Ultrahigh Energy Storage Performance of BiFeO3-BaTiO3 Flexible Film Capacitor with High-Temperature Stability via Defect Design.

Nanoengineering polar oxide films have attracted great attention in energy storage due to their high energy density. However, most of them are deposited on thick and rigid substrates, which is not conducive to the integration of capacitors and applications in flexible electronics. Here, an alternative strategy using van der Waals epitaxial oxide dielectrics on ultra-thin flexible mica substrates is developed and increased the disorder within the system through high laser flux. The introduction of defects can efficiently weaken or destroy the long-range ferroelectric ordering, ultimately leading to the emergence of a large numbers of weak-coupling regions. Such polarization configuration ensures fast polarization response and significantly improves energy storage characteristics. A flexible BiFeO3-BaTiO3 (BF-BT) capacitor exhibits a total energy density of 43.5 J cm-3 and an efficiency of 66.7% and maintains good energy storage performance over a wide temperature range (20-200 °C) and under large bending deformation (bending radii ≈ 2 mm). This study provides a feasible approach to improve the energy storage characteristics of dielectric oxide films and paves the way for their practical application in high-energy density capacitors.

Effects of Aegilops longissima chromosome 1Sl on wheat bread-making quality in two types of translocation lines.

KEY MESSAGE: Two wheat-Ae. longissima translocation chromosomes (1BS·1SlL and 1SlS·1BL) were transferred into three commercial wheat varieties, and the new advanced lines showed improved bread-making quality compared to their recurrent parents. Aegilops longissima chromosome 1Sl encodes specific types of gluten subunits that may positively affect wheat bread-making quality. The most effective method of introducing 1Sl chromosomal fragments containing the target genes into wheat is chromosome translocation. Here, a wheat-Ae. longissima 1BS·1SlL translocation line was developed using molecular marker-assisted chromosome engineering. Two types of translocation chromosomes developed in a previous study, 1BS·1SlL and 1SlS·1BL, were introduced into three commercial wheat varieties (Ningchun4, Ningchun50, and Westonia) via backcrossing with marker-assisted selection. Advanced translocation lines were confirmed through chromosome in situ hybridization and genotyping by target sequencing using the wheat 40 K system. Bread-making quality was found to be improved in the two types of advanced translocation lines compared to the corresponding recurrent parents. Furthermore, 1SlS·1BL translocation lines displayed better bread-making quality than 1BS·1SlL translocation lines in each genetic background. Further analysis revealed that high molecular weight glutenin subunit (HMW-GS) contents and expression levels of genes encoding low molecular weight glutenin subunits (LMW-GSs) were increased in 1SlS·1BL translocation lines. Gliadin and gluten-related transcription factors were also upregulated in the grains of the two types of advanced translocation lines compared to the recurrent parents. This study clarifies the impacts of specific glutenin subunits on bread-making quality and provides novel germplasm resources for further improvement of wheat quality through molecular breeding.

Self-supervised enhanced thyroid nodule detection in ultrasound examination video sequences with multi-perspective evaluation.

Objective.Ultrasound is the most commonly used examination for the detection and identification of thyroid nodules. Since manual detection is time-consuming and subjective, attempts to introduce machine learning into this process are ongoing. However, the performance of these methods is limited by the low signal-to-noise ratio and tissue contrast of ultrasound images. To address these challenges, we extend thyroid nodule detection from image-based to video-based using the temporal context information in ultrasound videos.Approach.We propose a video-based deep learning model with adjacent frame perception (AFP) for accurate and real-time thyroid nodule detection. Compared to image-based methods, AFP can aggregate semantically similar contextual features in the video. Furthermore, considering the cost of medical image annotation for video-based models, a patch scale self-supervised model (PASS) is proposed. PASS is trained on unlabeled datasets to improve the performance of the AFP model without additional labelling costs.Main results.The PASS model is trained by 92 videos containing 23 773 frames, of which 60 annotated videos containing 16 694 frames were used to train and evaluate the AFP model. The evaluation is performed from the video, frame, nodule, and localization perspectives. In the evaluation of the localization perspective, we used the average precision metric with the intersection-over-union threshold set to 50% (AP@50), which is the area under the smoothed Precision-Recall curve. Our proposed AFP improved AP@50 from 0.256 to 0.390, while the PASS-enhanced AFP further improved the AP@50 to 0.425. AFP and PASS also improve the performance in the valuations of other perspectives based on the localization results.Significance.Our video-based model can mitigate the effects of low signal-to-noise ratio and tissue contrast in ultrasound images and enable the accurate detection of thyroid nodules in real-time. The evaluation from multiple perspectives of the ablation experiments demonstrates the effectiveness of our proposed AFP and PASS models.

