part of the aneurysmal cavity was occluded, and immediately after the procedure obvious blood whirling in the aneurysmal sac was seen. A total of 7 stents and 17 coils were used in treating the three patients. No aneurysm rupture or thrombosis occurred. The patients were followed up for 3 - 8 months. In one case the headache disappeared in 8 months, no dysneuria was detected, and angiography showed that the aneurysmal sac disappeared and the parent artery was patent. In another patient the headache disappeared in 3 months, and the angiography showed that the aneurysmal cavity had slight visualization and the parent artery was patent. The remaining patient was asymptomatic at 3-month follow-up. Conclusion For the treatment of intracranial fusiform aneurysms, multiple overlapping stents combined with coils is clinically feasible and safe with excellent short-term efficacy although its long-term results need to be further studied. (J Intervent Radiol, 2014, 23: 277-280).

BACKGROUND:Patients with elder hip fracture has more complications, poor affordability and high perioperative risk, so the preoperative ful preparation and evaluation are needed.
OBJECTIVE:To predict the accuracy of the prognosis of elderly patients with hip fracture through comparing the difference between American Society of Anesthesiologists score and Daping orthopedics operation risk scoring system for senile patients.
METHODS:A retrospective study was performed on 300 cases with elderly hip fracture selected from January 2011 to December 2012 from Department of Orthopedics, Gongli Hospital of Pudong. American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were conducted before treatment, and the predictive values of two scoring systems on the incidence of complications and mortality were compared.
RESULTS AND CONCLUSION:According to the American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients, 148 cases and 97 cases had complications respectively. On the contrary, the actual number of complications was 89. The former predicted value was significantly higher than the actual value, and there was no significant difference between the latter forecast value and the actual value. The numbers of death predicted by American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were 27 cases and six cases, but the actual number of death was three cases, indicating that former predicted value was significantly higher than the actual value, and there was no significant difference between the latter predicted value and the actual value. The American Society of Anesthesiology score has a certain errors in predicting the postoperative complications and mortality of patients with elderly hip fractures, but it is simple and useful in clinic. The Daping orthopedics operation risk scoring system for senile patients can accurately evaluate elderly hip fracture operation risk, and can predict the postoperative complications and mortality more objective when compared with the American Society of Anesthesiology score.

OBJECTIVETo characterize the expressions of peroxiredoxin 1 (Prx1), peroxiredoxin 6 (Prx6) and glial fibrillary acidic protein (GFAP) in human brain astrocytoma and explore their clinical significance.

METHODSThe protein and mRNA expression levels of Prx1, Prx6 and GFAP in human brain astrocytoma and normal brain tissue specimens were determined by Western blotting, RT-PCR and immunohistochemistry.

RESULTSThe protein and mRNA expressions of Prx1 and Prx6 increased significantly in the order of normal brain tissue, grade II astrocytoma, grade III astrocytoma and grade IV astrocytoma (P<0.05). The protein and mRNA expressions of GFAP decreased significantly in grade III and IV astrocytoma compared with those in grade II astrocytoma and normal brain tissues (P<0.05).

CONCLUSIONPrx1 and Prx6 may play important roles in the invasion and malignant development of human brain astrocytoma, and may serve as biomarkers for evaluating the invasiveness, malignancy and prognosis of the tumor as well as potential molecular targets in astrocytoma therapy.

Adolescent ; Adult ; Aged ; Astrocytoma ; metabolism ; pathology ; Brain Neoplasms ; metabolism ; pathology ; Child ; Child, Preschool ; Female ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Male ; Middle Aged ; Peroxiredoxin VI ; metabolism ; Peroxiredoxins ; metabolism ; Young Adult

