ABSTRACT
Objective:To investigate the clinical effect of posterior fossa decompression combined with dural reconstruction in the treatment of Chiari malformation-Ⅰ(CM-Ⅰ) complicated with syringomyelia (SM).Methods:The clinical data of 50 patients with CM-Ⅰ complicated with SM who were treated in Yan′an University Xianyang Hospital from June 2019 to January 2021 were analyzed. They were divided into the study group (27 cases) and the control group (23 cases) according to the surgical methods. The former received posterior fossa decompression combined with dural reconstruction, while the latter received posterior fossa decompression alone. The clinical symptom improvement, neurological function, cerebrospinal fluid dynamics and syringomyelia changes were compared between the two groups before and after the surgery, and postoperative complications were compared.Results:The overall clinical symptom improvement rate between the two groups had no significant difference ( P> 0.05). After the surgery, the scores of pain, sensory disturbance, dyskinesia and ataxia in the study group were higher than those in the control group: (4.56 ± 0.35) points vs. (4.28 ± 0.43) points, (3.61 ± 0.82) points vs. (3.15 ± 0.73) points, (3.81 ± 0.44) points vs. (3.59 ± 0.50) points, (4.43 ± 0.41) points vs. (4.09 ± 0.53) points, there were statistical significant ( P<0.05). After the surgery, the cerebrospinal fluid stroke volume (SV) and mean flow (MF) in the study group were higher than those in the control group: (0.05 ± 0.02) ml vs. (0.04 ± 0.01) ml, (0.05 ± 0.01) ml/s vs. (0.04 ± 0.01) ml/s; the maximum peak flow velocity (V max) of the head and tail in the study group were lower than those in the control group: (3.14 ± 1.05) mm/s vs. (3.87 ± 1.13) mm/s, (5.56 ± 1.38) mm/s vs. (6.43 ± 1.22) mm/s, there were statistical significant ( P<0.05). There were no significant differences in the rate of reduction or disappearance of syringomyelia, the rate of no change and the rate of increase of syringomyelia after the surgery between the two groups ( P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). Conclusions:Posterior fossa decompression combined with dural reconstruction in CM-Ⅰ complicated with SM can better improve cerebrospinal fluid dynamics, and promote the reduction of syringomyelia without increasing postoperative complications.
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Objective To explore the decision-making process in different types of behavioral activation (BAS) individuals.Methods According to the behavioral inhibition/activation system scales of China,27 low BAS,32 moderate BAS and 26 high BAS individuals were enrolled.Three different kinds of decision tasks (low-risk,high-risk and ambiguity) were programmed with E-Prime,at the same time recorded the scores of earnings,preference selection,decision-making strategy.Results Under low-risk decision,there was significant differences among low,moderate and high BAS groups (low BAS group(54.00±8.15),moderate BAS group(32.63±8.94),high BAS group(27.69±12.12),F=2.240,P＜0.05).There was no significant difference in the three groups on preference selection (F=0.759-2.926,P＞ 0.05).Under low-risk decision,there were significant differences on stay strategy (low BAS＞moderate BAS,high BAS group,F=3.107,P＜0.05) and shift strategy(moderate BAS,high BAS＞low BAS group,F=2.309,P＜0.05).There was no statistically significant difference on quit strategy in the three groups (F=0.629-1.635,P＞0.05).Conclusion Under the low-risk decision-making,low BAS individuals are easier to get more earnings.Moderate and high BAS individuals are easier to change the decision-making strategy than low BAS individuals.
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Objective To summarize the sonographic features of fetal limb deformity. Methods Systematic continuous sequence approach (SCSA) was performed with two-dimensional and three-dimensional ultrasonography(USG) in 28 383 fetuses to observe the fetal limb development, posture abnormality and other accompanied malformations. Compared with the pathological and radiological findings, the characteristics of fetal limb deformity on USG were summarized. Results Among 28 383 fetuses prenatal ultrasound detected 207 cases of fetal malformations (0.7%, 207/28 383) including 29 cases of limb deformities (14%, 29/207). In the 29 cases, there were osteogenesis imperfecta in 2 cases, syndactyly in 1 case, cleft hand deformities in 1 case, uncifom hand in 1 case, clubfoot deformity in 12 cases, cleft foot in 1 case, micromelia in 4 cases, limb body wall complex in 1 case, forearm defect in 2 cases, and radius absence in 4 cases. Chromosome karyotype analysis was conducted in 7/29 cases, of which 6 cases were normal and 1 case was trisomy-13 with syndactyly. In addition, the fetal limb deformities were found at 17-19 weeks of gestation in 4 cases, at 20-24 weeks in 23 cases, and at 25-33 weeks in 2 cases. In summary, 27/29 cases were identiifed at 17-24 weeks of gestation. Conclusions Prenatal ultrasound is the ifrst-choice method for screening of fetal limb deformity. The detection rate of limb deformity could be greatly improved by using SCSA method with the supplement of 3D ultrasound.