Volume 99 ·  Issue 05 ·  2019

cardiac surgery associated-acute kidney injury (CSA-AKI) is a common serious complication after cardiac surgery, with an incidence rate of 1% to 40%^[1]Among them, 10% to 20% of patients need continuous renal replacement therapy (CRRT), with a mortality rate of 40% to 80%^[2,3]。 Early use of CRRT, especially before serious complications, can help improve renal function and reduce mortality^[4,5]。

To investigate the functional lateralization of major Chinese language cortex in patients with cerebral arteriovenous malformation (AVM) in dominant hemispheric via functional magnetic resonance imaging (fMRI).

Nine right-handed normal volunteers and fourteen patients with cerebral AVM in dominant hemisphere diagnosed in Beijing Tiantan Hospital between December 2017 and June 2018 were included. Three language tasks (semantic judgment, word reading, and listening comprehension) were applied to activate language areas. Lateralization index (LI) was used to show the dominant hemisphere.

In the control group, right-sided lateralization of BOLD signal activations was observed in 0/27 (0%) of the language tasks. While in the AVM patients, right-sided lateralization of BOLD signal activations was observed in 8/42 (19%) language tasks. The difference was statistically significant (χ²=5.73, P=0.019).

The dominant hemisphere of different language tasks may be different in patients with cerebral lesions. Compared with normal controls, patients with cerebral AVM in dominant hemispheric are more likely to have right-sided lateralization of language cortex.

To investigate the visualization of endolymph in patients with otogenic vertigo by intravenous administration of single dose of gadolinium contrast agents and magnetic resonance three-dimensional fluid-attenuated inversion recovery sequence (3D-FLAIR MRI), and further assess the extent of endolymphatic hydrops.

From Beijing Tongren Hospital of Capital Medical University between October 2017 and June 2018, 30 patients (16 males, 14 females) with unilateral otogenic vertigo were involved in this study, with the age of 30 to 68 years, mean age of (53±10) years. Eight hours after intravenous administration of single dose (0.1 mmol/kg, body weight) of gadopentetate (Gd-DTPA), 3D-FLAIR sequence was performed in 30 patients. The location of endolymphatic hydrops was observed and then the degree of hydrops was quantitatively elevated by two radiologists. The consistency test was used to analyze the location and degree of endolymphatic hydrops in the two radiologists and the paired t-test was used to compare the difference between the affected and healthy side of endolymphatic spaces of the patients with otogenic vertigo.

In 30 patients, the gadolinium distributed in all parts of the perilymph inside the inner ear, and can accurately outline the boundaries of the peri-and endolymph. Twenty-six patients (26/30, 86.7%) were found to have unilateral endolymphatic hydrops, including 18 mild hydrops, 8 significant hydrops. The two radiologists had a very good agreement on the assessment of endolymphatic hydrops(kappa=0.864, ICC=0.959). In the 3D-FLAIR MR images of 26 patients with endolymphatic hydrops, the saccule (26/26, 100%) had a higher rate of hydrops than the cochlea and utricle(16/26, 61.5%; 14/26, 53.8%), and two radiologists had a very good agreement on the location of endolymphatic hydrops(kappa=0.820). Moreover, there was a significantly statistical difference between the affected and healthy area of the endolymphatic space in this study (P<0.01).

The technique of 3D-FLAIR MR imaging through single dose intravenous gadolinium injection is feasible, which can estimate endolymphatic hydrops in patients with otogenic vertigo, and accurately classify the degree of hydrops.

To investigate the value of multiple parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and three-dimensional arterial spin labeling (3D-ASL) in Ki-67 labeling index (Ki-67 LI) and grading of human brain gliomas.

