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Objective To assess and compare the performance of fluorine‐18‐labeled fluorodeoxyglucose positron emission tomography (18F‐FDG‐PET/ CT) and gallium‐68‐labeled tetraazacyclododecanetetraacetic acid‐DPhe1‐Tyr3‐octreotate (68Ga‐ DOTATATE) PET/CT in the targeted imaging of culprit tumors causing osteomalacia. Methods This was a clinical retrospective analysis. We analyzed 13 patients (five men, eight women; mean age, 49 years; range, 19–55 years) with suspicion of tumor‐induced osteomalacia (TIO) between March 2017 and October 2019. All patients underwent two functional imaging methods to locate the culprittumors. Studies were performed on a PET/CT scanner. The injection doses of 18F‐ FDG and 68Ga‐DOTATATE were 0.5mCi/kg and approximately 5.0mCi, respectively. In the two scans, the whole body was captured from head to toe 45 to 60 min after intravenous tracer injection. 68Ga‐DOTATATE PET/CT and 18F‐FDG PET/CT imaging results locate culprit tumors according to the following criteria: (i) abnormal foci uptake concentration was observed locally, and the uptake level was higher than the background level of the right lobe of the liver; (ii) combined CT showed or did not have obvious abnormal density changes; and (iii) non‐specific ingestion lesions due to fracture, arthritis, necrosis of femoral head are excluded. Compared with the results of pathological examination and clinical follow‐up, the sensitivity, specificity and accuracy of 68Ga‐DOTATATE PET/CT imaging and 18F‐FDG PET/CT imaging for TIO were analyzed. Results All patients had symptoms of osteomalacia and hypophosphatemia. The lag time (symptoms to PET diagnosis) ranged from 2 to 12 years. There were eight cases of TIO patients and five cases of non‐TIO patients confirmed by surgery, pathology and follow‐up. Among the eight TIO patients, there were six cases (75.0%) of PMTs, one case (12.5%) of giant cell tumor, one case (12.5%) of hemangiopericutoma. Most (n = 6, 75.0%) of the confirmed tumors in our patient population were in the lower extremities, followed by craniofacial regions (n = 1, 12.5%), and torso (n = 1, 12.5%), respectively. Among the five non‐TIO patients, there were two cases of Fanconi syndrome, one case of rickets, and two cases of sporadic osteomalacia hypophosphorus. The culprit tumors could be located either in the bone (n = 5, 62.5%) or the soft tissue (n = 3, 37.5%). 18F‐FDG PET/CT was able to localize the tumor in six (6/13, 46.1%) patients. 68Ga‐DOTATATE PET/CT detected tumor in 8 (83.3%) of 13 patients. The sensitivity of 68Ga‐DOTATATE PET/CT imaging and 18F‐FDG PET/CT imaging in the evaluation of TIO in our patient population were 100% (8/8) vs 75% (6/8). The specificity of the two different methods was 80% (4/5). The overall accuracy was 92.3% (12/13) vs 76.9% (10/13). Conclusions 68Ga‐DOTATATE PET/CT is very effective in assessing hypophosphatemia patients with TIO typical symptoms compared with 18F‐FDG. Therefore, in clinically suspected cases of hypophosphatemic osteomalacia, 68Ga‐DOTATATE PET/CT should be preferred as an imaging modality investigation to avoid delay in the treatment of this disease., A 59‐year‐old man had difficulty working with worsening diffuse bone pain, for more than 3 years. His serum phosphate level was 0.60 mmol/L. 68Ga DOTATATE PET/CT image (A, C) demonstrated an intense activity with maximum standardized uptake value (SUVmax) of 17.2 (arrow) behind the right patella (C, white arrow), whereas 18F‐FDG PET/CT image (B, E) revealed no increased uptake in the soft tissue in the same lesion. The finding was suggestive of a causative tumor. After surgically removing a tumor 1.2 cm in its largest dimension from the right knee, the patient's symptoms promptly improved, and his postsurgical serum level returned to normal at 1.09 mmol/L. The results of the pathological examination confirmed the phosphaturic mesenchymal tumor (F).

