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Objective:To investigate the efficacy and safety of intravenous thrombolysis and antiplatelet therapy in patients with stroke warning syndrome (SWS), as well as influencing factors of the outcome in patients with SWS.Method:Patients with SWS admitted to the 521 st Hospital of Ordnance Group from June 1, 2018 to December 31, 2023 were retrospectively included. Some patients were treated with ateplase intravenous thrombolysis, followed by oral antiplatelet therapy; some patients only received antiplatelet therapy. The main outcome measure was the modified Rankin Scale score at 90 days after onset, with a score of 0-2 defined as good outcome. Results:A total of 35 patients with SWS were included, including 26 males (74.3%) with an age of 58.29±11.06 years. Nineteen patients (54.3%) received intravenous thrombolysis, and 27 (77.1%) had good outcome at 90 days. There was no statistically significant difference in demographic, baseline data, and good outcome between the intravenous thrombolysis group and the antiplatelet therapy group. One patient had new stroke and one had transient ischemic attack in the intravenous thrombolysis group. There were statistically significant differences in ABCD2 score, systolic blood pressure, low-density lipoprotein cholesterol, fasting blood glucose, highest National Institutes of Health Stroke Scale (NIHSS) score at onset, and symptom duration between the good outcome group and the poor outcome group (all P<0.05). Conclusions:The efficacy of intravenous thrombolysis is similar to that of antiplatelet drugs alone in treating SWS. ABCD2 score, systolic blood pressure, low-density lipoprotein cholesterol, fasting blood glucose, highest NIHSS score at onset, and duration of symptoms may be influencing factors for the outcome of patients with SWS.
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Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare, low-grade neoplasm, which is newly categorized into the neuronal and mixed neuro-glial tumor in 2016. The most characteristic imaging findings are diffuse leptomeningeal thickening and enhancement with multiple minor cysts. This article described a case with DLGNT mimicking meningitis, whose cystic lesions were not obvious, with swollen multiple lobes cortex, gyri form cortical calcification and enhanced meninges. Meningeal irritation sign repeated attacks and the clinical symptoms gradually improved after steroid pulse therapy. The biopsy and immunohistochemistry staining were diagnosed as DLGNT. The imaging features and clinical data of this case were analyzed to improve the understanding of the disease in clinical practice.
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Glioma is the most common malignant brain tumor and classification of low grade glioma (LGG) and high grade glioma (HGG) is an important reference of making decisions on patient treatment options and prognosis. This work is largely done manually by pathologist based on an examination of whole slide image (WSI), which is arduous and heavily dependent on doctors' experience. In the World Health Organization (WHO) criteria, grade of glioma is closely related to hypercellularity, nuclear atypia and necrosis. Inspired by this, this paper designed and extracted cell density and atypia features to classify LGG and HGG. First, regions of interest (ROI) were located by analyzing cell density and global density features were extracted as well. Second, local density and atypia features were extracted in ROI. Third, balanced support vector machine (SVM) classifier was trained and tested using 10 selected features. The area under the curve (AUC) and accuracy (ACC) of 5-fold cross validation were 0.92 ± 0.01 and 0.82 ± 0.01 respectively. The results demonstrate that the proposed method of locating ROI is effective and the designed features of density and atypia can be used to predict glioma grade accurately, which can provide reliable basis for clinical diagnosis.
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Humanos , Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Imageamento por Ressonância Magnética , Gradação de Tumores , Máquina de Vetores de SuporteRESUMO
Erythropoietin-producing hepatocellular A2 receptor (EphA2) is the most common subtype in the largest subfamily of the receptor tyrosine kinase superfamily, and is considered as a key factor in the regulation of malignant tumor progression. EphA2 is highly expressed in glioma, which plays an important role in the development and progression of glioma. This article reviews the structure, function, expression of EphA2 in glioma, and its role in glioma cell migration, maintenance of glioma stem cells, angiogenesis and targeted therapy.
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COVID-19 pandemic caused by SARS-CoV-2 infection severely threatens global health and economic development. No effective antiviral drug is currently available to treat COVID-19 and any other human coronavirus infections. We report herein that a macrolide antibiotic, carrimycin, potently inhibited the cytopathic effects (CPE) and reduced the levels of viral protein and RNA in multiple cell types infected by human coronavirus 229E, OC43, and SARS-CoV-2. Time-of-addition and pseudotype virus infection studies indicated that carrimycin inhibited one or multiple post-entry replication events of human coronavirus infection. In support of this notion, metabolic labelling studies showed that carrimycin significantly inhibited the synthesis of viral RNA. Our studies thus strongly suggest that carrimycin is an antiviral agent against a broad-spectrum of human coronaviruses and its therapeutic efficacy to COVID-19 is currently under clinical investigation.
