Search

Reverse end-to-side (RETS) nerve transfer has become increasingly popular in patients with severe high ulnar nerve injury, but the reported outcomes have been inconsistent.To evaluate the "babysitting effect," we compared outcomes after anterior interosseous nerve RETS transfer with nerve decompression alone. To evaluate the source of regenerating axons, a group with end-to-end (ETE) transfer was used for comparisons.Electrophysiology measures were used to quantify the regeneration of anterior interosseous nerve (AIN) and ulnar nerve fibers while functional recovery was evaluated using key pinch and Semmes-Weinstein monofilaments. The subjects were followed postsurgically for 3 years.Sixty-two subjects (RETS = 25, ETE = 16, and decompression = 21) from 4 centers in Western Canada were enrolled. All subjects with severe ulnar nerve injury had nerve compression at the elbow except 10 in the ETE group had nerve laceration or traction injury. Postsurgically, no reinnervation from the AIN to the abductor digiti minimi muscles was seen in any of the RETS subjects. Although there was no significant improvement in compound muscle action potentials amplitudes and pressure detection thresholds in the decompression and RETS group, key pinch strength significantly improved in the RETS group ( P.05).The results from published clinical trials are conflicting in part because crossover regeneration from the donor nerve has never been measured. Unlike those with ETE nerve transfers, we found that there was no crossover regeneration in the RETS group. The extent of reinnervation was also no different from decompression surgery alone. Based on these findings, the justifications for this surgical technique need to be carefully re-evaluated.

Propagation of high-current relativistic electron beam (REB) in plasma is relevant to many high-energy astrophysical phenomena as well as applications based on high-intensity lasers and charged-particle beams. Here we report a new regime of beam-plasma interaction arising from REB propagation in medium with fine structures. In this regime, the REB cascades into thin branches with local density hundred times the initial value and deposits its energy two orders of magnitude more efficiently than that in homogeneous plasma, where REB branching does not occur, of similar average density. Such beam branching can be attributed to successive weak scatterings of the beam electrons by the unevenly distributed magnetic fields induced by the local return currents in the skeletons of the porous medium. Results from a model for the excitation conditions and location of the first branching point with respect to the medium and beam parameters agree well with that from pore-resolved particle-in-cell simulations., Comment: 8 pages, 5 figures

One of the most promising approaches to reach a high gain in inertial confinement fusion is the fast ignition scheme. In this scheme, a relativistic electron beam is generated; this passes through the imploded plasma and deposits parts of its energy in the core. However, the large angular spread of the relativistic electron beam and the poorly controlled compression of the target affect realization of the fast ignition technique. Here, we demonstrate that indirectly driven (that is, driven by X-rays generated inside a gold hohlraum) implosions with a ‘high-foot’ and a short-coast time of less than 200 ps allow us to tightly compress the shell. Furthermore, we show the ability to optimize the symmetry of the imploding shell by changing the hohlraum length, successfully tuning a suitable tube-shaped shell to compensate for the large angular spread of the relativistic electron beam and to enhance the electron-to-core coupling efficiency via resistive magnetic fields. Benefiting from those experimental techniques, a significant enhancement in neutron yield was achieved in our indirectly driven fast ignition experiments. These results pave the way towards high-coupling fast ignition experiments with indirectly driven targets similar to those at the National Ignition Facility. Experiments realizing the indirect-drive fast ignition scheme for inertial confinement fusion are reported. Enabled by a tightly compressed target, an increase of neutron yield is observed.

