Objective To investigate the electrophysiological characteristics of the ventralis intermedius nucleus (Vim) in order to find an easy and safe way to confirm the target in Vim-thalamotomy. Method In microelectrode-guided selective Vim-thalamotomy for 23 Parkinson's disease patients, the background activity, amplitude and discharge frequencies of Vim were compared with its surrounding structures. The response of kinesthetic neuron and tremor cell to microstimulation was also compared. Result There were differences in backgroud activity and discharge amplitude for Vim, ventralis lateralis nucleus (VL), ventralis caudalis nucleus (VC), and internal capsule. Based on the response to active or passive movement of contralateral limb tremor cells were divided into two subgroups, which were different in localization. Contralateral tremor showed different response when the two subgroups of tremor cells were mircrostimulated. Conclusion The anterior border of Vim was easily found by microrecording. Only by combining microstimulation with microrecording could the posterior border of Vim and its interior and lateral ordination of target were identified exactly and safely. Kinesthetic neurons and tremor cells which responded to the movement of contralateral limbs should be destroyed.

Objective To summarize the clinical effect of individualized cranioplasty with different materials. Method The clinical data of 75 patients with skull defect were analyzed retrospectively. Ultrathin cranial CT and three-dimension reconstruction were done to delineate the shape and contour of cranial defect. The templet for repair was fabricated with methyl silicone rubber, bone cement or titanium mest according to the condition of the bone defect with laser rapid prototyping technique. With patient's consent, the individualized templet was implanted to repair the cranial defect. Results Methyl silicone rubber or bone cement were used for 40 of 75 patients to fill the defects, and in the other 35 patients titanium mesh was used to cover the defects with overlapping edges. The patches matched cranial defect perfectly without the necessity of revision. The average operation time was 45 minutes. Perfect or excellent cosmetic results was obtained in 63 of the 75 patients (84%). Postoperative complications were as follows: 5 patients complained of headache, which disappeared in there months. Collection of fluid under the scalp was found in 12 patients, among them the fluid was Absorbed 10 days after operation in 8 cases without any treatment, while in 3 patients it disappeared after suction for 1-4 times. In the remaining one patient, the bone cement templet was removed due to infection, and a titanium mesh was implanted one year later. Loosening and displacement of the templet occurred in 2 patients, and silk sufures were used for fixation in both patients. In these two patients, the templet became stable 3 months later, and in the other titanium was used for repair one year later. The incidence of complications was signifieantly different between inlay and onlay methods of repair (P

ObjectiveTo study a practical individualized computer-aided design project for cranioplasty in Chinese mainland. Methods6 patients with cranial defect was performed superthin skull CT,three-dimension reconstruction. The template for the skull defected was made simulating the shape and contour of cranial defect. after patient,s consent,silicone rubber terylene patch was made as a substrate for the repair of cranial defect. ResultsThis project provides a good result,especial an excellent cosmetic result. No side-effect appears,operation time is shorter than ever.ConclusionAn individual project for computer-assisted cranioplasty has been finished,which can be popularized for its value.

Objective To study the relationship between serum uric acid (UA) level and metabolic syndrome (MS) in elderly essential hypertensive (EH) patients.Methods Two hundred and one elderly EH patients were divided into hyperuricemia group (n=47) and normal UA group (n=154).Hyperuricemia was defined in males with their serum UA level ＞ 420 μmol/L and in females with their serum UA level ＞ 360 μmol/L.Relationship between serum UA level and MS in elderly EH patients was analyzed by Pearson correlation analysis and logistic regression analysis respectively.Results The age was significantly older,the waist circumference was significantly longer,the BMI and serum SCr,FPG,TG level and the incidence of MS,central obesity,high blood glucose and high TG were significantly higher while the serum HDL-C level was significantly lower in hyperuricemia group than in normal UA group.Pearson correlation analysis showed that waist circumference,BMI,serum FPG and TG level were positively related with serum UA level while serum HDL-C level was negatively related with serum UA level (P＜0.05,P＜0.01).Logistic regression analysis showed that waist circumference and serum TG level were the independent risk factors for elevated serum UA level in elderly EH patients (OR=1.080,95％ CI:1.035-1.127,P=0.000;OR=1.472,95％CI:1.021-2.122,P=0.038).Conclusion Serum UA level is closely related with MS and its components while waist circumference and serum TG level are the independent risk factors for hyperuricemia in elderly EH patients.