Background:Cerebral small vessel disease (SVD) is the common cause of cognitive decline in the old population. MRI can be used to clarify its mechanisms. However, the surrogate markers of MRI for early cognitive impairment in SVD remain uncertain to date. We investigated the cognitive impacts of cerebral microbleeds (CMBs), diffusion tensor imaging (DTI), and brain volumetric measurements in a cohort of post-stroke non-dementia SVD patients.Methods:Fifty five non-dementia SVD patients were consecutively recruited and categorized into two groups as no cognitive impairment (NCI) (n = 23) or vascular mild cognitive impairment (VaMCI) (n = 32). Detailed neuropsychological assessment and multimodal MRI were completed.Results:The two groups differed significantly on Z scores of all cognitive domains (all p < 0.01) except for the language. There were more patients with hypertension (p = 0.038) or depression (p = 0.019) in the VaMCI than those in the NCI group. Multiple regression analysis of cognition showed periventricular mean diffusivity (MD) (β = −0.457, p < 0.01) and deep CMBs numbers (β = −0.352, p < 0.01) as the predictors of attention/executive function, which explained 45.2% of the total variance. Periventricular MD was the independent predictor for either memory (β = −0.314, p < 0.05) or visuo-spatial function (β = −0.375, p < 0.01); however, only small proportion of variance could be accounted for (9.8% and 12.4%, respectively). Language was not found to be correlated with any of the MRI parameters. No correlation was found between brain atrophic indices and any of the cognitive measures.Conclusion:Arteriosclerotic CMBs and periventricular white matter disintegrity seem to be independent MRI surrogated markers in the early stage of cognitive impairment in SVD.

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To enhance the accuracy of radioactive seed implants in the head and neck, a digital model individual template, containing information simultaneously on needle pathway and facial features, was designed to guide implantation with CT imaging. Thirty-one patients with recurrent and local advanced malignant tumors of head and neck after prior surgery and radiotherapy were involved in this study. Before (125)I implants, patients received CT scans based on 0.75mm thickness. And the brachytherapy treatment planning system (BTPS) software was used to make the implantation plan based on the CT images. Mimics software and Geomagic software were used to read the data containing CT images and implantation plan, and to design the individual template. Then the individual template containing the information of needle pathway and face features simultaneously was made through rapid prototyping (RP) technique. All patients received (125)I seeds interstitial implantation under the guide of the individual template and CT. The individual templates were positioned easily and accurately, and were stable. After implants, treatment quality evaluation was made by CT and TPS. The seeds and dosages distribution (D(90),V(100),V(150)) were well meet the treatment requirement. Clinical practice confirms that this approach can facilitate easier and more accurate implantation.

No clear consensus has been reached at the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and Alzheimer's disease (AD) risk. Thus in this meta-analysis, a total of 19 case-control studies was assessed to evaluate the possible association. The data demonstrated that the frequency of T677 allele (T vs. C) was significantly associated with susceptibility to AD in all subjects (OR=1.15, 95% CI=1.06-1.26) and in East Asians (OR=1.22, 95% CI=1.08-1.39). There was statistical difference between AD patients and the controls under recessive genetic mode (CT+TT vs. CC) and homozygote comparison (TT vs. CC) in all subjects and in East Asians as well. Despite a small effect of the polymorphism on late-onset AD (LOAD) risk, MTHFR C677T polymorphism was not a major risk factor for LOAD in East Asians and Caucasians. A subgroup analysis in the subjects without APOE epsilon4 alleles showed T677 allele significantly increased risk of AD in all subjects (OR=1.21, 95% CI: 1.04-1.42) and in East Asians (OR=1.28, 95% CI: 1.06-1.55). However, no association was found in Caucasians. In conclusion, this meta-analysis supports that MTHFR C677T polymorphism is capable of causing AD susceptibility in East Asians, not in Caucasians.

To investigate general practitioners (GPs)' attitudes and confidence in handling dementia and its related problems.A questionnaire survey was conducted in GPs from Shanghai on 25th Sep, 2012. The questionnaire included the basic information of the GPs and their attitudes toward and confidence in handling dementia and its related problems.A total of 287 GPs from 73 hospitals participated in the survey.78.4% of them responded that they met fewer demented patients during their clinical practice and only 24.7% of them had attended some kinds of dementia-related knowledge training courses.Senior GPs were less enthusiastic than junior GPs in handling dementia and its related problems as they were more likely to think that dementia should be diagnosed by specialist (87.1% vs. 74.8%, OR = 2.28, 95%CI:1.14~4.57, P = 0.02), less likely to actively referral patients (22.0% vs. 10.1%, OR = 2.52, 95%CI:1.24~5.14, P = 0.01), and more likely to think about that GPs have very limited role in care of demented patients (9.7% vs. 0.7%, OR = 15.59, 95%CI:1.96~123.81, P = 0.00).The GPs in Shanghai are lack of trainings about the dementia and its' related knowledge and their attitudes toward the care of dementia are pessimistic. Thus, it is necessary to train the GPs more to enhance their confidence and enthusiasm in care of dementia.

