Magnetic resonance hyperintense vessel sign: clinical significance and related factors / 中华神经科杂志

Objective:To investigate clinical significance and related factors of magnetic resonance hyperintense vessel sign (HVS).Methods:The clinical data and related imaging parameters of 109 patients with acute anterior circulation occlusion cerebral infarction, who admitted to Northern Theater Command General Hospital of People′s Liberation Army from April 2017 to August 2019, were analyzed retrospectively. Brain magnetic resonance imaging (MRI) examinations including fluid attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI) and three dimensional time of flight magnetic resonance angiography (3D TOF MRA) sequences within 24 hours of onset were performed. According to the distribution range of HVS in FLAIR sequence, the patients were divided into four grades (0, 1, 2 and 3), grades 0 and 1 belonging to HVS low grade group, and grades 2 and 3 HVS high grade group. Univariate and multivariate analyses were made to explore related factors of HVS. Fifty-two patients who completed baseline CT within six hours of onset before MRI examination were performed CT-Alberta Stroke Program Early CT Score (CT-ASPECTS) and DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS).The difference between CT-ASPECTS and DWI-ASPECTS was calculated. When the difference of ASPECTS ≤1, they were categorized as ASPECTS unchanged group (AN group); when the difference of ASPECTS>1, they were categorized as ASPECTS changed group (AY group). These two groups were compared to explore whether there was any difference in HVS grade, and Spearman correlation analysis was performed to investigate the relationship between HVS grade and the difference of ASPECTS.Results:The difference of hyperlipidemia, TOAST classification (large artery atherosclerosis (LAA), other etiology (SOE) or undetermined etiology (SUE)) and Willis circle classification (types Ⅰ, Ⅱ, Ⅲ and Ⅳ) between HVS groups were remarkable (58.6% (34/58) vs 37.3% (19/51), χ2=4.959, P=0.026; 23/5/23 vs 43/1/14, P=0.004; 3/14/12/22 vs 7/29/14/8, χ2=13.124, P=0.004). Other clinical factors and the locations of vessel occlusion did not show significant difference ( P>0.05). Multivariate Logistic regression analysis indicated that LAA in TOAST classification (LAA vs SOE or SUE, OR=3.054, 95% CI1.257-7.422, P=0.014), Willis circle type Ⅰ (type Ⅰ vs type Ⅳ, OR=5.494, 95% CI1.074-28.091, P=0.041), and type Ⅱ (type Ⅱ vs type Ⅳ, OR=5.571, 95% CI1.895-16.372, P=0.002) were independent related factors to stimulate wide distribution of HVS. The grades of HVS were significantly different between the AN group and the AY group (1/15 vs18/18, χ2=9.114, P=0.002). Spearman correlation analysis showed that HVS grade was negatively correlated with the difference of ASPECTS ( r=-0.573, P<0.001). Conclusions:Both TOAST and Willis circle classifications are crucial factors affecting HVS distribution. HVS distribution range reflects the status of collateral compensatory. Recognizing HVS may help to evaluate the progress of early cerebral infarction volume.

Invasive breast lobular carcinoma with extracellular mucin: a clinicopathological analysis / 中华病理学杂志

Objective@#To study the clinicopathological features of invasive lobular carcinoma (ILC) of the breast with extracellular mucin and outcomes of patients.@*Method@#Clinicopathological features and clinical follow-up (39-123 months and a median follow-up of 55 months) of seven ILC with extracellular mucin were obtained. Hematoxylin-and-eosin (H&E) and immunohistochemistry (IHC) stained sections were reviewed, and fluorescence in situ hybridization (FISH) assay was performed for tumors with HER2 IHC 2+. Patient prognosis was analyzed and literatures related to ILC with extracellular mucin were reviewed.@*Results@#All seven patients were female, aged from 43 to 73 years (median age, 55 years). The tumors ranged in size from 1 to 5 cm (median size 2 cm). All seven cases were of histological grade 2. Most areas of the tumors presented with the morphology of classic ILC, and variable amount of extracellular mucin were observed focally. In six cases, part of the tumor cells contained intracellular mucin, and the nucleus were pushed to one side of the cells, creating the impression of signet-ring cells. Two patients had lymph node metastases at diagnosis, and developed liver and bone metastases at 38th and 48th month, respectively, after surgery, and died at 48th and 123th month, respectively. While the other five patients, except one lost to follow-up, had been disease-free during the follow-up period. IHC results showed estrogen receptor (ER) and progesterone receptor (PR) positivity in 7/7 and 6/7 cases, respectively. Tumors of six patients were HER2 IHC 0/1+. The remaining one was HER2 IHC 2+, while FISH assay revealed HER2 gene amplification in that tumor. The proportion of cases with HER2-positivity was 1/7. The proliferation index Ki-67 ranged from less than 5% to 30%, and Ki-67 less than or equal to 10% were in 5/7 cases. According to the 2013 St. Gallen International Expert Consensus on breast cancer, all tumors were of luminal types; of those, two were luminal A and five were luminal B.@*Conclusions@#ILC with extracellular mucin tends to occur in women over 50 years old. All tumors in the study are grade 2 classic ILC, with signet-ring cells as a common feature. All seven tumors are classified as luminal types, with luminal B as the main molecular subtype.

