AIM: To evaluate the relationships between maternal serum alpha-fetoprotein (MSAFP) levels and middle cerebral artery peak systolic velocity (MCA-PSV) in pregnancies with fetal anaemia and to compare the sensitivities of MSAFP and MCA-PSV for the predicting the risk of fetal anaemia. METHODS: Fifty-five measurements of MSAFP and MCA-PSV were carried out in 32 women at risk of fetal anaemia (4 cases of alloimmunisation, 11 cases of thalassemia, 10 cases of parvovirus infection and 7 cases of placental chorioangioma). The relationship between MSAFP and MCA-PSV was studied, and 19 fetal blood samples, in which MCA-PSV measurements were abnormal, were taken and the fetal heamoglobin were tested in order to evaluate the correlation of MSAFP and MCA-PSV. RESULTS: A correlation between MSAFP and MCA-PSV (n=55, r=0.57, P<0.01) was observed, in which 15 cases of fetal anaemia and 4 cases false positive (non-anaemia) were detected among the 19 fetal blood samples. The MSAFP levels of 4 false-positive cases were normal. The MSAFP levels in 15 fetal anaemia cases were higher than those in non-anaemia. The elevation of MSAFP level was 15-20 d earlier than that of MCA-PSV in the cases of alloimmunisation and thalassemia, and it was 10-12 d later in the cases of parvovirus infection and placental chorioangioma significantly (P<0.05). Both MSAFP (r=-0.87) and MCA-PSV (r=-0.67) were significantly correlated with fetal heamoglobin level. CONCLUSION: The MSAFP level is significantly correlated with both MCA-PSV measurements and fetal haemoglobin. The time and process of the elevations of MSAFP indicate that MSAFP is more sensitive than MCA-PSV to predict and monitor the pregnancies at the risk of fetal anaemia.

Objective To evaluate the function of clinical-diffusion mismatch (CDM) in intraarterial thrombolysis treatment for acute middle cerebral artery occlusion (MCAO) and to evaluate specialty of CDM in predicting the putative penumbra.Methods All 106 acute MCAO patients within 6 hours after onset and examined by magnetic resonance angiography (MRA) were assigned into two groups:the intraartery thrombolysis group (n =36) and without thrombolysis group ( n =70).Both groups were subdivided into CDM sub-group and non-CDM sub-group based on the criteria of CDM:National Institutes of Health Stroke Scale (NIHSS) score ≥8 and ischemic volume on DWI ≤25 ml upon admission.NIHSS scores at the day 30 and 3 month after onset,and infarct volumes on T2 weighted imaging (T2 WI)at day 14 after onset were analyzed and compared between each sub-groups.Results The NIHSS scores in the CDM sub-group at both day 30 and the 3 month were significantly lower than the scores in the non-CDM sub-group among the patients having thrombolysis(3.20 ± 2.40 vs 6.76 ± 4.00,t =- 3.330,P =0.002 ; 2.20 ± 1.70 vs 6.05 ± 4.06,t =3.895,P =0.001 ),but not among the non-thrombolysis patients (5.22 ± 2.95 vs 5.66 ± 3.21,t =- 1.756,P =0.084 ;4.34 ± 2.53 vs 5.34 ± 3.42,t =1.234,P =0.353 ).Among the patients having CDM,the thrombolysis group resulted significant lower NIHSS scores at both day 30 and 3 month follow-up than non-thrombolysis group did (3.20 ±2.40 vs 5.22 ±2.95,t =- 2.210,P =0.034;2.20 ± 1.70 vs 4.34 ± 2.53,t =-3.128,P =0.003 ).However,among the patients of non-CDM,there was no difference in the NIHSS score between the thrombolysis group and the non-thrombolysis group at day 30 and 3 month (6.76±4.00 vs 5.66±3.21,t=1.209,P=0.231;6.05 ± 4.06 vs 5.34 ± 3.42,t =1.234,P=0.460).Among the CDM patients,the T2 WI infarct volume in the thrombolysis group was significantly smaller than that in the non-thrombolysis at day 14 onset ( ( 6.29 ± 4.41 ) ml vs ( 60.25 ± 49.23 ) ml,Z =- 4.848,P =0.001 ).Conclusion CDM may predict the putative penumbra with high specificity and can be applied in the therapy of intra-artery thrombolytic for acute MCAO patients.

