[Task-related functional connectivity of anterior cingutate in opiate drug addicts during physical detoxification: a task fMRI study].

Objective: To explore the brain areas which have abnormal functional connectivity with anterior cingutate in opiate drug dependence during physical detoxification using a task-related functional magnetic resonance imaging(fMRI), and to find out the role of anterior cingutate dysfunction in the relapse of opiate drug addicts during physical detoxification. Methods: From January to December 2016, eighteen participants of opiate drug addicts during physical detoxification who completed in Drug Rehabilitation Center of Anhui Province, and eighteen healthy controls recruited performed a cue-elicited craving task in a MRI scanner while signal data were collected. Two regions of interest were the right anterior cingutate and the left anterior cingutate, then the linear correlation between the whole brain and the anterior cingutates was calculated to find out the abnormal functional connectivity of the anterior cingutates. Results: Contrasted experimental group with the healthy controls, the functional connectivity of bilateral fusiform gyrus, caudate nucleus, and the anterior cingutates was increased in the opiate drug addicts during physical detoxification group (P<0.05),and the functional connectivity between anterior cingutates and polus temporalis, hippocampi, Middle frontal gyrus of orbit, Supplementary motor area, dorsolateral superior frontal gyrus was decreased(P<0.05). Conclusion: The anterior cingutates dysfunction of functional connectivity in a cue-elicited craving task may play a important role in the relapse of opiate drug addicts during physical detoxification.

[Comparison of the accuracy of neuronavigation and linear measurement in the positioning of parasagittal meningioma].

Objective: To explore the accuracy of preoperative positioning of neuronavigation and linear measurement localization in the parasagittal meningioma. Methods: Thirty-eight patients with parasagittal meningioma who underwent neurosurgery in the First Affiliated Hospital of Bengbu Medical College from January 2016 to April 2018 were preoperatively positioned with neuronavigation localization and linear measurement localization. The actual position of the tumor was observed during operation, and the accuracy of the two methods was compared. The time taken by the neural navigation positioning and the linear measurement positioning method was recorded, and the difference between the two methods was compared. Results: All cases were treated with neuronavigation and linear measurement, and the tumors were completely exposed after localization. Compared with the actual tumor center position measured during surgery, the average error distance between 38 nerve navigation and actual tumor center position was (2.7±1.9) mm, and the average error distance between linear measurement and actual tumor center position was (3.2±1.3) mm. The difference was not statistically significant, P value=0.207. Neuronavigation includes booting, data import, registration, positioning, etc., which takes an average of (22.3±2.3) minutes. The linear positioning method included image data measurement and localization, and the average time was(1.7±0.3) minutes. The difference between the two groups was statistically significant, and the P value was less than 0.001. Conclusion: The linear measurement localization method and the neuronavigation localization method have good accuracy for preoperative localization of the parasagittal meningioma.

[Application of modified brain protection double-lumen drainage tube in external drainage of chronic subdural hematoma].

Objective: To compare the clinical effects of modified double-lumen drainage tube and traditional silicone tube in external drainage of chronic subdural hematoma. Methods: Selected 49 patients suffering from chronic subdural hematoma hospitalized in the Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College between July 2016 and June 2018 who underwent external drainage, and divided them randomly into experimental groups (using modified brain protection double lumen drainage tube in 23 cases) and control group (using traditional silicone drainage tube in 26 cases). Comparison of postoperative hematoma residual volume, the tube indwelling time, the numbers of drainage tube contact with brain tissue and arachnoid membrane, the numbers of infections, the numbers of postoperative epilepsy cases, and changes in Modified Rankin Scale scores between the two groups. Results: At the time of extubation, the residual amount of hematoma in the experimental group was (13±7) ml, and that in the control group was (17±8) ml. There was no significantly statistical difference in the residual amount of hematoma between the experimental group and the control group (P>0.05). The tube indwelling time of the experimental group was (2.0±0.9) days, and that of the control group was (2.7±0.8) days. The difference between the experimental group and the control group in the drainage tube indwelling time was statistically significant (P<0.05). No cases of drainage tube contact with brain tissue and/or arachnoid membrane appeared in the experimental group, and 7 cases of drainage tube contact with brain tissue or arachnoid membrane appeared in the control group. No infection occurred in both groups. No cases of epilepsy occurred in preoperative, and there were 0 cases of epilepsy in the experimental group and 1 case in the control group in postoperative. There were significantly statistical differences in each of the two groups in the modified Rankin scale before and after surgery (P<0.001), there was no significant difference in postoperative Modified Rankin Scale scores between the two groups. Conclusion: The modified brain protection double-lumen drainage tube has good drainage effect in the external drainage of chronic subdural hematoma, and the short tube retention time, causing fewer complications. It is a safe and effective tool for treating chronic subdural hematoma, and it is worthy of clinical promotion.