From December 2015 to May 2018, 45 patients of gliomas confirmed by surgical pathology in Li Huili Hospital, Ningbo Medical Center were divided into low-grade group (20 cases of WHO grade Ⅱ) and high-grade group (12 cases of WHO grade Ⅲ, 13 cases of WHO grade Ⅳ), and the Ki-67 LI of glioma was obtained by immunohistochemistry. All patients, 24 males and 21 females, aged 25-83 years, mean(53±12)years, underwent conventional magnetic resonance imaging (MRI), IVIM-DWI and 3D-ASL before operation, then measured the true water diffusion coefficient (D), microcirculation perfusion coefficient (D^*), perfusion fraction (f) and cerebral blood flow (CBF) in the tumor solid area and the contralateral normal white matter area. Those parameters and the Ki-67 LI were compared between the low-and high-grade groups with Mann-Whitney U test. Spearman′s correlation was used to analyze the correlation between the quantitative parameters and Ki-67 LI. The ROC curve was used to assess the diagnostic efficacy of parameters in the grading assessment of brain gliomas.

The D(0.791×10^-3mm²/s) and f (0.261) of the high-grade group were lower than those of the low-grade group, whereas D^* (4.153×10^-3 mm²/s), CBF(102.027 ml·min^-1·100 g^-1) and Ki-67 LI (0.25) were higher (P<0.05). There was a moderate negative correlation between D, f and Ki-67 LI(r=-0.513,-0.457, all P<0.05). There was no significant correlation between D^* and Ki-67 LI (P=0.571). The area under the curve (AUC) for identifying high-and low-grade gliomas by D, D^*, f and CBF values was 0.965, 0.745, 0.842, and 0.830 respectively (all P<0.05).

D and f can be used for quantitative prediction of Ki-67 LI. IVIM-DWI and 3D-ASL are helpful in the grading assessment of gliomas, and the diagnostic efficiency of D is the highest.

To compare and analyze the differentially expressed plasma exosomic proteome between healthy control group (Control group) and viral myocarditis group (VMC group) to search for biomarkers that maybe used for early diagnosis of VMC.

Fifty plasma samples of Control group and VMC group were collected respectively from Henan Provincial People′s Hospital (from January 2016 to December 2017), and then 5 samples (1 ml) of each group were selected randomly, after exosomes extraction with ultra-centrifugation, difference gel electrophoresis (DIGE) was used to isolate the total proteins, and then the protein spots with more than 2-fold changes between VMC and Control group were picked up after the software analysis, afterward, the varied proteins were identified by MALDI-TOF/TOF mass spectrometry. Finally, the specifically related protein was selected to be verified by ELISA with the plasma exosomic samples of Control (n=40) and VMC (n=40).

A total of 10 varied protein spots were found including 8 up-regulated proteins and 2 down-regulated proteins between VMC and Control group. After MS analysis, the up-regulated proteins in VMC group contained KRT2, KRT5, KRT9, KRT77, KRT78, AZGP1, HP and RBP4, whereas the down-regulated ones were CD5L and C1QB. RBP4 was selected to validate by ELISA analysis, and the corresponding results showed that RBP4 was increased specifically in plasma exosomes of VMC group (P<0.05) after comparing with Control group, which was consistent with DIGE.

Ten proteins related to VMC are detected in total, and RBP4 might serve as a potential specific biomarker for early screening and diagnosis of VMC.

To assess outcome, safety and possible mechanism of loading dose clopidogrel in patients with transient ischemic attack (TIA) and minor stroke.

We reviewed patients with confirmed TIA and minor stroke admitted between July 2016 and December 2017 into the First Affiliated Hospital of Soochow University. Loss-of-function allele carriers of CYP2C19 were included and randomly divided into loading dose group (first dose of 300 mg clopidogrel) and standard dose group (first dose of 75 mg clopidogrel), 100 mg aspirin was gave at the same time, followed by aspirin 100 mg/d plus clopidogrel 75 mg/d maintaining for 20 days. Platelet aggregation (maximum aggregation ratio, MAR) induced by Adenosine diphosphate (ADP) was examined before and 3 days after administration. The National Institutes of Health Stroke Scale (NIHSS) score method was employed to assess the NIHSS scores before and after treatment in each group of patients; the modified Rankin Scale (mRS) was used to assess the 3-month functional outcome.