Objective To explore the effect of probucol on the inflammatory response in rabbits with arteriosclerosis obliterans.Methods SPF male new zealand white rabbits were subjected to incomplete right femoral artery ligation model of arteriosclerosis obliterans.The model rabbits were divided into experimental group and control group.The rabbits in experimental group were treated by probucol.After treatment for 4 weeks,HE staining was used to evaluate the injury severity of right femoral artery in rabbits;ELISA was used to measure the levels of IL-1,IL-6,TNF-α and CRP;Realtime PCR was used to detect the expressions of IL-1,TNF-α in right femoral artery;Western blot was used to measured the nucleus accumulations of NF-κB,and the phosphorylation of IκB.Results Compared with control group,the degree of pathological injury of right femoral artery was significantly atteunated,the levels of IL-1 、IL-6 、TNF-α and CRP in plasma,the mRNA expressions of IL-1 、TNF-α and the nucleus accumulations of NF-κB,and the phosphorylation of IκB in right femoral artery decreased significantly.Conclusion Probucol attenuates the inflammatory response in rabbits with arteriosclerosis obliterans significantly.

Objective To assess the prediction value of nonbronchial systemic arterial supply in hemoptysis patients with non-enhanced CT. Methods Fifty-six consecutive patients with hemoptysis underwent non-enhanced CT. Thickness of pleural adjacent to parenchymal lesion larger than 3 mm was regarded as index of nonbronchial systemic arterial supply. Conventional angiography was used as the standard of reference. CT findings were compared with those of conventional angiography. The sensitivity, specificity, and accuracy of CT for predicting nonbronchial systemic arterial supply were assessed. Results The sensitivity, specificity and accuracy of CT for predicting nonbronchial systemic arterial supply were 72.73%, 95.00% and 91.11%, respectively. Sensitivity was higher when nonbronchial systemic arterial supply located in superolateral and posterolateral lung, and lower in anteromedial and inferior lung. Specificity and accuracy were high for predicting nonbronchial systemic arterial supply in every locations. Conclusion Non-enhanced CT can predict nonbronchial systemic arterial supply in patients with hemoptysis, which is helpful for selecting angiography and embolization.

Objective To assess the feasibility, safety, and efficacy of balloon disruption of thrombus by using a deflated balloon catheter combined with intraarterial thrombolysis for the treatment of acute middle cerebral artery(MCA) occlusion. Methods Five consecutive patients with acute MCA occlusion underwent balloon disruption combined with intra-arterial thrombolysis. The microballoon was inflated in the distal carotid artery and then deflated and advanced just distal to the occlusion site in the MCA. Thereafter, intra-arterial thrombolysis of the MCA was applied and the maximum dosage of urokinase was 500,000 U. Results Complete recanalization was achieved in 3 patients and partial recanalization in 2. All patients got favourable clinical outcome. There was no major intracerebral hemorrhage. Conclusion The penetration of the MCA with a deflated balloon catheter combined with an intra-arterial thrombolysis may be a safe and effective treatment for acute ischemic stroke.

Objective To investigate the use of assistive devices for children with physical disability. Methods Caregivers of children　with physical disability accepted wheelchairs, walkers, standing frames, orthoses freely from 2009 to 2011 were cluster sampled from various　regions, and investigated with the quality, use, service and others. Results and Conclusion Disabled children and their caregivers expressed　satisfaction with these assistive devices. However, the satisfaction of orthosis was the poorest among the assistive devices.