Background and Purpose: To assess the validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) in the detection of vascular mild cognitive impairment (VaMCI) in patients with subcortical ischemic vascular disease (SIVD). Methods: Among 102 SIVD patients, both cutoff scores of the MMSE and MoCA for differentiating VaMCI from no cognitive impairment (NCI) or differentiating VaMCI from vascular dementia (VaD) were determined by the receiver operator characteristic (ROC) analysis. Optimal sensitivity with specificity of cutoff scores was obtained after the raw scores were adjusted for education. Results: After adjusting for education, the MoCA cutoff score for differentiating VaMCI from NCI was at 24/25 and that for differentiating VaMCI from VaD was at 18/19. After applying the adjusted MoCA scores from 19 to 24 to identify VaMCI in all SIVD patients, sensitivity was at 76.7% and specificity was at 81.4% (κ = 0.579). The adjusted cutoff score of the MMSE for differentiating VaMCI from NCI was at 28/29 and that for differentiating VaMCI from VaD was at 25/26. The sensitivity and specificity of the adjusted MMSE was at 58.1 and 71.2%, respectively, when using the score from 26 to 28 to identify VaMCI in SIVD patients (κ = 0.294). Conclusions: The MoCA detected subcortical VaMCI better than the MMSE.

To analyze the factors affecting on early efficacy of intravenous thrombolysis with alteplase.The clinical data of 100 acute cerebral infarction patients treated by intravenous thrombolysis with alteplase were retrospectively analyzed. The patients were divided into early effective group and ineffective group, which assessed by National Institute of Health Stroke Scale (NIHSS) with criteria of whether there were3 or not at 24 hours after therapy. Univariate analysis and multivariate logistic regression analysis were used to determine the differences of clinical data between the two groups.Univariate analysis revealed that the early improvement was significantly associated with favorable outcome at 3 month (P = 0.000). Multivariate logistic analysis revealed that the systolic pressure at baseline was moderately positively associated with early improvement (OR 1.031, 95%CI 1.008 - 1.056, P = 0.009).Moderately lower baseline systolic pressure is associated with early improvement after thrombolytic therapy which is associated with favorable outcome at 3 month.

To compare distribution difference in risk factors of patients with first-ever ischemic stroke (IS) of different age and gender.A total of 1027 patients admitted to the neurological department in Shanghai Renji Hospital with first-ever IS were recruited and divided into young adult group (50 years old), middle-aged group (50 - 80 years old), and very old group (80 years old) according to their ages. Risk factor analysis included history of smoking, high alcohol consumption, hypertension (HT), diabetes mellitus (DM), heart diseases, atrial fibrillation (AF) and family history of cardiovascular diseases.Female patients were globally older than male patients (71.1 vs 65.7, P0.001) at the first attack of IS and having higher prevalence of DM (26.8% vs 19.2%, P = 0.004), heart diseases (28.8% vs 19.2%, P0.001) and AF (7.6% vs 3.9%, P = 0.009). However, female patients were less likely to drink heavily (1.0% vs 31.6%, P0.001) or smoke (4.4% vs 59.9%, P0.001) than the male patients. The rates of smoking and heavy drinking in young adult group were higher than that in other two groups. Patients in very old group had higher prevalence of heart diseases and AF but lower proportion of positive family cardiovascular diseases history than patients in other two groups. HT and DM were equally frequent among three groups. In young adult group, female patients were more likely to have heart diseases and family history of heart diseases (P = 0.015 and P = 0.048). In middle-old group, HT, DM, heart disease and AF were more common in women than in men (P = 0.021, P = 0.004, P = 0.001 and P = 0.039).There are differences in risk factor distribution in patients with first-ever IS of different age and gender. Therefore, screening and health education should be performed in allusion to different risk factors.

