Objective:To evaluate the long-term clinical outcomes of total hip arthroplasty with the 4th ceramic-on-ceramic bearing in patients with history of hip injury.Methods:During December 2008 to December 2011, a total of 153 patients (157 hips) with history of hip injury were treated with 4th ceramic-on-ceramic bearing total hip arthroplasty. There were 25 cases (25 hips) were not followed up (16.3%). Ultimately, a total of 128 cases (132 hips) aged 49.26±14.18 (range 17-76) years including 87 males and 41 females were included in the study. In these patients, there were 15 cases (11.4%) with acetabular fracture, 90 cases (68.2%) with femoral fracture, 5 cases (3.8%) with hip dislocation and 22 cases (16.7%) with unknown history. Clinical outcomes, including operation duration, Harris score, range of motion, complications and noises, were evaluated. The survivorship was investigated by using Kaplan-Meier method.Results:The operation duration was 135.61±41.65 (range 64-320) min. The average follow-up duration was 9.62±0.82 (range 8.2-11.3) years. The Harris score increased from preoperative 44.07±19.71 to 94.03±4.10 at the last follow-up ( t=24.155, P<0.001). The range of hip motion increased from 75.90±28.05 degrees to 117.14±12.36 degrees ( t=13.176, P<0.001). There was no significant difference in Harris scores and ranges of motion among the groups with different history of fracture and dislocation. There were periprosthetic fracture in 1 case and hip dislocation in 2 cases. There was no periprosthetic hip infection or fracture of ceramic liner during the follow up. Thirteen cases (13 hips, 9.8%), including squeaking in 9 cases (6.8%) and clicking in 4 cases (3.0%), reported hip noise without pain and impairment on the quality of life. The survivorship was 100% at 10 years when regarded revision as an end point. However, the survivorship was 99.24% (95% CI: 97.8%, 100%) at 10 years when reoperation revision as an end point. Conclusion:Total hip arthroplasty with 4th ceramic-on-ceramic bearing could have excellent results for patients with a history of hip fracture or dislocation in the long-term follow-up. Although the prevalence of hip noise was about 10% in this cohort study, there was no impairment on the quality of life.

Objective To explore the clinical efficacy of laser-assisted sclerectomy and cataract extraction combined with angle separation in the treatment of angle-closure glaucoma.Methods A total of 162 patients with angle closure glaucoma were selected as the research subjects.Eighty-one patients in the experimental group under-went laser-assisted sclerectomy and cataract extraction combined with angle separation,and another 81 patients in the control group underwent cataract extraction combined with angle separation.The therapeutic effects of two groups of patients were observed.Results The postoperative visual acuity,BCVA,angle width,and corneal endothelial cell count of the experimental group were higher than those of the control group,but the intraocular pressure,central anterior chamber depth,and corneal thickness were all lower than those in the control group.The incidence of adverse reactions in the experimental group(6.2% )was lower than that in the control group(13.6% ).During postop-erative follow-up,there was no further increase in intraocular pressure in the two groups,while the height of filtering blebs in the control group decreased significantly when compared with that in the experimental group.One month after surgery,the BCVA and corneal endothelial cell count in the experimental group were higher than those in the control group(P<0.05),and the corneal thickness was lower than that in the control group(P<0.05),but no statistical significance was found at 3 and 6 months after surgery.The astigmatism in the experimental group was better than that in the control group 3 months after surgery,but there was no statistically significant difference at 1 month and 6 months after surgery.Conclusion Laser-assisted sclerectomy and cataract extraction combined with angle separa-tion are effective and safe in the treatment of angle closure glaucoma.