Objective:To investigate the correlation between fluid attenuated inversion recovery vascular hyperintensities (FVH) -diffusion weighted imaging (DWI) mismatch and the outcomes after endovascular mechanical thrombectomy (EMT) in patients with acute middle cerebral artery M1 segment occlusive stroke.Methods:Patients with middle cerebral artery M1 segment occlusive stroke who received EMT treatment and whose FLAIR images showed FVH in the Affiliated Hospital of Yangzhou University from January 2016 to June 2020 were enrolled retrospectively. The demographics and basic clinical information of the patients were collected. The modified Rankin Scale was used to evaluate the outcomes at 3 months after the onset of symptoms. 0-2 was defined as a good outcome, and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 77 patients were enrolled in the study. Their age was 67.16±9.63 years, 51 were males (66.23%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 14.16±7.49. Forty patients (51.95%) had a good outcome, and 37 (48.05%) had a poor outcome. Univariate analysis showed that the proportion of patients with FVH-DWI mismatch in the good outcome group was significantly higher than that in the poor outcome group (60.00% vs. 29.73%; χ2=7.103, P=0.008), and baseline NIHSS score (11.60±4.44 vs. 16.92±9.05; t=-3.312, P=0.001) and the proportion of patients with hypertension (65.00% vs. 86.49%; χ2=4.774, P=0.029) were significantly lower than those in the poor outcome group. Multivariate logistic regression analysis showed that FVH-DWI mismatch was independently associated with the good outcomes (odds ratio [ OR] 0.345, 95% confidence interval [ CI] 0.121-0.984; P=0.047), baseline NIHSS score was independently associated with the poor outcomes ( OR 1.133, 95% CI 1.036-1.239; P=0.006). Conclusion:FVH-DWI mismatch was independently associated with the good outcomes after EMT treatment in patients with acute middle cerebral artery M1 segment occlusive stroke.

Objective To investigate the clinic efficacy of two section and three leaves approach on laparoscopic radical cystectomy (LRC) or robot assisted radical cystectomy (RARC).Methods A retrospective statistical analysis collected a total of 103 cases with bladder cancer undergoing LRC or RARC,from Jan 2013 to Dec 2015 in our center.Those patients were divided into two groups,including two section and three leaves approach group (46 cases) and conventional group (57 cases).The two section,which means that to cut lateral prostate gland and lateral vesical gland respectively,the three leaves include lateral lobe of lateral vesical gland (superior vesical arteries and veins),medial lobe of lateral vesical gland and lateral prostate gland.In two groups,whose age ranged from 35 to 84 years,the median age were (63.3 ± 9.8) years and (63.7 ± 9.1) years,respectively.The median BMI values were (23.2 ± 2.9) kg/m2 and (23.0 ± 2.2) kg/m2,respectively.The occurrence of history of abdominal surgery were 4 (8.7％) cases and 9(15.8％) cases,respectively.In two section and three leaves approach,the ASA scores of 1,2,3 were found in 5,35,6 cases,respectively.In conventional group,the ASA scores of 1,2,3 were found in 12,38,7 cases,respectively.The difference between two groups in age distribution,BMI value,ASA score,history of abdominal surgery,urinary diversion,surgical methods,pathological staging and grading had no statistical significance (P ＞ 0.05).Then,the operation time,the blood loss and the time to remove drainage tube,et al of the above two groups were compared.Patients with BMI≥24 kg/m2 in the two groups were 24 cases and 20 cases,respectively,following the strategy based on BMI ≥24 kg/m2 and BMI ＜ 24 kg/m2 to compare the difference of subgroups in the operation time and the bleeding amount,for the purpose of corroborating the applied effectiveness of two section and three leaves approach compared with the conventional measure on LRC or RARC for patients with BMI ≥ 24 kg/m2.Results All endoscopic operations were completed successfully.No conversion was recorded.In two groups,the median operation time were (255.1 ± 99.3) min and (284.2 ± 171.3) min,respectively,the difference was statistically significant (P =0.011).The blood loss was (233.1 ± 196.9)ml and (272.0 ±268.8) ml,respectively(P =0.009).The time to remove drainage tube were (10.6 ± 5.0) d and (9.9 ± 4.4) d,respectively (P =0.880).In addition,the difference in the intraoperative blood transfusion rate(10.9％ vs.21.1％),occurrence of lymph fistula (13.0％ vs.17.5％),gastric extubation time [(4.3 ± 1.9) d vs.(4.0 ± 1.9) d],time for flatus recovery [(3.9 ±1.2) d vs.(3.7 ± 1.7) d],the incidence of perioperative complications (26.1％ vs.36.8％) and postoperative hospital stay [(13.3 ± 5.5) d vs.(13.5 ± 4.8) d] were no statistical significance (P ＞0.05).The results of comparisons for patients with BMI ≥ 24 kg/m2 between subgroups included the operation time were (264.3 ± 68.1) min and (298.5 ± 80.2) min,respectively.The blood loss were (247.8 ± 199.4) ml and (295.3 ± 204.5) ml,respectively,both of them were statistical significance (P ＜0.05).The two section and three leaves approach was significantly better than those patients operated by conventional method.Conclusions Compared with conventional method undergoing LRC or RARC,two section and three leaves approach could shorten operative time and reduce the blood loss markedly,especially for patients with BMI≥24 kg/m2.

