Volume 99 ·  Issue 09 ·  2019

Thinking and walking are two important human functions. Walking (gait) disorder is a common clinical symptom of cerebral small vessel disease. Gait disorders may cause falls, which in turn increase the risk of trauma, cardiovascular risk factors and even death, seriously affecting the quality of life of patients. However, gait disorders in patients with cerebral small vessel disease receive insufficient attention compared with cognitive disorders. The behavioral characteristics, brain network mechanism and long-term prognosis of gait disorder in cerebral small vessel disease need to be further studied.

Genetic engineering model of hereditary small vessel disease, chronic hypertension model, atherosclerosis diet model and hypoperfusion model are four common animal models in the research of cerebral small vessel disease at present. They simulate the pathophysiological characteristics of cerebral small vessel disease to a certain extent, and also have the advantages and disadvantages of their own models. In the future, the study of cerebral small vessel disease model should construct a cerebral small vessel disease model with multiple vascular risk factors including genetic factors, and simulate an animal model more in line with clinical characteristics.

To investigate the prevalence on imaging, topographic distribution and risk factors of perivascular space (PVS) in community population.

This study was based on the population of Shunyi Study in China from June 2013 to September 2016. One thousand two hundred and thirty-two stroke free participants older than 35 years, who completed cerebral MRI, were included. Cardiovascular risk factors were assessed by interview, physical examination and blood sample tests. PVS were evaluated on high-resolution 3-dimensional-T1WI, T2WI and FLAIR sequences. On T1WI, PVS were detected according to 3D imaging criteria. The number and anatomic location of large PVS (≥3 mm) were recorded. And severity of PVS was then semiquantitatively graded in both white matter (WM) and basal ganglia (BG). Associations between risk factors and PVS were analyzed by multinominal Logistic regression models and adjusted for age, gender and relevant confounders.

Perivascular spaces were observed in the BG or WM in every subject, aged (55±10) years and 37.3% male. Large PVS were detected in 19.0% (460/1 232) of participants. Severity of PVS was found to be strongly associated with age in both basal ganglia (severe versus mild: OR=1.81; 95%CI 1.45-2.27, P<0.01) and white matter (OR=1.39; 95%CI 1.13-1.71, P<0.01), and the proportion of subjects with hypercholesterolemia decreased with the severity of PVS in BG (OR=0.58, P=0.01) . The present of large PVS was found to be associated with age(present versus absent: OR=1.03, 95%CI 1.02-1.05, P<0.01) and ApoE ε4 carrier genotype( OR=1.53, 95%CI 1.01-2.23, P=0.04).

Perivascular spaces are always detected in the BG or WM in elderly people, and large PVS are also prevalent in community-based population. The risk factors are different due to distribution and size, and may depend on anatomic or pathologic characteristics.

To investigate the effect of non-breathing-related sleep fragmentation on cognitive function in patients with atherosclerotic cerebral small vessel disease(CSVD).

Seventy-two patients with arteriosclerotic CSVD in the Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University were enrolled in this study from August 2017 to July 2018. The patients undertook MRA(Magnetic Resonance Angiography)+SWI(Susceptibility weighted imaging), polysomnography, Montreal Cognitive Inventory (MoCA) and Concise Mental State Examination (MMSE). The patients were divided into study group (≥19) and control group (<19) according to the median number of arousal events (median=19) at night.

The sleep efficiency, rapid eye movement (REM) sleep ratio and non-rapid eye movement-3 (NREM-3) sleep ratio of the study group were significantly lower than those of the control group (P<0.05), and the total MoCA score (18.2±4.3) , visual space score(1.9±1.4) and delayed recall score(1.4±0.9) of the study group were significantly lower than those of the control group (22.7±3.5, 2.9±1.2, 2.9±1.1, P<0.05).

The incidence of non-breathing-related sleep fragmentation is high in CSVD patients and this kind of fragmentation is associated with cognitive impairment.

To investigate the correlation of vasogenic white matter lesions with retinal vascular network parameters using fully automatic retinal image analysis of fundus photographs.

A total of 106 patients with cerebral small vessel disease who were hospitalized in Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University during March and October 2015, and were able to undertake cerebral MRI and fundus photography in a sitting position were included. They were divided into two groups (mild or moderate-severe) according to the Fazekas scores of periventricular white matter lesions and deep white matter lesions shown by MRI. The clinical data and retinal vascular network parameters were compared between mild and moderate-severe groups.