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Objective:To construct a multi-label learning MRI model for assisting diagnosis of sports injury in knee.Methods:A total of 1 391 knee MRI cases from 1 343 young adults with sports injury in Affiliated Jinling Hospital Nanjing University School of Medicine were retrospectively enrolled. The image cases were randomly divided into training set ( n=973), validation set ( n=139) and test set ( n=279) with ratio of 7∶1∶2. The knee injuries were divided into six categories: meniscus injury, tendon injury, ligament injury, osteochondral injury, synovial bursa disorder and soft tissue injury. Using PyTorch V1.1.0 algorithm package, the Yolo model of deep learning was used to construct the MRI knee joint sports injury detection model. The model was validated on the test set, and the sensitivity, specificity and mean average precision of lesion detection were evaluated. Results:Among the 279 patients in test set, the mean average precision of meniscus injury, tendon injury, ligament injury, osteochondral injury, synovial bursa disorder and soft tissue injury were 83.1%, 89.0%, 88.0%, 85.8%, 85.5% and 83.2%, respectively, and the overall mean average precision was 85.8%. The model was most effective in detecting tendon injury. The sensitivity and specificity of the model for tendon injury were 91.2% and 87.1% respectively.Conclusions:The multi-label MRI knee joint exercise-related injury detection model based on deep learning can effectively assist in detecting the exercise-related injury of knee joint in each tissue structure, and is expected to improve the efficiency of diagnosis and treatment in orthopedics.
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[This corrects the article DOI: 10.1016/j.apsb.2019.01.013.].
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Bicyclol is a synthetic drug for hepatoprotection in clinic since 2004. Preliminary clinical observations suggest that bicyclol might be active against hepatitis C virus (HCV) with unknown mechanism. Here, we showed that bicyclol significantly inhibited HCV replication and in hepatitis C patients. Using bicyclol as a probe, we identified glycolipid transfer protein (GLTP) to be a novel restrictive factor for HCV replication. The GLTP preferentially bound host vesicle-associated membrane protein-associated protein-A (VAP-A) in competition with the HCV NS5A, causing an interruption of the complex formation between VAP-A and HCV NS5A. As the formation of VAP-A/NS5A complex is essential for viral RNA replication, up-regulation of GLTP by bicyclol reduced the level of VAP-A/NS5A complex and thus inhibited HCV replication. Bicyclol also exhibited an inhibition on HCV variants resistant to direct-acting antiviral agents (DAAs) with an efficacy identical to that on wild type HCV. In combination with bicyclol, DAAs inhibited HCV replication in a synergistic fashion. GLTP appears to be a newly discovered host restrictive factor for HCV replication, Up-regulation of GLTP causes spontaneous restriction of HCV replication.
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Objective TosummarizeMRIfeaturesofadultreversiblespleniallesionsyndrome(RESLES)andevaluateitsdiagnosticvalue. Methods ClinicalandMRIdataof15patientswithRESLESwereanalyzedretrospectively.Primarydiseasesandcausesincluded:encephalitis disease,cerebrovasculardiseases,metabolicandelectrolytedisorders.Theclinicalsymptomswereheadache,dizziness,changeofconsciousness, epilepticseizuresandothernonspecificneurologicsymptoms.Thecranialimagingexaminationwasperformedat3.0T/1.5TsuperconductingMR, includingT1WI,T2WI,T2FLAIRandDWI,inwhich7casesunderwentMRIenhancedscanand5casesunderwentMRAexamination.Results Among15patients,MRIfindingsofallpatientswerecharacterizedbythecharacteristic"boomerangsign"ortheovoidabnormalitysignalinthe corporiscallosisplenium,whichwaspresentedascytotoxicedema.Besides,4ofthem werecombinedwithposteriorreversibleencephalopathy syndrome(PRES),whichwascharacterizedbyvasogenicedemainthebilateraloccipital,temporal,parietallobeandcerebellarhemisphere.The clinicalsymptomsofallpatientsimprovedafterreasonabletreatment.Conclusion MRIcharacteristicfindingofadultreversiblesple-niallesionsyndromeisthecytotoxicedemaofthecorpuscallosum,whichcanbeshowedas"boomerangsign"orovalform.Imagingfindingsand clinicalsymptomsarereversible.Thecorrectunderstandingofthisdiseaseisofgreatsignificancetoclinicalrationaldiagnosisandtreatment.