There was no significant difference in baseline data between the two groups (P>0.05).The proportion of early neurological function improvement in the two groups was 75.0% and 54.8%, and the difference was statistically significant (χ²=4.498, P=0.034). The 3-month prognosis was 79.5% and 61.3%, and the difference was statistically significant (χ²=4.000, P=0.045). Adverse events: 1 case in the loading dose group, 1 case in the standard dose group, the difference was not statistically significant (2.3% vs 1.6%, χ ²=0.061, P=0.806). After 3 days of antiplatelet therapy, the MAR of the loading dose group decreased (11%±8%), and the MAR of the standard dose group decreased (9%±4%), the difference was statistically significant (P=0.013).In the loading dose group, there were 32 (72.7%)CYP2C19*2 carriers and 42 (95.5%)CYP2C19*2+*3 carriers; early neurological function improvement in 33 cases, accounting for 93.8% and 76.2%, respectively, and the difference was statistically significant (χ²=4.122, P=0.042). There were 35 patients with good prognosis in 3 months, accounting for 96.9% and 81.0%, respectively. The difference was statistically significant (χ²=4.310, P=0.038); MAR of CYP2C19*2 carrier was decreased (15%±5%), and MAR of CYP2C19*2+*3 carrier was decreased (12%±8%). The difference was statistically significant (P=0.039).

Loading dose clopidogrel can improve the clinical prognosis of minor stroke/TIA without increasing the risk of bleeding. Loading dose clopidogrel may improve the prognosis of minor stroke/TIA by decreasing MAR of CYP2C19*2 carriers.

To analyze the clinical presentation, imaging features, and the mutation of the pathogenic genes in a Chinese Han atypical neuroaxonal dystrophy pedigree.

A family of atypical neuroaxonal dystrophy pedigree who came to Henan Provincal People′s Hospital in July 2016 was included. Clinical presentation, imaging features of the pedigree were analyzed, and all exon gene detection of the proband was performed to capture the target variations, then verified by sanger sequence. Another 4 family members′ and 100 normal healthy controls′ gene sequence of the mutations were also verified.

The proband(Ⅱ₃) of the family presented with walking unsteadily, intellectual disability, glossolalia, dystonia, epilepsy, and autonomic nervous dysfunction. The magnetic resonance imaging (MRI) of the proband showed cerebellar atrophy and iron deposit in basal ganglia. The gene detection showed the PLA2G6 gene compound complicated mutation of 80 codon p.A80T in the exon 3 and 331 codon p.D331Y in the exon 7. The two sisters of the proband (Ⅱ₁,Ⅱ₂) had the same mutation, the father of the proband carried the p.A80T, however, the mother carried the D331Y mutation. One of the proband′s sister (Ⅱ₁), whose onset age was 10 years old, had the similar symptoms with the proband. The proband′s another sister(Ⅱ₁) had abnormal gait at 24 years old. However, the MRI of the two sisters all showed cerebellar atrophy.

We report a PLA2G6 compound complicated mutation in an atypical neuroaxonal dystrophy Chinese family, that is the p. A80T and p.D331Y mutation, which may be a pathogenic mutation to cause the family′s disease.

To retrospectively investigate the effects of long segment fusion and short segment fusion on lumbar sagittal alignment and quality of life in patients with degenerative scoliosis.

From January 2011 to December 2014, 75 patients with degenerative scoliosis were treated with pedicle screw fixation. Total of 56 females and 19 males were included in this study. Fifty-four patients underwent short-segment fusion (≤3 segments) and 21 patients underwent long-segment fusion (>3 segments). The average age of the patients was (63±8) years. The patients were followed-up for a mean time of (2.9±1.3) years. The postoperative follow-up included Cobb angle, pelvic tilt, sacral slope, lumbar lordosis, visual analogue scale of pain on lumbar and lower extremities and Oswestry disability index. Fusion levels, blood loss, surgery length and postoperative hospital stay were recorded. All above parameters were evaluated statistically with Student′st test.