To evaluate the clinical characteristics of patients with depressive disorders at Department of Neurology in general hospitals.A total of 596 consecutive patients with depressive symptoms, such as insomnia, or somatic symptoms were collected prospectively and those who were unable to answer the questionnaire were excluded. Data of demography and clinical characteristics were obtained from a questionnaire. The 17-item Hamilton depression rating scale (HDRS17) was used to identify the presence of depressive disorders. Case control method was employed to evaluate the clinical characteristics of patients with depressive disorders.Among all patients, 347 were diagnosed as depressive disorders (58.1%). The mean score of HDRS17 was 21.9 ± 3.4. Fewer psychological symptoms were complained by patients with depressive disorder. The depressive mood was found in 146 (41.2%), a loss of interest or pleasure 161 (46.4%)and depressive mood plus a loss of interest or pleasure 108 (31.3%). The factors of manual worker, lower education level, worse marital status, lower economic status, irregular lifestyle and coexisting medical conditions were associated with depressive disorders. The most frequent complaints of somatic symptoms were as follows: hard to fall asleep 254 (73.2%), early awakening 218 (76.0%), poor memory 219 (63.1%), fatigue 181 (52.2%), palpitation 179 (51.6%), dizziness 170 (49.0%), headache 160 (46.1%) and dyspnea 140 (40.3%). The mean number of somatic symptoms was 6.87 ± 2.78. The patients complaining of multiple somatic symptoms (≥ 4) was 322 (92.8%). The number of somatic symptoms was correlated with depressive disorders.More minor depression and somatic symptoms are the main characteristics of patients with depressive disorder in general hospitals.

To describe the impact of stroke clinic on the usage of statins for secondary prevention of ischemic stroke.Data about the demography, social economic status, personal histories, blood lipid profiles, and the status of the usage of statins from 568 serial ischemic stroke patients were retrospectively analysed.A total of 51.3% patients followed up in stroke clinic (306 patients) and 7.6% patients followed up in general clinic (262 patients) were treated with statins. 71.6% patients with and 44.8% patients without hyperlipidemia in stroke clinics were taking statins, which were higher than that patients in the general clinics (27.1% and 2.0% respectively). The patients in the stroke clinics with high LDL-C level (3.4 mmol/L) were more likely to be treated with statins than those with lower level (25.6% vs 14.7%, P=0.017).The rate of statins usage is extremely low in stroke patients followed up in a general clinic, but it can been improved greatly in a stroke clinic. Stroke clinic can narrow the gap between the clinical practice and the guideline for secondary prevention of ischemic stroke.

Background/Aims: To investigate whether diffusion tensor imaging (DTI) is more sensitive than conventional MRI at detecting cognitive deterioration in patients with subcortical ischemic vascular disease (SIVD). Methods: Forty-two SIVD patients had a diagnosis of no cognitive impairment (NCI), vascular cognitive impairment/no dementia or vascular dementia (VaD). Whole-brain DTI histography and routine MRI were performed on these participants. Results: There were significant differences between cognitively impaired patients and NCI subjects in mean diffusivity and fractional anisotropy in either whole-brain white matter (WBWM) or in normal-appearing white matter (NAWM). All DTI indices within either WBWM or NAWM were found to be significantly correlated with both the attention-executive and memory measures in SIVD subjects. Lacune numbers and T2-weighted lesions correlated only with attention-executive measures, whereas hippocampal volumes correlated only weakly with memory measures. Whole-brain gray matter volumes correlated with Z scores for all cognitive domains but language. After VaD patients had been excluded from the analysis, cognitive measures remained significantly correlated with some of the DTI indices, but not with conventional MRI findings. Conclusions: Compared with conventional MRI, whole-brain DTI is a more reliable and sensitive technique for the early detection of cognitive impairment in SIVD patients.

To evaluate the efficacy of donepezil for post-stroke aphasia.Sixty patients with acute post-stroke aphasia were divided into treatment group and a control group. All patients had been treated for secondary prevention according to the guideline. The treatment group received donepezil hydrochloride (5 mg/d) for 12 weeks. The efficacy of treatment was measured by comparing the changes of scores of Western Aphasia Battery (WAB) between baseline and 12 weeks later.Compared with the baseline, the changes of scores of all items of WAB and Aphasia Quotient (AQ) in both group after 12 weeks follow-up were great, however, the change of AQ was significantly greater in donepezil group (34.14 +/- 17.70)than that in control group (20.69 +/- 17.26)(P = 0.004). The patients in donepezil group also showed significant recovery in spontaneous speech, comprehension, repetition, and naming than those in control group (P0.05). The rate of significant improving in donepezil group was 60.0% which was significantly greater than that in control group (26.7%) (P = 0.009).There are spontaneous recovery of post-stroke aphasia within 3 months. Donepezil may facilitate the recovery in spontaneous speech, comprehension, repetition, and naming functions.