Objective To construct a scoring system of combination of procalcitonin and C-reactive protein for diagnosis of invasive bacterial diarrhea in children. Methods The clinical data of hospitalized children with acute diarrhea were retrospectively analyzed. All of the children were divided into two groups, invasive bacterial diarrhea group and nonbacterial diarrhea group. The scoring system of combination of two markers for diagnosis of invasive bacterial diarrhea in children was constructed by means of two categories logistic regression analysis using procalcitonin and C- reactive protein as parameters. In addition,receiver operating characteristic curve(ROC)was used to evaluate the diagnostic accuracy.Results One hundred ten cases of invasive bacterial diarrhea and 108 cases of nonbacterial diarrhea were included. The levels of serum procalcitonin and C-reactive protein in invasive bacterial diarrhea group were significantly higher than those in nonbacterial diarrhea group, and there were statistical difference(P all<0.05).The area under the ROC curve(AUC)of invasive bacterial diarrhea was 0.894 when the established scoring system was used, which was higher than the AUCs when either serum procalcitonin or in C- reactive protein was used (P<0.05). The best diagnostic boundary value for combination of serum procalcitonin and C- reactive protein scoring was 0.52 with a sensitivity at 80.9% and specificity at 88.9%. Conclusions The scoring system of combination of procalcitonin and C- reactive protein has good accuracy in diagnosis of invasive bacterial diarrhea in children, and can assist the early diagnosis of the disease.

Objective To investigate the impact of actual gantry angle on the accuracy of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods A total of 27 patients with NPC were enrolled in this study. IMRT plans were designed with Pinnacle treatment planning system (TPS),and 8 beams with an interval of 30°(within 0°-360°) were selected for each plan. These plans were divided into plan A and plan B according to the beam parameters. In plan A,the minimum sub-field area was 5 cm2 ,the minimum number of sub-field monitor unit ( MU) was 5,and the maximum sub-field number was 80;in plan B,the minimum sub-field area was 8 cm2 ,the minimum number of sub-field MUs was 8,and the maximum sub-field number was 60.The gamma passing rate using the criteria of 3%/3 mm and 2%/2 mm at actual and zero degree gantry angles were calculated using Mapcheck 2 device for dose verification,and were compared with the paired t-test. The relationship between the above differences (Δ value) and the beam angle or the beam parameters was also analyzed. Results In plan A with the criteria of 3%/3 mm, the beams were significantly different (P=0000-0007) except for at angles of 270°,300°,and 300°,and the mean Δ value was 090%;under the criteria of 2%/2 mm,all beams were significantly different ( P=0000-0019) except for at an angle of 300°,and the meanΔvalue was 272%.In plan B with the criteria of 3%/3 mm,the beams showed no significant difference ( P=0052-0639) except for at an angle of 300 ° ,and the mean Δ value was 040%;under the criteria of 2%/2 mm,all beams showed no significant difference ( P>005) except for at angles of 210°,240°,270°,and 300°,and the meanΔvalue was 152%.When the plan B parameters were used, the Δ value was reduced;the results of two verification methods were more consistent,so the accuracy was also improved. Conclusions Compared with the validation method at zero degree gantry angle,the validation method at an actual gantry angle is associated with reduced gamma passing rate because of some factors such as gravity,which is not significantly related to the beam angle,but the beam parameters. In the design of IMRT plans for NPC,the total number of sub-fields should be decreased as far as possible,and the minimum sub-field area and the minimum number of MU should be increased, so as to improve the accuracy of treatment plans.