The short segment fusion group averaged (1.8±0.7) segments, and the long segment fusion group averaged (5.2±1.6) segments. Coronal Cobb angle changed from (21.3±7.8) degrees preoperatively to (15.3±5.6) degrees at final follow-up in short-segment fusion group (t=2.315, P=0.024) and from (44.5±11.2) degrees preoperatively to (11.4±5.8) degrees at the final follow-up in long-segment fusion group (t=8.214, P<0.01). In the short segment fixation group, the preoperative lumbar lordosis changed from (44.3±9.7) degrees to (48.9±8.2) degrees at final follow-up (t=2.123, P=0.038), and it changed from (25.3±9.5) degrees to (52.1±11.2) degrees in the long segment fusion group (t=5.982, P<0.01). The sacral slope in the short segment fusion group increased from (22.6±6.8) degrees preoperatively to (34.1±7.5) degrees at the final follow-up (t=2.872, P=0.006), and it increased from (12.1±9.5) degrees to (37.8±8.4) degrees in long segment fusion group (t=7.314, P<0.01). The pelvic tilt in the short segment fusion group changed from (23.5±5.5) degrees preoperatively to (19.5±4.7) degrees at final follow-up (t=2.217, P=0.031), and it decreased from (27.1±6.1) degrees to (22.9±4.3) degrees in the long segment fusion group(t=2.131, P=0.045). The visual analogue scale of pain on lumbar and lower extremities and Oswestry disability index were all improved after the operation in both groups.

Both short segment fusion and long segment fusion can achieve satisfactory surgical results and improves the spinal-pelvic parameters. Short segment fusion can reduce surgery trauma and shorten hospital stay relative to long segment fixation.

To investigate the ability of white blood cell (WBC), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the super-elderly patients with bloodstream infection.

It was a retrospective study. A total of 77 patients (≥85 years) admitted to the ICU of Peking Union Medical College Hospital from June, 2016 to December, 2017 were enrolled. The patients included 67 males and 10 females, with an age of 85-105 years and the average age was (92±5) years. According to the results of blood culture, patients were divided into positive blood culture group (n=50) and negative blood culture group (n=27). The data which obeyed normal distribution were compared with single sample t test between the two groups.

There was no significant difference in WBC level between the positive blood culture group and the negative blood culture group[12.4(7.8, 36.6)×10⁹/L vs 10.7(8.5, 18.7)×10⁹/L, U=0.109, P=0.124]. Compared to the positive blood culture group, the PCT level [2.6(0.8, 7.4)μg/L vs 1.5(0.6, 5.3)μg/L,U=3.015, P=0.004] and hs-CRP level [119(62, 220) mg/vs 54 (24, 80) mg/L, U=7.791, P<0.001] were significantly higher in the negative blood culture group. The ROC analysis showed that the area under the curves (AUC) of WBC, PCT and hs-CRP was 0.704(95%CI: 0.586-0.822, P<0.01), 0.896(95%CI: 0.829-0.964, P<0.01) and 0.864(95%CI: 0.778-0.949, P<0.01), respectively. The best cutoff value of PCT for discrimination of positive blood culture was 0.44 μg/L, which resulted in a sensitivity of 70.0% and a specificity of 92.6%. The best cutoff value of hs-CRP was 50.35 mg/L, which resulted in a sensitivity of 62.0% and a specificity of 88.9%.

Compared to WBC, both PCT and hs-CRP have a better ability to predict bloodstream infection in the Super-elderly patients.

To explore the relationship between simple numerical function and gray matter volume (GMV) in normal brain aging using the voxel-based morphometry(VBM) approach.

A total of 123 individuals from 18 to 70 years old (63 males,60 females,the average age was (43±14) years, were recruited from right-handed healthy Han Chinese volunteers at the Department of MRI at the First Affiliated Hospital of Zhengzhou University between October 2016 and June 2017. All subjects underwent magnetic resonance sagital three-dimensional imaging scanning, and statistical parameter graph (SPM) 8 software was used for voxel-based morphological analysis to compare the differences in gray matter volume between different age groups.Gray matter volume difference brain regions between different age groups were extracted as regions of interest, and correlation analysis was carried out on the score of simple numerical calculation to find the responsible atrophy brain regions related to the decline of simple digital computing ability.

The brain regions with different gray matter volume in different age groups mainly included bilateral frontal gyrus, bilateral anterior cingulate gyrus, bilateral middle cingulate gyrus, bilateral olfactory cortex, bilateral caudate nucleus and bilateral insula. Among them the GMV of bilateral superior frontal gyrus and anterior cingulate gyrus showed the strongest correlation with the simple numerical function. Before removing the effect of age, the correlation between the GMV of the bilateral superior frontal gyrus and medial cingulate gyrus and the corrected count of correct was significant (r=0.403,P=0.000), the correlation between GMV and the percent of correct was also significant (r=0.229,P=0.037).After removing age as a covariate, bilateral superior frontal gyrus and central cingulate gyrus were still positively correlated with the correct number after correction of simple numerical calculation function (r=0.225,P=0.014) and the correct percentage (r=0.245, P=0.007).