Objective To quantitatively analyze the correlation between stenosis ratio and cerebral perfusion in patients with solely symptomatic M1 stenosis of middle cerebral artery.Methods All the patients with solely symptomatic M1 stenosis of middle cerebral artery were selected to this study from consecutive 203 patients with elective stenting of symptomatic intracranial artery stenosis.Brain CT, CT perfusion (CTP) and DSA examinations were performed in all cases.The CTP parameters of mean transit time (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured in regions of interest (ROIs) including bilateral frontal lobe, anterior watershed, opercula of the insula (including parsopercluaris and part of insula), temporal lobe, posterior watershed and occipital lobe.Compared with the unaffected side as control, the change of CTP and their relative CTP parameters in these ROIs at affected side were analyzed.Based on DSA data, the ratio of M1 stenosis was measured manually and blindly, the source of collateral branch of compensative artery was estimated and the blood flow was graded.Correlation between the ratio of M1 stenosis and the CTP parameters including the absolute and the relative values was investigated.Results Twenty patients were selected into this study; their average M1 stenosis ration of the affected side was 70.5% ± 10.6% (53% to 91%).Compared with the unaffected side, MTT and CBF were no significant change but CBV increased in the affected frontal lobe; MTT prolonged, CBF was normal and CBV increased in the affected anterior watershed and opercula of the insula; MTT prolonged, CBF and CBV had no significant difference in the affected temporal lobe; MTT prolonged, CBF decreased and CBV had no significant difference in the affected posterior watershed; MTT, CBF and CBV were normal in occipital lobe.Tissue perfusion gradually decreased from the front to the backward in all the M1 stenosis affected cerebral regions and the posterior watershed area was the only region at hemodynamic failure stage.Leptomeningeal vessels of the anterior cerebral artery were the major sources of compensative arteries shown in the DSA in all cases.The ratio of M1 stenosis was positively correlated (r =0.66, P =0.002) with the rCBV in posterior watershed and there is no significant correlation between the ratio and any other CTP parameters in any regions.Conclusions Associated with distribution of collateral compensative artery,tissue perfusion showed obvious spatial distribution at different level in different cerebral region.M1 stenosis ratio is positively correlated with rCBV in hemodynamic failure regions, and there is no correlation with tissue perfusion in hemodynamic compromise regions.

Objective To assess the feasibility of arterial blood bypass using microcatheter in intraarterial thrombolysis for acute cerebral ischemic stroke.Methods Six patients with acute cerebral infarction within 6 hours underwent intraarterial thrombolysis,in which arterial blood bypass was used.A 2.3 F microcatheter was advanced through the clot and two milliliters of contrast was injected beyond the clot that remained stagnant in the major branches.At this point,20 ml of oxygenated blood from femoral artery was injected for 2 minutes through the microcatheter past the occluding clot Then,conventional intraarterial thrombolysis,including fibrinolytic agents infusion and mechanical disruption,was performed.Intraarterial thrombolysis and oxygenated blood infusion alternated every 30 minutes.Results Every patient received arterial blood bypass with average three times(from 1 to 5 times)in the process of the intraarterial thrombolysis,which cost(8.0±3.2)min.Recanalization was achieved in all 6 patients,but minor subarachnoid hemorrhage developed in one patient All the patients got favorable clinical outcome.The life conditions is excellent in 4 cases and good in 2 cases.Conclusions Arterial blood bypass using microcatheter in intraarterial thrombolysis for acute cerebral ischemic stroke might be feasible,which did not interfere with conventional intraarterial thrombolysis and prolong the operation time significantly but could protect ischemic penumbra.