Objective To investigate the relationship between the intraluminal characteristics of the occlusion segment and the degree of the primary collateral circulation(Circle of Willis)opening in patients with acute internal carotid artery occlusion(ICAO)and the occurrence of different subtypes of ipsilateral intracranial watershed infarction(WSI).Methods A total of 63 patients with unilateral acute ICAO accompanied by ipsilateral intracranial WSI were retrospectively included and divided into the internal watershed infarction(IWSI)group and the cortical watershed infarction(CWSI)group.The intraluminal characteristics of the occlusion segment and the degree of the Circle of Willis opening were analyzed using vessel wall magnetic resonance imaging(VW-MRI).Multivariate binary logistic regression analysis was employed to identify independent predictive indicators for the occurrence of CWSI.Results There was no significantly statistical difference in the occlusion range between the two groups.The range of intraluminal high signal involvement,the ratio of intraluminal relative highest signal,the incidence of high signal at the end of occlusion,and the degree of the Circle of Willis opening in the CWSI group were higher than those in the IWSI group(P<0.001).The range of intraluminal high signal involvement,high signal at the end of occlusion,and the degree of the Circle of Willis opening were identified as independent predictive factors for CWSI.Conclusion VW-MRI analysis of the intraluminal characteristics of the occlusion segment and the degree of the Circle of Willis opening can help to elucidate the mechanisms underlying the occurrence of IWSI/CWSI and can provide assistance in formulating etiology-based treatment strategies for clinical practice.

Objective To investigate the relationship between the intraluminal characteristics of the occlusion segment and the degree of the primary collateral circulation(Circle of Willis)opening in patients with acute internal carotid artery occlusion(ICAO)and the occurrence of different subtypes of ipsilateral intracranial watershed infarction(WSI).Methods A total of 63 patients with unilateral acute ICAO accompanied by ipsilateral intracranial WSI were retrospectively included and divided into the internal watershed infarction(IWSI)group and the cortical watershed infarction(CWSI)group.The intraluminal characteristics of the occlusion segment and the degree of the Circle of Willis opening were analyzed using vessel wall magnetic resonance imaging(VW-MRI).Multivariate binary logistic regression analysis was employed to identify independent predictive indicators for the occurrence of CWSI.Results There was no significantly statistical difference in the occlusion range between the two groups.The range of intraluminal high signal involvement,the ratio of intraluminal relative highest signal,the incidence of high signal at the end of occlusion,and the degree of the Circle of Willis opening in the CWSI group were higher than those in the IWSI group(P<0.001).The range of intraluminal high signal involvement,high signal at the end of occlusion,and the degree of the Circle of Willis opening were identified as independent predictive factors for CWSI.Conclusion VW-MRI analysis of the intraluminal characteristics of the occlusion segment and the degree of the Circle of Willis opening can help to elucidate the mechanisms underlying the occurrence of IWSI/CWSI and can provide assistance in formulating etiology-based treatment strategies for clinical practice.

Objective:To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy.Methods:From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study.Results:There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH （ P=0.010）. Stratify analysis， including stage of disease （Ⅰb1 and Ⅱa1）， histologic subtypes （squamous-cell carcinoma, adenocarcinoma）， lymph node metastasis， revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group （98.6% vs 93.6%, P=0.012）. In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% （ P=0.007）. ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference （ P=0.046）； for adenocarcinoma, the OS at five years were 91.0% and 88.6%， and there was no difference between two groups （ P=0.230）. ③ Lymph node metastasis： the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively ( P=0.156， P=0.093）. (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group （88.2% vs 75.8%, P=0.074）. Conclusions:The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.

Objective To investigate the changes and significance of plasma level of homocysteine (Hcy) in Parkinson disease (PD) patients with cognitive dysfunction. Methods Ninety-two PD patients were enrolled. Among them, 51 patients had mild cognitive impairment (CI), and the other 41 had not CI. Forty healthy subjects were enrolled as control group. The information including gender, age, illness duration, years of education and Hoehn and Yahr (H-Y) stage were recorded. Cognitive function of all the patients with PD and the controls were measured by using Montreal Cognitive Assessment (MoCA) scale. Plasma levels of Hcy, folic acid and vitamin B12 were measured by high performance liquid chromatography or radioimmunoassay. Results The plasma level of Hcy in PD group was significantly higher than that in control group: (16.72 ± 5.52) μmol/L vs. (13.65 ± 5.16) μmol/L, there was statistical difference (P<0.05). The plasma level of Hcy in patients with CI was (18.13 ± 4.67)μmol/L, and the patients without CI was (15.44 ± 3.71) μmol/L, the plasma levels of Hcy in patients with CI and without CI were significantly higher than that in control group, furthermore the plasma level of Hcy in patients with CI was significantly higher than that in patients without CI, there were statistical differences (P<0.05). The plasma level of folic acid in PD group was significantly lower than that in control group:(7.15 ± 3.54) μg/L vs. (8.73 ± 3.78) μg/L, there was statistical difference (P<0.05). The plasma level of folic acid in patients with CI was (7.11 ± 3.95) μg/L, and the patients without CI was (7.36 ± 3.84) μg/L, the plasma levels of folic acid in patients with CI and without CI were significantly lower than that in control group, there were statistical differences (P<0.05). But there was no statistical difference in the plasma of folic acid between patients with CI and patients without CI (P>0.05). There was no statistical difference in the plasma of vitamin B12 between the 2 groups (P>0.05). There was a negative relationship between plasma levels of Hcy and folic acid (r =-0.576, P<0.01). The plasma level of Hcy in early PD patients was significantly lower than that in middle-late patients:(15.14 ± 5.31)μmol/L vs. (17.75 ± 5.87) μmol/L, there was statistical difference (P<0.05), and there were no statistical differences in the plasma levels of folic acid and vitamin B12 between early PD patients and middle-late patients (P>0.05). The correlation analysis results showed that MoCA score was positive correlation with years of education (β = 0.541, P = 0.000), MoCA score was negative correlation with illness duration, H-Y stag and plasma level of Hcy (β=-0.417, -0.367 and-0.515;P=0.026, 0.037 and 0.000), but MoCA score was not correlation with age, plasma levels of folic acid and vitamin B12 (P>0.05). Conclusions The changes of plasma level of Hcy may be involved in the pathogenesis of patients with PD. The elevated plasma level of Hcy is significantly correlated with CI, it is an important risk factors of CI in patients with PD.