Objective To explore the safety and effectiveness of mechanical thrombectomy in patients ≥80 years old,and to analyze the causes of poor prognosis.Methods The data of twenty consecutive patients ≥ 80 years old with acute ischemic stroke who underwent mechanical thrombectomy in our hospital from January 2017 to June 2018 were retrospectively reviewed.Baseline information,imaging data,thrombectomy procedures,complications,and clinical prognosis were collected.The causes of poor prognosis were analyzed.Results A total of 20 advanced age patients were included,with an average age of (83.3±4.1)years(range 80 to 96 years).All patients underwent mechanical thrombectomy,and the successful recanalization rate(mTICI 2b-3)was 70 ％.The incidence of technical complications was 15％,of which the rate of symptomatic intracranial hemorrhage was 5％.Among the 11 patients with poor prognosis,the causes included the severe diseases and later revascularization in 2 patients,unsuccessful recanalization or complications in 3 cases,and advanced age-related factors in 6 cases,among which there were accompanied multiple severe stenoses,poor collaterals and the rapid progress of stroke in 3 cases and the aggravation of previous comorbidities in 3 cases.Conclusions The advanced age patients ≥80 years old often have more comorbidities,higher prevalence rates of multiple severe vascular stenosis except the occluded vessels,poor collateral compensation and the aggravation of original comorbidities.And all of them may be important factors for the poor prognosis after mechanical thrombectomy.

Objective: To observe the safety and long-term efficacy of carotid artery stenting(CAS)in octogenarians with carotid stenosis. Methods: Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid- and long-term follow-up results were analyzed. Results: A consecutive series of 61 patients(a median age of 81 years, 54 males)were enrolled.Of 61 patients, 23(37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS, one patient underwent bilateral CAS, and 26(42.6%)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period, the incidence of stroke was 6.6%(4/61), and no patient died.Eight(13.1%)patients had contrast-induced nephropathy, 4(6.6%)patients suffered from cardiac dysfunction, and 30(49.2%)patients had hypotension requiring vasopressor support postoperatively, and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months, with an interquartile interval of 44 months). The incidence of stroke and death was 8.2%(5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis, and was 93 months in asymptomatic patients, with the statistically significant difference between the two groups(χ²=4.258, P=0.039). Conclusions Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers, and the outcome of a mid- and long-term follow-up is good.

Objective To establish an animal model suitable for neurosurgeons for the comprehensive training of microvascular anastomosis using rat abdominal aorta and common iliac artery. Methods Twelve adult SD rats were selected,they were generally anesthetized and laparotomized.The abdominal aortas and bilateral common iliac arteries were exposed and fully separated.The lengths and diameters of abdominal aortas and common iliac arteries of each segment were measured.The end-to-end anastomosis were performed choosing the main trunk of the abdominal aorta without a branching artery and longer segment.The unilateral common iliac artery and the sacral median artery were used for end-to-side anastomosis.The bilateral common iliac arteries were used for end-to-side and side-to-side anastomosis.The micro Doppler ultrasound probe was used to detect the blood flow patency of each anastomotic stoma. Results Anatomical separation of the abdominal aortas and the common iliac arteries was successfully performed in 12 SD rats.Each rat could provide 4 vascular anastomosis exercises.The length of abdomen aorta trunk was 15.6 ± 2.5 mm and the diameter was 1.6 ±0.2 mm between the lower left renal artery and right iliolumbar artery.The side-to-side anastomosis was performed.The mean diameter of the median sacral arteries was 0.80 ±0.08 mm.After the fish mouth-like cutting,the end-to-side anastomosis of the right common iliac arteries were conducted.The lenth of left common iliac artery was 9.0 ± 1.5 mm,the diameter was 1.0 ± 0.1 mm,and was cut off at its origin and then the end-to-side anastomosis of the right common iliac arteries were conducted.After end-to-side anastomosis of bilateral common iliac arteries,its distal segment was arranged in parallel with a length of 5.1 ± 0.3 mm,and then the side-to-side anastomosis could be conducted. Conclusions The rat abdominal aorta and iliac artery model can be comprehensively used to simulate the commonly used neurosurgery bypass graft.It is suitable for neurosurgeons with a certain microsurgical basis to conduct a preliminary vascular anastomosis training.

