[Application of multiple post labeling delay time arterial spin labeling imaging in the quantitative blood flow analysis of brain subregions in healthy adults].

Objective: To explore the normal ranges of perfusion parameters between cerebral hemisphere, cerebellar hemisphere and brain anatomical subregions (56 pairs) in different gender and age groups with multiple post labeling delay time (Multi-PLD) arterial spin labeling (ASL) imaging. Methods: From November 2020 to December 2020, 42 healthy adult volunteers (Male 25, Female 17) were recruited to perform 7 PLD ASL imaging, including 21 young adults (15 males and 6 females, aged 23-35 years) and 21 seniors (10 males and 11 females, aged 36-74 years). The data was processed offline by Cereflow software to obtain arterial arrival time (ATT) and corrected cerebral blood flow (CBF) and cerebral blood volume (CBV) perfusion parameters. SimpleITK standardization function was used to standardize the calculated perfusion image according to the anatomical automatic labeling (AAL) template. Therefore, CBF, ATT, CBV perfusion values of brain subregions were obtained. Paired samples t test, Wilcoxon rank sum test, independent samples t test and Mann-Whitney U test were used to compare the differences of perfusion parameters in the cerebral hemisphere, the cerebellar hemisphere, brain subregions depending on side, gender and age. Pearson correlation analysis was used to compare the correlations of perfusion parameters with age. Results: CBF in 62.5% (35/56) subregions and CBV in 44.6% (25/56) subregions were higher in right side than those in left side. ATT in most brain anatomical subregions (16/56) were higher in left side. The CBF [(35.30±8.31) vs. (34.34±7.53) ml·100g-1·min-1, P=0.021], CBV [(0.47±0.11) vs. (0.45±0.09) ml/100g, P<0.001], ATT [(1.30±0.10) vs. (1.24±0.11) s, P<0.001] in left cerebellar hemisphere were higher than that of right side. The CBF (28/56) of cerebral hemisphere, cerebellar hemisphere and brain subregions was higher in females than that in males, while ATT in 83.9% (47/56) subregions was lower than that in males (all P<0.05). CBV in female subjects was higher only in 5 brain regions (superior occipital gyrus, middle occipital gyrus, inferior occipital gyrus, superior parietal gyrus and cerebelum_7b) (all P<0.05). In young subjects, CBF in 44.6% (25/56) subregions and CBV in 33.9% (19/56) subregions were higher than those in the senior group (all P<0.05). The ATT in most subregions in young group were lower than those in senior group, but the difference was statistically significant only in rectus gyrus (P=0.026) and paracentral lobule (P=0.006). The CBF (r=-0.430, P=0.005) and CBV (r=-0.327, P=0.035) of cerebral hemisphere were negatively correlated with age. The CBF (24/25, r range:-0.497 --0.343, all P<0.05) and CBV (16/19, r range:-0.474 --0.322, all P<0.05) in most subregions were negatively correlated with age, while ATT was positively correlated (gyrus rectus: r=0.311, P=0.045; paracentral lobule: r=0.392, P=0.010). Conclusions: Multi-PLD ASL imaging could be applied for quantitative analysis of brain perfusion. The perfusion parameters of anatomical subregions are different depending on side, gender, and age.

[The application of intravoxel incoherent motion diffusion imaging and 3D arterial spin labeling perfusion imaging in the evaluation of acute cerebral infarction].

