Volume 99 ·  Issue 27 ·  2019

Perioperative brain health of elderly patients refers to the preoperative screening, diagnosis and optimized treatment, intraoperative monitoring and early warning, systematic management and preventive measures, as well as active postoperative prevention, monitoring the occurrence of complications and timely intervention, so that the postoperative brain function of elderly patients can be maintained at the basic level before operation or even improved. Therefore, perioperative brain state management of elderly patients requires the joint participation of multidisciplinary experts to form a new medical model and clinical management path, including: (1) building a perioperative multidisciplinary evaluation center for elderly patients to screen neuropsychiatric diseases and sleep disorders that affect perioperative brain health of elderly patients; (2) Build a comorbidity ward for the elderly, and multidisciplinary experts participate in optimizing the brain health status of elderly patients before operation; (3) Systematically design perioperative management plans and clinical pathways to reduce the influence of intraoperative brain damage factors; (4) Closely monitor neuropsychiatric and sleep complications after operation, actively prevent and detect and treat them early; (5) Follow-up after discharge to confirm the ability of elderly patients' brain function to adapt to themselves, their families and society after operation.

Project Moderator:Wang Tianlong (Department of Anesthesiology, Xuanwu Hospital, Capital Medical University); Wang Dongxin (Department of Anesthesiology, Peking University First Hospital)

To explore the value of shear wave elastography(SWE)stiff rim sign and SWE stiff rim sign combined with BI-RADS classification in qualitative diagnosis and multiple SWE parameters in quantitative diagnosis of benign and malignant breast masses.

One hundred and eighty-eight patients, 18-83 (44±14) years old, with 199 breast masses (maximum diameter, 0.4-5.0 (2.1±1.0) cm) by ultrasound were selected.Qualitative diagnosis was made by SWE stiff rim sign, and SWEmax, SWEmean, SWEmin, SWE1max, SWE2max, SWE3max, SWE1mean, SWE2mean, SWE3mean were obtained. The ROC of each quantitative parameter was drawn, then the AUC was calculated.

There were 75 malignant masses and 124 benign masses in 199 breast masses confirmed by pathology. Qualitative diagnosis of BI-RADS classification (χ²=155.181) and of SWE stiff rim sign (χ²=117.304)and quantitative diagnosis of SWEmax, SWEmean (t=6.869,6.305), SWE1max, SWE2max, SWE3max (t=8.768,9.059,9.180), SWE1mean, SWE2mean, SWE3mean (t=10.041,10.312,10.576) were all statistically significant (all P<0.01). But there was no statistically significance in quantitative diagnosis of SWEmin (P>0.05). The AUC value of qualitative diagnosis of SWE stiff rim sign combined with BI-RADS classification was 0.967, and the sensitivity was 92.0%.For BI-RADS 4a masses,the positive rate of puncture could be increased from 15.3% to 77.8% by combination of SWE hard ring sign.

Qualitative diagnosis of SWE stiff rim sign and quantitative diagnosis of multiple SWE parameters are of high accuracy in differentiating benign or malignant breast masses. The combination of SWE stiff rim sign and BI-RADS classification could further improve the sensitivity of qualitative diagnosis, and increase the positive rate of puncture for 4a masses.

To investigate and evaluate the correlation between event-related potentials, cranial magnetic resonance imaging and electroencephalogram on cognitive function in patients with temporal lobe epilepsy.

According to the exclusion criteria, 60 adult temporal lobe epilepsy patients (24 males and 36 females, 34±13 years old of average age) were enrolled in the First Affiliated Hospital of Kunming Medical University from March 2017 to September 2018. The magnetic resonance imaging (MRI), 24 h video electroencephalogram (EEG) and event-related potentials (ERPs) were detected in all patients, comparing the latency of N1, P2, N2, P3 waves and the amplitude of P3 waves.

The mean latency of the waves of N1, P2, N2 and P3 and the mean amplitude of P3 wave were (108±25), (182±30), (256±33), (367±40) ms and (6.4±5.8) μV. There were significant differences in ERPs (latency of N1 wave, N2 wave and P3 wave) between the MRI abnormal group and the normal group (all P<0.05). There was a statistically significant difference in the ERPs (P3 wave latency) between EEG examination found epileptiform or paroxysmal slow waves release group and the patients with EEG normality in the past 1 year (P<0.05) and the EEG test results were positively correlated with the latency of P2, N2 and P3 waves in ERPs, and negatively correlated with the amplitude of P3 waves (P<0.05).

Patients with cognitive dysfunction in temporal lobe epilepsy are more likely to have abnormal MRI and EEG in the head. Both of them show different effects on the cognitive process of patients in ERPs.

An electrophysiological technique was established to determine Motor Unit Number Index (MUNIX), and to investigate the stability of MUNIX.