To test a new method to manufacture a maxillary applicator containing radioactive seeds for brachytherapy of malignant neoplasms based on computer aided design (CAD) and rapid prototyping (RP).Six patients with maxillary malignancy which had eroded the inferior wall of orbit and skull base were included in this study. After excision of the tumors, head CT data of these patients were transmitted into the computer. Three-dimensional digital image of the patient's defected region was then obtained with special software processing based on Mimics 8.11 and Geomagic 7.0 and the resin cast of the defected region was manufactured by rapid prototyping. The elastic obturator was then made on this resin cast which can duplicate the undercut tissue of the defected region. After the obturator was completed, the radiotherapy plan was made. (125)I radioactive seeds were implanted into the tissues, and they were also implanted into the target area of the obturator which was used as a maxillary applicator at the same time. The number of radioactive seeds was then counted and the stability of radioactive seeds was determined by CT examination. All these 6 patients were followed-up for 12 months.All the obturators had good retention and stability and fitted the designed target tissue very well. (125)I radioactive seeds in the form of the obturator applicator were stable. For all patients, the total number of radioactive seeds used was 189. Among them, 105 seeds, 55.6% of the total, were contained in obturator applicators. After the obturator applicators were used, the amount of radioactive seeds irradiating the target regions was significantly increased when compared with that of before. After follow-up of 12 months, there was no recurrence nor severe complications.(125)I radioactive seeds contained maxillary applicator made by computer aided design and rapid prototyping can effectively improve the brachytherapy of (125)I when it is used for the post-operation radiotherapy of maxillary malignant tumors.

To evaluate the value of (18)F-FDG and (11)C-MET PET-CT scan in differentiation of brain ringlike-enhanced lesions on MRI imaging.Forty-one brain ringlike-enhanced lesions on MRI imaging including 30 brain tumors and 11 non-neoplastic lesions confirmed pathologically or clinically underwent (18)F-FDG and (11)C-MET PET-CT brain scan. Among them, 15 patients who were suspected to have brain metastasis received body scan by (18)F-FDG PET-CT. Both images were analyzed visually and semi-quantitatively.Visual analysis: for brain tumors the diagnostic sensitivity, specificity and accuracy of (18)F-FDG PET-CT was 53.3%, 72.7%, 58.5%, versus 96.7%, 90.9%, 95.1% of (11)C-MET PET-CT, respectively. All the primary foci in 9 patients with brain metastases were detected by body (18)F-FDG PET-CT scan. Semiquantitative analysis: There was a significant difference in the uptake between highly differentiated malignant and poorly differentiated tumors as well as non-neoplastic lesions for both tracers (P0.01), while between low-grade malignant tumors and non-neoplasm lesions, there was a difference in uptake only by (11)C-MET (P0.01). No significant difference between the uptakes in brain metastasis and glioblastomas was found by both tracers (P0.05).Both (18)F-FDG and (11)C-MET PET-CT are useful in differentiation of brain ringlike-enhanced lesions on MRI imaging. (11)C-MET PET-CT is more helpful than (18)F-FDG PET-CT in differential diagnosis of low-grade neoplastic from non-neoplastic lesions. Combination of (18)F-FDG and (11)C-MET PET-CT scans can improve the accuracy of differential diagnosis for brain ringlike-enhanced lesions on MRI imaging.