Objective: To investigate the clinical value of magnetic resonance (MR) intravoxel incoherent motion (IVIM) diffusion imaging and 3D pseudo continuous arterial spin labeling (3D-pcASL) perfusion imaging in the evaluation of acute cerebral infarction. Methods: MR images of 49 patients with unilateral acute cerebral infarction diagnosed and treated in Affiliated Yancheng Hospital of Southeast University Medical College from October 2015 to February 2019 were retrospectively analyzed. High signal infarction area (S(D)) on diffusion image slice with the biggest lesion level and abnormal perfusion area (S(CBF)) on the corresponding level were measured. The presence of ischemic penumbra (IP) was represented by S(CBF)> S(D), and patients were divided into group IP and group non-IP. Regions of interest were set on the infarction core, brain tissue near the edge of the lesion (BNL) and their corresponding contralateral regions. The values of apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion related diffusion coefficient (D(*)), perfusion fraction (f) and cerebral blood flow (CBF) of each region of interest were recorded and relative values of infarction lesion to its contralateral region (rADC, rD, rD(*), rf, rCBF) were calculated. Differences of each parameter value between infarction core, BNL and their corresponding contralateral regions and of each relative parameter value between infarction core and BNL, and between the two groups were compared.The differential diagnostic efficacy of relative parameter value with differences between groups was analyzed by receiver operating characteristics (ROC) curve. The correlations of each relative parameter value of 3D-pcASL and IVIM sequences were analyzed. Results: The ADC, D, f and CBF values of infarction core were significantly lower than those of contralateral regions in both groups (all P<0.01). Among all parameters of BNL in both groups, only the CBF value of group IP was significantly lower than that of contralateral region ((27.58±3.53) vs (41.20±5.66) ml·100 g(-1)·min(-1), P<0.01). The rADC, rD, rf and rCBF of infarction core were significantly lower than those of BNL in both groups (all P<0.01). The rCBF of BNL in group IP was significantly lower than that in group non-IP (0.68±0.12 vs 0.97±0.15, P<0.01), and the area under the curve was 0.949, the optimal threshold was 0.823, and the youden index was 0.855 for identifying the two groups. Other relative parameters values of infarction core and BNL had no statistical difference between the two groups. There were positive correlations between rCBF and rADC, rD, rf (r=0.428,0.335,0.565) of infarction core, rADC and rD, rf (r=0.853,0.602) of infarction core, also rADC and rD (r=0.336) of BNL (all P<0.05). Conclusions: IVIM can effectively evaluate the difusion and perfusion information of acute cerebral infarction lesions. However, its perfusion related parameters are not as good as 3D-pcASL in IP evaluation, which should be flexibly selected according to the actual needs of patients' condition evaluation.

[The combined application of magnetic resonance DTI and 3D-pcASL in differential diagnosis of hyper-acute and acute ischemic cerebral infarction].

Objective: To explore the clinical value of magnetic resonance diffusion tensor imaging (DTI) combined with 3D pseudo continuous arterial spin labeling (3D-pcASL) perfusion imaging in differential diagnosis of hyper-acute and acute ischemic cerebral infarction. Methods: A total of 42 patients with confirmed unilateral ischemic cerebral infarction from February 2015 to October 2017 of Affiliated Yancheng Hospital of Southeast University Medical College were collected. DTI and 3D-pcASL images of hyper-acute (14 patients, group A) and acute (28 patients, group B) ischemic cerebral infarction were retrospectively analyzed. The slice with the biggest lesion on diffusion weighted imaging (DWI) was selected to measure the infarction area (S(DWI)) and abnormal cerebral blood flow (CBF) perfusion area (S(CBF)). Regions of interest (ROIs) were set on the infarction core (IC) area, mismatch area of S(CBF) and S(DWI) (MACD), and their corresponding contralateral regions. The values of CBF, average diffusion coefficient (DC(avg)), and fractional anisotropy (FA) parameter images in these ROIs in patients with both S(CBF)>S(DWI) and lower perfusion in the IC were recorded. The relative values of each infarction lesion to its corresponding contralateral region (rCBF, rFA, and rDC(avg)) were calculated. Differences of each parameter value between the IC, MACD and their corresponding contralateral regions and of the relative values between group A and group B were investigated. Results: The CBF and DC(avg) values in the IC and the CBF value in the MACD were lower than that of their corresponding contralateral regions in both groups (P<0.05). The DC(avg) in the MACD in group A patients and the FA in the IC in group B patients were lower than that in their corresponding contralateral regions (P<0.05). Compared to group A patients, group B patients showed decreased rFA, rDC(avg) in the IC and rFA in the MACD, and increased rDC(avg) and rCBF in the MACD (P<0.05). Receiver operating characteristics (ROC) curve analysis indicated that the best diagnosis cut off values of the rFA and rDC(avg) values in the IC and the rCBF, rFA, and rDC(avg) values in the MACD were 0.890 and 0.541 and 1.139, 0.902 and 0.455, respectively, for identifying two groups. Conclusion: The changes of the CBF, FA, and DC(avg) values and their relative values can be applied to differentially diagnose patients with hyper-acute and acute cerebral infarction, which could provide the basis for selecting more reasonable treatment protocols.

[Endovascular implantation of iodine-125 seeds strand and portal vein stenting followed by transcatheter arterial chemoembolization combined therapy with sorafenib for hepatocellular carcinoma with main portal vein tumor thrombus].

