Objective To evaluate the changes in cerebral perfusion after moyamoya disease revascularization using two-phase arterial spin labeling(ASL)combined with territorial arterial spin labeling(t-ASL).Methods A retrospective selection was conducted on 34 moy-amoya disease patients with 37 cerebral hemispheres who underwent revascularization surgery.ASL[post labeling delay(PLD)of 1.5 s and 2.5 s],t-ASL,and digital subtraction angiography(DSA)were performed before and after surgery.The cerebral blood flow(CBF)and relative cerebral blood flow(rCBF)values in the middle cerebral artery(MCA)supply area from ASL were com-pared before and after surgery.t-ASL and DSA were used to score the area of revascularization on a 3-point scale,and weighted Kappa was used to compare the consistency of the revascularization area assessments.A DSA score greater than 1 point was classified as good revascularization.The diagnostic efficacy of ASL(PLD 1.5 s,2.5 s)and t-ASL for revascularization were compared.Results In ASL PLD 1.5 s,the preoperative and postoperative CBF values were(32.65±12.71)mL·100 g-1·min-1 and(43.09±18.05)mL·100 g-1·min-1,respectively,and the rCBF values were 0.76±0.23 and 1.02±0.31;In ASL PLD 2.5 s,the preoperative and postoperative CBF val-ues were(47.07±13.28)mL·100 g-1·min-1and(52.85±14.98)mL·100 g-1·min-1,respectively,and the rCBF values were 1.21±0.31 and 1.33±0.29.There were statistically significant differences between preoperative values and postoperative values above(P<0.05).The revascularization area score showed strong consistency(weighted Kappa coefficient=0.729).Receiver operating charac-teristic(ROC)curve analysis revealed that t-ASL reflected the revascularization area with area under the curve(AUC)of 0.982,while ASL PLD 1.5 s and 2.5 s CBF reflected the revascularization area with AUC of 0.813 and 0.794,espectively.Conclusion The com-bination of two-phase ASL and t-ASL more effectively evaluates cerebral blood after moyamoya disease revascularization.Furthermore,t-ASL demonstrates higher efficacy in evaluating postoperative revascularization.

Objective To evaluate the changes in cerebral perfusion after moyamoya disease revascularization using two-phase arterial spin labeling(ASL)combined with territorial arterial spin labeling(t-ASL).Methods A retrospective selection was conducted on 34 moy-amoya disease patients with 37 cerebral hemispheres who underwent revascularization surgery.ASL[post labeling delay(PLD)of 1.5 s and 2.5 s],t-ASL,and digital subtraction angiography(DSA)were performed before and after surgery.The cerebral blood flow(CBF)and relative cerebral blood flow(rCBF)values in the middle cerebral artery(MCA)supply area from ASL were com-pared before and after surgery.t-ASL and DSA were used to score the area of revascularization on a 3-point scale,and weighted Kappa was used to compare the consistency of the revascularization area assessments.A DSA score greater than 1 point was classified as good revascularization.The diagnostic efficacy of ASL(PLD 1.5 s,2.5 s)and t-ASL for revascularization were compared.Results In ASL PLD 1.5 s,the preoperative and postoperative CBF values were(32.65±12.71)mL·100 g-1·min-1 and(43.09±18.05)mL·100 g-1·min-1,respectively,and the rCBF values were 0.76±0.23 and 1.02±0.31;In ASL PLD 2.5 s,the preoperative and postoperative CBF val-ues were(47.07±13.28)mL·100 g-1·min-1and(52.85±14.98)mL·100 g-1·min-1,respectively,and the rCBF values were 1.21±0.31 and 1.33±0.29.There were statistically significant differences between preoperative values and postoperative values above(P<0.05).The revascularization area score showed strong consistency(weighted Kappa coefficient=0.729).Receiver operating charac-teristic(ROC)curve analysis revealed that t-ASL reflected the revascularization area with area under the curve(AUC)of 0.982,while ASL PLD 1.5 s and 2.5 s CBF reflected the revascularization area with AUC of 0.813 and 0.794,espectively.Conclusion The com-bination of two-phase ASL and t-ASL more effectively evaluates cerebral blood after moyamoya disease revascularization.Furthermore,t-ASL demonstrates higher efficacy in evaluating postoperative revascularization.