To identify the prevalence and risk factors that were associated with post-stroke cognitive impairment (PSCI) among a large cohort of consecutive ischemic stroke patients.526 consecutive patients, who had suffered from ischemic stroke 3 months ago were recruited in this study. Patients were classified as having no cognitive impairment (NCI), cognitive impairment but no dementia (CIND) and vascular dementia (VaD) according to their cognitive function. They were also categorized as with subcortical ischemic vascular diseases (SIVD) or cortical ischemic vascular diseases (CIVD) with neuroimaging findings. Their demographic data, vascular risk factors and stroke characteristics were also documented.The overall prevalence of PSCI (CIND + VaD) was 36.7%. Compared with the NCI subjects, PSCI subjects were older, more dominant femininely, less educated, with more cases of right hemi-paralysis and higher depression scores, but did not have more specific vascular risk factor. Separately, VaD patients demonstrated lower economic level, less spouse-caring, more prevalence of dysphasia, higher rate of incontinence and more cases with CIVD, while CIND patients had more cases with SIVD. The VaD patients had more cortical lesions and lower depression scores than the CIND patients. On logistic regression analysis, older age, female gender, lower economic level, dysphasia, SIVD, CIVD and higher depression scores were independent risk factors for PSCI.PSCI is common among ischemic stroke patients and related to demographic factors, stroke types, and depression.

To describe the clinical features of patients with posterior circulation ischemic stroke.216 patients with posterior circulation ischemic stroke admitted in our department during 2004-2006 were analyzed retrospectively. All patients were undertaken MRI on admission and responsible lesions were identified at the posterior circulation territories. The patients' clinical symptoms and signs were evaluated and the relationships between lesion locations and clinical characteristics were analyzed.The common symptoms of posterior circulation ischemic stroke were unilateral limb weakness (81.9%), speech difficulty (46.3%), dizziness (33.8%), and unilateral limb numbness (31.0%). The common signs of posterior circulation ischemic stroke were unilateral limb weakness (81.9%), central facial or lingual palsy (61.1%), dysarthria (46.3%), unilateral limb sensory loss (31.0%), and ataxia (30.1%). The incidence of crossed paralysis was low (2.8%). Isolated vertigo was rare (1.4%). Predominant clinical features such as bulbar paralysis, unconsciousness, visual disorder and amnesia can help to localize the lesions. Typical brainstem syndromes had topographic meanings.The clinical features of patients with posterior circulation ischemic stroke were complex. Predominant symptoms can help to diagnose the posterior circulation ischemic stroke.

With the physician training program and stroke clinic, the gap between clinical practice and the guideline for secondary prevention of ischemic stroke can been narrowed.305 patients with ischemic stroke were enrolled in a stroke clinic after their discharge from the hospital. Among the 305 patients, 87 were discharged before the institution of a physician training program (pre-training group) and 218 after the institution (post-training group). Their usage of antithrombotic agents, statins, non-standardized therapies and antihypertensive agents were compared at the time of discharge from the hospital and follow-up in the stroke clinic comparison was also made for the two groups of patients discharged before and after the physician training program.After the physician training program, implementation rates increased for antithrombotic agents (79.3% vs 93.1%, P0.01) and statins (19.5% vs 59.2%, P0.01), using of non-standardized therapies decreased (47.1% vs 27.5%, P = 0.001), but no change was found for using of antihypertensive agents (88.4% vs 94.0%, P0.05). Comparing with the usage of medications at the time of discharge, the usage of antithrombotic agents and statins after discharge i,e. in the stroke clinic were further increased (for antithrombotics, in the pre-training group 79.3% vs 86.2%, P = 0.229, in the post-training group 93.1% vs 94.0%, P = 0.696; for statins, in the pre-training group 19.5% vs 39.1%, P = 0.005, in the post-training group 59.2% vs 69.7%, P = 0.021), while the usage of non-standardized therapies decreased further (in the pre-training group 47.1% vs 17.2%, P0.01, in the post-training group 27.5% vs 14.2%, P = 0.001). Implement of guideline at discharge influenced the compliance as the patients with high rates of usage of antithrombotic agents and statins at the time of discharge had also high rates of the usage of them at follow-up in the stroke clinic.Physician training program increases the implement of the guideline for secondary stroke prevention and stroke clinic can improve the compliance with it. Usage of medications at the time of discharge influences the compliance with them during the follow-up period.

To test a new cast-making method based on computer aided design (CAD) and rapid prototyping (RP) technology for defected maxilla.Head CT data of 12 patients with defected maxilla were transmitted into a computer. Three-dimensional digital image of the patient's defected maxilla was then obtained based on Mimics 8.11 and Geomagic 7.0 and the plastic cast of the defected region was manufactured by prototyping. The obturator was made on this plastic cast that duplicated the undercut tissue of defected area. The prominent part of the obturator was made of elastic heat-curing resin and it was helpful to gain the retention through the engagement between the obturator and the tissue undercut. After the obturator was finished, the upper removable partial denture was fabricated in conventional method. The combination of these two parts was achieved using magnetic attachment. Clinical effects of obturator and removable partial denture were evaluated and the nasalance value of 5 patients before and after insertion of the obturator was measured using nanometer.The obturator and removable partial denture could be seated into place separately. They all had good retention and stability. After the obturator was seated in place, the nasalance of non-nasal and vowel text decreased from (46.53 +/- 13.86)% to (22.60 +/- 8.52)% (P0.001).The cast-making method based on CAD and RP technology for cast-making of defected maxilla is feasible and practical.