Objective To investigate the safety and efficacy of endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms (VAFAs).Methods The clinical,imaging and follow-up data of 26 consecutive patients with VAFA treated with endovascular reconstruction at the Department of Neurosurgery,Beijing Hospital between October 2009 and September 2017 were analyzed retrospectively.Results (1) Twenty-six patients had 26 VAFAs.Their age ranged from 38 to 69 years old.Nine patients had ruptured aneurysms and 17 had unruptured aneurysms.The diameter of the aneurysms ranged from 5 to 12 mm.The success rate of reconstruction technology was 100％.(2)In 9 patients of the rupture group,8 were embolized by stent-assisted coils,1 was treated with stent-assisted coil embolization alone.Five patients were treated with multiple-stent reconstruction and 4 were treated with stent reconstruction alone.Of the 17 patients in the unrupture group,13 were treated with stent-assisted embolization and 4 were treated with stent implantation alone;7 were treated with multiple-stent reconstruction,and 10 were treated with stent reconstruction alone.No perioperative complications occurred.(3) The patients were followed up for 8.0-97.5 months with a median time of 39.5 months.No new cerebral infarction or cerebral hemorrhage occurred.The patients with good prognosis (the modified Rankin scale scale 0-2) was 100％.Twenty-two patients were followed up for 3.5 to 34.0 months with a median time of 10.3 months.Fourteen patients (63.6％) were cured,4 (18.2％) were stable or improved,and 4 (18.2％) had recurrence;Five of 8 patients were cured in the rupture group;9 of 14 were cured in the unrupture group.There were 2 cases of relapse in each of the two groups.Conclusions Endovascular reconstruction for ruptured and unruptured VAFAs is clinically feasible and the safety is higher.The efficacy of mid-term and long-term follow-up is better.The recurrence rate of ruptured VAFAs has an increasing trend,and close follow-up is required after procedure.

Metabolic disease is a cluster of metabolic abnormalities,including hypertension,diabetes,obesity,dyslipidemia,hyperuricemia,etc.The incidence rate of metabolic disease has increased in recent years.Metabolic diseases are closely related to the occurrence,development and prognosis of renal carcinoma.This article aims to summarize research progress on the correlation between metabolic diseases and renal carcinoma so that we could provide valuable information for the prevention,treatment and prognosis of renal carcinoma.

Objective: To evaluate the spatiotemporal relationship between the root apex of mandibular molars and the inferior alveolar nerve canal (IANC) in adults. Methods: Cone-beam computed tomography (CBCT) images were collected in 236 patients, and the distances from the root apexes of mandibular molars to the IANC were measured in NNT 4.6 software. The relationship between distance and gender was evaluated. Results: In two-rooted mandibular first molars, the distances from the mesial root and distal root to the IANC were 7.34 ± 2.07 mm and 6.69 ± 2.08 mm, respectively, in males and 6.47 ± 2.22 mm and 5.94 ± 2.11 mm in females. In three-rooted mandibular first molars, the distances from the mesial root, distobuccal root, and distolingual to the IANC were 7.29 ± 1.30 mm, 7.40 ± 2.33 mm, and 9.97 ± 2.19 mm, respectively, in males and 6.08 ± 2.57 mm, 6.35 ± 2.40 mm, and 9.01 ± 2.90 mm, respectively, in females. In one-rooted mandibular second molars, the distance from the root to the IANC was 4.09 ± 1.64 mm in males and 3.89 ± 1.76 mm in females. In two-rooted mandibular second molars, the distances from the mesial root and distal root to the IANC were 5.14 ± 2.08 mm and 4.39 ± 1.85 mm, respectively, in males and 3.78 ± 1.69 mm and 3.24 ± 1.72 mm, respectively, in females. There were no significant with in-gender differences between the left and right side in the distances from the root apexes to the IANC (P>0.05). The distances from the mandibular first molar were greater in males than in females. The longest average distance was from the distolingual root apexes of three-rooted mandibular first molars to the IANC, and the distances were longer from the distobuccal root apexes of three-rooted mandibular first molars to the IANC than from the distal root apexes of two-rooted mandibular first molars to the IANC (P<0.05). There was no within-gender difference in the distances from the root apexes of single-rooted mandibular second molars to the IANC (P>0.05), but the distances in two-rooted mandibular second molars were larger in males than in females (P<0.05). The distances from the root apexes to the IANC were smaller in mandibular second molars than in mandibular first molars (P<0.05). Conclusion There are significant differences between adult males and females in the distance from the root apex to the IANC for mandibular first molars and two-rooted mandibular second molars. The distances from the root apexes to the IANC were smaller in mandibular second molars than in mandibular first molars.