There is extensive gray matter volume atrophy during the normal brain aging process. The decrease of simple numerical function in normal brain aging may be related to the decrease of frontal and anterior cingulate gray matter volume.

To explore the clinical value of static and dynamic magnetic resonance imaging (MRI) in evaluating the effect of electrical stimulation combined with biofeedback in the treatment of pelvic organ prolapse postpartum.

A total of 50 primiparas diagnosed as pelvic organ prolapse postpartum from February 2016 to November 2017 were randomly divided into treatment group (24 cases) and control group (26 cases). The control group recovered spontaneously, and the treatment group received electric stimulation combined with biofeedback therapy (6 weeks). All subjects underwent static and dynamic MRI before and after treatment. The thickness of bilateral puborectal muscles, levator ani hiatus area (LHA), H line, M line and levator ani plate angle (LPA) were respectively measured in rest state and strain state at 42 days and 12 weeks postpartum, and the differences of parameters were compared between two groups.

(1) Compared with 42 days postpartum, the effective rate of pelvic organ prolapse was 15.4% (4/26) in the control group and 62.5% (15/24) in the treatment group, which was significantly higher than that of the control group (P<0.01). (2) Compared with 42 days postpartum, the thickness of bilateral puborectal muscles in the treatment group increased at 12 weeks postpartum, while that of the H line, LHA, M line and LPA in strain state decreased. (3) At 12 weeks postpartum, the thickness of the bilateral puborectal muscle in the treatment group was greater, and LHA, M line, and LPA in strain state were less than that in the control group (all P<0.05).

Electrical stimulation combined with biofeedback therapy can improve pelvic organ prolapse due to vaginal delivery, and the static and dynamic MRI can objectively evaluate the effect of pelvic floor rehabilitation therapy on improving the pelvic floor supporting structure and function, providing an important support and guidance for restoration of postpartum pelvic organ prolapse.

The clinical data and follow-up results of 4 children with gastrointestinal stromal tumor (GIST) were analyzed. Age 9-12 years old. The time from onset to diagnosis is 1 month to 3 years. Three cases were physically fit in the past, and one case underwent mesodermal nephrotomy resection after birth. The main clinical manifestations are abdominal mass, abdominal pain, melena, paroxysmal vomiting and obstructive jaundice. There were no obvious abnormalities in the common childhood tumor markers. Located in the small curvature of the stomach, 3 cases were all removed by surgery, of which 1 case took imatinib regularly after surgery; One patient located in the duodenal pancreatic head area underwent open biopsy and external biliary drainage, chemotherapy for 4 cycles after operation, and then tumor and duodenectomy. The mutation test of KIT/PDGFRA gene was negative in 2 children, and the mutation was revealed in 1 case. The patients with tumor originating from small curvature of stomach survived without events during follow-up, and one patient with tumor originating from duodenum recurred and died after operation. Gastrointestinal stromal tumors in children are very rare, and most of them lack KIT and PDGFRA gene mutations. Complete resection is effective, and the prognosis of gastrogenic GIST is good.

This paper reports a case of Rathke's cyst located in the cerebellopontine angle region. The histogenesis, clinical manifestations, imaging, differential diagnosis and treatment of Rathke's cyst are discussed in combination with literature review.

Immune-mediated cerebellar ataxia (IMCAs) is a disease spectrum with extremely heterogeneous etiology involved by anti-cerebellar neuron antibodies or immune mechanisms, which has gained attention for its treatable characteristics. Paraneoplastic cerebellar degeneration is classic IMCA. In addition, in recent years, non-paraneoplastic IMCAs such as glutamate decarboxylase antibody-related ataxia, Hashimoto's encephalopathy, gluten ataxia and partial autoimmune encephalitis have gradually emerged. This article will review the common classifications of IMCAs and their respective clinical features and diagnostic points.