Tuning oxygen vacancies in epitaxial LaInO3 films for ultraviolet photodetection.

LaInO3 (LIO) represents a new, to the best of knowledge, type of perovskite oxides for deep-ultraviolet (DUV) photodetection owing to the wide bandgap nature (∼5.0 eV) and the higher tolerance of defect engineering for tunable carrier transport. Here we fabricate fast-response DUV photodetectors based on epitaxial LIO thin films and demonstrate an effective strategy for balancing the photodetector performance using the oxygen growth pressure as a simple control parameter. Increasing the oxygen pressure is effective to suppress the oxygen vacancy formation in LIO, which is beneficial to suppress the dark current and enhance the response speed. The optimized LIO photodetector achieves a fast rise/fall time of 20 ms/73 ms, a low dark current of 2.0 × 10-12 A, a photo-to-dark current ratio of 1.2 × 103, and a detectivity of 6 × 1012 Jones.

Ageing and degeneration analysis using ageing-related dynamic attention on lateral cephalometric radiographs.

With the increase of the ageing in the world's population, the ageing and degeneration studies of physiological characteristics in human skin, bones, and muscles become important topics. Research on the ageing of bones, especially the skull, are paid much attention in recent years. In this study, a novel deep learning method representing the ageing-related dynamic attention (ARDA) is proposed. The proposed method can quantitatively display the ageing salience of the bones and their change patterns with age on lateral cephalometric radiographs images (LCR) images containing the craniofacial and cervical spine. An age estimation-based deep learning model based on 14142 LCR images from 4 to 40 years old individuals is trained to extract ageing-related features, and based on these features the ageing salience maps are generated by the Grad-CAM method. All ageing salience maps with the same age are merged as an ARDA map corresponding to that age. Ageing salience maps show that ARDA is mainly concentrated in three regions in LCR images: the teeth, craniofacial, and cervical spine regions. Furthermore, the dynamic distribution of ARDA at different ages and instances in LCR images is quantitatively analyzed. The experimental results on 3014 cases show that ARDA can accurately reflect the development and degeneration patterns in LCR images.

Ultrahigh Ferroelectric and Piezoelectric Properties in BiFeO3-BaTiO3 Epitaxial Films Near Morphotropic Phase Boundary.

Ferroelectric solid solutions with composition near the morphotropic phase boundary (MPB) have gained extensive attention recently due to their excellent ferroelectric and piezoelectric properties. Here, we have demonstrated a strategy to realize the controllable preparation of BiFeO3-BaTiO3 (BF-BT) epitaxial films near the MPB. A series of high-quality BF-BT films were fabricated by pulsed laser deposition via adjusting oxygen partial pressure (PO2) using a BF-BT ceramic target. A continuous transition from rhombohedral to tetragonal phase was observed upon increasing PO2. Particularly, the film with a pure tetragonal phase exhibited a large remnant polarization of ∼90.6 µC/cm2, while excellent piezoelectric performance with an ultrahigh strain (∼0.48%) was obtained in the film with coexisting rhombohedral and tetragonal phases. The excellent ferroelectric and piezoelectric properties endow the BF-BT system near the MPB with great application prospects in lead-free electronic devices.

Automatic segmentation and grading of ankylosing spondylitis on MR images via lightweight hybrid multi-scale convolutional neural network with reinforcement learning.