Background Studies were carried out to detect brain tissue damage in patients with vascular cognitive impairment (VCI) using diffusion tensor imaging (DTI) histogram analysis, and to determine the correlations between DTI histogram-derived measures and Mini-Mental State Examination (MMSE) scores. Methods Conventional MRI and DTI scans were performed on 19 patients with VCI, 19 age- and sex-matched post-stroke patients without cognitive impairment (stroke group) and 19 cognitively normal subjects (CN group). Histograms of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of the whole brain were analyzed. Results Analysis showed that the patterns of the whole brain ADC and FA histograms of the VCI group differed from those of the stroke and CN groups. Compared with those of the two control groups, the mean FA value was significantly lower and the FA histogram peak height was higher in the VCI group. However, the patterns of the whole brain ADC and FA histograms in the stroke group were similar to those of the CN group, and there were no significant differences in any of the DTI histogram-derived measures between these two groups. The mean FA value, the FA histogram peak height, and the FA histogram peak location in VCI patients correlated with the MMSE scores. Conclusions Our findings suggest that VCI leads to abnormal diffusion in brain tissue, and that DTI histogram-derived measures might be used to monitor the severity of cognitive impairment in this disease.

To look for the way of three-dimensional simulation of the craniofacial system.A three-dimensional laser scanner was used for gypsum models digitization and computed tomography scans was employed for skull reconstruction, then the data of teeth and temporomandibular joint were picked up and integrated. The ARCUS sigma system was used to record spatial mandibular movements. The data of both digital reconstruction and spatial movements were transferred into one coordinate system. The software for three-dimensional simulation was programmed.The preliminary program could be used to analyze static and dynamic occlusion and gnathic relations, to check the contact points and to show from various visual angles and slices. The occlusal plane, curves, and helical axis were initially defined and displayed.Using available instruments and methods, we developed the primary edition for three-dimensional simulation of the craniofacial system. However, it is far from a mature system and there is still plenty of work to be done.

Surgery to reshape the nose with an implant has been a regular procedure for enhancing a patient's appearance and self-confidence. The purpose of this study was to establish a three-dimensional surgical simulation system. which can provide the patients with realistic prediction of their own postoperative appearance in computer and specifically produce a nose implant for an individual patient.Preoperative CT data and image-processing techniques were employed to generate a three dimensional template of the papatient' s face. Three-dimensional morphing processes were then applied to predict and compare the outcome of plastic procedures on a patient-specific nose surface, according to the patient' s expectation. By comparing and revising the changes before and after simulation, digital prototypes of the nose implants could be generated. The templates to create custom-made silicone implants were than produced by a computer controlled device.Accurately regeneration of 3-D images and realistic operative simulations could be achieved with this system. The implants produced exactly conformed to the results of simulation. No curving and reshaping were needed during operating. The clinical results extremely matched with the simulations.The system enhances surgeon-patient communication and facilitates preoperative planning. It is especially desirable for implant surgery with less guesswork of size, contour, and orientation of the implant. The best chance of optimal results could be achieved.

Background: Estrogen promotes and modulates vascular endothelial function, which may be protective against development of atherosclerosis. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, has been reported to be associated with the impairment of vascular endothelial function. Recent studies suggested estrogen replacement therapy lowers plasma concentrations of ADMA in healthy postmenopausal women. However, the relation between endogenous estrogen and ADMA and their effect on endothelial function in patients with coronary heart disease (CHD) remains unclear. Methods: Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) of the brachial arteries were detected by using high-resolution ultrasound in 33 women with CHD and 17 healthy controls. Plasma estradiol, ADMA, and lipid concentrations were also measured in all subjects. Results: In comparison with control group, FMD and NID were significantly decreased in the CHD group (1.73±1.26% vs. 5.37±3.20%, p