Based on the basic theories of Poole Frenkel (P-F) emission, Fowler Nordheim (F-N) tunnel and Ohmic transport models, the linear relationship between breakdown voltage (BV) and leakage, I-V and accelerated stress test (AST) characteristics of a-Si dielectric layers are analyzed by the manufactured metal-to-metal (MTM) anti-fuse cells in details. The effects of different ion implant conditions on the amorphization degree of a-Si films are characterized by X-Ray diffraction (XRD). Meanwhile, the influence of annealing and ion implant process on the electrical properties of a-Si thin films are studied. Lastly, it is found that the implantation of E15 Si, Ar and SiF3 ions can promote the further amorphization of a-Si films, effectively improve the BV uniformity, reduce the leakage current and enhance the reliability of MTM anti-fuse cells. Especially, SiF3 ion implantation can reduce the leakage current of MTM anti-fuse cells by two orders of magnitude, which is mainly attributed to a-Si conductive band being greatly elevated by strong negative F ions, and it results in the increase of the potential barrier of a-Si/metal interface. Therefore, it can be further proved that SiF3 ion implant process may promote modification of a-Si films.

Transport of high-current relativistic electron beams in dense plasmas is of interest in many areas of research. However, so far the mechanism of such beam-plasma interaction is still not well understood due to the appearance of small time- and space-scale effects. Here we identify a new regime of electron beam transport in solid-density plasma, where kinetic effects that develop on small time and space scales play a dominant role. Our three-dimensional particle-in-cell simulations show that in this regime the electron beam can evolve into layered short microelectron bunches when collisions are relatively weak. The phenomenon is attributed to a secondary instability, on the space- and timescales of the electron skin depth (tens of nanometers) and few femtoseconds of strong electrostatic modulation of the microelectron current filaments formed by Weibel-like instability of the original electron beam. Analytical analysis on the amplitude, scale length, and excitation condition of the self-generated electrostatic fields is clearly validated by the simulations.

The COVID-19 disease broke out globally, bringing great challenges to public health security and increasing the difficulties in constructing ecological civilization governance system. Under the leadership of the Central Committee of the Communist Party of China with Comrade Xi Jinping at its core, the Chinese Government and people have fought against the disease with courage and put people’s health and safety first. Through hard work, China has made achievements in controlling the COVID-19 pandemic and accelerated the restoring of work and life back to normalcy. While continuing to control the pandemic domestically, China promotes the building of a human community with shared destiny, and plays an active role in promoting global cooperation in public health, contributing extraordinarily to global public health and world economy. Guided by Xi Jinping’s Thought of Ecological Civilization, China has endeavored for modernization characterized by harmonious coexistence between man and nature. In response to the current crisis in public health and the challenges facing human–nature harmony thus incurred, the Editorial Department of Chinese Journal of Urban and Environmental Studies has co-hosted a seminar with CASS Thinktank for Eco-civilization Studies, aiming at brainstorming on and enhancing faith in continuing the building of an ecological civilization after completing the construction of a moderately well-off society in all respects. This paper intends to call for other countries to exchange and cooperate in building ecological civilization and building the world into a beautiful home for all.

This pilot study aimed to investigate the feasibility of trans-oral ultrasonography of the temporomandibular joint (TMJ) in oblique sagittal plane. Six volunteers who were receiving residency training at Hainan Hospital of General Hospital of Chinese PLA were recruited into this study, five of them had normal TMJ and one had anterior displaced disc all of which had been confirmed by MRI. A hockey-stick-shaped ultrasound probe was placed between the cheek and maxilla to push against the mucosa lateral to posterior maxillary tuberosity, and every volunteer underwent bilateral scans. The sonographic imaging were completed successfully on the six volunteers; the condyle, the superior and the inferior head of the lateral pterygoid muscle, the disc and the maxillary vein were clearly identified in all the twelve ultrasonographic scans. The feasibility of trans-oral ultrasonography of TMJ in oblique sagittal plane was confirmed.探索经口对颞下颌关节进行斜矢状位超声成像的可行性。选取2019年2—5月于解放军总医院海南医院接受住院医师规范化培训的志愿者6名，其中5名经MRI证实双侧颞下颌关节结构正常，1名为双侧关节盘前移位，用拐杖形超声探头经上颌前庭沟和颊部软组织之间进入颊廊直至上颌结节后外方黏膜，对颞下颌关节进行斜矢状位超声扫描，每名志愿者均扫描双侧关节。6名志愿者均顺利完成超声扫描，12侧关节的超声图像均可清晰辨认髁突、翼外肌上下头、上颌静脉和关节盘。经口对颞下颌关节进行斜矢状位超声成像具备一定的可行性。.