BACKGROUND:Repair programs of posterolateral tibial plateau fracture included posterior plate screws, lateral plate screw and anterior and posterior lag screw fixation. To choose which fixation methods depends on clinical experiences of physicians. Study results are mainly clinical reports, and lack of mechanical evidence.
OBJECTIVE:To compare biomechanical changes in three fixed manners (lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group) in the repair of posterolateral fracture of tibial plateau from the angle of biomechanics.
METHODS:A total of tibial specimens of six adult male antisepsis corpses (12 samples) were used for measuring bone mineral density of metaphysis. 1/2 posterolateral tibial plateau fracture model was established by electric pendulum saw. The model was randomly divided into three groups:lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group. Finite element method and biomechanics were used to test axial displacement value and the maximal displacement distribution area under the axial loads of 250, 500, and 1 000 N.
RESULTS AND CONCLUSION:There was no significant difference in average bone density in three groups of metaphysis (P>0.05). The minimum axial displacement of the fracture fragments was in the anterior and posterior lag screw group (0.013 521 mm), fol owed by posterior plate screw group (0.016 991 mm), and the maximum was visible in the lateral plate screw group (0.138 200 mm) under 250 N load. Displacement value was similar to the 250 N under 500 and 1 000 N. According to the results of biomechanics, displacement values of anterior and posterior lag screw was obviously less than the lateral plate screw group and posterior plate screw group (P<0.05). There was no significant difference between the lateral plate screw group and posterior plate screw group (P>0.05). The maximal displacement distribution area was proximal tibiofibular joint border zone in two methods. These data indicated that the biomechanical stability was most advantageous in the anterior and posterior lag screw group, and poorest in the lateral plate screw group. In the clinic, anterior and posterior lag screw fixation can be used as a first choice for repair of posterolateral tibial plateau fracture.

Objective To investigate the diagnostic value of susceptibility weighted imaging ( SWI) in patients with mild traumatic brain injury(MTBI).Methods From June 2016 to October 2017,a retrospective analysis of 89 patients with MTBI (Glasgow score 13 to 15) in the First People's Hospital of Xiaoshan District was conducted.All patients were given head CT ,MRI and SWI within 1 week after admission.Combined with CT and phase diagram ,after removing blood vessels ,calcification and skull base artifact ,the low signal intensity on the SWI was cerebral contusion and hemorrhage.The sites,the number and the size of lesion detected on CT ,MRI and SWI images were recorded and analyzed with clinical symptoms.Results According to the presence or absence of clinical symptoms in the group ,the detection rates of microbleeds hemorrhage in patients with traumatic cerebral by SWI were 94.4%,54.2%,100.0%, 95.5%,respectively,which were higher than those by CT (16.6%,4.2%,15.0%,4.5%) and MRI conventional sequences(33.3%,8.3%,20.0%,13.6%),the differences were statistically significant (χ2＝6.633,P＝0.010;χ2＝4.260,P＝0.039,all P ＜0.05),especially in MTBI patients with a history of transient coma or persistent clinical symptoms after trauma(the detection rate was 100.0%).Conclusion Compared with conventional CT and MRI,the micro-contusion and small hemorrhagic lesions of SWI is more accurate and important in the diagnosis of MTBI,and has a significant prognostic value for clinical treatment and judgment of patients with MTBI .

Objective:To analysis the effect of two methods of transposition of pectoralis major in different degrees deep sternal wound infection(DSWI) after undergoing cardiac surgery.Methods:128 patients with DSWI after cardiac surgery were treated, 72 were mild, and 56 were severe. 66 cases of pectoralis major muscle flap docking method(medial muscle flap docking group) and 62 cases of lateral pectoralis major muscle flap turnover method(lateral muscle flap turnover group) were implemented respectively. Drainage tube indwelling time, reoperation rate, incidence of lung infection, long-term thoracic stability and other aspects were observed to compared the treatment effect.Results:In the mild patients, the medial muscle flap docking group and the lateral muscle flap turnover group were compared( P<0.05). The postoperative hospital stay [(14.2±4.7)days vs.(17.1±3.9)days], drainage tube retention time[(6.2±1.7)h vs.(9.1±2.9)h], and reoperation rate(2.4% vs. 6.7%), the incidence of lung infection(14.3% vs. 23.3%), long-term thoracic stability[73.8%(31/42)vs.43.3%(13/30)]. In the severe patients, the medial muscle flap docking group and the lateral muscle flap turnover group were compared. The postoperative hospital stay[(24.2±7.2)days vs.(20.1±3.5)days], drainage tube retention time[(20.2±6.6)h vs.(13.2±3.1)h], reoperation rate(20.8% vs.12.5%), incidence of pulmonary infection(41.7% vs. 31.3%), long-term thoracic stability[25.0%(6/24)vs.68.8%(22/32)]. The differences of the indicators in each group were significant , P<0.05. In the mild group, each index of the pectoralis major medial muscle flap docking method was superior to the lateral muscle flap turnover method, but the treatment results of the two methods in the severe group were opposite. Conclusion:Patients with mild deep DSWI treated with medial pectoralis major muscle flap docking and suture have less hospital stay, less reoperation rate, less complications and better treatment effect than reverse lateral pectoralis major muscle flap turnover. But the two treatments in the severe DSWI have the opposite effect.

