Red Cell Distribution Width is Related to Mild Cognitive Impairment: A Cross-Sectional Study of Community Residents.

BACKGROUND AND OBJECTIVE: Previous literature has reported that red cell distribution width (RDW) correlated with Alzheimer's disease (AD), but the correlation with mild cognitive impairment (MCI) was not clear. This study aimed to investigate MCI in the residents aged ≥65 living in the suburban of Shanghai, China. MATERIALS AND METHODS: A total of 550 participants were recruited as MCI (MCI group, 226) and normal (NC group, 284) groups and received blood examination voluntarily. Blood routine indexes were tested by blood tests using Sysmex XT-4000i (Japan). The Chi-square test, t-test, and linear regression analysis were used to find the statistical difference and correlation of data, respectively. RESULTS: Each cognition domain of MCI was found to be impaired, the weight of which, however, was different in integral damage. Most MCI people had impairment of attention among cognitive domains (235, 88.3%). According to the results of the binary logistic regression, the highest weight among impaired cognitive domains was for attention in MCI, and the Wald value of attention was higher than those of others (Wald = 51.83). Additionally, RDW had the greatest negative correlation with attention score (P < 0.05). CONCLUSIONS: Increased RDW may be considered as a biomarker of MCI.

Multimodal Imaging for the Diagnosis of Massive Left Atrial Metastasis from Lung Cancer - A Case Report.

BACKGROUND: Secondary cardiac tumors are a rare disease that is hard to detect when the tumor is small and asymptomatic. This case report focuses on a massive pulmonary metastasis filling almost the entire left atrium. Multimodal enhancement imaging, cardiac contrast-enhanced ultrasound (CEUS), enhanced electron computed tomography, and positron emission tomography imaging were applied to detect the malignant origin of this case. The aim of this project was to provide an important basis for clinical treatment and decision-making with multimodal imaging. CASE PRESENTATION: The patient was hospitalized with suspected to be a lumbar spine fracture. According to the multimodal imaging, pathologically confirmed to suffer a cardiac metastasis from small cell lung cancer. EP-regimen (Etoposide 0.1gd 1-5+Nedaplatin 30mgd 1-4) was selected for the systemic chemotherapy of the patient. During three years of follow-up, the left intra-atrial occupancy was significantly reduced. CONCLUSION: Multimodality imaging can cover up the deficiencies of single imaging examinations and further clarify and enrich the understanding of the relationship between the location and the surrounding structure of the mass, thus providing a good reference for clinical treatment and decisionmaking.

Case report: Anxiety and depression as initial symptoms in a patient with acute hypoxia and patent foramen ovale.

The prevalence of patent foramen ovale (PFO) is 15-35% among adults. The role of right-to-left shunting through the PFO, anxiety, depression, and hypoxemia in the systemic circulation remains poorly understood. Herein, we present the case of a 52-year-old woman with no heart or lung disease, who was admitted due to anxiety for 5 months and had symptom exacerbation with dizziness for 4 days and presented with cyanosis. She was noted to have acute hypoxemia, with an oxygen saturation of 94.48% on room air, and arterial blood gas showed an oxygen tension of 65.64 mmHg. Agitated saline contrast echocardiography showed right-to-left shunting due to PFO. Arteriovenous fistula, pneumonia, pulmonary embolism, pulmonary hypertension, congestion peripheral cyanosis, ischemic peripheral cyanosis, and methemoglobin were excluded. Additionally, the patient improved by taking Paroxetine, Oxazepam, and Olanzapine. Her oxygen tension returned to 90.42 mmHg, and her symptoms resolved. In the case of severe anxiety and depression, right-to-left shunting through the PFO may cause acute systemic hypoxemia via a flow-driven mechanism, occasionally manifesting as cyanosis. When anxiety improved, hypoxia also improved. Thus, the treatment of anxiety and depression seems effective in improving hypoxemia. Notably, this is a rare report, and we hope to draw the attention of psychosomatic specialists, psychiatrists, and clinicians to seek the relationship between anxiety appearing as acute stress and PFO. This may be a new therapeutic method for treating severe anxiety disorder.

Prenatal ultrasound diagnosis of fetal giant pericardial cyst: A case report.