Detailed transmission electron microscopy examinations verified that α′-martensite formed in micron-sized pillars is nearly dislocation free, surprisingly different than its counterpart in bulk samples, which usually contains a high dislocation density. Furthermore, the martensite was found to nucleate at the intersection between two packets of stacking faults in this low stacking fault energy material. A corresponding mechanism for the nucleation and growth of martensite in micron-sized pillars was proposed.

In this study, an interval fuzzy-robust two-stage stochastic-robust programming (IFRTSRP) model is developed for water resources management under uncertainty. The developed IFRTSRP model incorporates two-stage stochastic programming (TSP), fuzzy robust programming (FRP), interval linear programming (ILP), and stochastic robust optimization (SRO) within a general optimization framework. The IFRTSRP model can not only deal with uncertainties presented as probability distributions, fuzzy membership functions, discrete interval numbers, and their combinations, but also provide an effective linkage between the pre-regulated water resources management policies and the associated economic implications. The IFRTSRP model can also enhance the robustness for the optimization process by delimiting the uncertain decision space through dimensional enlargement of the original fuzzy constraints. Moreover, the IFRTSRP model can evaluate the trade-offs between system economy and stability by incorporating the variability measures on penalty costs into the objective function. The IFRTSRP model is applied to a hypothetical case study of water resources management. The results indicate that reasonable solutions would be generated under different levels of λ and/or ω (non-negative weight coefficients); moreover, a higher net system benefit would correspond to lower system stability and higher system failure risk. Thus, the modeling results can be used for generating decision alternatives and thus help the managers to identify desired water allocation policies based on the reasonable consideration of system economy, system stability, and system failure risk.

6 cases died, and 6 cases survived, including 4 cases with pulmonary function disturbance to different degrees; 12 cases had ABCA3 gene mutations, 9 cases had composite ABCA3 gene mutations, in 11 cases the mutation occured in the exon of coding region, in 1 case in the intron, 9 cases had heterozygous mutations, 3 cases had homozygous mutations.

It is shown that the filamentation instability of relativistically intense laser pulses in plasmas can be mitigated in the case where the laser beam has an elliptically distributed beam profile. A high-power elliptical Gaussian laser beam would break up into a regular filamentation pattern-in contrast to the randomly distributed filaments of a circularly distributed laser beam-and much more laser power would be concentrated in the central region. A highly elliptically distributed laser beam experiences anisotropic self-focusing and diffraction processes in the plasma channel ensuring that the unstable diffractive rings of the circular case cannot be produced. The azimuthal modulational instability is thereby suppressed. These findings are verified by three-dimensional particle-in-cell simulations.

We use three-dimensional particle-in-cell simulations to demonstrate that a plasma density channel can stably guide the petawatt laser pulse in near critical plasmas. In this regime, a directed, collimated, and micro-sized gamma photon beam is emitted by the direct-laser accelerated electrons along the channel axis. While in the case without the plasma density channel, the laser tilting behavior leads to the generation of randomly deflected gamma photon beams with a large divergence angle and transverse source size. In addition, in the plasma density channels, the divergence angle of the gamma photon beams can be much reduced by using a smaller value of n0/a0nc. The energy conversion efficiency can also be improved by increasing the laser power or the plasma density. This regime provides an efficient and compact approach for the production of high quality gamma photon beams.

The electric-field (E-field) controlled exchange bias (EB) in a Co90Fe10/BiFeO3 (BFO)/SrRuO3/PMN-PT heterostructure has been investigated under different tensile strain states. The in-plane tensile strain of the BFO film is changed from +0.52% to +0.43% as a result of external E-field applied to the PMN-PT substrate. An obvious change of EB by the control of non-volatile strain has been observed. A magnetization reversal driven by E-field has been observed in the absence of magnetic field. Our results indicate that a reversible non-volatile E-field control of a ferromagnetic layer through strain modulated multiferroic BFO could be achieved at room temperature.