Objective To investigate the operation strategy of pediatric intracranial arachnoid cysts (IACs).Methods Surgical intervention was performed in 76 patients with pediatric IACs,admitted to our hospital from January 2003 to October 2013; cyst-peritoneal shunt was chosen in 40 patients and fistulation in 36 (including microscopic fistulation in 31 and endoscopic fistulation in 5).According to the changes of cyst volume and the relief of symptoms,the efficacy was evaluated,and the complications after operation,including the recent complications (within 2 months of operation) and long-term complications (longer than 2 months of surgery),were observed.Results The efficiency of cysts-peritoneal shunt was 80％ (32/40); the rate of recent complication for patients performed cysts-peritoneal shunt was approximately 17.5％ (7/40),including 3 of CSF leakage,3 of intracranial infection and 1 of wound infection; the rate of long-term complications was approximately 22.5％ (9/40),including 3 of shunt-dependency,2 of intracranial infection,2 of obstruction of the catheter,1 of off the catheter and 1 of skin channel infections.Meanwhile,the efficiency of fistulation was approximately 91.67％ (33/36); the rate of recent complication was approximately 8.33％ (3/36),including 1 of intracranial infection,2 of subdural hematoma; the rate of long-term complications was 0.Significant difference was noted in the surgical efficiency (x2=1.126,P=0.289) and the rate of recent complication (x2=0.707,P=0.401) between cyst-peritoneal shunt and fistulation; however,the rate of long-term complications in patients after cyst-peritoneal shunt insertion was significantly higher than that in patients after fistulation (x2=7.159,P=0.008).Conclusion Fistulation might be the preferred method for pediatric IACs,and shunt should be avoided.

Objective To summarize the clinical features of pediatric intracranial arachnoid cysts (IACs).Methods Retrospective analysis of clinical data of 488 patients with pediatric IACs,admitted to our hospital from January 2003 to September 2013,was performed; 342 males and 146 females (M∶F=2.34∶1,mean age=[5.61±3.25] years) were chosen.Results A total of 221 patients (45.29％) were discovered accidentally,while 267 patients (54.71％) existed clinical chief complaints,including123 (46.07％) can be found being responsible for.Atotalof364 patients (74.59％) were simple IACs,and 124 patients (25.41％) were combined with other congenital diseases.IACs located at the middle cranial fossa (n=355,72.75％),the posterior fossa (n=82,16.80％),the anterior cranial fossa (n=20,4.10％),the cerebralconvexity (n=12,2.46％),the suprasellarcistern (n=7,1.43％),the intracerebral ventricle (n=5,1.02％),the quadrigeminal cistern (n=5,1.02％),and the inter hemispheres (n=2,0.41％).Four hundred and forty-nine patients (92.01％) were single cyst,and 39 (7.99％) were multiple cysts.In aspect of the tension effects based on imaging,127 patients (26.02％) were positive,and 361 (73.98％) were negative.All 76 patients (15.57％) accepted surgical operation,and 412 (84.43％) adopted the conservative treatment.After 3-72 months follow-up (mean 32.43±8.92 months),the symptoms relieved and the volume of cysts reduced in operation cases in different degrees; while 407 patients (98.78％) were stable,3 (0.73％) worsened on clinical symptoms,and 2 (0.49％) were improved.Conclusions The clinical complaints of IACs in children are complex,but only part could be determined the responsibility relations between the clinical complaints and IACs.Some IACs could be accompanied with other congenital diseases.In the natural history of IACs,most cysts maintain the stable volume,and only a few ofIACs need operation intervention.

Objective To explore the clinical features,differential diagnosis,preoperative imaging and microsurgical treatment skills/experiences of falcotentorinal meningiomas.Methods Nine patients with falcotentorinal meningiomas,admitted to and performed microsurgical resection in our hospital from January 2009 to October 2015,were chosen in our study.Preoperative examinations included MR imaging and CT angiography:the Galen's veins were totally occluded in two patients and stenosed of different degrees in 7 patients;3 patients had meningiomas at the above of Galen's veins,and 6 under the Galen's veins.Seven patients were resected via Poppen approachs,and 2 with considerable lateral extensions tumors were via bilateral Poppen approach.Results Simpson Grade Ⅰ-Ⅱ tumor resection was achieved in 7 patients and Grade Ⅲ in two patients.Postoperative complications included cortical blindness in two patients recovering within 3 months of follow-up,intracranial infection in one patient curing two weeks later;no postoperative death or severe disabilities were noted.Clinical follow-up was available in 9 patients for a period ranging from 0.5 to 7 years:7 patients enjoyed Simpson Grade Ⅰ-Ⅱ resection had no tumor recurrence and were self-reliable;in two patients with Simpson Grade Ⅲ resection,one accepted postoperative treatment of Gamma knife,another one without other treatment,and these two patients had no tumor progression in the 28 months of follow-up.Conclusion The microsurgery is preferred in the resection of falcotentorinal meningiomas,and sufficient preoperative imaging evaluation,reasonable operation concept,technique and experience of adept micromanipulation are the keys to the safe and effective removal of the tumors.