According to the severity of periventricular white matter lesions, Logistic regression analysis showed that after adjusting baseline information, decreased asymmetry index of artery (OR=1.71, 95%CI 1.02-2.88, P<0.05)was associated with periventricular white matter lesions. As for deep white matter lesions, Logistic regression analysis showed that after adjusting baseline information, decreased central retinal artery equivalent(OR=5.19, 95%CI 1.06-25.44, P<0.05), decreased asymmetry index of artery (OR=2.96, 95%CI 1.42-6.17, P<0.05), decreased asymmetry index of venule (OR=2.99, 95%CI 1.48-6.02, P<0.05) and increased central retinal vein equivalent (OR=0.14, 95%CI 0.03-0.67, P<0.05) were associated with deep white matter lesions.

White matter lesions of different places could be contributed to different pathological process. Therefore, the early diagnosis and observation of them are applicable to different retinal vascular network parameters.

To explore the relationship between the findings of whole body diffusion weighted imaging (WBDWI) and the clinical result in patients with multiple myeloma.

A total of 43 cases of multiple myeloma patients were retrospectively collected from May 2015 to May 2017 in Tianjin First Central Hospital.Twenty-nine cases were male and 14 were female. The median age was 54 years old with a range from 36 to 73 years old. The patients were divided into two groups with and without abnormal findings pending on whole body diffusion weighted imaging. The clinical data and the ADC value were compared between the two groups, as well as comparison in patients with abnormal findings between pre-and post-treatment.

In 43 patients, normal findings on WBDWI were found in 10 cases, 7 males, 3 females, age (59±9) years old, and abnormal findings in 33 cases, 22 males, 11 females, age (57±10) years old.No statistical differences of age and gender were found between two groups (P>0.05) .The ratio of plasma cells and the proportion of β ₂ microspheres in patients with abnormal WBDWI (50.0% (14.0%, 78.0%) , 4.8 (2.7, 7.7) mg/L)were significantly higher than those in the normal group(5.0% (2.5%, 15.0%) , 2.4 (2.0, 3.7) mg/L) (P<0.05).ADC value in different body parts of abnormal group including costal ((0.66±0.15)×10^-3 mm²/s), sternal bone((0.71±0.20)×10^-3 mm²/s), clavicles((0.67±0.17)×10^-3 mm²/s), thoracic vertebra((0.63±0.17)×10^-3 mm²/s), lumber vertebra((0.69±0.20)×10^-3 mm²/s), pelvic((0.83±0.36)×10^-3 mm²/s), proximal humerus((0.76±0.13)×10^-3 mm²/s), proximal femur((0.64±0.17)×10^-3 mm²/s), shaft of femur((0.70±0.22)×10^-3 mm²/s), proximal tibia((0.97±0.18)×10^-3 mm²/s), shaft of tibia((0.83±0.18)×10^-3 mm²/s) which were significantly higher than those of normal group (all P<0.05). The albumin concentration of the patients after treatment was significantly higher than those before treatment (P<0.05).

Different imaging findings on WBDWI can reflect clinical different result in patients with multiple myeloma, and when WBDWI is normal, the clinical symptoms are mild. When abnormal findings detected on WBDWI, the clinical symptoms are still severe although albumin concentration increased after treatment.

To explore the neuromechanism of nicotine dependence, structural covariation networks (SCNs) based on voxel-based morphometry (VBM) were used to study the synergistic changes in gray matter volume in different cerebral cortices of nicotine dependent individuals.

During the period from August 2016 to February 2018, a total of 118 long-term smokers and 57 non-smoking healthy controls (both 18-55 male volunteers) through online platforms and leaflets were recruited. The subjects were scanned with SIEMENS Skyro 3.0T magnetic resonance scanner and underwent routine MRI sequence (preliminary elimination of intracranial lesions) and 3D-T1 (3D-mprage) sequence structure. Two imaging experts used Matlab software platform to carry on segmentation by using SPM8, and to find out the differences between the two groups of brain regions, and differences in brain regions as region of interest (ROI) structure association network analysis.