Laser-driven ion acceleration potentially offers a compact, cost-effective alternative to conventional accelerators for scientific, technological, and health-care applications. A novel scheme for heavy ion acceleration in near-critical plasmas via staged shock waves driven by intense laser pulses is proposed, where, in front of the heavy ion target, a light ion layer is used for launching a high-speed electrostatic shock wave. This shock is enhanced at the interface before it is transmitted into the heavy ion plasmas. Monoenergetic heavy ion beam with much higher energy can be generated by the transmitted shock, comparing to the shock wave acceleration in pure heavy ion target. Two-dimensional particle-in-cell simulations show that quasi-monoenergetic ion beams with peak energy 168 MeV and considerable particle number are obtained by laser pulses at intensity of in such staged shock wave acceleration scheme. Similarly a high-quality ion beam with a well-defined peak with energy 250 MeV and spread can also be obtained in this scheme.

We report room temperature ferromagnetism in boron-doped ZnO both experimentally and theoretically. The single phase Zn1-xBxO films deposited under high oxygen pressure by pulsed-laser deposition show ferromagnetic behavior at room temperature. The saturation magnetization increases monotonously from 0 to 1.5 emu/cm3 with the increasing of B component x from 0 to 6.8%. The first-principles calculations based on density functional theory demonstrate that the ferromagnetism in B-doped ZnO originates from the induced magnetic moments of oxygen atoms in the nearest neighbor sites to the B-Zn vacancy pair. The calculated total magnetic moment increasing tendency with B component is well consistent with experiments., Comment: 16 pages, 1 table, 4 figures.

SummaryChanges in the fibrinolytic and coagulation values measured preoperatively in brain tumor patients have not been done systematically using individual rather than global assays. Such measurments can provide meaningful information on the status of tumor-host interactions and could potentially help in predicting thromboembolic and hemorrhagic tendencies.A complete fibrinolytic profile including total fibrinolytic activity (TFA), tissue plasminogen activator (t-PA), plasmin inhibitor (PI), plasminogen activator inhibitor (PAI), protein C (PC) and plasminogen (PLG) was obtained preoperatively in 114 brain tumor patients.PLG and PI did not show much variation among the groups. TEA was slightly reduced (15%) in patients with malignant brain tumors. t-PA, however, was abnormally low in several patients and in almost 40% of patients with brain metastasis. PAI was above the upper limit of normal in approximately 50% of the patients but particularly in glioma, glioblastoma and metastasis patients. Finally, mean PC was abnormally increased in the glioblastoma and metastasis groups (p In conclusion, plasma fibrinolytic levels show marked changes in a substantial number of brain tumor patients prior to surgery - suggesting an ongoing tumor-host interaction.

Crystallographic textures in a CoCrPtTa/Cr/NiAl multilayer magnetic recording media were studied by electron diffraction. It was found that texture quality evolves through the thickness of the films. A large improvement of texture quality was discovered at the interface of the Cr and NiAl layers. Surprisingly, there remains a portion of randomly oriented grains in the CoCrPtTa layer, in addition to the anticipated grains of [1010] texture. The texture quality of the CoCrPtTa layer remains similar to that of the underlying Cr layer.

One of the problems in nursing home care in Taiwan is resident restraint, including physical and chemical restraints. This pre-experimental study was conducted to investigate whether a restraint reduction program could reduce the prevalence of restraint in nursing homes. Three registered nursing homes were randomly selected from nursing homes in the Kaohsiung area. Staff and residents of these nursing homes were educated in restraint alternatives, balance training and managing behavior problems in one month of interventions. Three days before and after interventions, prevalence of restraints, falls, and of pressure sores, balance reaction, frequency of agitation, use of psychotic drugs, as well as the restraint knowledge of the nursing staff, was measured. After the restraint reduction program, the prevalence of restraint and frequency of resident agitation decreased significantly. The prevalence of falls and pressure sores of residents was not changed significantly. The restraint knowledge of the nursing staff significantly increased after the restraint reduction program. The information from this study led to a better strategy to reduce restraint for the elderly in nursing homes. The results could also provide a model to improve the quality of care in nursing homes in Taiwan.