Objective:To compare the differences of brain activation in patients with neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) under contact heat stimulation (CHS), and to explore the characteristics of pain-related brain networks in NMOSD and MS patients.Methods:Fourteen NMOSD patients (NMOSD group) and 12 MS patients (MS group) admitted to Affiliated Hospital of North Sichuan Medical College from September 2022 to December 2022 who met the diagnostic criteria were collected. Twelve healthy individuals (HC group) matched with gender and age were recruited during the same period. Visual Analogue Scale (VAS) score was used to evaluate the pain of the subjects, CHS painful stimuli were given, and task-state functional magnetic resonance imaging (fMRI) scans were performed at the same time, and the differences in brain activation among the 3 groups were analyzed and compared.Results:(1) Compared with the HC group, the NMOSD group had a stronger activation degree than the HC group in the brain regions including the cortex around the left distance fissure, bilateral medial superior frontal gyrus; the activation degree of the NMOSD group was weaker than that of the HC group in the brain areas including the left medial and paracingulate gyrus, right superior parietal gyrus, left postcentral gyrus, and right supplementary motor area (all P<0.05). (2) Compared with the HC group, the brain regions whose activation degree was weaker in the MS group included the left caudate nucleus, left medial and paracingulate gyrus, left paracentral lobule, right superior parietal gyrus, left postcentral gyrus, left precuneus, right supplementary motor area, right superior temporal gyrus and right thalamus, and there was no brain area in the MS group whose activation degree was stronger than that of the HC group (all P<0.05). (3) Compared with the MS group, the brain regions with stronger activation degree in the NMOSD group included the left perifissure cortex and right thalamus, but no brain regions with weaker activation degree were found in the NMOSD group (all P<0.05). (4) There was a correlation between somatic pain VAS scores and activation of the medial superior frontal gyrus in the NMOSD group ( r=0.66, P<0.05). Conclusions:The results of CHS-fMRI in the NMOSD group, MS group and HC group showed that multiple brain regions were activated, indicating that multiple brain regions were involved in the generation and processing of pain, and there was a pain-related brain network. Pain-related brain networks were altered in NMOSD patients and MS patients, and there were differences in pain-related brain networks between the two diseases.

Objective:To observe the changes in brain functional magnetic resonance imaging (fMRI) in migraine patients under olfactory stimuli and analyze the characteristics of olfactory-related brain networks.Methods:Twenty-seven migraine patients (migraine group) enrolled in the Department of Neurology, Affiliated Hospital of North Sichuan Medical College from January 2021 to January 2022 were included, and 20 healthy adults were recruited as control group during the same period. All subjects underwent synchronous fMRI scanning under olfactory task stimulation, and magnetic resonance imaging data processing was performed using SPM12 and Matlab2019b softwares, and statistical analysis was performed with SPSS 23.0 software.Results:The activated brain regions in the control group included the left cerebellum, left inferior temporal gyrus, left fusiform gyrus, right middle frontal gyrus, right anterior central gyrus, insula, right central sulcus, superior marginal gyrus, right lenticular putamen, middle cingulate gyrus, paracentral lobule, and superior parietal gyrus ( P<0.05). The activated brain regions in the migraine group included the left cerebellum, right fusiform gyrus, right inferior temporal gyrus, right anterior central gyrus, and right posterior central gyrus ( P<0.05). Compared with the control group, the activation intensity of the migraine group was weaker in the right insula, right middle frontal gyrus orbit, left inferior frontal gyrus orbit, right dorsolateral superior frontal gyrus, right superior temporal gyrus, right superior occipital gyrus, medial and paracingulate gyrus, and right superior parietal gyrus ( P<0.05). Conclusion:Migraine patients have multiple brain regions involved in olfactory processing and have specific olfactory-related brain networks.