Objective.Ankylosing spondylitis (AS) is a disabling systemic disease that seriously threatens the patient's quality of life. Magnetic resonance imaging (MRI) is highly preferred in clinical diagnosis due to its high contrast and tissue resolution. However, since the uncertainty and intensity inhomogeneous of the AS lesions in MRI, it is still challenging and time-consuming for doctors to quantify the lesions to determine the grade of the patient's condition. Thus, an automatic AS grading method is presented in this study, which integrates the lesion segmentation and grading in a pipeline.Approach. To tackle the large variations in lesion shapes, sizes, and intensity distributions, a lightweight hybrid multi-scale convolutional neural network with reinforcement learning (LHR-Net) is proposed for the AS lesion segmentation. Specifically, the proposed LHR-Net is equipped with the newly proposed hybrid multi-scale module, which consists of multiply convolution layers with different kernel sizes and dilation rates for extracting sufficient multi-scale features. Additionally, a reinforcement learning-based data augmentation module is utilized to deal with the subjects with diffuse and fuzzy lesions that are difficult to segment. Furthermore, to resolve the incomplete segmentation results caused by the inhomogeneous intensity distributions of the AS lesions in MR images, a voxel constraint strategy is proposed to weigh the training voxel labels in the lesion regions. With the accurately segmented AS lesions, automatic AS grading is then performed by a ResNet-50-based classification network.Main results. The performance of the proposed LHR-Net was extensively evaluated on a clinically collected AS MRI dataset, which includes 100 subjects. Dice similarity coefficient (DSC), average surface distance, Hausdorff Distance at95thpercentile (HD95), predicted positive volume, and sensitivity were employed to quantitatively evaluate the segmentation results. The average DSC of the proposed LHR-Net on the AS dataset reached 0.71 on the test set, which outperforms the other state-of-the-art segmentation method by 0.04.Significance. With the accurately segmented lesions, 31 subjects in the test set (38 subjects) were correctly graded, which demonstrates that the proposed LHR-Net might provide a potential automatic method for reproducible computer-assisted diagnosis of AS grading.

CT-TEE Image Registration for Surgical Navigation of Congenital Heart Disease Based on a Cycle Adversarial Network.

Transesophageal echocardiography (TEE) has become an essential tool in interventional cardiologist's daily toolbox which allows a continuous visualization of the movement of the visceral organ without trauma and the observation of the heartbeat in real time, due to the sensor's location at the esophagus directly behind the heart and it becomes useful for navigation during the surgery. However, TEE images provide very limited data on clear anatomically cardiac structures. Instead, computed tomography (CT) images can provide anatomical information of cardiac structures, which can be used as guidance to interpret TEE images. In this paper, we will focus on how to transfer the anatomical information from CT images to TEE images via registration, which is quite challenging but significant to physicians and clinicians due to the extreme morphological deformation and different appearance between CT and TEE images of the same person. In this paper, we proposed a learning-based method to register cardiac CT images to TEE images. In the proposed method, to reduce the deformation between two images, we introduce the Cycle Generative Adversarial Network (CycleGAN) into our method simulating TEE-like images from CT images to reduce their appearance gap. Then, we perform nongrid registration to align TEE-like images with TEE images. The experimental results on both children' and adults' CT and TEE images show that our proposed method outperforms other compared methods. It is quite noted that reducing the appearance gap between CT and TEE images can benefit physicians and clinicians to get the anatomical information of ROIs in TEE images during the cardiac surgical operation.

A Fluorescence Resonance Energy Transfer Probe Based on DNA-Modified Upconversion and Gold Nanoparticles for Detection of Lead Ions.

We report a new sensor for the specific detection of lead ions (Pb2+) in contaminated water based on fluorescence resonance energy transfer (FRET) between upconversion nanoparticles (UCNPs) as donors and gold nanoparticles (Au NPs) as receptors. The UCNPs modified with Pb2+ aptamers could bind to Au NPs, which were functionalized with complementary DNA through hybridization. The green fluorescence of UCNPs was quenched to a maximum rate of 80% due to the close proximity between the energy donor and the acceptor. In the presence of Pb2+, the FRET process was broken because Pb2+ induced the formation of G-quadruplexes from aptamers, resulting in unwound DNA duplexes and separated acceptors from donors. The fluorescence of UCNPs was restored, and the relative intensity had a significant linear correlation with Pb2+ concentration from 0 to 50 nM. The sensor had a detection limit as low as 4.1 nM in a buffer solution. More importantly, the sensor exhibited specific detection of Pb2+ in complex metal ions, demonstrating high selectivity in practical application. The developed FRET prober may open up a new insight into the specific detection of environmental pollution.

Astragaloside IV inhibits progression of glioma via blocking MAPK/ERK signaling pathway.