Fifty healthy subjects (25 males and 25 females) from the Outpatient Service of Peking University Third Hospital between December 2017 and September 2018 were included and divided into 5 groups according to age. The relevant parameters were detected in bilateral deltoid muscle (axillary nerve), double little finger abductor muscle (ulnar nerve), double quadriceps muscle (femoral nerve), double tibialis anterior muscle (peroneal nerve). The same muscle and the same healthy subjects were tested again three months later. Three-step detection were conducted: first, the surface electrode was attached to the muscle belly of each muscle, and the reference electrode was placed 2-3 cm away from the muscle belly. At the same time, the maximum compound muscle action potential (CMAP) of corresponding nerve was obtained, and the negative peak amplitude was measured. The second step was to collect the interference phase of the surface electromyography (SIP). There were 10 levels in total. And the measurement was repeated for three times, and the whole interference phase range was measured in the end. In the third step, the negative peak amplitude and SIP value of CMAP were substituted into the Excel table, and the MUNIX and motor unit number size (MUSIX) values were automatically calculated by the instrument through mathematical functions.

The mean MUNIX values of deltoid, extensor little finger, quadriceps femoris and tibial anterior were 193.2, 189.0, 159.7, 147.2, MUSIX were 46.9, 54.3, 49.6, 48.1 μV, respectively. The detection rates of MUNIX and MUSIX in the four muscles were 100%, respectively. With the increase of age, it could be seen that MUNIX declined, with statistically significant difference ( P<0.05), but there was no significant change in MUSIX. There was no statistically significant difference in MUNIX and MUSIX between different gender, lateral sides and baseline and 3-month’s reexamination results (P>0.05).

MUNIX technology can improve the motor unit count of proximal upper limb and lower limb muscles. Its parameters are monitored using a mathematical model based on the composite muscle action potential and the interference phase of surface electromyography. Result is stable and reliable.

To investigate the application of adaptive statistical iterative reconstruction-V (ASIR-V) in contrast-enhanced abdominal CT scanning with low-dose for liver cirrhosis.

From June 2017 to May 2018, a total of 112 liver cirrhosis patients who underwent contrast-enhanced abdominal CT scanning were collected prospectively as the study group. According to Child-Pugh grading of liver function, the study group was divided into A, B and C groups. Thirty examiners with normal liver function who underwent contrast-enhanced abdominal CT scanning no abdominal diseases were collected as the control group. The control group applied 0 pre-ASIR-V. The study group applied 30%, 40% and 50% pre-ASIR-V in plain scanning, arterial and portal vein phase, respectively. The control and study group both combined with 60% post-ASIR-V. The difference of qualitative parameters (contrast to noise ratio of the liver, pancreas, spleen, abdominal aorta and portal vein), image noise and radiation dose were compared by One-way ANOVA. Subjective score of images were compared by Kruskal-Wallis H test.

The volume computed tomography dose index (CTDI_vol), dose length product (DLP) and the effective dose (ED) of study group were lower than the control group in the same phase (F=13.354-28.192, P<0.01). And the ED were decreased by 1.12 (23.9%), 1.54 (33.5%), 2.14 mSv (46.7%). The CNR values of liver and portal vein in Child C group was 0.34-0.42 and 0.43-0.49 lower than that of Child A and control group, respectively (q=2.851-4.658, P<0.05). Image noise had no difference in study and control group. There were no statistical differences between each group of subjective score in arterial and portal vein phase. The mean score of Child C in portal phase was lower than 3, which affected the diagnosis. And there were significant difference among the control, Child A and Child C group(Z=26.734-29.218, P<0.05).

According to the classification of liver function, liver cirrhosis combined with ASIR-V can ensure the image quality while reduce the radiation dose. When liver function is Child-Pugh A or B, preset 50%ASIR-V is recommended; 40%ASIR-V is recommended for Child-Pugh C.

To investigate the application value of the weight-bearing magnetic resonance imaging (MRI) in evaluating the stability of knee joint after anterior cruciate ligament reconstruction.

From July 2011 to August 2013, a total of 25 patients with anterior cruciate ligament rupture and reconstruction surgery in the Second Affiliated Hospital of Soochow University were enrolled in this study, including 18 males and 7 females, with an average age of (32±5) years. All the patients underwent the weight-bearing MRI, knee joint passive relaxation test (Kneelax 3), and Lysholm score before the surgery and 3 and 6 months after the surgery. The three examinations before and after the operation were analyzed by repeated measures of general linear model, and paired t test was used to compare the results before and after the operation. The correlation between the three preoperative examinations was statistically analyzed.

The relaxation data measured by Kneelax 3 after the surgery was significantly lower than that before the operation [(1.1±0.9) mm vs (6.1±1.3) mm, t=16.9, P<0.01]. The post-operative lateral tibial plateau anterior shift score was less than the pre-operative score [(3.0±0.7) mm vs (4.8±1.2) mm, t=6.2, P<0.01]. The post-operative Lysholm score was significantly higher than that before the operation (89±6 vs 64±14, t=-8.3, P<0.05). There was a negative correlation between the anterior displacement of the lateral platform and Lysholm score (r=-0.902, P<0.01). There was no correlation between anterior displacement and passive relaxation of the lateral platform in preoperative weight-bearing MRI.