Proton acceleration by ultra-intense laser pulse irradiating a target with cross-section smaller than the laser spot size and connected to a parabolic density channel is investigated. The target splits the laser into two parallel propagating parts, which snowplow the back-side plasma electrons along their paths, creating two adjacent parallel wakes and an intense return current in the gap between them. The radiation-pressure pre-accelerated target protons trapped in the wake fields now undergo acceleration as well as collimation by the quasistatic wake electrostatic and magnetic fields. Particle-in-cell simulations show that stable long-distance acceleration can be realized, and a 30 fs monoenergetic ion beam of >10 GeV peak energy and

Four-thousand women aged 18-40 underwent an early induced abortion at hospitals and family planning clinics in six counties in Sichuan province, China, between 1 July 1990 and 30 June 1991. The subjects were followed-up three times, on days 15, 90 and 180 after the operation. Information was obtained about their age, parity, contraceptive use, social behaviors, and gynecological and psychological characteristics before and after the abortion. The results indicate that induced abortion is safe when provided by medically trained personnel in health facilities such as hospitals or clinics. Depressive symptomatology was assessed by the CES-D and SCL-90 scales. The depressive symptoms declined over time. A substantial proportion of the abortions were to unmarried women or resulted from non-use of contraception or contraceptive failure, implying that the incidence of unintended pregnancies and induced abortions could be reduced by more effective and accessible contraception.

A new laser-plasma ion acceleration mechanism, snowplow ion acceleration, is proposed using an ultra-relativistically intense laser pulse irradiating on a combination target. When the thickness of the foil D is less than the length where the double-layer consisting of electron and ion layers is formed, the relativistic ion beam pre-accelerated by radiation pressure acceleration can be trapped and accelerated to the TeV level by the laser plasma wakefield over a long distance in the snowplow regime. Based on the classic wakefield theory, the snowplow structure can control the beam quality in terms of pulse duration, leading to the fact that the heavy-ion beam is theoretically shorter than half of the total wakefield structure, the size of the acceleration region. An analytical model is established, suggesting that ultra-short (70 μm) and ultra-highly energetic (3.2 TeV) carbon ion bunches generated by a centimeter-scale laser wakefield acceleration are expected, driven by a circularly polarized (CP) laser pulse with intensity of 1023 W/cm2 and duration of 66 fs. The particle-in-cell simulations agree well with theoretical results.

We have studied the room temperature ferromagnetism (FM) in Cu-doped and (Cu, Al) co-doped ZnO thin films which were grown on quartz substrates by chemical method based on a sol-gel process combining with spin-coating technology. X-ray diffraction (XRD) patterns demonstrate that both the Cu-doped and (Cu, Al) co-doped ZnO films have the hexagonal wurtzite structure with c-axis orientation. Alternating Gradient Magnetometer (AGM) measurements confirm that all the doped ZnO samples are ferromagnetic at room temperature. When the doped Cu content is 1 %, the Cu-doped ZnO film has the strongest FM. The FM significantly decreases in the (Cu, Al) co-doped ZnO films. The doping of Al ions suppresses the FM induced by the doped Cu ions.

The elevated estradiol/testosterone (E2/T) ratio had been proved to be a risk factor for coronary heart disease (CHD) in elderly men. We conducted a randomized placebo controlled crossover study on the effects of a new androgenic preparation "Andriol" in 62 elderly men with CHD over a period of 2.5 months. The results showed significant differences between Andriol- and placebo-treated groups at the end of this period: in the former, serum T level was elevated significantly (P0.001), E2 level was unchanged (P0.05), E2/T ratio was reduced (P0.05), angina pectoris (AP) was relieved (total effective rate, 77.4%), and myocardial ischemia in ECG and Holter recordings were improved (total effective rate, respectively 68.8% and 75%). Doppler echocardiography showed that 12 parameters of cardiac function were unchanged in both groups. No obvious side effect was found in those who took Andriol.