Literature of TCM contains abundant information of Chinese medicine. Traditional Chinese medicine information is characterized by its high degree of knowledge-intensive and complex inter-knowledge, so it is difficult to integrate and share knowledge. TheShanghanlun is one of the Chinese medical classics, and it includes the rules and methods of syndrome differentiation and treatment and it showed good effects in the clinical application. However, it is difficult to master for beginners. As a kind of knowledge organization tool, topic maps can flexibly define the relationship between knowledge, which realizes the visualization of knowledge network, and integrates and shares the distributed knowledge. This paper focused on the current situation of topic maps researches. The topic maps was used to organize the original content ofShanghanlun, construct the concept model of it and explore the specific application of topic maps technology in the field of traditional Chinese medicine.

Objective To investigate the efficacy of microsurgical subinguinal varicocelectomy for unilateral varicocele.Methods One hundred and five cases with left side varicocele were enrolled from August 2012 to October 2016.Thirty one cases suffered from varicocele in Ⅱ degree,and other seventy four cases in Ⅲ degree.Clinical data including operation time,sperm quality,testosterone level,complications and natural pregnoncy rate were retrospectively analyzed.The measurement data were expressed by (x) ± s.Sperm concentration,sperm motility,the rate of sperm normal morphology and serum testosterone levels were compared before and after operation with paired t test.Results The average operative time of varieocele was (58 ± 9) minutes in the outer ring of the microscope.Compared with preoperation's,sperm concentration,sperm motility,the rate of sperm normal morphology was remarkable improved after 3 month.However,serum testosterone levels were steady.In the outpatient follow-up,there were no complications,such as orchiatrophy,hydrocele of tunica vaginalis or recurrence of varicocele.The rate of natural pregnoncy in one year was 46.7％.Conclusions Microsurgical subinguinal varicocelectomy can remarkably improve sperm quality for patients,who suffer from varicocele in Ⅱ or Ⅲ degree.The complication of microsurgical subinguinal varicocelectomy is rare.Male infertility patients resulted from varicocele will get favorable natural pregnoncy rate.

The application of four kinds of hemostatic tools in tactical combat casualty care (TCCC) of foreign armies was introduced,including extremity tourniquet,junctional tourniquet,hemostatic dressing.and elastic bandage as well as tranexamic acid.The above hemostatic tools were described from the aspects of structure,operating process,application range and technical points,and the histories of some tourniquet were also expounded.The problems of Chinese PLA were analyzed in designing and developing hemostatic tool.Some suggestions were put forward such as enhancing the practicability and portability of hemostatic tool,rational allocation of TCCC drugs and instruments and etc.

Objective To investigate the relationship of age,gender,carotid artery atherosclerosis with carotid artery tortuosity.Methods The data of patients with carotid computed tomography angiography (CTA)at Beijing Hospital from January 2014 to June 2016 were retrospectively reviewed.A total of 100 patients aged ≥50 years with normal carotid arteries and 100 patients with atherosclerotic carotid artery diseases were selected with age-and gender-stratified and random sampling method.Three-dimensional images of bilateral carotid arteries were reconstructed by using Mimics software.The common carotid artery(CCA)tortuosity index,extracranial internal carotid artery(EICA) tortuosity index,and the CCA-ICA bifurcation angle were measured.Association of laterality,age and gender with carotid artery tortuosity was analyzed and the differences in parameter values of carotid artery tortuosity were compared between normal carotid artery subjects and patients with atherosclerotic carotid artery.Results In normal carotid artery group,the EICA tortuosity index and ICA angle were larger in left-side than in right side(P＜0.001),and CCA tortuosity index was less in left side than in right side(all P＜0.001).The bilateral EICA and CCA tortuosity index were positively correlated with age(the left ICA:rs=0.284,P =0.004;the right ICA:rs =0.308,P =0.002;the left CCA..rs=0.371,P＜0.001;the right CCA:rs=0.243,P=0.015).The EICA and CCA were more tortuous in women than in men[the left EICA:1.180(0.200)vs.1.105(0.140),Z=-2.996,P=0.003;the right EICA:1.150(0.128)vs.1.105(0.123),Z=-2.189,P=0.029;the left CCA:1.060(0.073)vs.1.045(0.060),Z=-2.145,P=0.032;the right CCA:1.145(0.158)vs.1.080(0.083),Z=2.324,P=0.020].The ICA angle was not related with advanced age or gender(P＞0.05).Manne-Whitney tests showed no statistically significant differences in EICA tortuosity,ICA angle or CCA tortuosity between patients with versus without atherosclerotic carotid artery stenosis(P ＞0.05).Conclusions The tortuosity in both EICA and CCA increases with age,and the EICA and CCA are more tortuous in female.There is no significant correlation between carotid artery tortuosity and atherosclerotic carotid artery disease.