Clinicopathologic features of breast lymphoma in core needle biopsy / 中华病理学杂志

Objective@#To investigate the clinicopathologic features and differential diagnosis of breast lymphoma in core needle biopsy.@*Methods@#Seventy-two cases of breast lymphoma in core needle biopsy between 2011 and 2016 were extracted from the pathology database of Fudan University Shanghai Cancer Center. The clinicopathologic features were analyzed. The histological diagnosis of the tumors was based on the WHO classifications of tumors of hematopoietic and lymphoid tissues. Immunohistochemistry and molecular methods were performed to detect related antigens and genes.@*Results@#Seventy-one patients were female and one was male. The median age was 54 years. The tumors were located in the right breast in 32 (44.4%) patients and in the left breast in 40 (55.6%) patients. Seven patients had a previous history of lymphoma. Most of the cases presented as a single and painless breast mass. Sixty-three patients received systemic treatment, and nine patients received systemic therapy after excision. The common morphological feature was that single tumor cells infiltrated the stroma, without cohesiveness between tumor cells, and lacking glandular or nested epithelioid structures. The normal ductal and lobular structures of the mammary gland were typically preserved. The tumor cells in some cases were distributed in single rows, and should be differentiated from invasive carcinoma. All cases were positive for LCA, negative for CK. Sixty-eight cases were classified as B-cell lymphoma, including 63 cases (87.5%) of diffuse large B-cell lymphoma (DLBCL; including 3 cases of EBV-positive DLBCL and 60 cases of DLBCL, NOS), two cases of Burkitt lymphoma, one case of mantle cell lymphoma, one case of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and one case of precursor B lymphoblastic leukemia/lymphoma. The remaining cases included two peripheral T-cell lymphoma (NOS), one extranodal NK/T cell lymphoma, nasal type and one myeloid sarcoma. In 63 cases of DLBCL, 22 cases (34.9%) expressed germinal center B-cell-like (GCB) phenotype and 41 cases (65.1%) showed non-germinal center B-cell-like (non-GCB) phenotype.@*Conclusions@#Core needle biopsy could be the preferred method for diagnosis of breast lymphoma. Diffuse large B-cell lymphoma is the most common histologic type of breast lymphoma, and non-GCB subtype is more frequent than GCB subtype.

Clinical symptoms and etiological classification in patients with isolated midbrain infarction / 中国脑血管病杂志

Objective To investigate the clinical manifestations,imaging features,and etiological classification in patients with isolated midbrain infarction. Methods From December 2013 to January 2017,40 consecutive patients with isolated midbrain infarction admitted to the Department of Neurology, General Hospital of Shenyang Military Command were enrolled retrospectively. The general data,clinical and imaging data of the patients were analyzed retrospectively. According to the vascular control range and MRI characteristics,the midbrain infarcts were divided into anteromedial,anterolateral,lateral and dorsal infarcts . The differences of baseline data,clinical manifestation and etiological typing of various types of patients were analyzed. Results In the 40 patients,23 were anteriomedial infarction,14 were anterolateral infarction, 1 was lateral infarction,and 2 were mixed location infarction,0 was dorsal infarction. The common signs were dysarthria in 23 cases (57. 5%),limb and／or gait ataxia in 18 cases (45. 0%),oculomotor disturbances and／or ptosis in 15 cases (37. 5%),and limb movement disorders in 14 cases (35. 0%). The differences were statistically significant in central facial paralysis and／or lingual paralysis (3／23 vs. 8／17 ),oculomotor disturbances (15／23 vs. 0 ),and etiological types between the patients with anterior medial infarction and those infarction at other sites (all P＜0. 05). Of the 40 patients,38 had a short-term good prognosis (95. 0%)and 2 had poor prognosis (5. 0%). Conclusions Isolated midbrain infarcts mainly manifested as dysarthria,ataxia,and oculomotor disturbances. Oculomotor disturbances occurred in anteromedial infarction. The common causes of anteromedial infarction are large atherosclerosis and small vascular lesions,while the cause of infarction in other sites is often large atherosclerosis.

