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Spontaneous intracranial hypotension can frequently result in several complications including subdural hygroma, subdural hematoma and cerebral venous thrombosis, but coma rarely. A case of spontaneous intracranial hypotension presented with orthostatic headaches was described. He experienced somnolence, disorientation, incontinence, and then coma, though received conservative treatment. Brain imaging demonstrated acute-on-chronic subdural hematoma, magnetic resonance myelography using heavily T 2-weighted fast spin-echo pulse sequences showed spinal longitudinal extradural collection, and magnetic resonance myelography with intrathecal gadolinium revealed cerebrospinal fluid leak at the level of T 6, T 7. The patient recovered consciousness after surgical evacuation of the hematoma, and the headache disappeared after a targeted epidural blood patch. The hematoma resolved 2 months later and the patient kept free from headache during follow-up.
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Aim To evaluate the mechanism by which intermdin(IMD)inhibits lipopolysaccha ride(LPS)-induced polarization in RAW264.7 cells.Methods RAW264.7 cells were divided into control groups, LPS groups, LPS+IMD groups, LPS+IMD+Compound C groups.The mRNA expressions of tumor necrosis factor-α,(TNF-α,), CD86, inducible nitric oxide synthase(iNOS), Arginase-1(Arg-1)and CD206 were detected by Realtime-PCR.The protein expressions of p-AMPK, AMPK, TNF-α, intereukin-6(IL-6)and intereukin-10(IL-10)were detected by Western blot.The proportion of CD86+ M1 type cells was detected by Flow cytometry.In addition, the expression levels of supernatant cytokines, including IL-6 and TNF-α, were detected by ELISA.Results Compared with control and LPS groups, IMD treatment could up-regulate the expression level of p-AMPK and the ratio of p-AMPK/AMPK.LPS promoted M1 polarization, since the expressions of CD86, TNF-α and iNOS increased, while the expressions of CD206 and Arg-1 decreased by LPS induction.The proportion of M1 type cells increased and the secretion of TNF-α, IL-6 in the cell supernatant increased.And IMD treatment could inhibit the polarization of M1 induced by LPS.These effects were reversed by Compound C, an inhibitor of AMPK.Conclusion IMD can inhibit the M1-type polarization of LPS-induced macrophages by activating AMPK signaling pathway.
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Objective: To investigate the MRI features of adult hypoxic-ischemic encephalopathy. Methods: Data of 18 patients who underwent MR scanning after ischemia and hypoxia due to various reasons were collected and analyzed. Results: Among 18 patients, 17 were found with abnormal MRI signals, involving cerebral cortex, subcortical white matter, deep white matter, lateral ventricle white matter, corpus callosum, basal ganglia, hippocampus, thalamus, pons and cerebellum. Diffuse brain atrophy was shown in 9 patients, while plain T1WI showed hyper-intensity along the cerebral cortex or basal ganglia in 5 cases. Restricted diffusion was shown on DWI in 9 cases. Enhanced MR scanning was performed in 5 patients and showed mild gyral enhancement in cerebral cortex in 1 patient. MRI showed no obvious lesion in 1 case. Conclusion: MRI can display abnormal signals of hypoxic ischemic encephalopathy involving many brain regions. MRI features can not only reflect the severity of hypoxic-ischemic encephalopathy, but also predict treatment effect and evaluate the prognosis of patients.
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Objective To investigate changes of functional connectivity between the right anterior insula and the frontal operculum in mild cognitive impairment(MCI).Methods Twenty-one MCI patients served as MCI group and twenty age-and gender-matched subjects with normal cognitive function served as a control group in this study.Resting-state fMRI was performed and functional connectivity to right anterior insula and the frontal operculum was obtained with a voxel-wise manner.The difference in functional connectivity between the two groups was obtained with two -sample t-test.Results The mini-mental state examination score was significantly lower in MCI group than in control group(25.8±0.6 vs 29.2±0.3,P＜0.01).In healthy elderly,a distributed set of regions,including bilateral inferior parietal lobule,right middle and posterior cingulated cortex,right middle frontal gyrus,right mediodorsal nucleus of thalamus,right supplementary motor area,left anterior insula and the frontal operculum,left superior temporal gyrus,left inferior frontal gyrus,left precentral gyrus and left olfactory cortex(orbital and vertical gyrus),showed functional connectivity to right anterior insula and the frontal operculum.While bilateral inferior parietal lobule,right inferior frontal gyrus(opercularis,orbitalis,triangularis),right middle frontal gyrus,right middle cingulated cortex,right thalamus,left anterior insula and the frontal operculum and ACC,showed functional connectivity to right anterior insula and the frontal operculum in MCI.Compared to healthy elderly,decreased functional connectivity to right anterior insula and the frontal operculum was identified in left olfactory cortex and left superior parietal lobule,while increased in right medial prefrontal lobe.At the same time,a tendency of decreased functional connectivity to left anterior insula and the frontal operculum was also observed in left olfactory cortex.Conclusion The changes of functional connectivity to right anterior insula and the frontal operculum can be a significant biomarker in the differential diagnosis of MCI.
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Objective To study the value of breast imaging reporting and data system (BI-RADS)in Chinese breast cancer screening. Methods A total number of 3483 women participated in breast cancer screening with mammography in Hexi district in Tianjin from August to December 2009, which was organized by ministry of public health. BI-RADS assessment categories and recommendations were compared with histological findings. The precision, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Among 3483 screening mammography cases, 267 were almost entirely fat breast, 1245 were scauered fibroglandular, 1890 were dense and 81 extremely dense.There were 1011 patients(29.0%) with category 1, 1741 (50.0%) with category 2, 383 (11.0%) with category 3, 59 patients(1. 7%) with category 4 and 16 (0. 5%) with category 5 according to BI-RADS assessment categories. Totally, 71 women with 77 lesions were confirmed by histological examinations. There were 29 malignant and 48 benign lesions. The diagnostic precision, sensitivity, specificity of BI-RADS were 63. 6% (49/77) , 93. 1% (27/29) and 45.8% (22/48) . The general PPV of BI-RADS was 50. 9%(27/53). The PPV of categories 0, 4, 5 were 25.0% (1/4), 36. 4% (12/33) and 87. 5% (14/16). The NPV of categories 2 and3 were90.9% (10/11), 100.0% (12/12). Conclusions B1-RADS is of much value in assessing the breast malignancy. It is applicable in Chinese breast cancer screening.