OBJECTIVE: To compare the therapeutic effect of portal vein stenting and endovascular implantation of iodine-125 seeds strand followed by transcatheter arterial chemoembolization combined with or without sorafenib in patients for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT). METHODS: A total of 53 patients with HCC complicated by MPVTT who received portal vein stenting and endovascular implantation of iodine-125 seeds strand followed by transcatheter arterial chemoembolization combined without (group A, n=38) or with (group B, n=15) sorafenib in Affiliated Yancheng Hospital of Southeast University Medical College during January 2010 and August 2015 were analyzed retropectively.Overal survival, progress free survival and procedure-related adverse event were compared between the two groups. RESULTS: The technical success rate was 100% for placement of (125)I seeds strand and stent in the obstructed main portal vein.No serious procedure-related adverse events occurred. Median survival time of group A and B were 12.1 and 14.8 months, respectively (P=0.037). Additionally, Median progress free survival time of group A and B were 2.8 and 4.0 months, respectively (P=0.002). CONCLUSIONS: Endovascular implantation of iodine-125 seeds strand and portal vein stenting followed by transcatheter arterial chemoembolization combined with sorafenib could improve the survival time, the progress free survival time of patients with HCC complicated by MPVTT.

Comparison of high-intensity focused ultrasound therapy under nasal endoscopy guidance versus first-line drug treatment in patients with persistent allergic rhinitis.

The aim of this study was to determine whether high-intensity focused ultrasound (HIFU) therapy under nasal endoscopy guidance could provide better efficacy and safety in patients with persistent allergic rhinitis (PAR) than the first-line drugs recommended by the World Health Organization. A total of 120 adult patients with PAR were randomly divided into 2 groups (N = 60 each). One group underwent HIFU therapy under nasal endoscopy guidance using an ultrasound rhinitis therapeutic machine. The other group served as the control group and was treated with corticosteroid nasal spray and oral cetirizine hydrochloride. All patients underwent follow-up treatment for 1 year, after which the efficacy and safety were evaluated. There was no significant difference between the two groups (P > 0.05) in the total effective rate. Moreover, no complications such as nasal adhesion, septal perforation, mucosal atrophy, and hyposmia were observed, indicating that HIFU was as effective as the first-line drug treatments recommended by the World Health Organization for symptom relief in PAR patients. The treatment efficacy, repeatability, safety, economical aspects, ease of performance, and few complications of HIFU therapy strongly suggest that HIFU should be routinely incorporated into clinical practice.

Effects of partial tonsillectomy on the immune functions of children with obstructive sleep apnea-hypopnea syndrome at early stage.

The purpose of this study was to investigate the changes in the humoral and cellular immunity of children with obstructive sleep apnea-hypopnea syndrome and hypertrophy of tonsils before and after plasma-mediated temperature-controlled radiofrequency ablation treatment. Fifty-seven children suffering from obstructive sleep apnea-hypopnea syndrome and with hypertrophy of tonsils were enrolled in this study. Thirty-seven children were grouped in the partial tonsillectomy group and 20, in the tonsillectomy group. The levels of CD3(+), CD4(+), CD8(+), and CD4(+)/CD8(+) were measured for cellular immunity, and the levels of IgG, IgA, and IgM were measured for humoral immunity. Blood samples were collected before and 1 and 3 months after the operation. The IgG, IgA, and IgM levels in the tonsillectomy group were significantly decreased 1 month after the operation, and recovered to the normal levels within 3 months of the operation (P < 0.05). However, the levels of IgG, IgA, and IgM in the partial tonsillectomy group decreased slightly, without a significant difference (P > 0.05). The cellular immunity of the 2 groups was not statistically different pre- and post-operation (P > 0.05). The results from the present study indicate that partial tonsillectomy by plasma-mediated temperature-controlled radiofrequency ablation did not impact on the humoral and cellular immunity of children.

Absence of the adenosine A2A receptor confers pulmonary arterial hypertension and increased pulmonary vascular remodeling in mice.