Improvement role of clotrimazole suppositories and fluconazole combined therapy in sex life of patients with candidal vaginitis / 中国生化药物杂志

Objective To investigate the improvement role of clotrimazole suppositories and fluconazole combined therapy in sex life of patients with candidal vaginitis.MethodsThe clinical data of 80 cases of patients with candidal vaginitis in our hospital from January 2015 to January 2017 were retrospectively analyzed, these patients were divided into clotrimazole suppositories and fluconazole combined therapy group (combined treatment group, n=40) and fluconazole single therapy group (single treatment group, n=40) according to the treatment methods, the clinical effects, main clinical symptoms and signs improvement time, quality of life of the two groups were statistically analyzed.ResultsThe total treatment efficiency of the combined treatment group 100.0% (40/40) was significantly higher than the single treatment group 87.5% (35/40) (P<0.05), the vaginal itching, pain, burning sensation, abnormal leucorrhea, abnormal discharge improvement time were significantly shorter than the single treatment group (P<0.05), the sexual desire, sexual arousal, lubrication, orgasm and sexual satisfaction scores were significantly higher than the single treatment group (P<0.05), the pain score was significantly lower than the single treatment group (P<0.05).ConclusionClotrimazole suppositories and fluconazole combined therapy can more effectively improve the sex life of patients with candidal vaginitis than fluconazole single therapy.

Grey zone lymphoma with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma: clinicopathologic characterization of 16 cases showing different patterns / 中华病理学杂志

<p><b>OBJECTIVE</b>To profile the clinicopathologic features of a series of grey zone lymphoma (GZL) cases with hybrid features of diffuse large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma (CHL), with a purpose to gain an in-depth understanding of the borderline B-cell neoplasm.</p><p><b>METHODS</b>The clinical, morphologic and immunophenotyical characteristics of 16 cases were retrospectively analyzed.</p><p><b>RESULTS</b>The patients were mostly male adults, with a male to female ratio of 1.7: 1.0 and a mean age of 40.2 years. Eight patients presented with peripheral nodal lesions and five cases with mediastinal involvement. Histologically and immunophenotypically, the 16 cases were classified into three sub-categories. In 4 cases, the morphologic features resembled CHL more closely, but the neoplastic cells showed uniform and intense positive staining of CD20 (pattern 1). Although the initial impression of the other 8 cases was that of DLBCL, the expression levels of CD20 and PAX5 were variable, and CD30 or CD15 was positive (pattern 2). A characteristic feature of pattern 3, observed in the remaining 4 cases, demonstrated a broad spectrum of morphology with hybrid features of both CHL and DLBCL. The neoplastic cells in pattern 3 were positive for CD20, CD30 and CD15. EBV-LMP1 was detected in 6 of the 11 tested cases. Clinically, most patients with GZL seemed insensitive to immuno-chemotherapy of the R-CHOP regimen.</p><p><b>CONCLUSIONS</b>The diagnostic criteria for GZL with features intermediate between DLBCL and CHL is proposed by the three histologic patterns commonly seen in these lesions. Cases presented with peripheral lesions might differ from those with mediastinal presentation pathologically. At current time, there is no effective treatment for these borderline B-cell lymphomas and the prognosis is poor.</p>