RATIONALE: We describe 1 case of fetal giant pericardial cyst was diagnosed by fetal echocardiography in the second trimester, and the changes of the cyst were recorded by follow-up observation in the late trimester and after birth. We then review and discuss the knowledge about its diagnosis and treatment. PATIENT CONCERNS: A 34-year-old pregnant woman was referred to our hospital because of a diagnosis of a fetal pericardial effusion at 22 5/7 weeks at another hospital. DIAGNOSIS: Fetal echocardiography revealed an irregular anechoic area in the right side of the fetal right atrium and right ventricle that was closely related to but not communicated with the pericardiumis and suggested fetal pericardial cyst. Fetal cardiothoracic magnetic resonance imaging showed cystic FIESTA signal in the right lung region, with clear boundary, and a seemingly line-like low signal shadow within. INTERVENTIONS: Since fetal pericardial cysts keep decreasing in size during maternal pregnancy, follow-up observation measures are taken. OUTCOMES: Fetal pericardial cysts disappear on their own 4 months after delivery. LESSONS: Asymptomatic pericardial cysts in the fetal period can be followed up and observed, and intervention is performed only when the cyst rapidly enlarges or ruptures and becomes infected in the fetal or neonatal period. Echocardiography can be used as a first-line detection method for their initial detection and follow-up.

A Systematic Review and Meta-Analysis of the Association between Residual Shunts after Patent Foramen Ovale Closure and Long-Term Cerebrovascular Events.

BACKGROUND: The association between a patent foramen ovale (PFO) and cryptogenic stroke (CS) is well established, and the benefits of PFO closure are clearly recognized. This study aimed to investigate the presence of a residual shunt in patients who have experienced cryptogenic cerebrovascular events following a PFO closure. METHODS: Two researchers systematically searched the PubMed and Embase online database for pertinent clinical studies published between January 2000 and July 2021 concerning the recurrence of cerebrovascular events after PFO closures. RESULTS: Upon screening an initial list of 2,342 articles, six studies were identified, involving 2,083 patients. Overall, the analysis indicated a marked difference in the recurrence of cerebrovascular events in 8.89% of residual shunt (RS) cases compared to only 2.90% of non-RS cases. The summary odds ratio was 3.484 (95% confidence interval, 2.169-5.596), which suggested that RS may be a risk factor for recurrent cerebrovascular events in patients that experienced PFO-related cerebrovascular events within 6 months after PFO closure surgery. CONCLUSIONS: The presence of RS significantly increases the risk of recurrent cerebrovascular events in patients with clinical PFO closure.

Machine-learning-based analysis of the sensitivity and specificity on lipid-lowering effect of one-month-administered statins.

Few predictive studies have been reported on the efficacy of atorvastatin in reducing lipoprotein cholesterol to be qualified after 1-month course of treatment in different individuals. A total of 14,180 community-based residents aged ≥ 65 received health checkup, 1013 of whom had low-density lipoprotein (LDL) higher than 2.6mmol/L so that they were put on 1-month course of treatment with atorvastatin. At its completion, lipoprotein cholesterol was measured again. With < 2.6 mmol/L considered as the treatment standard, 411 individuals were judged as the qualified group, and 602, and as the unqualified group. The basic sociodemographic features covered 57 items. The data were randomly divided into train sets and test ones. The recursive random-forest algorithm was applied to predicting the patients response to atorvastatin, the recursive feature elimination method, to screening all the physical indicators. The overall accuracy, sensitivity and specificity were calculated, respectively, and so were the receiver operator characteristic curve and the area under the curve of the test set. In the prediction model on the efficacy of 1-month treatment of statins for LDL, the sensitivity, 86.86%; and the specificity, 94.83%. In the prediction model on the efficacy of the same treatment for triglyceride, the sensitivity, 71.21%; and the specificity, 73.46%. As to the prediction of total cholesterol, the sensitivity, 94.38%; and the specificity, 96.55%. And in the case of high-density lipoprotein (HDL), the sensitivity, 84.86%; and the specificity, 100%. recursive feature elimination analysis showed that total cholesterol was the most important feature of atorvastatin efficacy of reducing LDL; that HDL was the most important one of its efficacies of reducing triglycerides; that LDL was the most important one of its efficacies of reducing total cholesterol; and that triglyceride was the most important one of its efficacies of reducing HDL. Random-forest can help predict whether atorvastatin efficacy of reducing lipoprotein cholesterol to be qualified after 1-month course of treatment in different individuals.