BACKGROUND: Pulmonary arterial hypertension (PAH) is characterized by sustained elevation of pulmonary vascular resistance resulting from endothelial and smooth muscle cell dysfunction and collagen deposition in pulmonary vascular walls. In this study, we investigated the role of the adenosine A(2A) receptor (A(2A)R) in the development of PAH by determining the effect of genetic inactivation of A(2A)Rs on pulmonary vascular remodeling in mice. METHODS AND RESULTS: We characterized hemodynamic, histological and ultrastructural changes in pulmonary vascular remodeling in A(2A)R knockout (KO) mice compared with their wild-type (WT) littermates after exposure to normoxia and hypoxic conditions. After exposure to normoxia, compared to WT mice, A(2A)R KO mice displayed: (1) increased right ventricular systolic pressures and an elevated ratio of the right ventricle over left ventricle plus septum (Fulton index), (2) increased wall area and thickness as well as enhanced smooth muscle actin immunoreactivity in pulmonary resistance vessels, (3) increased proliferating cell nuclear antigen-positive cells in pulmonary resistance vessels and (4) increased smooth muscle cells hypertrophy and collagen deposition in the adventitia of pulmonary arteriole walls as revealed by electron microscope. By contrast, histological analysis revealed no features of hypertensive nephropathy in A(2A)R KO mice and there was no significant difference in systemic blood pressure, and left ventricular masses among the 3 genotypes. Furthermore, following chronic exposure to hypoxia, A(2A)R KO mice exhibited exacerbated elevation in right ventricular systolic pressure, hypertrophy of pulmonary resistance vessels and increased cell proliferation in pulmonary resistance vessels, compared to WT littermates. Thus, genetic inactivation of A(2A)Rs selectively produced PAH and associated increased smooth muscle proliferation and collagen deposition. CONCLUSIONS: Extracellular adenosine acting at A(2A)Rs represents an important regulatory mechanism to control the development of PAH and pulmonary vascular remodeling.

[Association between gestational weight gain and adverse pregnancy outcomes: a prospective study].

Objective: To explore the association between gestational weight gain (GWG) and adverse pregnancy outcomes. Methods: A prospective study was conducted among 1 220 healthy singleton pregnant women in the first trimester of pregnancy, from Chengdu city, Sichuan province. Pre-gestational body mass and other basic information were collected through a set of questionnaires. Weight at the last week before delivery was measured and GWG was classified by IOM criteria (2009). Related information on pregnancy outcomes was collected after delivery, through the hospital information system. Multiple non-conditional logistic regression models were used to test the association between GWG and adverse pregnancy outcomes. Results: In total, data on 1 045 pregnant women were analyzed. Compared with adequate GWG, excessive GWG was associated with the increased risks of cord entanglement and large for gestational age (OR=1.641, 95%CI: 1.197-2.252; OR=1.678, 95%CI: 0.132-2.488), respectively. Additionally, when compared with the adequate GWG, insufficient GWG was associated with the increased risk of preterm delivery (OR=3.189, 95%CI: 1.604-6.341). Conclusions: Both excessive and insufficient GWG appeared associated with the pregnancy outcomes. Weight monitoring should be strengthened for pregnant women to reduce related risks on adverse pregnancy outcomes.

[Association between gestational weight gain per trimester/total gestational weight gain and gestational diabetes mellitus].

Objective: To understand the association between gestational weight gain (GWG) per trimester/total (GWG) and gestational diabetes mellitus (GDM). Methods: A prospective cohort study was conducted among 829 healthy pregnant women from Chengdu who delivered a singleton during March-September 2013. Basic information about pre-pregnancy was collected at the first time, exercise information per trimester, dietary intake information per trimester and gestational age at delivery were obtained by questionnaire. Weight at the (12 ± 1)th, (28 ± 1)th, (36 ± 1)th and last week before delivery were measured. GDM was diagnosed according to the National Diabetes and Pregnancy Prevention Guidelines (2014). At last, a total of 682 pregnant women were analyzed. After controlling the potential confounders, multiple logistic regression models were used to test the associations between GWG per trimester/total GWG and GDM. Results: After adjusting for age at delivery, pre-pregnancy body mass index, family histories of type 2 diabetes and hypertension, exercise in the first trimester, parity and energy intake in trimester and other potential confounders. Compared with adequate GWG in the first trimester, insufficient and excessive GWG in the first trimester were associated with increased risk of GDM (OR=1.23, 95%CI: 0.63-2.38, and OR=2.20, 95%CI: 1.12-4.35). Compared with adequate GWG in the second trimester, insufficient and excessive GWG in the second trimester were associated with decreased risk of GDM (OR=0.47, 95%CI: 0.18-1.19, and OR=0.78, 95% CI: 0.43-1.42). Compared with adequate GWG in the third trimester, insufficient GWG in the third trimester was associated with increased risk of GDM (OR=1.48, 95%CI: 0.77-2.84), excessive GWG in the third trimester was associated with decreased risk of GDM (OR= 0.53, 95% CI: 0.28-0.99). Compared with adequate total GWG in pregnancy, insufficient GWG in pregnancy was associated with increased risk of GDM (OR=2.16, 95% CI: 1.04-4.46), excessive GWG in pregnancy was associated with decreased risk of GDM (OR=0.74, 95% CI: 0.38-1.46). Conclusions: Insufficient and excessive GWG in the first trimester were associated with increased risk of GDM, the first trimester may represent a critical period for risk of GDM. The effects of GWG in the second and third trimester on GDM need further study.

