Volume 100 ·  Issue 17 ·  2020

The novel coronavirus pneumonia (COVID-19), referred to as COVID-19 for short, was first reported in China in late December 2019, with an outbreak in Wuhan. Because of its strong infectivity, population susceptibility, long incubation period and diversified clinical manifestations, it has had a serious impact on people's normal work and life. SARS-CoV-2 (2019-nCoV) is a beta-coronavirus that can cause cardiovascular events such as acute myocardial injury, arrhythmia, and cardiac insufficiency in addition to mainly causing respiratory lesions^[1,2]。 Analysis of 72,314 cases of COVID-19 in China by the Chinese Center for Disease Control and Prevention found that the current crude mortality rate of COVID-19 is 2.6%, and the mortality rate is as high as 10.5% when combined with cardiovascular disease^[3]。 Because the population base of cardiovascular diseases in China is as high as 290 million, accounting for nearly 20% of the total population^[4]As a result, the number of deaths is also large, which should be paid enough attention to.

behavioral and psychological symptoms of dementia (BPSD) can be early symptoms of dementia patients or concomitant symptoms during the development of the disease. Timely identification, diagnosis and treatment of BPSD is of great clinical significance for accurately diagnosing dementia subtypes and improving the level of disease management of dementia patients.

dementia is an acquired persistent mental impairment syndrome. In addition to Alzheimer's disease (AD), other common causes and types include vascular dementia (VaD), dementia with Lewy bodies (DLB), Parkinson disease dementia (PDD), frontotemporal lobe degeneration (FTLD), and other central nervous system diseases or dementia caused by systemic, metabolic, and toxic diseases. Treatment includes pharmacological and non-pharmacological interventions targeting etiology, cognitive symptoms, and psychiatric behavioral symptoms. The intervention aimed at mental behavior will be introduced in a special article. This article mainly discusses the treatment aimed at cognitive function.

To investigate the predictive value of gadolinium-ethoxybenzyl- diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI imaging features combined with quantitative parameters for the pathologic grading of hepatocellular carcinoma (HCC).

Eighty patients (65 males, 15 females; range 30-74 years,average age (59±11) years old) with HCC who underwent curative resection or biopsy from June 2016 to June 2019 in the First Affiliated Hospital of Soochow University after Gd-EOB-DTPA-enhanced MRI were evaluated retrospectively.According to the pathological results of the postoperative pathology, eighty patients were divided into poorly differentiated group (26 cases, 22 males, 4 females) and moderately-well differentiated group (54 cases, 43 males, 11 females). In Gd-EOB-DTPA-enhanced MRI, qualitative parameters were assessed. Quantitative parameters including tumor size, tumor-to-liver signal intensity ratio(SIR) of arterial phase (AP), portal vein phase (PP), equilibrium phase (EP) and hepatobiliary phase (HBP), contrast enhancement ration AP (CER-AP)were measured and calculated. Clinical data and qualitative parameters between poorly differentiated group and moderately-well differentiated group were analyzed by using χ ² test.Quantitative parameters were analyzed by using independent sample t test. Statistically significant qualitative parameters, quantitative parameters, qualitative combined with quantitative parameters and AFP combined with qualitative and quantitative parameters were included in binary logistic regression model. The receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the four prediction model for the pathologic grading of HCC.

There was a statistical difference between poorly differentiated group and moderately-well differentiated group in AFP, arterial peritumoral enhancement, arterial rim enhancement, peritumoral hypointensity on HBP and tumor signal (all P<0.05). In two groups, tumor size, SIR-AP and SIR-PP were (7.0±3.7) vs (3.9±2.4)cm,1.11±0.29 vs 1.31±0.32 and 0.89±0.21 vs 1.03±0.27 (all P<0.05). AUC of qualitative parameters, quantitative parameters, qualitative combined with quantitative parameters and AFP combined with qualitative and quantitative parameters were 0.805, 0.804, 0.855, 0.892.There was a statistical difference between qualitative parameters and qualitative combined with quantitative parameters in sensitivity(80.8% vs 92.3%, P<0.05).