Objective:To analyze the clinical, imaging and pathological characteristics of pleomorphic xanthoastrocytoma (PXA), and to explore the effective treatment of PXA.Methods:A total of 25 patients with PXA admitted to our hospital from July 1, 2012 to December 1, 2019 were chosen in our study. Their clinical manifestations, imageology features, pathology features, treatments, and prognoses were retrospectively analyzed.Results:Headache ( n=12) and epilepsy ( n=8) were the most common first symptoms in 25 patients. The tumors in 8 patients were located in the parietal lobe, 6 were in the temporal lobe, and 6 were in the frontal lobe. Among the pathological results, the average positive rate of cell proliferation antigen Ki-67 and P53 in patients with WHO grading II was 6.4% and 21.2%, respectively; the average positive rate of Ki-67 and P53 in patients with WHO grading III was 22.2% and 48.3%, respectively. Synaptophysin protein was confirmed in 12 of the 15 patients. Twenty patients were followed up for 31 months after surgery; 19 survived; 9 had no tumor recurrence or residue, including 8 with WHO grading II and one with WHO grading III. Conclusion:Pathological result play an important role in PXA diagnosis; the prognosis of patients with WHO grading II is obviously better than that of patients with WHO grading III.

Objective:To investigate the relationship between carotid atherosclerosis(CAS)and subclinical left ventricular(LV)dysfunction in type 2 diabetes mellitus patients with preserved LV ejection fraction(LVEF).Methods:A total of 120 patients with type 2 diabetes mellitus who had LVEF≥50% were selected in the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from June 2021 to October 2021. The global longitudinal strain(GLS)was obtained by two-dimensional speckle tracking echocardiography(STE)to assess subclinical LV systolic function. The mitral ratio of peak early to late diastolic filling velocity(E/A), and mitral velocity to early diastolic velocity of the mitral annulus(E/E′)ratio were obtained by pulsed tissue Doppler echocardiography to assess LV diastolic function. Acrroding to bilateral carotid ultrasound examination, the subjects were divided into normal carotid arteries group( n=46) and CAS group( n=74). Demographics and biochemical parameters were compared between two groups. Binary logistic regression and Pearson correlation analysis were used to evaluate the relationship between CAS and subclinical LV dysfunction. Results:The CAS group had a higher proportion of men, older age, and a longer duration of diabetes than the normal carotid arteries group(all P<0.05). There was no difference in LVEF and GLS between the two groups [normal carotid arteries group vs CAS group, LVEF: (60.72±4.73)% vs(60.07±4.28)%; GLS: (18.24±3.72)% vs(17.81±3.47)%, respectively; both P>0.05]. However, compared with normal carotid arteries group, E/A ratio was decreased and E/E′ ratio was significantly increased in CAS group(both P<0.01). Pearson correlation analysis showed that GLS was not correlated with carotid plaque thickness and carotid intima-media thickness(CIMT; both P>0.05). By contrast, E/E′ ratio was positively correlated with carotid plaque thickness and CIMT(both P<0.05). Binary logistic regression analysis showed that GLS and E/E′ ratio were not associated with CAS( both P>0.05). However, decreased E/A ratio was significantly associated with the existence of CAS( OR=0.09, 95% CI 0.01-0.67, P=0.018). Conclusions:In type 2 diabetes mellitus patients without overt heart failure and with preserved LVEF, the occurrence of CAS is not associated with subclinical LV systolic impairment assessed by GLS, but is significantly associated with LV diastolic dysfunction, and is independent of traditional cardiovascular risk factors.