[Photodynamic therapy by topical drup for the treatment of juvenile onset laryngeal papillomatosis].

Objective:To observe the therapeutic effect of photodynamic therapy(PDT) on the treatment of juvenile onset laryngeal papillomatosis. Method:Twenty-eight cases of children with laryngeal papilloma were treated,only 2 cases for the first time, and the rest were repeatedly treated outside our hospital, the average hospital surgery were more than 4 times. Under self retaining laryngoscope and microscope and endoscope assisted by semiconductor laser and plasma and cold instrument method，visible tumor resection and local affixed deposited 20% 5-aminolevulinic acid(photosensitizer) 3 hours later, with 635 nm semiconductor laser photodynamic,200-280 mW and can volume density of 80 to 120 J/cm², 20 min irradiation. PDT should be repeated after 25 days until no visible tumor.Then,2 times PDT must be done. Result:In 28 cases, 24 cases were followed up for more than 1 years(12 cases were followed up for 3 years),19 had no recurrence, the cure rate was 79.2%(19/24)；5 cases recurrence, and the recurrence rate was 20.8%(5/24)，among them,2 cases were abandoned because of the relapse，the other 3 cases were cure after 3 times of PDT.The main complications were adhesion of larynx. Conclusion:The preliminary effect of PDT by topical drug for the treatment of juvenile onset laryngeal papillomatosis is encouraging. The principle of PDT and the principle of the recurrence of laryngeal papilloma in children were also introduced in this paper.

Quantitative meta-analysis of grey matter anomalies in neuropathic pain.

BACKGROUND: Increasing neuroimaging studies have revealed grey matter (GM) anomalies of several brain regions by voxel-based morphometry (VBM) studies in patients with neuropathic pain. The changes have been suggested to be related to central sensitization. Our aim was to investigate concurrence across VBM studies to identify whether different subtypes of neuropathic pain share a common pathophysiological basis revealed by structural abnormalities. METHODS: A systematic search of VBM studies of patients with neuropathic pain and healthy controls published in PubMed and Embase databases from January 2000 to March 2014 was conducted. A quantitative meta-analysis of whole-brain VBM studies in patients with neuropathic pain compared with healthy controls was performed by means of effect-size signed differential mapping. RESULTS: Ten studies comprising 240 patients with neuropathic pain and 263 healthy subjects were systematically included in the present study. Compared to healthy controls, the patients showed consistent decreased GM in bilateral anterior insula and thalamus, right superior frontal gyrus and left postcentral gyrus, and increased GM in right medial frontal gyrus and right posterior insula. The results remained largely unchanged in the following jackknife sensitivity analysis. CONCLUSIONS: This meta-analysis shows strong evidence of brain GM anomalies within the pain matrix in patients with neuropathic pain compared with healthy subjects. Further studies are needed to determine whether the reported changes are specific to neuropathic pain or whether they may be common to other chronic pain.

Gray matter anomalies in anterior cingulate cortex as a correlate of depressive symptoms in drug-naïve idiopathic restless legs syndrome.

BACKGROUND: Depressive symptoms are frequent in idiopathic restless legs syndrome (RLS). However, little is known, so far, about the neurological basis. The present study aimed to explore the neuroanatomical anomalies in depressed drug-naïve RLS patients using voxel-based morphometry (VBM) analysis. METHODS: We recruited 16 drug-naïve idiopathic RLS patients with depressive symptoms (RLS-D), 18 drug-naïve idiopathic RLS patients without depressive symptoms (RLS-ND), and 18 normal controls. All participants underwent structural MRI scans on a 3-T MR system. The differences in regional gray matter (GM) density were determined across groups by VBM8. Additional regression analysis was used to identify any associations between regional GM density and clinical symptoms. RESULTS: GM density of the bilateral anterior cingulate cortex (ACC) was significantly reduced in RLS-D patients when compared to RLS-ND patients or to the healthy controls. However, there were no significant differences of GM density either when the whole RLS group or the RLS-ND group was compared to healthy controls, respectively. Particularly, we found GM density of right ACC was negatively correlated with the severity and duration of depressive symptoms in RLS-D patients. CONCLUSIONS: Depressive symptoms are associated with GM anomalies in ACC in patients with RLS. We propose that ACC is perhaps an important neuroimaging marker for facilitating treatment strategies in patients with RLS when assessing depressive symptoms.