New advances in lymphoma pathology / 中国癌症杂志

Updated knowledge about lymphoma pathology has been accumulated ever since the publication of the current WHO classiifcation of lymphomas in 2008. For B-cell non-Hodgkin lymphomas, endeavors have been made for approaching a better classiifcation of those highly aggressive and heterogeneous subtypes (e.g., diffuse large B-cell lymphomas) on the molecular biological basis. In addition, there is a growing interest in understanding and deal-ing with the borders of overt malignant lymphomas and certain clonal lymphproliferative disorders that are not overtly malignant. On the other hand, recent advances in understanding the subsets of T and NK (T/NK)-cell lineage and their differentiation, as well as the genetic aberrations or dysregulated signaling pathways in their neoplastic counterparts, have provided us novel insights into the biology of peripheral T/NK-cell lymphomas. Indolent clonal T/NK-cell prolif-erations, especially those arising from the mucocutaneous sites, have also received increased attention. These advances may contribute to the evolution of the classiifcation of lymphomas.

Reevaluation of predictive biomarkers of diffuse large B-cell lymphoma in the rituximab era / 中国癌症杂志

Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease in terms of molecular pathogenesis and cell of origin. Earlier prognostic models relied mainly on such clinical variables as age, stage of disease, and performance status, which did not display its heterogeneity. Many studies have reported that some biomarkers could be used for prognostication, while older prognostic models need to be revalidated and modified as improved therapeutic options become available. In this review, we discussed pertinent studies on individual biomarkers and pattern-based biomarker models, with an emphasis on markers evaluated in patients treated with rituximab-containing chemotherapy.

A retrospective study of 26 cases of pathologically established cerebral amyloid angiopathy / 中华神经科杂志

Objective To study the clinical feature of 26 cases which were diagnosed pathologically as cerebral amyloid angiopathy ( CAA ) and to improve the level of diagnosis.Methods The clinical characteristics of the 26 cases with CAA in our hospital from 1983 to 1999 were retrospectively reviewed and analyzed,including previous history,clinical manifestation,and laboratory examination.Results Of the 26 CAA patients,there were 17 men and 9 women with age ranging from 45 to 78 years.Eight patients (30.7％ ) had the history of hypertension; 6 cases (23.1％ ) suffered from diabetes; 2 patients(7.6％ ) were taking anticoagulant or antiplatelet agents in whom serious CAA and multiple hemorrhages were histopathologically confirmed by autopsy.There were 20 cases diagnosed as cerebral hemorrhage,including 2 patients with single lobe hemorrhage,8 patients with multiple lobe hemorrhage,5 patients with putamen hemorrhage,2 patients with cerebral ganglion hemorrhage,2 patients with cerebellar hemorrhage,and 1 patient with brain stem hemorrhage.Of the 26 CAA patients,there were 2 patients with subaracchnoid hemorrhage,1 patient with hemorrhagic cerebral infarction,1 patient with basal ganglia infarction,1 patient with basilar artery occlusion,1 patient with subdural hematoma.The clinical manifestation of the 20 cases diagnosed as cerebral hemorrhage included headache,limb palsy,coma,and hyperspasmia.Conclusions CAA always begin as cerebrovascular disease symptoms with or without hypertension.The most common manifestation of CAA is lobe hemorrhage,while the CAA-related hemorrhage seldom occurs in basal ganglia,cerebellum and brainstem.CAA can also manifest cerebral infarction and subarachnoid hemorrhage.Anticoagulant (warfarin) or antiplatelet agents (aspirin) maybe a contributing factor for CAA-related hemorrhage.

Clinical Study on Treatment of Congestive Heart Failure by Cardiotonic Pill And Monopril / 中国中医药信息杂志

Objective To observe the clinical efficacy of Cardiotonic Pill and Monopril in treating congestive heart failure disease. Methods Seventy-eight patients with congestive heart failure were randomly divided into two groups. The control group received routine treatment (Monopril), and the treated group were given Cardiotonic Pill besides routine treatment. The symptoms, physical signs and the parameter and classify of cardiac function were evaluated in all patients. Results The symptoms and physical signs after treatment were better than before. The cardiac function were improved. Comparison between the two groups showed difference (P

Effects of Buyanghuanwu Herbal Decoctions on Microalbuminur in Noninsulin-dependent Diabetes Mellitus / 中国中医药信息杂志