Glioma is one of the most common primary brain tumors in adults with a high mortality rate and relapse rate. Thus, finding better effective approaches to treat glioma has become very urgent. Astragaloside IV (AS-IV), the major active triterpenoid in Radix Astragali, has shown anti-tumorigenic properties in certain cancers. However, its role in glioma remains unclear. Here, we studied the effects of AS-IV on glioma in vitro and in vivo, and explored the underlying mechanisms. Our results revealed that AS-IV dose-dependently inhibited the proliferation of U251 cells in vitro and attenuated tumor growth in vivo. In addition, the migration and invasion ability of U251 cell has been suppressed in presence of AS-IV. The levels of proliferating cell nuclear antigen (PCNA), Ki67, matrix metallopeptidase (MMP) -2, MMP-9 and vascular endothelial growth factor (VEGF) were decreased significantly by the treatment of different concentrations AS-IV. Furthermore, AS-IV also significantly weakened the activation of Mitogen-activated protein kinase/Extracellular regulated protein kinase (MAPK/ERK) signaling pathway in vitro and in vivo. Taken together our study has identified a novel function of AS-IV and provided a molecular basis for AS-IV potential applications in the treatment of glioma and other cancers.

MicroRNA-181 inhibits glioma cell proliferation by targeting cyclin B1.

Small non­coding RNAs from the microRNA family (miRs) are important elements in the posttranscriptional control of gene expression. miRs are known to regulate numerous cellular processes and are of crucial importance during development and in pathological conditions, including tumor initiation and progression. In the present study, the expression level of miR­181 was reduced in glioma tissues compared with the adjacent normal tissues. The enforced expression of miR­181 was able to inhibit cell proliferation in U251 and SHG­44 cells, while antisense miR­181 oligonucleotides (antisense miR­181) enhanced cell proliferation. At the molecular level, these results further revealed that the expression of cyclin B1, a positive cell­cycle regulator, was negatively regulated by miR­181. Therefore, the data reported in the present study demonstrates that miR­181 is an important regulator in glioma. These results may contribute to improving the understanding of the key misregulated miRNAs in glioma.

Relationships between PTEN gene mutations and prognosis in glioma: a meta-analysis.

We conducted a meta-analysis in order to investigate the relationships between PTEN gene mutations and the prognosis in glioma. The following electronic databases were searched for relevant articles without any language restrictions: Web of Science (1945 ~ 2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966 ~ 2013), EMBASE (1980 ~ 2013), CINAHL (1982 ~ 2013), and the Chinese Biomedical Database (CBM) (1982 ~ 2013). Meta-analyses were conducted using the STATA software (Version 12.0, Stata Corporation, College Station, Texas USA). Hazard ratio (HR) with its corresponding 95 % confidence interval (95%CI) was calculated. Six independent cohort studies with a total of 357 glioma patients met our inclusion criteria. Our meta-analysis results indicated that glioma patients with PTEN gene mutations exhibited a significantly shorter overall survival (OS) than those without PTEN gene mutations (HR = 3.66, 95%CI = 2.02 ~ 5.30, P < 0.001). Ethnicity-stratified subgroup analysis demonstrated that PTEN gene mutations were closely linked to poor prognosis in glioma among Americans (HR = 3.72, 95%CI = 1.72 ~ 5.73, P < 0.001), while similar correlations were not observed among populations in Sweden, Italy, and Malaysia (all P > 0.05). Our meta-analysis provides direct and strong evidences for the speculation of PTEN gene mutations' correlation with poor prognosis of glioma patients.

The effects of intracranial pressure monitoring in patients with traumatic brain injury.

BACKGROUND: Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI), there were conflicting outcomes attributable to ICP monitoring according to the published studies. Hence, we conducted a meta-analysis to evaluate the efficacy and safety of ICP monitoring in patients with TBI. METHODS: Based on previous reviews, PubMed and two Chinese databases (Wangfang and VIP) were further searched to identify eligible studies. The primary outcome was mortality. Secondary outcomes included unfavourable outcome, adverse events, length of ICU stay and length of hospital stay. Weighted mean difference (WMD), odds ratio (OR) and 95% confidence intervals (CIs) were calculated and pooled using fixed-effects or random-effects model. RESULTS: two randomized controlled trials (RCTs) and seven cohort studies involving 11,038 patients met the inclusion criteria. ICP monitoring was not associated with a significant reduction in mortality (OR, 1.16; 95% CI, 0.87-1.54), with substantial heterogeneity (I(2) = 80%, P<0.00001), which was verified by the sensitivity analyses. No significant difference was found in the occurrence of unfavourable outcome (OR, 1.40; 95% CI, 0.99-1.98; I(2) = 4%, P = 0.35) and adverse events (OR, 1.04; 95% CI, 0.64-1.70; I(2) = 78%, P = 0.03). However, we should be cautious to the result of adverse events because of the substantial heterogeneity in the comparison. Furthermore, longer ICU and hospital stay were the consistent tendency according to the pooled studies. CONCLUSIONS: No benefit was found in patients with TBI who underwent ICP monitoring. Considering substantial clinical heterogeneity, further large sample size RCTs are needed to confirm the current findings.

