Objective To assess the impact of different number of diffusion gradient directions (NDGD) of diffusion tensor imaging (DTI) on dispersion degree of fractional anisotropy (FA) values and signal-to-noise ratio (SNR) for adult brain tissues. Methods Eight healthy volunteers underwent DTI with 7 NDGD respectively, and the associated FA maps were obtained. Four region of interest (ROI) (genu and splenial of corpus callosum, genu and posterior limb of internal capsule) were chosen in white matter of FA maps, FA values and the corresponding SNRs of the ROIs were computed and analyzed with NDGD increasing. Results FA values within all ROIs did not change remarkably with NDGD increasing. Variance of FA value within two ROIs with high gray value (genu and splenial of corpus callosum) fluctuated randomly and SNR increased slightly, while variance of FA value within the ROIs with low gray value (genu and posterior limb of internal capsule) diminished significantly with NDGD increasing. Conclusion In clinical applications of DTI, an optimum NDGD for DTI data acquisition should be selected according to the ROIs in human brain to be inspected.

Objective To investigate the therapeutic effects of varied operative for the treatment of intrahepatic bile duct stones.Methods The clinical data of 176 consecutive cases of hepatolithiasis surgically treated in the past 3 years in our hospital were retrospectively analyzed.There were 45 type Ⅰ patients,25 type Ⅱ a patients,25 type Ⅱ b patients,3 type Ⅱ c patients,52 type Ea patients,19 type Eb patients,and 7 type Ec patients.These 176 patients were divided into 4 groups according to modus operandi:choledocholithotomy and T-tube drainage in 71 patients (type Ea 31 patients,type Ⅰ 15 patients,type Ⅱ a 25 patients) ; choledocholithotomy and choledochojejunostomy in 25 patients (type Ea 14 patients,type Eb 7 patients,type Ec 4 patients) ; choledocholithotomy and hepaticojejunostomy in 10 patients (type Ⅱb 5 patients,type Ⅱ c 3 patients,type Ea 2 patients) ; hepatectomy plus T-tube drainage or choledochojejunostomy in 70 patients (type Ⅰ 30 patients,type Ⅱ b 20 patients,type Ea 5 patients,type Eb 12 patients,type Ec 3 patients).The postoperative residual stone rate,perioperative complications and long term results were compared between groups.Results Patients undergoing hepatectomy have less postoperative residual stone rate,higher rate of good long term efficacy as compared with those who did not undergo hepatectomy (17.1％ (12/70) vs 43.4％ (46/106),91.4％ (53/58) vs 77.0％ (67/87)).Though patients undergoing hepatectomy had higher rate of perioperative complications (37.1％ (26/70) vs 14.2％ (15/106)).Conclusions Hepatectomy is the most effective procedure for the treatment of type Ⅰ and type Ⅱ b hepatolithiasis.Hepaticojejunostomy is the main procedure for the treatment of type Ⅱ c hepatolithiasis.

Objective To detect the expression of genes Her-2/neu,DPC4 and P16 in pancreatic carcinomas and to investigate the role of their alterations in tumorigenesis and progression of pancreatic carcinomas.Methods We studied the immunohistochemical markers Her-2/neu,DPC4 and P16 in 34 adenocarcinomas and 12 nonmalignant specimens of the pancreas,and the relationship between DPC4 alterations and various clinicopathological parameters was evaluated.Results There was a significant difference between normal pancreatic tissues and benign pancreatic lesions and primary pancreatic carcinomas for frequency of Her-2/neu expression and loss of P16 expression(P

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 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 separate the CD133 + subpopulation in human hepatocellular carcinoma (HCC) and investigate the tumorigenicity.Methods The human liver cancer tissues were subcutaneously transplanted into nude mice to generate xenograft tumors which were then isolated to prepare single cell suspension.The expression of CD133 + subpopulation was further detected using flow cytometry.The CD133 + subpopulations were separated and depurated with magnetic-activated cell sorting system.Immunofluorescence was performed to identify the histological phenotype of CD133 + subpopulation.The in vitro and in vivo clone formation assay and in vivo xenograft formation assay were performed, respectively.Results Flow cytometry analysis revealed that a percentage of (4.1 ± 0.6) ％ CD133 + cells were detected in xenografts.Immunofluorescence studies showed that (86.8 ± 7.5) ％ of the isolated cells were CD133 +.Compared with CD133-population, CD133 + cells showed a higher capability to generate clone sphere in vitro and a higher tumorigenicity in nude mice (P ＜ 0.05).Conclusion The CD133 + subpopulation in human hepatocellular carcinoma had a potent tumorigenicity and was enriched in cancer stem cells.