The gray matter volume (GMV) of the right anterior central gyrus and the left inferior parietal lobe in the smoking group decreased(voxels size were 55 and 284, respectively), and no gray matter volume (GMV) area increased. The network structure of covariant analysis found that when the inferior parietal lobe as the seed points, the smoking group showed a rising trend in left parietal lobe and left temporal pole, bilateral middle temporal gyrus, left postcentral gyrus and right middle frontal gyrus gray matter volume, and a downtrend in the right side of the left medial frontal gyrus, superior parietal lobe, bilateral temporal gyrus, left cingulate gyrus and left cerebellum (central) compared with the control group.

In long-term smokers, there is a volume change of gray matter in the brain structure. Abnormal changes in the structure covariant network of the inferior parietal lobe can lead to impaired brain function in nicotine dependent patients.

To investigate MRI features of lower limbs in patients with facioscapulohumeral dystrophy(FSHD).

The clinical manifestations, myopathological findings and MRI images of 5 FSHD patients were studied retrospectively from June 2016 to December 2017 at Department of Neurology, Henan Provincial People′s Hospital, 3 of which had a family history. Analysis of T₁WI images enabled us to describe muscle fatty infiltration and STIR images to describe muscle edema. Each muscle was scored according to its fatty degeneration (fat replacement score range from 0-4).

The 5 patients were all asymmetrically involved. At the thigh level, the hamstrings were more affected than anterior muscles in 4 patients, and anterior muscles were more affected than hamstrings in only 1 patient. The most affected thigh muscles were usually the adductor magnus, semimembranosus, semitendinosus, femoral biceps long head and vastus medialis muscles (average fat replacement score of each muscle was more than 3). The calves were less affected than thighs.The average fat replacement score of the calf muscles was 1.0 for soleus, 0.9 for medial gastrocnemius, 0.8 for tibialis anterior, and 0.4 for lateral gastrocnemius. There was no fatty infiltration in peroneus and tibialis posterior. 4 out of 5 patients had edema in the lower limb muscles.

Asymmetric involvement is a definitely helpful clue suggesting FSHD, and edema is a common phenomenon. At the thigh level, no unique imaging pattern can be highlighted in all the FSHD patients, overall, the hamstring, adductor magnus and vastus medialis are usually the most severely affected muscles. The calf muscles are less affected than the thigh muscles or spared. Soleus, medial gastrocnemius, and tibialis anterior are preferentially involved at the calf level.

To investigate clinical outcomes of total knee arthroplasty with ultra-congruent insert(UC) or posterior stability insert (PS).

A retrospective study was performed on 97 patients (17 males, 80 females, 119 knees) with knee osteoarthritis who received total knee arthroplasty. Of the patients, 42 cases (50 knees) received UC protheses and 55 cases (69 knees) received PS protheses in total knee arthroplasty by the same surgeon in Peking University Third Hospital from March 2015 to November 2015. The data including age, gender, body mass index (BMI), range of motion (ROM), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and Hospital for Special Surgery Knee Score (HSS) before and after the surgery were collected and compared in the two groups. The data were compared between the two groups by single-sample t test.

There was no significant differences in age, gender, BMI, ROM, HHS and WOMAC scores between the two groups before operation(all P>0.05). At 3 months and 2 years of follow-up, ROM, HSS and WOMAC scores were significantly improved in the two groups(all P<0.05), but there was no statistical difference between the two groups(t=-0.303, -1.593, Z=-0.500, all P>0.05). One patient with PS prosthesis recieved revision surgery due to prothesis loosening; and no complication found in the UC group(χ²=0.731, P>0.05).

There is no obvious difference between PS and UC in TKA, UC insert seems to be a practical alternative to the PS.

To observe and evaluate the therapeutic efficacy of LVIS stent and Enterprise stent assisted coil in embolization of vertebral artery dissection aneurysm (VDA).

Clinical data of 96 patients with VDAs treated by LVIS stent and Enterprise stent assisted coil were analyzed retrospectively between January, 2013 and June, 2017.Of all, the LVIS stent assisted coil was performed in 28 patients (LVIS-stent group) and Enterprise in 68 patients (Enterprise-stent group). The clinical and imaging follow-up were performed. The instant embolization rate, complications, and recurrence rate were analyzed and compared between the two groups.