Gd-EOB-DTPA-enhanced MRI imaging features combined with quantitative parameters can be used to predict the pathologic grading of HCC preoperatively, which has a great applicative value.

To explore the MR characteristics of normal anatomy and injured peroneal tendon and the diagnostic value of MR in the peroneal tendon injuries.

From February 2018 to December 2018, a total of 20 healthy volunteers (40 ankle joints) were selected, 10 males and 10 females, with an age range of 20-30 (26±3) years. Retrospective analyzed 62 patients with ankle sprain and peroneal tendon injuries confirmed by operation, 34 males and 28 females, with an age range of 14-78(41±14) years. All volunteers and patients underwent MR examination. The MRI characteristics of the normal anatomy of peroneal tendon were analyzed. The patients were classified according to the MR diagnostic criteria of injury. Then the MRI features of different types of injured peroneus longus tendon and peroneus brevis tendon were analyzed. At last, imaging findings were compared with surgical results.

The peroneal tendon of 20 healthy volunteers showed oval and elliptical band-like structures on T₁WI and PD-FS sequences, with natural alignment, clear boundary and uniform low signal. The whole length of the peroneal tendon can′t be displayed completely on the same imaging plane. It needed multi-dimensional observation combined with axial, coronal and sagittal directions. There were 62 cases of peroneal tendon injury, including 46 cases of peroneal tendon tear (7 cases of partial-thickness tear, 11.3% of the total injuries, 39 cases of full-thickness tear, 62.9% of the total injuries), 16 cases of peroneal tendon dislocation (15 cases of intrathecal dislocation, 24.2% of the total injuries, 1 case of extrathecal dislocation, 1.6% of the total injuries). In 7 cases of partial-thickness tear (4 cases of peroneus brevis tendon tear, 3 cases of peroneus longus tendon tear), MR showed irregular tendon shape and local continuity interruption. In 39 cases of full-thickness tear (31 cases of peroneus brevis tendon tear, 8 cases of peroneus longus tendon tear), MR showed that the tear was penetrated through the whole layer of tendon from dorsolateral side to plantar side of foot, and the range of tear was different. The torn tendon could be accompanied by tendinitis or effusion of tendon sheath; 15 cases of intrathecal dislocation (3 cases of type A, 12 cases of type B), MR findings of type A dislocation showed that the peroneus longus tendon was located in the deep part of the peroneus brevis tendon, MR findings of type B dislocation showed that the peroneus longus tendon was displaced into the longitudinal tear of peroneus brevis tendon. In 1 case of extrathecal dislocation (type Ⅲ), MR showed that the SPR and the attached cortex of lateral malleolus were avulsed together, and the peroneal tendon was displaced under the avulsed fracture piece.

MR can accurately demonstrate the fine anatomical structure of peroneal tendon and the imaging features of injuries. It has important clinical application value for the early diagnosis and accurate treatment of peroneal tendon injuries.

To investigate the clinical efficacy radiofrequency ablation (RFA) combined with ¹²⁵I radioactive seed implantation in treatment of hepatocellular carcinoma HCC with the tumor diameter 3-5 cm.

One hundred patients with HCC diagnosed clinically or pathologically with Barcelona staging of B or C in Lishui Central Hospital from February 2012 to September 2017 were retrospectively analyzed. Of the included 100 cases, 89 were males and 11 were females with the mean age of 18-80 (57±11) years old.According to the treatment modality, the subjects were divided into control group (RFA, n=67) and combined group (RFA+¹²⁵I, n=33). Patients in control group were only received RFA and cases in combined group received RFA plus sequenced with ¹²⁵I implantation therapy. The prognosis of progression free survival (PFS) and overall survival (OS) between the two groups were compared through the Kaplan-Meier curve and Log-rank test.

The median follow-up time period was 6-55 months in the last follow-up time point of Dec 30, 2017. The median PFS were 4-55 (23.0±4.7) and 1-53 (12.0±1.6) months for combined and control groups respectively with significant statistical difference (P=0.015). The median OS were 6-55 (42.0±7.9) and 2-55 (38.0±2.8) months for combined and control groups with the trend of improvement in combined group, but without statistical difference (P=0.444). Subgroup analysis further indicated that the PFS was significant improved in patients with residual tumor lesions who received the combined treatment (PFS: 18 vs 9 months, P=0.025). However, there was no statistical difference for PFS between the control and combined treatment groups for cases without residual tumor lesions after RAF treatment(P=0.685).