Anterior cruciate ligament reconstruction can improve the knee stability. The stability of knee joint can be evaluated by weight-bearing MRI. The anterior tibial displacement measured by the weight-bearing MRI is correlated with the clinical score.

To describe the secular trends of institutional delivery (ID) rate in minority inhabited areas of China from 1996 to 2017 according to national health policies.

The number of live births and IDs for each county/district in 31 provinces of China were derived from the datasets collected by the Office for National Maternal & Child Health Statistics of China. Information on health policies and ethnical areas was derived from official governmental websites. The calendar years were divided into three periods: pre-program period (1996 to 1999), program implementation period (2000 to 2008) and post-program period (2009 to 2017). Minority autonomous regions, autonomous prefectures, and autonomous counties were defined as minority inhabited areas. The ethnic that a county was classified into was determined by a principle of close proximity to the name of the county or its next higher level administrative division. A total of 700 counties in minority inhabited areas were included in the analysis.

A total of 45 684 265 live births including 35 098 855 delivered in institutions were analyzed. The ID rate in minority inhabited areas was 37.5% (696 221/1 856 164) in 1996 and 99.2% (2 371 209/2 390 131) in 2017, with an annual growth rate of 4.7%. During the 22-years period, the ID rates in the eastern, central and western regions increased simultaneously, with the annual growth rates of 3.1%, 4.2% and 4.9% respectively. The difference between the eastern and western regions decreased steadily from 16% in 1996 to <1% in 2017 and the difference between the urban and rural areas decreased from 32.1% in 1996 to <1% in 2017. Besides, the ID rates in Tibetan and Yi inhabited areas with lower baseline levels increased 73 and 63 percentage points respectively. The number of counties with the ID rate of <96% were substantially reduced from 589 in 1996 to 72 in 2017; the 71 counties were all located in national deep poverty-stricken areas named Three Districts and Three States, predominantly involving Tibetan (58), Yi (6), Uygur (2) and Lisu (2) ethnics.

During the past 22 years, the ID rate in minority inhabited areas in China has dramatically increased, achieving the goal of 2 020 ahead of schedule, but there remains a few western counties where ID rates are still<96%, indicating that minority inhabited western areas should be focused in developing national policies concerning institutional delivery.

To evaluate ROMA in assessing malignancy risk of pelvic mass with Meta-analysis.

PubMed, ISI Web of Science, and Cochrane literature were searched until December 2017. Combine and analyse sensitivity, specificity, positive likelihoodratio, negative likelihood ratio, diagonistic odd ratio and AUC.

Data of ROMA was retrieved from 8 studies, sensitivity and specificity were 86% and 77% respectively, and AUC was 0.899.

According to Meta analysis of previous studies, sensitivity and specificity of ROMA are high enough to be used as an index in setting of ovarian cancer diagnosis.

This paper reports a case of repeated pregnancy loss in a couple with normal chromosome karyotype analysis. After human whole exon sequencing and copy number variation detection, it was found that both parties share partial deletion of pregnancy specific glycoprotein encoding gene; The value of new gene detection technology and platform in the diagnosis of repeated pregnancy loss was discussed.

In a patient with congenital myasthenia (CMS) caused by DOK7 gene mutation, the diagnosis mainly depends on genetic screening. After treatment with cholinesterase (AChE) inhibitors, the condition improved for a short time and then deteriorated rapidly. This effect reversal phenomenon is extremely rare in patients with CMS caused by DOK7 gene mutation, and needs to be paid attention by clinicians.

A middle-aged and elderly woman with slowly progressing involuntary tremor of both lower limbs showed mainly resting and orthostatic tremor of lower limbs without signs of ataxia. No responsible mutations were found in the detection of dystonia and Parkinson's disease-related genes. Family investigation found that many people in the family walked unsteadily. Spinocerebellar ataxia-related genes were examined, and the clinical diagnosis was spinocerebellar ataxia type 3.

The spinal-pelvic sagittal equilibrium relationship plays a decisive role in overall sagittal equilibrium. In patients with spinal diseases or postoperative spinal surgery, the abnormal spinal-pelvic sagittal balance relationship affects the acetabular cup placement angle and postoperative dislocation rate in total hip arthroplasty, etc. This article reviews the research progress of the influence of spinal-pelvic sagittal balance relationship on the acetabular cup placement angle in total hip arthroplasty, so as to provide reference for follow-up research.

Peripheral nerve lymphomatosis refers to a rare disease in which lymphoma cells directly infiltrate the peripheral nervous system, and the main manifestations are damage to cranial nerves, peripheral nerves, nerve plexus and nerve roots. The diagnosis mainly depends on pathology. PET-CT is highly sensitive, which is helpful for the early detection of this disease and the selection of biopsy site.