Instant angiographic results:in the LVIS stent group, complete occlusion was achieved in 17 VDAs (60.7%), near-complete occlusion in 10VDAs (35.7%), and partial occlusion in 1 VDA (3.6%). In the Enterprise stent group, complete occlusion was achieved in 27 VDAs (39.7%), near-complete occlusion in 34VDAs(50.0%), partial occlusion in 7VDAs (10.3%). Procedure-related complications occurred in 3 patients (10.7%) in LVIS stent group and 3 patients (4.4%) in Enterprise stent group. DSA follow-up was performed during 6 to 12 months after surgery, and 10 patients with vertebral artery dissection aneurysm recurred, 2 in the LVIS group and 8 in the Enterprise stent group. The latest modified Rankin Scale score was 0 in 55 patients,1 in 13, 2 in 1, 3 in 1, and 6 in 1. Among them, all follow-up patients in the LVIS stent group had good prognosis, while in the Enterprise stent group, 50 patients (94.4%) had a good prognosis.

The stent-assisted coils have a higher degree of embolization in the vertebral artery dissection aneurysms, a higher rate of near-total embolization, a lower incidence of neurological complications, and a good prognosis. The complete andnear-complete occlusion rates and the incidence of neurological complicationsin the LVIS group was higher than that in the Enterprise groupand the recurrence ratesin the LVIS group was lower than that in the Enterprise group,both with no statistically significant difference.

This study explored the prognostic factors of patients with supratentorial anaplastic gliomas and tried to propose a prognostic scoring scale with aim to provide theoretical reference for clinical treatment.

The clinical data of 198 patients surgically treated for primary anaplastic glioma in Henan Provincial People′s Hospital between Jan 2009 and Jan 2018 were reviewed. Univariate and multivariate analyses were used to identify prognostic factors with methods of Kaplan-Meier plot and Cox proportional hazard model, respectively. Based on the prognostic factors, a scoring scale was thereby proposed.

Univariate analysis results showed age, tumor location, tumor diameter, preoperative KPS, extent of resection, radiotherapy, chemotherapy, pathology with oligodendroglial components, 1p/19q, IDH, MGMT were significantly correlated with survival (P<0.05). Multivariate analysis results showed age ≥45 years old, tumor diameter ≥6 cm, preoperative KPS<70, without radiotherapy, 1p/19q intact, MGMT promoter unmethylation were independent prognostic risk factors (P<0.05). Patients were scored with 0-6 points based on the formulation that each independent prognostic risk factor was assigned with 1 point. Then patients were further grouped according to the score. Those with less than 2 points were low-risk group, equal to 2 points were medium-risk group, equal to 3 points were high-risk group, more than or equal to 4 points were extremely high-risk group. There were significant differences in survival between the different groups (P<0.000 1).

The higher score, the shorter survival time. This prognostic scoring scale can provide a theoretical basis for the prognosis estimation of patients with anaplastic glioma and help to carry out personalized clinical treatment.

To investigate the efficacy of soft neuroendoscopic techniques in the treatment of chronic subdural hematoma (CSDH).

A retrospective analysis of 201 cases of CSDH diagnosed and treated at Beijing Shijitan Hospital (CMU) from January 2006 to December 2017 was conducted. From January 2006 to December 2010, 126 cases of CSDH were treated with skull drilling and drainage (non-endoscopic group). From January 2011 to December 2017, 75 cases of CSDH were treated with soft neuroendoscopy (endoscopic group). The operation time of the non-endoscopic and endoscopic groups, the hematoma clearance rate on the first day after surgery, the time of the drainage tube, the length of hospital stay, the incidence of complications, mortality and recurrence rate were compared.

There were no deaths in both groups. The average operation time of the non-endoscopic group was 43 min, compared with the average operation time of the endoscopy group of 50 min, there was no significant difference (P>0.05). The average hematoma clearance rate on the first day after surgery in the endoscopy group (98.2%) was significantly higher than that in non-endoscopic group (87.3%) (P<0.01). The average time of drainage tube in the endoscopy group (23 h) was significantly shorter than that in the non-endoscopic group (50 h) (P<0.01). On the first postoperative day, the proportion of patients with mRS≤3 in the endoscopic group was significantly higher than that in the non-endoscopic group (P<0.01). At the time of discharge, the proportion of patients with mRS≤3 in the endoscopy group was also significantly higher than that in the non-endoscopic group, P<0.05. There was no significant difference in the average hospital stay between endoscopy group (7 d) and non-endoscopic group (8 d) (P>0.05). The postoperative complication rate in the endoscopy group was significantly lower than that in the non-endoscopic group (P<0.01). During 0.5-8 years of follow-up, the recurrence rate of CSDH in the endoscopic group (5.33%) was significantly lower than that in the non-endoscopic group (15.07%) (P<0.01).