Objective To observe the efficacy of Buyanghuanwu herbal decoctions on microalbuminur in noninsulin-dependent diabetes mellitus. Methods Sixty-six patients with noninsulin-dependent diabetes mellitus patients with 30～300 mg/24 h microalbuminur were randomly divided into the treated group (treated with Buyanghuanwu herbal decoctions) and the control group (treated with injection of Huangqi). The clinical efficacy was observed and levels of blood-fat, hemorheology and microalbuminur were determined. Results The levels of blood-fat, hemorbeology and microalbnminur were decreased in treated group. Comparison between the two groups showed significant difference (P

A clinicopathologic study of CD30-positive sinusoidal large B-cell lymphoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To explore the clinicopathologic features of CD30-positive sinusoidal large B-cell lymphoma (CD30 + SLBCL) and its relative correlation with Epstein-Barr virus (EBV).</p><p><b>METHODS</b>Two cases of CD30 + SLBCL, a 65-year-old men and a 85-year-old women were morphologically and immunophenotypically analyzed. EBV status was also evaluated through not only the polymerase chain reaction (PCR) amplification to the EBV Bam HIW DNA sequence, but also an immunohistochemical detection of the latent membrane protein 1 (LMP1).</p><p><b>RESULTS</b>The patients presented with similarly superficial lymphadenopathy. One of them died of the tumor within 10 months. Microscopically, both of the neoplasms were characterized by a cohesive sinus growth pattern and the monomorphic cytology of the tumor cells. Immunohistochemically, They were both positive for CD45, CD30, and CD20 or CD79alpha, whereas neither expressed EMA, ALK1, nor any histiocytic/T-lineage markers. No evidence of EBV-infection could be found either.</p><p><b>CONCLUSIONS</b>CD30 + SLBCL is a morphologically and immunophenotypically distinctive variant of diffuse large B-cell lymphoma, which should be distinguished from T/null cell type anaplastic large cell lymphoma and some other nodal lesions with a predominantly sinusoidal infiltrative pattern. CD30 + SLBCL may not be correlation with EBV.</p>

Immunophenotype and expression of cytotoxic granule proteins of nasal NK/T cell lymphoma and its significance / 中国癌症杂志

Purpose: To study the immunophenotype and the expression of cytotoxic granule proteins of nasal NK/T cell lymphoma and its significance. Methods: 44 cases of nasal NK/T cell lymphoma were studied by the two-step method of DAKO EnVisionTM using a series of antibodies including CD3, CD20, CD43, CD45, CEI45RO, CD56, CD57, CD79?, TIA-1, granzyme-B and perform. Results: All the cases of nasal NK/T cell lymphoma were CD45 positive. 43% of the cases expressed CD3 with positive signal located in the cytoplasm, which was different from peripheral T cell lymphoma. 45% and 52% of the cases were CD43 and CD45RO positive respectively. Cases that reacted to CD56 accounted for 52% of the cases, 43% of which were also positive to CD3. Concerning the reactions to both CD3 and CD56, 10 cases showed CD3 + CD56 + , 13 showed CD3-CD56 + , 9 were CD3 + CD56- and 12 were CD3-CD56-. None of the 44 cases showed positive reaction to CD20, CD79? and CD57. All cases were reactive to TIA-1. 93% and 95% of the cases showed the reactions to granzyme-B and perform. All the controls were negative to TIA-1, granzyme-B and perform. Conclusions: The immunophenotypes of nasal NK/T cell lymphoma showed less consistency. CD56 was not always positive in the cases of this tumor. The different locations of the positive signal to CD3 showed that the cell lineage of this tumor was different from T lymphocytes. The high frequency of the staining by cytotoxic granule proteins, TIA-1, granzyme-B and perform, showed that these cells may have originated from NK cells. The distinctive differences in immunohistochemical staining of cytotoxic granule proteins in nasal NK/T cell lymphoma make their detection very useful and important in diagnosis and differential diagnosis.