Objective To discuss the microanatomy features of jugular foramen region in transpetrosal-presigmoidal minimally invasive approach based on virtual reality image models.Methods CT and MRI scans were performed to fifteen adult cadaver heads,and then,imaging data were inputted into Vitrea virtual reality system to establish three-dimensional anatomy models of jugular foramen region.Different minimally invasive transpetrosal-presigrnoidal approaches exposing superior edge of internal acoustic meatus (route A),anterior edge of jugular foramen (route B),and posterior edge of jugular foramen (route C) were simulated by selecting osseous landmark points.Anatomic exposures in surgical trajectory following alternation of minimally invasive approach were observed,measured and compared.Results Spacial sequence of nerves and vessels in the route simulating transpetrosal-presigmoidal approach for exposure of jugular foramen region was displayed clearly;route A had the highest location and route C was the lowest.Volumes of route and petrosal osseous structure involved in route A was the largest,and then,volumes of route and osseous structure involved in route B was larger than those in route C,with significant differences (P＜0.05).Volumes of involved venous sinus were as follow:route B＞route A＞route C,with significant differences (P＜0.05).Volumes of facial-acoustic nerve complex and anterior inferior cerebellar artery involved in route A were (53.32± 5.54) mm3 and (30.55±3.51) mm3,respectively.Volumes of lower cranial nerves involved in route B were (84.59±9.23) mm3.Conclusion There are different impacts on the osseous structures and venous sinus for the minimally invasive routes of transpetrosal-presigmoidal approach exposing different targets,of which combinations are helpful to utilize respective advantages.

Objective: To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in robot-assisted laparoscopic pyeloplasty in pediatric patients. Methods: Sixty pediatric patients of both sexes with hydronephrosis, aged 3-12 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019, were divided into 2 groups using a random number table method: control group (group C, n=28) and ERAS group (n=32). In ERAS group, preoperative ERAS education was carried out, the time of preoperative food and water deprivation was shortened, pediatric patients drank glucose water at 2 h before surgery, anesthetic regimen was optimized, lung protective ventilation and target-directed fluid therapy were performed, and intraoperative warming and multi-mode antiemetic measures were carried out during operation, and multi-mode analgesic measures were taken after operation, and pediatric patients received water and food intake early through the mouth and got out of bed as soon as possible after operation.In group C, the traditional concept was adopted for perioperative management.Immediately after tracheal intubation, at 30 min and 1 and 2 h after establishing pneumoperitoneum, at 5 min after the end of pneumoperitoneum and at 5 min after extubation, the airway peak pressure and tidal volume were recorded, and blood gas analysis was performed.The occurrence of cardiovascular events was recorded during surgery.The postoperative time of extubation, time of first intake, the first postoperative off-bed time, the first flatus time, time of pulling out the ureter and drainage tube, and length of hospital stay were recorded.The Pediatric Anesthesia Emergence Delirium scale was used to assess the agitation during the recovery period.The Faces Pain Scale-Revised scale was used to assess the degree of pain within 72 h after surgery.When Faces Pain Scale-Revised scale score ≥4, fentanyl 0.25 μg/kg was intravenously injected as rescue analgesic.The requirement for rescue analgesia was recorded.The overall complications were evaluated by using Clavin-Dindo grading, and postoperative complications included nausea and vomiting, abdominal distension, abdominal pain, incision infection, abdominal infection, anastomotic leakage, fever, etc. Results: Compared with group C, the preoperative food and water deprivation time was significantly shortened, the time of postoperative extubation was prolonged, the postoperative length of hospital stay, time of first intake, the first postoperative off-bed time, the first flatus time, and time of pulling out the ureter were shortened, airway peak pressure was decreased at 1 and 2 h of pneumoperitoneum, arterial blood lactate concentrations were decreased at each time point of pneumoperitoneum (P<0.05 or 0.01), and no significant change was found in the incidence of postoperative agitation, nausea and vomiting, incision infection, abdominal infection or fever in group ERAS (P>0.05). No intraoperative adverse cardiovascular events were found, and no pediatric patients required rescue analgesia after operation in two groups. Conclusion ERAS can be safely and effectively used for the pediatric patients undergoing robot-assisted laparoscopic pyeloplast.