[The curative effect analysis of unilateral subfrontal combined with interhemispheric approach on the microsurgery of large anterior skull base meningioma].

Objective: To explore the surgical technique and curative effect of microsurgical resection of large anterior skull base meningioma via unilateral subfrontal and interhemispheric approach. Method: The clinical data of 14 patients with large anterior skull base meningioma who received surgical treatment in the Department of neurosurgery in First Affiliated Hospital of Bengbu Medical College from April 2015 to September 2017 were analysed retrospectively.Of 9 cases were olfactory groove meningioma and 5 cases were tuberculum sellae meningioma.The microsurgical resection approach of all the patients was the unilateral subfrontal combined with interhemispheric approach. Results: According to the Simpson classification of meningioma resection, 13 cases(92.8%) were Simpson grade Ⅰand Ⅱ, 1 case was grade Ⅲ.The clinical symptoms were improved in 12 cases (85.7%), and no improvement in 2 cases.Fourteen patients had postoperative complications in 2 cases (14.2%), and all of them were no cerebrospinal fluid leakage and death. Conclusion: Microsurgical removal of large anterior skull base meningioma through unilateral frontal and interhemispheric approach is safe and effective, providing a new way for surgical treatment of large anterior skull base meningioma. It had a positive significance for the prognosis of patients.

[Curative effect analysis of 15 cases of cervical intra-and extra-spinal tumors by microsurgical resection].

Objective: To explore the curative effect of microsurgical treatment of cervical intra- and extra-spinal tumors. Methods: The clinical data of 15 patients with cervical intra-and extra-spinal tumors in Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College from January 2013 to February 2017 were retrospectively analyzed. According to Shaw's tumor stage: 6 cases in stage Ⅰ, 5 cases in stage Ⅱ, 3 cases in stage Ⅲ, and 1 case in stage Ⅳ. About the surgical methods: 9 cases were treated via posterior median semi-laminectomy approach, of which were internal fixation in 2 cases, and via posterior median approach spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty in 3 cases, other 3 cases were operated via anterior cervical approach, including internal fixation in 1 case. After the surgery, vertebral canal MRI was adopted to evaluate the tumor, and CT three-dimensional reconstruction or X-ray of the spine was used for assessing the stability of spinal column, and Frankel grading standard was employed to evaluate the recovery of spinal cord function. Results: The tumors were totally resected in the first stage with the help of a microscope. Histological types of the tumors included schwannoma in 14 cases, gangliocytoma in 1 case. There was no leakage of cerebrospinal fluid and infection of incisional wound after operations. After the surgery, Frankel grading standard was adopted to assess the recovery of the spinal cord function, and the results showed grade D in 4 patients and grade E in 11 patients. All patients were followed-up for 1 to 24 months with an average of 13 months without tumor recurrence and spinal instability. Conclusion: Appropriate surgical approach should be selected to treat the cervical intra- and extra-spinal tumors, totally resection of the tumor could be achieved under the microscope, and the corresponding vertebral reconstruction and spinal fixation should be used to maintain spinal stability if necessary.

[Curative effect analysis of two surgical methods for removal of pituitary adenoma via endonasal transsphenoidal approach].