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OBJECTIVE: To determine the feasibility of reduced field-of-view diffusion-weighted imaging (rFOV DWI) with multi-b values to detect functional variability in transplanted kidneys. MATERIALS AND METHODS: Using a 3T MRI scanner, multi-b rFOV DWI of transplanted kidney or native kidney was performed in 40 renal transplantation recipients and 18 healthy volunteers. The patients were stratified, according to an estimated glomerular filtration rate (eGFR): Group 1, eGFR ≥ 60 mL/min/1.73 m2; Group 2, eGFR ≥ 30 mL/min/1.73 m2 and < 60 mL/min/1.73 m2; Group 3, eGFR < 30 mL/min/1.73 m2. Total apparent diffusion coefficient (ADCT), perfusion-free ADC (ADCD) and perfusion fraction (FP) of kidneys were calculated and compared among the four groups. Correlations between the imaging results and eGFR were assessed. RESULTS: All volunteers had eGFR ≥ 60 mL/min/1.73 m2, while 16, 16, and 8 patients were included in Groups 1, 2, and 3, respectively. In the renal cortex, ADCT was higher in Group 1 ([1.65 ± 0.13] × 10−3 mm2/s) than Group 3 ([1.44 ± 0.11] × 10−3 mm2/s) (p < 0.05), and the inter-group differences of FP values were significant (all p < 0.05) (0.330 ± 0.024, 0.309 ± 0.019, 0.278 ± 0.033, and 0.250 ± 0.028 for control group, Groups 1, 2, and 3, respectively). Renal cortical ADCT, ADCD, FP, and renal medullary ADCT and FP correlated positively with eGFR (r = 0.596, 0.403, 0.711, 0.341, and 0.323, respectively; all p < 0.05). When using 0.278 as the cutoff value, renal cortical FP had a sensitivity of 97.1% and a specificity of 66.7% for predicting decreased renal function. CONCLUSION: Multi-b rFOV DWI presents transplanted kidneys with high resolution, which is a promising functional tool for non-invasively monitoring function of transplanted kidneys.
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Humanos , Difusão , Taxa de Filtração Glomerular , Voluntários Saudáveis , Transplante de Rim , Rim , Imageamento por Ressonância Magnética , Perfusão , Sensibilidade e Especificidade , Transplante , VoluntáriosRESUMO
Objective To explore crossed cerebellar diaschisis (CCD) in cerebral gliomas with three dimensional arterialspin-labeling (3D ASL) perfusion MRI.Methods The images of 31 patients with cerebral gliomas and 31 normal subjects were retrospectively analyzed.The cerebral blood flow (CBF) were measured with 3D ASL technology,and the asymmetry index (AI) of cerebellar hemispheric CBF value changes were calculated and compared in patients.And the relationship between the AI values of cerebellar hemispheric and the AI values of tumor region in cerebral hemispheric,tumor histological grade and size were investigated.Results Compared with tumor ipsilateral cerebellar hemisphere of supratentorial glioma,the CBF value of contralateral cerebellar hemisphere significantly reduced (t=5.04,P<0.01),and the AI values of cerebellar hemispheric in patients obviously increased compared to normal subjects (t=4.13,P<0.01).But there was no significant difference in the AI values of cerebellum between high grade and low grade gliomas (t=1.31,P>0.05).In cerebral gliomas patients,there was no significant correlation between the AI values of cerebellar hemispheres and the AI values of cerebral hemisphere (tumor:r=-0.28;tumor parenchyma:r=-0.24;tumor plus edema:r=-0.19,all P>0.05),and tumor size (r=0.18,P>0.05).Conclusion Cerebral glioma can cause CCD phenomenon,and 3D ASL is able to quantitatively assess the degree of cerebellar hypoperfusion noninvasively.This phenomenon may not be associated with tumor histological grade,size and the AI values of cerebral hemispheric.
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OBJECTIVE To study the modified infralabyrinthine approach in order to open the internal auditory canal,and to provide anatomic reference.METHODS In this study,the modified infralabyrinthine approach was performed on 10 adult cadaver heads(20 sides temporal bones),and some relative structures were observed and measured.RESULTS The posterior wall of internal auditory canal was opened successfully in 16/20 sides temporal bones via the modified infralabyrinthine approach,the average exposure length was (72.44 ± 14.19)% of the whole length of the internal auditory canal.The mean distance from the inferior edge of the posterior semicircular canal to the superior edge of the jugular bulb was (4.60 ± 3.47) mm,the mean distance from the vertical portion of the facial nerve to the anterior edge of the sigmoid sinus in the infralabyrinthine area was (8.40 ± 2.74) mm,the mean distance from the superior edge of the jugular bulb to the internal auditory canal was (5.88±2.88) mm,the mean distance from the superior edge of endolymphatic sac to the internal auditory canal was (13.24±3.41) mm.CONCLUSION The modified infralabyrinthine approach had the advantages of tiny trauma and the disadvantages of more difficulty,if we selected suitable cases and prepared sufficiently,the surgery could be achieved safely and effectively.