PFS was obviously increased in HCC patients(tumor diameter 3-5 cm) who received¹²⁵I implantation after radiofrequency ablation, especially for cases with residual tumor lesions.

To investigate the expression of T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) in patients with chronic heart failure and its modulatory activity on T lymphocytes.

Eighty-six patients with chronic heart failure (CHF group) who were hospitalized in Department of Cardiology, the First Affiliated Hospital of Zhengzhou University between January and October 2018 were enrolled in the study. Meanwhile, thirty-two healthy controls (HC group) who received healthy examination were also selected. Peripheral blood mononuclear cells were isolated, and TIM-3 expression of CD4⁺and CD8⁺T cells was investigated by flow cytometry. CD4⁺and CD8⁺T cells were purified, and were stimulated by anti-TIM-3 antibody. Interferon-γ (IFN-γ), interleukin (IL)-4, IL-10, IL-35, IL-17, and IL-22 expressions in the supernatants of cultured CD4⁺T cells and tumor necrosis factor-α (TNF-α) and IFN-γ expressions in the supernatants of cultured CD8⁺ T cells were measured by enzyme-linked immunosorbent assay. mRNA expressions of T-bet, GATA-3, FoxP3, and RORγt in CD4⁺T cells and perforin and granzyme B in CD8⁺T cells were semi-quantified by real-time PCR. Student t test or paired t test was used for comparisons between the two groups.

TIM-3⁺ CD4⁺ T cell percentage significantly increased in CHF group than that of HC group (3.47%±1.06% vs 0.92%±0.27%, P<0.001). TIM-3⁺CD8⁺T cell percentage also notably elevated in CHF group compared to HC group (6.12%±1.91% vs 1.77%±0.63%, P<0.001). CD4⁺T and CD8⁺T cells were dysfunctional in chronic heart failure. The levels of IFN-γ, IL-17, and IL-22 secreted by purified CD4⁺ T cells significantly reduced in CHF group, while IL-10 and IL-35 expressions elevated in CHF group (all P<0.05). The relative mRNA expression levels of T-bet and RORγt in CD4⁺ T cells remarkably decreased in CHF group than those of HC group (all P<0.01), while relative expression level of FoxP3 mRNA increased in CHF group (1.93±0.88 vs 0.97±0.28, P=0.031). The levels of TNF-α and IFN-γ produced by purified CD8⁺T cells notably reduced in CHF group than those of HC group (all P<0.05), and relative mRNA expression levels of perforin and granzyme B also decreased in CHF group (all P<0.05). The levels of anti-TIM-3 antibody stimulation-produced IFN-γ, IL-17, and IL-22 increased (allP<0.05) but IL-35 secretion reduced [(61±13) ng/ml vs (72±17) ng/ml, P=0.029] by CD4⁺T cells in CHF group. The relative mRNA expression levels of T-bet and RORγt also elevated in response to anti-TIM-3 antibody stimulation (allP<0.05). Anti-TIM-3 antibody stimulation promoted TNF-α and IFN-γ production by CD8⁺T cells in CHF group (all P<0.01). The relative mRNA expression levels of perforin and granzyme B also increased (all P<0.05).

TIM-3 was increasingly expressed in T cells from patients with chronic heart failure, and might take part in the regulation of T cell dysfunction in chronic heart failure.

To explore the effect of phenolamine on the outcome and prognosis of patients with myocardial injury due to sepsis.

From January 2015 to December 2017, 62 septic patients with myocardial injury were randomly divided into study group (n=32) and control group (n=30). Two groups were given conventional treatment, while the study group was treated with phentolamine. The NT-pro brain natriuretic pepitide (NT-proBNP), cardiac troponin I (cTnI), lactate dehydrogenase (LDH), creatine kinase isoenzymes (CK-MB) and tumor necrosis factor (TNF)-α, high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-1β, IL-6 were detected at 0,12, 24, 48, 72 h and 7 d after hospitalization. And left ventricular ejection fraction (LVEF), e′, E and A in each time period were observed. The 28 d survival rate and length of ICU stay were observed in both groups. The data were compared with single samplet test between the two groups.