ObjectiveTo investigate whether the T1-weighted dynamic contrast-enhanced perfusion magnetic resonance imaging (DCEPMRI) technique can help to delineate the clinical target volume of brain glioma patients.MethodsThe DCE T1-weighted images from 28 glioma patients were collected after GdDTPA was injected.After the acquired images were processed and analyzed using modified Tofts-Kermode'two compartment analysis model and de-convolution method,the value and its pseudo mapping of quantitative parameter Ktrans related to microvascular permeability were obtained.The tumor size in the largest diameter slice measured both in routine enhanced MRI and Ktrans mapping of T1-weighted DCEPMRI were compared.ResultsThe vascular permeability and tumor infiltration was lower in low grade glioma,the difference of the tumor size between T1-weighted DCEPMRI and routine enhanced MRI reached 0.2％ -0.3％ there was significant difference of tumor size between T1 -weighted DCEPMRI and routine enhanced MRI ( grade Ⅰ and Ⅱ grade with 2.93 cm2∶2.46 cm2(t=6.90,P=0.000) and 4.18 cm2∶3.21 cm2(t=10.22,P=0.000) ).While in high grade glioma,the vascular permeability and the tumor infiltration were higher,the difference of the tumor size between T1-weighted DCEPMRI and routine enhanced MRI reached 25％ - 26％( the size of grade Ⅲ and Ⅳ were 6.46 cm2 vs 5.48 cm2 ( t =10.83,P =0.000) and 8.26 cm2 vs 6.52 cm2(t =18.53,P =0.000) ).ConclusionsThe pseudo mapping of quantitative parameter Ktrans related to microvascular permeability acquired by T1-weighted DCEPMRI reflect the infiltrating circumscription in glioma,T1-weighted DCEPMRI can provide more information in delineation the clinical target volume,and it can be used as a new method for tumor volume evaluation.

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 retrospectively investigate the impact of postoperative radiotherapy ( RT) on the relationship between molecular subtype and survival in patients with breast cancer ( BC ) . Methods A total of 716 women who were admitted to our hospital in 2008 and newly received unilateral mastectomy were divided into Luminal A ( LA ) , Luminal B?HER?2?negative ( LB1 ) , Luminal B?HER?2?positive ( LB2) , HER?2 overexpression ( HER?2+) , triple?negative ( TN) , and unassigned subtypes according to the 2011 St. Gallen Consensus. The Cox model was used to analyze the differences in overall survival ( OS) and disease?free survival ( DFS ) rates between subtypes in all patients, RT group, or non?RT group. The Kaplan?Meier method was used to calculate OS and DFS rates. The Cox model was used to perform the factor analysis. Results In all patients, the median follow?up time was 71?4 months;the overall mortality rate was 10?5%;the incidence of treatment failure ( death+relapse+metastasis) was 14?9%;217 patients ( 30?3%) received RT. The multivariate analysis showed that there was no significant difference in OS between subtypes in any group ( all P>0?05 ) . In all patients, patients with LB1 subtype or unassigned subtype had significantly poorer DFS rates than those with LA subtype ( HR= 1?881, P= 0?035;HR= 1?907, P=0?049) . In the non?RT group, patients with LB1 subtype had significantly poorer DFS rates than those with LA subtype (HR=3?324, P=0?01). In the RT group, there was no significant difference in DFS rate between subtypes ( all P>0?05) . The two?dimensional cross analyses of RT and subtype demonstrated that patients with LB1 subtype in the non?RT group had lower OS and DFS rates than patients with LA subtype in the RT group ( P=0?09,0?06) . Conclusions Patients with LB1 subtype have lower OS and DFS rates than patients with LA subtype, especially in the non?RT patients. RT has no impact on the relationship between subtype and prognosis.

Objective To observe therapeutic effect in the near future of the operation of vertebrascope in route of retreat to treat lumbar disc protrusion and complications.Method According to symptoms,signs,myelography and CTM results to determine protrusion interspace and side type,applied the operation of vertebrascope in route of retreat to treat lumbar disc protrusion and perform functional exercises.Results 86 patients were followed up,and within these patients,58 appeared excellent (67% ),25 appeared good (29% ), 2 appeared not bad (2% ),and 1 appeared bad(1% ).Conclusion The technology has many advantages, such as little wound, little hemorrhage, little pain and fast restoration,which provide advantageous conditions for early functional exercises after operation.