The medical metaverse is a combination of medicine and other cutting-edge technologies such as computer and information ones. In the medical metaverse, medical knowledge in the real world will be transformed into a digital form, so that activities concerning diagnosis, treatment, education and clinical practice can be carried out in a virtual environment. Based on the latest research advances at home and abroad, this review expounds on the medical metaverse from the aspects of supporting technologies, applications in clinic and medical education, current deficiencies and future development.

Objective To evaluate the effect of low-dose norepinephrine (NE) combined with goal-directed fluid therapy (GDFT) on cerebral oxygen metabolism in patients undergoing intracranial tumor resection.Methods Forty patients of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged ≥ 18 yr,scheduled for elective intracranial tumor resection,were divided into 2 groups (n =20 each) using a random number table method:GDFT group (group G) and low-dose NE combined with GDFT group (group N).Fluid was replaced according to stroke volume variation (SVV) under the guidance of Flotrac-Vigileo system in both groups.When SVV ≤13％,fluid was replaced at 1-2 ml · kg-1 · h-1.When SVV＞ 13％ for more than 5 min,fluid replacement was enhanced to reduce it below 13％.In group N,NE was infused continuously via the central vein at 0.01-0.03 μg· kg-1 · min-1 after anesthesia induction,and mean arterial pressure (MAP) was maintained ≥ 65 mmHg.After anesthesia induction (T1),when the dura of brain was opened (T2),at 1 h after opening the dura (T3) and at the end of surgery (T4),the heart rate and MAP were recorded,and blood samples were collected from the internal jugular venous bulb and radial artery for blood gas analysis.The fluid input and output were recorded.Arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,cerebral lactic acid production rate and ratio of cerebral blood flowto cerebral oxygen metabolic rate were calculated.Results Compared with group G,MAP at T4 and cerebral oxygen extraction rate at T3,4 were significantly increased,the total volume of fluid and volume of crystalloid solution were decreased (P＜0.05),and no significant change wasfound in arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,ratio of cerebral blood flow to cerebral oxygen metabolic rate or cerebral lactic acid production rate in group N (P＞0.05).Conclusion Low-dose NE combined with GDFT can reduce the intraoperative volume of fluid infused and improve cerebral oxygen supply when applied to the patients undergoing intracranial tumor resection.

Objective To evaluate the efficacy of multimodal-antiemetic therapy on postoperative dizziness,headache,nausea and vomiting (PONV) in patients undergoing thyroidectomy.Methods One hundred patients (39 males and 61 females,ASA physical status Ⅰ or Ⅱ) scheduled for thyroidectomy were randomly divided into two groups according to random number table: control group (group C) and multimodal-antiemetic therapy group (group M).Two groups received total intravenous anesthesia (TIVA) with propofol and remifentanil.Prophylactic dexamethasone 10 mg were given after anesthesia induction and palonosetron hydrochloride 0.25 mg was used 30 min before the end of surgery in both groups.Mannitol 2 ml/kg in group M and the same amount of normal saline in group C were given 30 min before the end of surgery.The incidence of dizziness,headache and PONV were observed for 24 h in two groups.Results The incidence of headache was 5 cases (10%)and PONV was 5 cases (10%) in group M,which were respectively significantly lower than that of group C of 15 cases (30%) and 12 cases (24%) in 24 h after surgery (P<0.05).The additional antiemetic therapy for 24 h after surgery in group M of 2 cases (4%) was significantly lower than that of group C of 9 cases (18%) (P<0.05).Conclusion The multimodal-antiemetic therapy: prophylactic dexamethasone,palonosetron hydrochloride and mannitol were used 30 min before the end of surgery could significantly reduce the incidence of dizziness,headache and PONV after thyroidectomy.