After 12, 24, 48, 72 h and 7 d, NT-proBNP, cTnI, LDH, CK-MB, TNF-α, hs-CRP, IL-1β, IL-6 in the study group were all significantly lower than those in the control group (allP<0.05). The cardiac function indexes of LVEF, E/A and E/e′ in the study group were all significantly improved when compared with those in the control group (all P<0.05). The length of ICU stay and 28-day mortality in the study group were significantly lower than those in the control group ((9.8±3.6) d vs (13.0±4.1) d, t=3.152, P=0.004; 21.9% vs 36.7%, χ ²=5.078, P=0.021).

Combined application of phentolamine can significantly improve the outcome of sepsis patients with myocardial injury and improve the survival rate.

To investigate the effects of age and body mass index (BMI) on embryo development time kinetic parameters, embryo development potential and clinical pregnancy outcomes.

A retrospective study was conducted to analyze the data of 6 294 embryos from 832 patients who underwent in vitro fertilization and embryo transfer (IVF-ET) in the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from September 2016 to November 2018. According to the age, they were divided into two groups:<35-year-old group (655 cases, 5 076 embryos), ≥35-year-old group (177 cases, 1 218 embryos). According to the BMI, they were divided into three groups: low body mass group (BMI<18.5 kg/m², 47 cases, 355 embryos), normal body recombination (18.5-23.9 kg/m², 517 cases, 3 813 embryos), hyperrecombination (BMI>23.9 kg/m², 268 cases, 2 126 embryos). Embryo development time kinetic parameters, embryo development potential and clinical pregnancy outcomes in each group were compared.

Embryo development to 3 cells, 4 cells were faster in <35-year-old group than in ≥35-year-old group. The blastocyst formation rate, high-quality blastocyst formation rate, pregnancy rate, implantation rate, delivery rate, live birth rate, and abortion rate were all statistically significant (all P<0.05). There were no significant differences in normal fertilization rate, cleavage rate, embryo utilization rate, high quality embryo rate, pregnancy rate, implantation rate, abortion rate, delivery rate, live birth rate between the three BMI groups (all P>0.05).

The age has an effect on the partial embryo development time kinetic parameters, but BMI has a little effect on it.

To compare the clinical application effect of totally implantable venous access ports (TIVAP) via the internal jugular vein,the subclavian vein and the brachiocephalic veins under the guidance of ultrasound combined with DSA.

The clinical materials of 346 patients (162 males and 184 females) who implanted TIVAP in intervention Department of Jiangsu Cancer Hospital between August 2018 and January 2019 were retrospectively reviewed and the average age was (57±12) years (17 to 83 years). The patients were divided into three groups according to the different implantation approaches. One hundred and twenty-six patients (67 males and 59 females) were group A who implanted from the internal jugular vein and the average age was (52±11) years,114 patients (52 males and 62 females) were group B who implanted from the subclavian vein and the average age was (58±10) years,106 patients (43 males and 63 females) were group C who implanted from the brachiocephalic vein and the average age was (60±9) years.The first-puncture success rate,operating time,implanting length,intraoperative pain score, one month comfort rating after surgery, unscheduled decannulation rates, early and late complication rates were compared among three groups.

All the patients implanted the TIVAP successfully.There were no significant differences about the first-puncture success rate (χ²=1.375,P=0.503),operating time (F=0.968, P=0.624), unscheduled decannulation rates (χ²=1.570, P=0.456), and the total pipe length among the three groups (F=0.821, P=0.441),while the catheter length inside the blood vessel were the shortest in group C (F= 263.618, P=0.000), and the one month comfort rating after surgery of group C were higher compared with group A and B (F=52.248,P=0.000).Pitch-off syndrome was a unique complication of group B (χ²=6.159,P=0.046) and other complications were no significant differences (P>0.05).

There are high accuracy and safety among three implantation approaches,and the approach via brachiocephalic vein under the guidance of ultrasound combined with DSA is more comfortable and lower complication rates, which could be priority to choose.