Sixty-two elderly men with coronary heart disease (CHD), 54 of them also suffering from hyperlipidemia, were treated with a new oral androgenic preparation (Andriol) through crossover study. The results showed that after oral Andriol administration for one month, serum estradiol/testosterone (E2/T) ratio was reduced, (P0.05) symptom of angina pectoris was relieved (total effective rate, 77.4%), signs of myocardial ischemia in ECG and Holter monitoring were improved (total effective rate, 68.8% and 75% respectively), serum total cholesterol (TC) and triglyceride (TG) levels were reduced dramatically (both P0.001) and the serum level of high density lipoprotein cholesterol (HDL-ch) was increased (P0.05), but the blood levels of apolipoprotein-AI (APO-AI) and B (APO-B) remained unchanged. No significant side effect of Andriol was observed.

Intense short-petawatt-laser driven relativistic electron beams in a hollow high-Z plasma fiber embedded in low-Z plasmas of different densities are studied. When the plasma is of lower density than the hollow fiber, resistive filamentation of the electron beam is observed. It is found that the electron motion and the magnetic field are highly correlated with tens of terahertz oscillation frequency. Depending on the material property around the hollow fiber and the plasma density, the beam electrons can be focused or defocused as it propagates in the plasma. Relativistic electron transport and target heating are also investigated.

A scheme to reduce the current loss of laser-driven energetic electron beams propagating in solid-density targets is proposed. In the scheme, two intense laser pulses irradiate the solid target consisting of two materials, one enveloping the other. Because of the resistivity and density gradients at the material interface, the first pulse generates tens of megagauss robust interface magnetic fields that can considerably reduce the divergence of the electron beam generated by the second pulse. It is shown that by using a coaxial gold-aluminum target instead of a simple gold target, beam current loss can be lowered by about 30%.

Changes in the fibrinolytic and coagulation values measured preoperatively in brain tumor patients have not been done systematically using individual rather than global assays. Such measurements can provide meaningful information on the status of tumor-host interactions and could potentially help in predicting thromboembolic and hemorrhagic tendencies. A complete fibrinolytic profile including total fibrinolytic activity (TFA), tissue plasminogen activator (t-PA), plasmin inhibitor (PI), plasminogen activator inhibitor (PAI), protein C (PC) and plasminogen (PLG) was obtained preoperatively in 114 brain tumor patients. PLG and PI did not show much variation among the groups. TFA was slightly reduced (15%) in patients with malignant brain tumors. t-PA, however, was abnormally low in several patients and in almost 40% of patients with brain metastasis. PAI was above the upper limit of normal in approximately 50% of the patients but particularly in glioma, glioblastoma and metastasis patients. Finally, mean PC was abnormally increased in the glioblastoma and metastasis groups (p less than 0.001). This is the first study that has measured protein C in brain tumor patients. In conclusion, plasma fibrinolytic levels show marked changes in a substantial number of brain tumor patients prior to surgery--suggesting an ongoing tumor-host interaction.

Perpendicular recording media consisting of isolated CoPt magnetic grains separated with a nonmagnetic oxide grain boundary can be prepared by sputtering a Ru interlayer and then cosputtering CoPt with an oxide material, with low adatom mobility. The oxide material moves into the grain boundaries and isolates the magnetic grains. An increase in the oxide volume fraction in the magnetic layer does not affect the saturation magnetization but significantly reduces the magnetocrystalline anisotropy of magnetic grains. This may impose a limit on the areal density capability of this media design since media with smaller grains will require a larger oxide volume fraction that will reduce magnetocrystalline anisotropy of the CoPt based magnetic grains.