[The association of vitamin D receptor gene ApaI and BsmI polymorphism with systemic lupus erythematosus].

OBJECTIVE: To determine the distribution of vitamin D receptor (VDR) gene ApaI and BsmI polymorphism in systemic lupus erythematosus (SLE) and the association with SLE in Chinese Han patients. METHODS: Genomic DNA from 244 Chinese SLE patients and 162 sex and ethnically matched controls were typed for VDR ApaI and BsmI polymorphism combination by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Clinical characteristics were analyzed between different ApaI and BsmI genotypes. RESULTS: There was no significant difference between the distribution frequencies of allelic gene A and a in SLE patients and the controls, but the distribution frequency of genotypes heterozygote Aa in SLE patients was higher than that in the controls (38.9% vs 22.2%, χ(2) = 12.442, P = 0.000). There was no significant difference between the distribution frequency of allelic gene and genotypes of BsmI in SLE patients and the controls (P > 0.05). However, there was significant difference between the distribution frequencies of ApaI and BsmI genotypes combination in SLE patients and the controls (χ(2) = 18.226, P = 0.006). The distribution frequency of genotypes Aa-bb in SLE patients was higher than that in the controls (32.4% vs 17.9%, χ(2) = 10.449 P = 0.001), while the distribution frequency of genotypes Aa-bb in SLE patients was lower than that in the controls (30.3% vs 42.0%, χ(2) = 5.808, P = 0.016). Furthermore, analyzing the effect of VDR ApaI and BsmI polymorphism combination to the symptoms of SLE, significant difference was observed in SLE patients carrying Aa-bb genotypes involved in serositis (P = 0.003), hematological system disorder (P = 0.021), and anti-Sm antibodies (P = 0.01) compared with other genotypes. CONCLUSION: There is significant association between ApaI and BsmI gene polymorphism Aa-bb genotypes and the incidence of SLE in the Han population of China, and genotype Aa-bb is more involved in serositis, hematological system disorder and has a positive effect on production of antibodies.

[Relationship of vitamin D receptor gene Fok I polymorphism with systemic lupus erythematosus].

AIM: To investigate the relationship of vitamin D receptor (VDR) gene Fok I polymorphism with systemic lupus erythematosus (SLE) and to observe VDR mRNA levels in Chinese Han SLE patients. METHODS: Genomic DNAs from 271 Chinese SLE patients and 130 healthy controls were determined for Fok I polymorphism by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP), and VDR mRNA levels from 48 Chinese SLE patients and 38 healthy controls were detected by real-time polymerase chain reaction (RT-PCR). RESULTS: Gene frequencies of allelic F and f were significantly different between the SLE patients and the controls (P=0.001).The relative risk of SLE in the presence of allelic gene F was 1.630 (95%CI=1.210-2.196, P=0.001). The frequency of homozygote FF in the SLE patients was higher than that in the controls (42.8% vs 25.4%, x(2);=11.417, P=0.001). Serositis, anti-dsDNA antibody, anti-Sm antibody and anti-histone antibody in the SLE patients carrying homozygote FF and heterozygote Ff were higher than those in the SLE patients carrying homozygote ff (P=0.001, P=0.001, P=0.047, P=0.001, respectively). The VDR mRNA was decreased in the SLE patients, with a delta;Ct value of 9.26 ± 2.37 (P=0.026), as compared with a delta;Ct value of 7.82 ± 3.05 in the controls (the bigger of the delta;Ct value, the lower of VDR mRNA expression). The delta;Ct value of VDR mRNA in the SLE patients carrying FF and Ff was bigger than that in the SLE patients carrying ff (10.54 ± 1.88 vs 7.15 ± 3.78, P=0.019). CONCLUSION: VDR gene Fok I polymorphism is associated with SLE in the Han population of southern China. The SLE patients carrying F allel ± are more likely to have serositis and produce anti-dsDNA antibody, anti-Sm antibody and anti-Histone antibody, presumably as a result of down-regulation of VDR mRNA.

[Detecting anti-megakaryocyte antibodies in serum of systemic lupus erythematosus patients by indirect immunofluorescence].