To exploer the effect of mammalian target ofrapamycin(mTOR)on cognitive dysfunction of mice with Alzheimer′s disease (AD) induced by amyloid β _1-42 (Aβ_1-42) via observing the regulation effect of rapamycin on Homer3 in hippocampus.

The 32 mice were randomly divided into fourgroups: sham group (the hippocampus of mice was injected with normal saline); AD group (the hippocampus of mice was injected with Aβ_1-42); DMSO group(AD mice induced by Aβ_1-42 were intraperitoneally injected with dimethylsulfoxide for 14 days);RAPA group(AD mice induced by Aβ_1-42 were intraperitoneally injected with rapamycin 1 mg/kg for 14 days). Morris maze and Y maze experiments to measuring cognitive function and immunowestern bloting detecting the expression of Aβ_1-42, mTOR, p-mTOR and Homer3 in the hippocampus were conducted on each group of mice.

Compared with sham group,the AD group showed significantly longer escape latency,shoter residence time of objective quadrant, less numbers of crossing of original platform, lower alternation ratio(P<0.05); Compared with DMSO group, RAPA group showed significantly shorter escape latency, longer residence time of objective quadrant, more numbers of crossing of original platform, more alternation ratio(P<0.05). The levels of Aβ_1-42 and p-mTOR were increased, the levels of Homer3 were decreased in DMSO group mice′s hippocampus compared with sham group(P<0.05); the levels of Aβ_1-42 and p-mTOR were decreased,the levels of Homer3 were increased in RAPA group mice′s hippocampus compared with DMSO group(P<0.05).

The inhibitor of mTOR rapamycin can improve the cognitive dysfunction of mice with AD induced by Aβ_1-42 and reduce deposition of Aβ_1-42 in the hippocampus, and the possible mechanism is rapamycin depressing the phosphorylation of mTOR as the same as Up-regulation the expression level of Homer3.

To investigate the effect of sleep fragmentation on perioperative neurocognitive disorders (PND) and central neuroinflammation by simulating sleep patterns of postoperative patients with sleep fragmentation in aged mice.

Thirty-two elderly ICR mice were randomly divided into four groups (n=8): normal group (C), surgery group (S), fragmented sleep group (F), and surgery+fragmented sleep group (D). Fragmented sleep was conducted after internal fixation of tibia fractures, cognitive function was evaluated by novel object recognition (NOR) and fear conditioning (FC) test, and changes in expression of inflammatory cytokines in hippocampus were detected by ELISA.

NOR test: the recognition index (RI) of mice in group C, group S, group F and group D was 0.69±0.07, 0.48±0.07, 0.54±0.10 and 0.50±0.12, respectively. The RI of mice in group S, group F and group D was significantly lower than that in group C (t=4.885, 3.521 and 4.433, all P<0.01). There was no significant difference in RI between group S and group D (t=0.967 1, P>0.05). Contextual FC test: the freezing time of mice in group C, group S, group F and group D was(21.34±6.48), (13.83±4.26), (11.50±6.25) and (6.17±4.77) s, respectively. The freezing time of mice in group S, group F and group D was significantly lower than that in group C (t=2.722, 3.566, 5.496, P<0.05 or P<0.01). The freezing time of mice in group D was significantly lower than that in group S (t=2.774, P<0.05). Cue FC test: the freezing time of mice in group C, group S, group F and group D was (74.36±17.09), (43.91±9.71), (46.34±13.43) and (24.90±14.21) s, respectively. The freezing time of mice in group S, group F and group D was significantly lower than that in group C (t=4.393, 4.043 and 7.136, all P<0.01). The freezing time of mice in group D was significantly lower than that in group S (t=2.743, P<0.05). The levels of TNF-α, IL-6 and IL-1β in hippocampus of mice in group S, F and D were significantly higher than those in group C, while the levels of TNF-α and IL-6 in hippocampus of mice in group D were significantly higher than those in group S, with statistically significant differences (P<0.05 or P<0.01).

Postoperative fragmented sleep aggravates postoperative cognitive impairment and increases the hippocampal neuroinflammation in aged mice.