Objective: To compare the efficacy of endoscopic endonasal transsphenoidal surgery and microsurgery for pituitary adenomas. Methods: One hundred and ten patients with pituitary adenoma who were treated by single nostril transsphenoidal surgery in the department of neurosurgery of the First Affiliated Hospital of Bengbu Medical College from June 2014 to December 2016 were enrolled.These cases were randomly divided into endoscopic group 53 cases (including 36 cases of functional pituitary adenoma and 17 cases of non-functional pituitary adenoma) and microscope group 57 cases (including 34 cases of pituitary adenoma and 23 cases of non-functional pituitary adenomas), with no significant difference in preoperative clinical data about gender, age, tumor size and endocrine function (P>0.05). The total tumor resection rate, postoperative complication rate and the rate of functional tumor hormone levels were compared between the two groups. Results: The total resection rate of tumor in patients with endoscope and microscope group were 75.5% (40/53) and 70.2% (40/57) without statistically significant difference (P>0.05). The total resection rate and hormone level decline effective rate of functional pituitary adenomas in neuroendoscope group (91.7%, 33/36; 83.3%, 30/36) were higher than those in microscope group (70.6%, 24/34; 61.8%, 21/34) with statistically significant difference (P<0.05). Another side, there was no statistically significant difference in total resection of non-functional pituitary adenomas between endoscope group (41.2%, 7/17) and microscope group (69.6%, 16/23) (P>0.05). The total incidence of postoperative complications in endoscopic group (9.4%, 5/53) was lower than that in the microscope group (24.6%, 14/57), with statistically significant difference (P<0.05), in which the rate of postoperative complications of functional pituitary adenomas and nonfunctional pituitary adenoma in endoscopy group (8.3%, 3/36; 11.8%, 2/17) and in microscope (20.6%, 7/34; 30.4%, 7/23) had no statistical significance (P>0.05). Conclusion: Pituitary adenoma resection rate in two ways had no obvious difference, but the advantages of endoscopic surgery for functional pituitary adenomas were obvious.The incidence of postoperative complications of endoscopic surgery was lower than that of microscopic surgery, but there was no difference between functional and non-functional tumors.

[Research on the application of "H shaped" single-tube double-lumen drainage tube in the treatment of chronic subdural hematoma].

OBJECTIVE: To explore the effect of chronic subdural hematoma external drainage surgery using self-made "H shaped" flush type single-tube double-lumen drainage tube. METHODS: There were 56 cases chosen from the First Affiliated Hospital of Bengbu Medical College between Jan 2013 and Aug 2015. These patients with unilateral chronic subdural hematoma requiring surgery to place drilling external drainage catheter were randomly divided into group A (21 cases, using self-made single-tube double lumen "H shaped" drainage tube) and group B (35 cases, traditional silicone drainage tube), then the residual liquid volume after drainage on the first day, the days that the tube stay in body and the residual fluid volume after removing the tube were compared between the two groups. RESULTS: The residual liquid volume after drainage on the first day in group A was (23±15)ml, in group B was (31±15)ml. The days that the tube stay in body in group A was (2.7±1.0)d, in group B was (3.3±1.1)d, the two groups had statistical differences (P<0.05). The residual fluid volume after removing the tube in group A was (13±7) ml, in group B was (16±8)ml, but the data in these two groups had no significantly statistical differences (P>0.05). CONCLUSION: The effect of self-made "H shaped" flush type single-tube double-lumen drainage tube in the drainage of chronic subdural hematoma drainage is good, with short tube stay in the body; therefore, it is a safe and effective way to treat chronic subdural hematoma, and is worthy of clinical application.

Factors determining normalization of pulmonary vascular resistance following successful balloon mitral valvotomy.

Balloon mitral valvotomy (BMV) provides improvement in pulmonary vascular resistance (PVR) in patients with severe mitral stenosis. Its normalization, however, remains questionable. We evaluated PVR before, after BMV, and at follow-up in 37 patients who had a previous successful BMV. Patients were divided into 2 groups: group 1 had 21 patients with normalized PVR (<125 dynes/s/cm5) either after BMV or at follow-up, and group 2 had 16 patients with persistently abnormal PVR. Patients in group 2 were older than patients in group 1 (55+/-13 vs 43+/-14 years, p = 0.01) and had atrial fibrillation more frequently (10 [63%] vs 6 [29%], p = 0.04). Age, cardiac rhythm, mitral valve area, pulmonary bed gradient, pulmonary artery pressure, and PVR before the procedure were significant univariate predictors for normalization of PVR. Age, echocardiographic score, systolic pulmonary artery pressure, and mitral regurgitation were all independent determinants of normalization of PVR in a multivariate logistic regression model. We conclude that PVR failed to return to normal in 16 patients (43%) after successful BMV; this can be predicted by baseline clinical and hemodynamic parameters.