Objective To evaluate the safety and efficacy of the use of Enterprise stent in the treatment of symptomatic intracranial atherosclerotic stenosis (sICAS) . Methods The clinical data of 27 patients with sICAS, who were treated with Enterprise stent implantation at First Affiliated Hospital of Zhengzhou University, China, during the period from January 2012 to December 2017, were retrospectively collected. The patient's basic parameters, characteristics of target lesions, technical success rate, perioperative safety and follow-up results were analyzed. Results A total of 27 patients (28 lesions in total) were enrolled in this study, and a total of 28 Enterprise stents were implanted. The preoperative mean stenosis degree of lesions was (75.7 ±6.7) ％, the postoperative residual stenosis degree was (23.2 ±16.6) ％. The technical success rate was 100％. Postoperative complication of perforating branch events occurred in 2 patients. No severe complications such as hemorrhage, artery dissection, in-stent thrombosis, hyper-perfusion syndrome, or cardiovascular events occurred. All patients were followed up for (10.8±9.1) months, and 3 instent restenosis lesions (≥50％) were detected although the patients had no target lesion-related symptoms, the incidence of in-stent restenosis was 10.7％. No newly-developed stroke caused by responsible blood vessel, bleeding events or death occurred. Conclusion For the treatment of sICAS, balloon dilatation followed by Enterprise stent implantation is technically feasible, and clinically safe and effective. The incidence of perioperative complications is low and the follow-up results are satisfactory. Further randomized controlled trials are still needed before its long-term efficacy is clarified.

Objective To evaluate the clinical safety and efficacy of LVIS stent (a low profile knitting designed self-expandable stent) in assisting endovascular embolization for intracranial saccular aneurysms.Methods A total of 127 patients with intracranial saccular aneurysm,who were admitted to authors' hospital during the period from April 2014 to June 2016 to receive LVIS stent-assisted endovascular embolization,were retrospectively analyzed.The safety of the operation,the immediate postoperative outcomes,the recurrence rate,and the clinical and radiographic follow-up results were analyzed.Results A total of 130 LVIS stents were successfully implanted in the 127 patients with intracranial saccular aneurysm,implantation failure was seen in one patient,the technical success rate was 99.2％.During or after the endovascular embolization process in-stent thrombosis was observed in 7 patients (7/127,5.5％).Neither perioperative bleeding nor death occurred.Immediately after the operation,complete occlusion of the aneurysm was obtained in 112 aneurysms (88.1％) and neck remnant was observed in 15 aneurysms (11.9％).The patients were followed up for a mean period of 8 months.Follow-up angiography was performed in 37 patients,which showed that complete occlusion of the aneurysm was obtained in 33 patients (89.1％),and visualization of the aneurysm was seen in 4 patients (10.9％),including 3 patients who had aneurysm visualization immediately after embolization and one patient who had aneurysm recurrence.No death occurred.Conclusion The use of LVIS stent to assist endovascular embolization for intracranial saccular aneurysms is safe and effective,although its long-term effect needs further observation.

OBJECTIVEThe aim of this study was to determine the level of exposure of mercury (Hg) miners and smelter workers to elemental mercury (Hg(0)) vapor in China, who work in Hg mines without using protective equipment against Hg(0) vapor. In addition, the level of methylmercury (MeHg) intake by the workers was estimated from the MeHg concentration in their hair.

METHODSUrinary total mercury (THg) and hair THg and MeHg concentrations were measured in 26 Hg miners and smelter workers (i.e., exposed group), and 48 unexposed people (unexposed group).

RESULTSThe exposed group showed high geometric mean THg concentrations in urine (258 ng/ml, 226 μg/g creatinine) and hair (20.0 μg/g). The urinary THg concentration of the smelter workers in particular was extremely high (338 μg/g creatinine in urine). The highest urine THg concentration reached 4577 μg/g creatinine. THg concentrations in urine and hair showed a significant correlation in the exposed group (r=0.62), indicating the adhesion of Hg(0) vapor to hair. However, no such significant correlation was found in the unexposed group. Hair MeHg concentration in the exposed group (1.97 μg/g) was about threefold higher than that in the unexposed group (0.60 μg/g).

CONCLUSIONSThis study shows that smelter workers in a Chinese Hg mine are exposed to extremely high levels of Hg(0) vapor, and that Hg miners are exposed to higher levels of MeHg than the unexposed subjects. Further study is needed to determine the cause of the higher hair MeHg concentration in the exposed group.