The effect of interlayer thickness on the magnetic properties of exchange-coupled composite media has been studied. Films consisting of a CoPtO hard magnetic layer and a CoCrPt soft layer separated by a Pt interlayer with a thickness varying from 0to40A have been fabricated. At low Pt thicknesses (⩽16A) the exchange coupling forces the layers to switch as a single unit with a reduction in the hard magnetic layer coercivity of >2.5kOe. Thicker Pt layers induce sufficient decoupling to permit each layer to reverse separately. The variation of the coercivity with Pt thickness is complex and suggests that the coupling between the layers is a combination of dipolar and exchange effects.

Plasma discharge characteristics of a dc magnetron system were measured by a single Langmuir probe at the center axis of the dual-side process chamber. Plasma potential, floating potential, electron and ion densities, and electron temperature were extracted with varying dc power and gas pressure during sputter deposition of a metal target; strong correlations were shown between these plasma parameters and the sputter parameters. The electron density was controlled mostly by secondary electron generation in constant power mode, while plasma potential reflects the confinement space variation due to change of discharge voltage. When discharge pressure was varied, plasma density increases with the increased amount of free stock molecules, while electron temperature inversely decreased, due to energy-loss collision events. In low-pressure discharges, the electron energy distribution function measurements show more distinctive bi-Maxwellian distribution, with the fast electron temperature gradually decreases with increased gas pressure.

The physical parameters of the guard gap between the guard and the guarded electrodes of the three-electrode system generally used for dielectric loss measurements can be modelled by a simple T-network. Theoretical analysis shows that under certain conditions these parameters can cause great errors or even make the apparent dissipation factor negative, when measured with a Schering bridge. The sharp edges of the guard and the guarded electrodes may result in the creation of high local fields and give rise to electrical discharges under high voltage conditions. Local discharges near the sharp edges directly modify the physical parameters of the guard gap. Such anomalous phenomena have been experimentally observed and they can be attributed to the change in physical parameters in the guard gap. Experimental results are in good agreement with the theoretical analysis based on the T-network model. Methods for suppressing or minimizing these anomalous effects are also discussed.

Our experiences with a patient who developed recurrent hemispheric transient ischemic attacks 3 1/2 years after ipsilateral carotid endarterectomy are described. Although repeat arteriography demonstrated smooth and unobstructed common and internal carotid arteries and a normal intracranial circulation, there was complete occlusion of the external carotid artery at its origin, which appeared as a stump or diverticulum at the origin of the internal carotid artery. This stump was filled with atherothrombotic debris and served as a source of emboli to the adjacent and patent internal carotid artery. Excision of the stump effected complete relief of the recurrent ischemic symptoms. The pernicious potential of an external carotid obstruction when adjacent to a patent internal carotid artery should be recognized. To prevent this avoidable complication of carotid endarterectomy, we recommend that the origin of the external carotid artery be treated with the same standards of technical perfection as those customarily applied to the internal and common carotid arteries during this procedure.

From 1957 to 1976, 143 patients with small cell lung cancer (SCLC) were treated with surgical resection followed by chemotherapy. The 5 year survival rates were 38.7%, 8.7% and 3.5% in stages I, II and III. The prognostic factors were clinical stage and chemotherapy. 4 stage I and 1 stage II patients without chemotherapy have survived for more than 5 years. It seems to suggest that SCLC in stage I be indicated for surgery. 4 stage III have survived for more than 5 years, all of whom had received postoperative chemotherapy for more than 4 courses. From 1980 to 1982, 96 patients with SCLC were treated, 37 of whom by chemotherapy combined with surgery. 11/37 patients were alive for more than 2 years, 7 for more than 3 years and 4 for more than 4 years. In the preoperative chemotherapy followed by selective resection plus postoperative chemotherapy group (13 patients), the mean survival time was 22.7 months, but in the postoperative chemotherapy group (24 patients), it was 11.0 months. It indicates that full-dose chemotherapy before and after operation may be superior to the postoperative chemotherapy alone.