This study was purposed to investigate the mechanism of thrombocytopenia in patients with systemic lupus erythematosus (SLE) through detecting anti-megakaryocyte antibodies in SLE patients. The serum anti-megakaryocyte antibodies in 36 SLE cases with thrombocytopenia were detected by using indirect immunofluorescence, the detected results were compared with detected results of 30 SLE cases without thrombocytopenia and 30 healthy persons. The results showed that the positive incidences of anti-megakaryocyte antibody in serum of 36 SLE cases with thrombocytopenia, 30 SLE cases without thrombocytopenia and 30 healthy persons were 19.4% (7/36), 6.7% (2/30) and 3.3% (1/30) respectively. As compared with SLE patients without thrombocytopenia and healthy persons, SLE patients with thrombocytopenia had higher incidence of anti-megakaryocyte antibodies, moreover there was significant difference between SLE patients with thrombocytopenia and healthy persons (p < 0.05), while there was no significant difference between SLE patients with or without thrombocytopenia (p > 0.05). It is concluded that autoantibodies against megakaryocytes exist in SLE patients and may partially contribute to the incidence of thrombocytopenia in SLE patients. The detection of anti-megakaryocyte antibodies with a enough case number is needed to make a final conclusion on thrombocytopenia pathogenesis in SLE.

Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia.

OBJECTIVE: To evaluate the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. METHODS: A group of 45 patients with typical trigeminal neuralgia and 17 patients with atypical trigeminal neuralgia treated by micro-vascular decompression from 2000 to 2002 were reviewed, including their clinical presentations, operative findings, and outcomes. RESULTS: Of 45 patients with typical trigeminal neuralgia, the mean duration was 3.1 years, and the mean age of pain onset was 60.3 years. Single trigeminal division was involved in 20 patients (44.4%), and 2 or 3 divisions were involved in the other 25 patients (55.6%). During the operation, artery compression was found in 39 patients (86.7%), and the combined artery and venous compression was found in 6 patients (13.3%). Postoperatively, complete pain relief was achieved in 44 patients (97.8%), and significant pain relief was achieved in 1 patient (2.2%). As for 17 patients with atypical trigeminal neuralgia, the mean duration and the mean age of pain onset was 8.7 years and 55.5 years, respectively. Two or 3 trigeminal divisions were involved in all of these patients. During operation, artery compression occurred in 10 patients (58.8%), and the combined artery and venous compression was found in 7 patients (41.2%). Postoperatively, complete pain relief was achieved in 5 patients (29.4%), and partial pain relief was achieved in 10 patients (58.8%), and 2 patients showed no response to microvascular decompression. CONCLUSIONS: The operative outcome of microvascular decompression in patients with typical trigeminal neuralgia was better than that of patients with atypical trigeminal neuralgia, which perhaps related to short duration, late onset of pain, limited distribution, artery compression, and complete operative decompression.

Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression.

BACKGROUND: Microvascular decompression has been widely used as the first choice in treating trigeminal neuralgia, but in a few patients, facial pain cannot be effectively controlled by microvascular decompression. We sought to clarify the important factors for good operative outcomes. METHODS: We reviewed 62 patients with trigeminal neuralgia treated by microvascular decompression during the period 2000 through 2002, including clinical presentation, operative findings, techniques, and outcomes. Neurovascular conflicts were divided into single contact, contact and indentation, single adhesion, adhesion and indentation, and trigeminal nerve atrophy. Operative outcomes were graded into immediate postoperative complete pain relief (excellent), delayed postoperative complete pain relief (better), significant pain relief (good), and no response to microvascular decompression (poor). RESULTS: All patients' presentations were typical at the time of pain onset, but the symptom in 17 patients changed to atypical before surgery. During operation, single contact and single adhesion was found in 14 patients and 15 patients, respectively; contact or adhesion in combination with indentation was found in 7 patients and 18 patients, respectively; atrophy occurred in 8 patients. Postoperatively, immediate and delayed complete pain relief was achieved in 32 (51.6%) patients and 17 (27.4%) patients, respectively; 11(17.7%) patients got significant pain relief; and 2 patients showed no response. The overall rate of complete pain relief in patients with shorter duration, typical presentation, artery compression and complete decompression was higher than that in patients with longer duration, atypical presentation, venous compression, and incomplete decompression. CONCLUSIONS: Shorter duration, typical presentation, single artery compression, and complete decompression are the positive factors for better operative outcomes with microvascular decompression. Worse outcomes are usually related to venous compression, longer duration, and atypical presentation.

Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery.

OBJECTIVE: To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. METHODS: Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed. RESULTS: Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves. CONCLUSIONS: Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.