The application of visualization features of soft neuroendoscopy in the treatment of CSDH can significantly improve hematoma clearance, shorten the time of drainage tube, reduce postoperative complications and recurrence rate, and improve surgical outcomes.

To explore the brain areas which have abnormal functional connectivity with anterior cingutate in opiate drug dependence during physical detoxification using a task-related functional magnetic resonance imaging(fMRI), and to find out the role of anterior cingutate dysfunction in the relapse of opiate drug addicts during physical detoxification.

From January to December 2016, eighteen participants of opiate drug addicts during physical detoxification who completed in Drug Rehabilitation Center of Anhui Province, and eighteen healthy controls recruited performed a cue-elicited craving task in a MRI scanner while signal data were collected. Two regions of interest were the right anterior cingutate and the left anterior cingutate, then the linear correlation between the whole brain and the anterior cingutates was calculated to find out the abnormal functional connectivity of the anterior cingutates.

Contrasted experimental group with the healthy controls, the functional connectivity of bilateral fusiform gyrus, caudate nucleus, and the anterior cingutates was increased in the opiate drug addicts during physical detoxification group (P<0.05),and the functional connectivity between anterior cingutates and polus temporalis, hippocampi, Middle frontal gyrus of orbit, Supplementary motor area, dorsolateral superior frontal gyrus was decreased(P<0.05).

The anterior cingutates dysfunction of functional connectivity in a cue-elicited craving task may play a important role in the relapse of opiate drug addicts during physical detoxification.

Undifferentiated embryonic sarcoma of the liver (UESL) is a very rare primary malignant mesenchymal tumor of the liver. This article systematically summarizes the clinical and imaging manifestations, pathological and molecular genetic manifestations, diagnosis and differential diagnosis, treatment and prognosis of UESL.

Morvan's syndrome is a rare autoimmune disease. This patient was a 39-year-old male with residual thymus. The clinical manifestations were extensive muscle twitching, severe insomnia, hyperhidrosis, pain in both calves, and serum anti-contact protein-associated protein 2 antibody and anti-leucine-rich glioma inactivating protein 1 antibody were positive. He was diagnosed with Morvan's syndrome, and the symptoms improved after immunotherapy.

A case of solitary fibrous tumor of the pancreas is reported.

Periarticular bursitis is a chronic inflammatory disease that mainly affects the knee, elbow, hip, ankle and shoulder joints, and rarely involves the wrist joint; The pathogenesis of rice grain is still unclear, and the treatment plan is not uniform in relevant research reports. Most case reports are mainly surgical treatment. Now, the etiology, diagnosis and treatment are briefly discussed based on the clinical manifestations, imaging and pathological results of a patient with intratendinous bursitis in the palmar side of the wrist and rice grain formation admitted to our hospital.

Patellar dislocation is a common type of knee joint injury. For patients with initial patellar dislocation, the incidence of sequelae after dislocation can reach 50%, including recurrent pain and patellofemoral arthritis. Because of the high rate of recurrent dislocation and the serious complications that occur after dislocation, it is crucial to take measures after dislocation. In this article, the treatment options and indications of patellar dislocation, surgery and postoperative rehabilitation exercise are reviewed.

Effector T cell (Th17) /regulatory T cell (Treg) immune imbalance is a key factor in the pathogenesis of rheumatoid arthritis (RA). As a key regulatory component for maintaining T cell homeostasis and immune tolerance, the decreased number or function of CD4+ CD25+ FoxP3+ Treg plays an important role in immune imbalance in RA patients. The PI3K/Akt axis is one of the important mechanisms that regulate the balance of Th17/Treg, and has important effects on the differentiation, function and proliferation of the two axes. PTEN gene is a natural pathway inhibitor of PI3K/Akt axis, which can inhibit the abnormal proliferation of synovial cells and osteoclast activation in RA. PTEN also affects follicular helper T cells (Tfh) and follicular regulatory T cells (Tfr), and can improve RA symptoms by altering Th17/Treg imbalance. This article reviews the recent progress of PTEN in the mechanism of immune imbalance between RA and Th17/Treg.