Diagnosis of descending aorta-pulmonary venous fistula combined with pulmonary arteriovenous fistula by color Doppler ultrasound combined with CT: A case report.

Aorto-pulmonary venous fistula combined with pulmonary arteriovenous fistula is a rare condition with an unknown incidence. We experienced a case of descending aorto-pulmonary venous fistula combined with a pulmonary arteriovenous fistula, which was treated with pulmonary arteriovenous fistula embolization and improved.

Random-Forest-Algorithm-Based Applications of the Basic Characteristics and Serum and Imaging Biomarkers to Diagnose Mild Cognitive Impairment.

BACKGROUND: Mild cognitive impairment (MCI) is considered the early stage of Alzheimer's Disease (AD). The purpose of our study was to analyze the basic characteristics and serum and imaging biomarkers for the diagnosis of MCI patients as a more objective and accurate approach. METHODS: The Montreal Cognitive Test was used to test 119 patients aged ≥65. Such serum biomarkers were detected as preprandial blood glucose, triglyceride, total cholesterol, Aß1-40, Aß1-42, and P-tau. All the subjects were scanned with 1.5T MRI (GE Healthcare, WI, USA) to obtain DWI, DTI, and ASL images. DTI was used to calculate the anisotropy fraction (FA), DWI was used to calculate the apparent diffusion coefficient (ADC), and ASL was used to calculate the cerebral blood flow (CBF). All the images were then registered to the SPACE of the Montreal Neurological Institute (MNI). In 116 brain regions, the medians of FA, ADC, and CBF were extracted by automatic anatomical labeling. The basic characteristics included gender, education level, and previous disease history of hypertension, diabetes, and coronary heart disease. The data were randomly divided into training sets and test ones. The recursive random forest algorithm was applied to the diagnosis of MCI patients, and the recursive feature elimination (RFE) method was used to screen the significant basic features and serum and imaging biomarkers. The overall accuracy, sensitivity, and specificity were calculated, respectively, and so were the ROC curve and the area under the curve (AUC) of the test set. RESULTS: When the variable of the MCI diagnostic model was an imaging biomarker, the training accuracy of the random forest was 100%, the correct rate of the test was 86.23%, the sensitivity was 78.26%, and the specificity was 100%. When combining the basic characteristics, the serum and imaging biomarkers as variables of the MCI diagnostic model, the training accuracy of the random forest was found to be 100%; the test accuracy was 97.23%, the sensitivity was 94.44%, and the specificity was 100%. RFE analysis showed that age, Aß1-40, and cerebellum_4_6 were the most important basic feature, serum biomarker, imaging biomarker, respectively. CONCLUSION: Imaging biomarkers can effectively diagnose MCI. The diagnostic capacity of the basic trait biomarkers or serum biomarkers for MCI is limited, but their combination with imaging biomarkers can improve the diagnostic capacity, as indicated by the sensitivity of 94.44% and the specificity of 100% in our model. As a machine learning method, a random forest can help diagnose MCI effectively while screening important influencing factors.

Electric wire as a urethral foreign body: A case report.

RATIONALE: Most self-insertion of urethral foreign bodies is the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Ultrasound has been proven to be an effective tool for determining the presence, location, and characteristics of the urethral foreign body. PATIENT CONCERNS: A 48-year-old man presented with a mass in the urethra for 2 years. Physical examination suggested swelling and ulcer in the scrotum. The white blood cell count was elevated (12.60 × 109/L). Urinalysis showed an increased white cell count (484.60/µL) and urine occult blood (±). DIAGNOSIS: Ultrasound examination of the genitourinary system identified an 8.3 cm linear hyperechoic object and hyperechoic spots in the urethra. Computed tomography revealed an extremely hyperdense lesion in the penis. Intraoperative findings showed electric wire bending and winding surrounded by fibrous tissues with urethral rupture. INTERVENTIONS: The patient was treated with urethrotomy as the endoscopic treatment failed. and the electric wire was removed successfully. OUTCOMES: The patient was followed up for 45 days without discomfort. Ultrasound examination of the genitourinary system suggested that the wound was almost healed, but with a small urethral effusion, with a maximum depth of approximately 1.9 mm. LESSONS: A foreign body was inserted into the patient's urethra for 2 years without any medical treatment. Urethral perforation was found during surgery. In such cases, ultrasound examination can determine the location, shape, and size of the urethral foreign body and play an important role in the diagnosis of foreign bodies.