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OBJECTIVE To provide computed tomographic reference for the infralabyrinthine approach to the internal auditory canal.METHODS Temporal bone CT images of forty patients(80 sides) were randomly selected without ear lesions,and some relative structures were observed and measured.RESULTS The mean distance from the inferior edge of the posterior semicircular canal to the superior edge of the jugular bulb was (4.69±2.91)mm left and (3.10±3.01)mm right,the mean thickness of the bone inferior to the posterior semicircular canal was (0.92 ± 0.37)mm left and (0.69 ± 0.37)mm right,the mean distance from the vertical portion of the facial nerve to the anterior edge of the sigmoid sinus was (8.66±2.71)mm left and (7.74± 1.99)mm right,the mean distance from the superior edge of the jugular bulb to the internal auditory canal was (6.32 ± 2.88)mm left and (5.39 ± 2.61) mm right,the mean distance from the superior edge of the jugular bulb to the single foramen was (6.82 ± 3.02)mm left and (5.84 ± 2.82)mm right,the mean distance from the external aperture of vestibular aqueduct tothe posterior edge of internal acoustic porus was (14.38 ± 2.56)mm left and (14.12±2.76)mm right,the mean distance from the external aperture of vestibular aqueduct tothe midpoint of internal auditory canal was (12.02 ± 2.46)mm left and (11.91 ± 2.53)mm right.There were statistical differences in distances of different sides among the anterior three groups,no statistical differences were seen in distances of different sides among the posterior four groups.CONCLUSION The temporal bone CT images are helpful to the infralabyrinthine approach to the internal auditory canal.
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Objective Analysis of MRI image of lateral ventricular subependymomas to improve our recognition of radiology manifestation of the disease. Methods Clinical data and MRI findings of 6 patients with subependymomas proved by surgical pathology, observed from January 2007 to June 2013, were analyzed retrospectively. Results Six patients (4 males and 2 females) presented with headache and dizziness. Among these 6 patients, tumor developed in right lateral ventri-cle in three patients, in left lateral ventricle in 2 patients and in frontal of dual lateral ventricle in one patient. In MRI image, tumors showed iso-intense to hypointense to normal white matter on T1-weighted and DWI images, hyperintense on T2-weighted and FLAIR. Mild or no enhancement was noted in most cases. MRS showed findings consistent with low-grade tu-mor, with a normal choline peak and depressed N-acetyl-aspartate peak. Conclusion Lateral ventricular subependymo-mas have characteristic MRI features and multi-direction images are helpful for diagnosis.
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Heart rate variability (HRV) is a non-invasive index for quantitative evaluation of cardiac autonomic nervous function, its analysis methods mainly include linear time domain analysis, frequency domain analysis, and nonlinear analysis. This article review the relationship between stroke lesion type, lesion location, degree of neurological deficit, duration and HRV, as well as the possible mechanism and intervention measures of stroke caused HRV.
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Objective To evaluate the protective effect and mechanism of luomaishutong(LMST)on acute myocardial ischemia-reperfusion injury in rabbits.Method Twenty-four New Zealand white rabbits were randomly divided into 3 groups:the LMST group,the control group and the sham-operated group.The AMI reperfusion model was established by removing the blockade after the occlusion of coronary artery for 2 hours.The changes of hemodynamics,oxygen free radical and clearance system were measured in all rabbits.Results (1)Compared with the control group,left ventricular systolic pressure(LVSP)and maximal changing rate of left ventricular innner pressure(?dp/dt_(max))increased remarkably in the LMST group after reperfusion,meanwhile, LVEDP decreased significantly.(2)In the control group,MDA level of cardiocyte was noticeably higher,while SOD and NOS levels were lower than in the sham-operated group.Compared with the control group,MDA level in the LMST group was significantly lower.Furthermore,SOD and NOS levels were higher in LMST group,and the infarcted area was smaller in the LMST group as well.Conclusions LMSF can protect myocardium after ischemia-repcrfusioninjury and improve cardiac function through inhibiting induced by oxygen free radicals.
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Objective To study the relationship between serum level of tumor necrosis factor-?(TNF-?)and insulin resistance in patients with type 2 diabetes. Methods by using the homeostasis model assessment (Homa-R), 20 patients with insulin resistance(IR group) and 20 patients with non-insulin resistance(NIR group) were selected in this study, and 20 age and BMI-matched healthy subjects were also recruited as control group. Serum levels of insulin, TNF-?, lipids, apolipoprotein and glucose were measured after overnight fasting. Results The serum level of TNF-? was significantly higher in the patients of IR group than that in the patients of NIR group and the subjects of control group(P