Clinical and pathological study of basilar artery aneurysm / 临床神经病学杂志

Objective To discuss the clinical characteristics and pathological changes of basilar artery aneurysm.Methods The clinical materials and brain topography results were analyzed retrospectively in 4 patients with basilar artery aneurysm.Results The onsets of disease in all cases were acute and common manifestations were coma,positive meningeal irritation sign and ocular dyskinesis.3 cases showed hypertention,2 cases presented with hemiparalysis,all cases died of herniation.3 cases of basilar artery trunk fusiform aneurysm and 1 case of basilar artery furcation saccular aneurysm were detected in autopsy.There were aneurysm rupture,subarachnoid hemorrhage and swell,necrosis,softening,gliosis of brain tissue confirmed pathologically in all cases.Conclusion Hypertension is probably the most important cause of aneurysm rupture.Signs and symptoms of subarachnoid are the most common manifestation when basilar artery aneurysm ruptures with poor prognosis.Herniation is the main cause of death.

Advancement of the relationship ERCC1 and platinum resistance in digestive system malignant tumors / 中国临床药理学与治疗学

Due to the high incidence and mortality of digestive system malignant tumor,so it is of great significance to make further research for digestive tract tumor.Platinum drugs,one of the traditional drugs which is used for the chemotherapy for digestive system tumor,which has been extensively applied to the chemotherapy for malignant tumor.However,the resistance to the drugs exerts a serious influence on its curative effect.At present,it is believed that the nucleotide excision repair(NER)constitutes one of the most important mechanisms which results in the resistance to platinum drugs,mainly because it causes the twisting of DNA helix by removing large numbers of platinum compounds.The nucleotide excision repair cross complementation group 1(ERCC1)plays an important role in the process of NER.The different expression of ERCC1 in peripheral blood and tumor tissue of patients with digestive sysem tumor has a close connection with therapeutic effect of the platinum-containing chemotherapy.This article aims to provide an overview of the relation between the ERCC1 research development and the curative effect of cisplatin chemotherapy for digestive system tumor.

Clinical and pathological features of herniation secondary to cerebral infarction / 临床神经病学杂志

Objective To discuss the clinical and pathological features of herniation secondary to cerebral infarction. Method Clinical and pathologic characteristics of 50 cases died of herniation due to cerebral infarction were analysised. Results The clinical manifestations,such as consciousness disturbance,pupillary change,hemiplegia or tetraplegia were detected in all 50 cases,the average time from onset to herniation was (3.36?1.12)d,the time herniation to death was 20 h～7 d,average about (1.5?0.98)d. The large size cerebral infarctions caused by internal carotid artery,middle cerebral artery and/or vertebral artery occlusion were pathologically confirmed.hemorrhagic cerebral infarctions caused by cerebral embolism were found in 25 cases and the ischenmic infarctions caused by cerebral thrombosis in 25 caese.Site of infarction were cerebral hemisphere (31 cases), brain stem (15 cases), supratentorial and infratentorial brain (4 cases).Of the 50 cases,36 cases had hippocampal gyrus herniation,36 cases with cerebellur throat-almond herniation,18 cases with central herniation,17 cases with cingulated gyrus herniation,and 27 cases with sphenoidal crest herniation. Usually there were several herniation existing in the same patient. Among 50 cases,11cases had two kinds of herniation,10 cases with three kinds of herniation,9 cases with four kind of herniation, and 5 cases with five kinds of herniation.Conclusions Herniation secondary to cerebral infarction were mainly presented in the large size cerebral infarction caused by internal carotid artery or middle cerebral artery occlusion.the time of herniation was in early stage of disease.Most of patients were hippocampal gyrus herniation and cerebellur throat-almond herniation.Usually there were several herniation existing in the same patient.

THE RADIOLOGICAL MANIFESTATION AND CLASSIFICATION OF THE VERTEBRAL ARTERY SULCUS RING OF ATLAS IN 56 PILOTS / 解放军医学杂志

The presence of the cervical artery sulcus ring was found on the atlas in 56 out of 346 air pilots. The X ray appearance could be classified as follows. Type Ⅰ:Complete sulcus ring in 32 cases, in whom the sulcus might be complete unilaterally or bilatrally. Type Ⅱ: Incomplete or half ring in 18 cases. This type could be further divided into Ⅱ a , consisting of 4 persons with half ring in the anterior aspect, andⅡ b , half ring posteriorly in14 persons. Type Ⅲ: Broken ring in 6 persons. It is an anatomic variation, which may be have some relationship to vertigo. It is suggested that the presence of cervical artery sulcus ring on atlas should be taken as an disqualification factor in air pilot recruitment.