Comparison of Superb Microvascular Imaging and Conventional Doppler Imaging Techniques for Evaluating Placental Microcirculation: A Prospective Study.

BACKGROUND Superb microvascular imaging (SMI) is a new blood flow imaging technique used to evaluate microvascular blood flow. This study evaluated whether SMI was superior to color Doppler flow imaging (CDFI) for evaluating placental microcirculation. MATERIAL AND METHODS This prospective study included pregnant women in their third trimester who were evaluated at General Hospital of Hebei Province from February to June 2017. The distribution of vascular patterns, including pulsatility index (PI), resistance index (RI), S/D, time average velocity (TAV), and vessels per unit area, were evaluated by SMI and CDFI. RESULTS This study evaluated 110 pregnant women of mean age 29.53 years. SMI and CDFI yielded statistically significant differences in PI (0.76 vs. 0.62), RI (0.71 vs. 0.47), S/D (2.23 vs. 1.71), TAV (14.35 vs. 22.45), and vessels per unit area (0.26 vs. 0.05) (P<0.001 each). The weight of the pregnant women correlated positively with RI (P=0.048) and negatively with vessels per unit area (P=0.040) as determined by SMI. Weeks of gestation correlated negatively correlated with PI (P=0.008), RI (P=0.004), S/D (P=0.015), and vessels per unit area (P=0.014) by CDFI, and positively with RI (P<0.001) and S/D (P=0.001) by SMI. The results of stratified comparisons of CDFI and SMI based on age, weight, and gestational weeks were consistent overall. CONCLUSIONS SMI, which has a higher rate of placental vascularity, a clearer display of capillaries, a greater sensitivity to low flow, and an advantage in displaying microcirculation of the placenta, can serve as a new and effective method of evaluating placental blood flow.

Improved antifungal activity of amphotericin B-loaded TPGS-b-(PCL-ran-PGA) nanoparticles.

To develop amphotericin B-loaded biodegradable TPGS-b-(PCL-ran-PGA) nanoparticles (PLGA-TPGS-AMB NPs) for fungal infection treatment, PLGA-TPGS NPs and PLGA NPs were synthesized by a modified double emulsion method and characterized in terms of size and size distribution, morphology and zeta potential. Drug encapsulation efficiency, in vitro drug release, and in vitro/vivo tests against Candida glabrata were completed. The data showed that both of the two AMB-loaded NPs (PLGA-AMB NPs, PLGA-TPGS-AMB NPs) achieved significantly higher level of antifungal effects than water suspended AMB. In comparison with PLGA-AMB NPs, PLGA-TPGS-AMB NPs had a stronger protective effect against candidiasis and gained an advantage of prolonged antifungal efficacy. In conclusion, PLGA-TPGS-AMB NPs system significantly improves AMB bioavailability by increasing the aqueous dispersibility and improving the antifungal activity. And this would be an excellent choice for the antifungal treatment of the entrapped drug because of its low toxicity and higher effectiveness.

Crystal structure of inactive form of Rab3B.

Rab proteins are the largest family of ras-related GTPases in eukaryotic cells. They act as directional molecular switches at membrane trafficking, including vesicle budding, cargo sorting, transport, tethering, and fusion. Here, we generated and crystallized the Rab3B:GDP complex. The structure of the complex was solved to 1.9Å resolution and the structural base comparison with other Rab3 members provides a structural basis for the GDP/GTP switch in controlling the activity of small GTPase. The comparison of charge distribution among the members of Rab3 also indicates their different roles in vesicular trafficking.