高分辨弥散加权成像在心房颤动导管消融围术期无症状脑栓塞发生的评估价值

目的比较高分辨弥散加权成像（hDWI）和常规DWI（cDWI）检测心房颤动（房颤）导管消融相关无症状性脑栓塞（ACE）的发生率及其特征。 方法连续入组2018年11月至2018年12月南京医科大学第一附属医院的32例房颤消融患者,以及上海市东方医院2019年1月至2019年2月的18例房颤消融患者。消融前24 h进行头颅高分辨率DWI检查以除外近期脑栓塞事件,消融后48 h内重复hDWI和cDWI检查。比较同一患者消融术后hDWI与cDWI中ACE的发生率、数量、大小和位置。 结果与cDWI相比,hDWI显示急性ACE的发生率更高（70%对42%,P<0.001）,ACE病灶数量明显更多（102对42,P < 0.001）,且hDWI测量的病灶尺寸较大（5.42 mm对4.21 mm,P < 0.001）。多因素回归分析显示,左心室射血分数受损（P=0.047）和术中激活凝血时间较低（P=0.003）与ACE发生相关。 结论hDWI能够更好地显示房颤消融相关ACE的发病情况及病灶特点。在评估ACE的研究中应考虑磁共振设置。     

Adiposity is not beneficial to bone mineral density in 0–5 year old Chinese children: The Jiangsu bone health study

ObjectiveData on obesity in relation to bone mineral density(BMD) in infants and preschool children were sparse in China. The objective of this study was to examine the associations between body mass index (BMI) and BMD.Subjects and methodsThis was a large population-based multicenter study in which the representative children aged 0–5 years were recruited from 13 Children’s Health Care Centers by a stratified cluster random-sampling method in Jiangsu Province, China. BMD was measured by using quantitative ultrasound. The association of BMD with BMI and obesity were evaluated using multiple linear regression and logistic regression analysis taking into account the effects of confounders. The relations between age, weight, height, BMI and BMD were analyzed by using Pearson’s correlation and further tested using partial correlation in the additive model.ResultsA total of 5,289 children (2786 boys and 2503 girls) were recruited. The BMD was positively linear relation with age, length/height, and was inversely linear relation with BMI (r = 0.711, P < 0.001; r = 0.727, P < 0.001; r = −0.318, P < 0.001, respectively). The BMD gradually increased when the weight was in the range within 21.2 kg, but started to gain slowlyand even decreased when the weight was over 21.2 kg. After adjusting for confounders, compared with control group, children with obesityhad higher odds of low BMD (OR 95%CI: 2.73 (1.57, 4.76), P < 0.001), the speed of sound (SOS)value in children with obesity was lower 47.45 (β = −47.45, 95%CI = −85.07, −9.83, P = 0.013).ConclusionsAdiposity was not advantageous for bone mineral density in 0-5-year-old Chinese children.     

The role of ficolins and MASPs in hereditary angioedema due to C1-inhibitor deficiency

Background and ObjectiveHereditary angioedema due to C1-inhibitor deficiency (HAE-C1-INH) causes disturbances in the complement system. However, the influence of HAE-C1-INH on the lectin pathway of complement is unresolved. Thus, we studied the main initiator molecules, enzymes and regulators in the lectin pathway in patients with HAE-C1-INH.MethodsThe serum concentrations of ficolin-2, ficolin-3, MBL, MASP-2, MASP-3, and MAP-1 were measured during symptom-free periods in 91 patients with HAE-C1-INH, and in 100 healthy controls using sandwich ELISAs.ResultsCompared with controls, the levels of ficolin-2 (p < 0.0001) and MASP-2 (p = 0.0238) were reduced, while the levels of MBL and MASP-3 were elevated (p = 0.0028 and p < 0.0001, respectively) in HAE-C1-INH patients. Ficolin-3 and MAP-1 levels did not differ significantly between the two groups. Ficolin-2 correlated with MASP-3 in patients (r = 0.3443, p = 0.0008), while these parameters showed an opposite relationship in controls (r = −0.4625, p < 0.0001). In the patients, ficolin-3 correlated with MASP-2 (r = 0.3698, p = 0.001). Ficolin-2, -3, and MAP-1 correlated negatively with the annual requirement of plasma derived C1-INH concentrate (r = −0.2863, p = 0.0059; r = −0.2654, p = 0.0110 and r = −0.2501, p = 0.0168, respectively). Ficolin-3 showed a negative correlation with the annual number of attacks (r = −0.2478, p = 0.0179).ConclusionsWe found significant differences between patients and controls in the levels of some of the molecules belonging to the lectin complement pathway. Low concentrations of particularly ficolin-2 and -3 were inversely correlated with the severity of HAE-C1-INH, while this was not observed for MBL. This suggests a previously unrecognized involvement of the ficolin-dependent lectin complement pathway in the pathophysiology of HAE-C1-INH.     

A phase 1, randomized,controlled dose-escalation study of EP-1300 polyepitope DNA vaccine against Plasmodium falciparum malaria administered via electroporation

Plasmodium falciparum malaria is one of the leading infectious causes of childhood mortality in Africa. EP-1300 is a polyepitope plasmid DNA vaccine expressing 38 cytotoxic T cell epitopes and 16 helper T cell epitopes derived from P. falciparum antigens expressed predominantly in the liver phase of the parasite’s life cycle. We performed a phase 1 randomized, placebo-controlled, dose escalation clinical trial of the EP-1300 DNA vaccine administered via electroporation using the TriGrid Delivery System device (Ichor Medical Systems). Although the delivery of the EP-1300 DNA vaccine via electroporation was safe, tolerability was less than that usually observed with standard needle and syringe intramuscular administration. This was primarily due to acute local discomfort at the administration site during electroporation. Despite the use of electroporation, the vaccine was poorly immunogenic. The reasons for the poor immunogenicity of this polyepitope DNA vaccine remain uncertain.Clinical Trials Registration: ClinicalTrials.gov NCT01169077.     

Low-intensity pulsed ultrasound: effects on nonunions

To study the efficacy of low-intensity pulsed ultrasound (US), or LIPUS, of 85 treated nonunion cases with a minimum fracture age of 8 months, 67 cases met the study criteria. These were: no surgical intervention during 4 months before US treatment and radiographically ceased healing for 3 months before US. In a self-paired control study, the mean fracture age of the 67 patients was 39 +/- 6.2 months. After a daily 20-min US treatment at home for an average of 168 days, 85% (57 of 67) of the nonunion cases were clinically and radiographically healed. The study did not include any cases that were malaligned, grossly instable, actively infected or that had extensive bone loss. The results demonstrate that the specific US can effect heal rates similar to those achieved by surgical means, without the associated risks and complications, and to those achieved by electrical bone growth stimulation or by extracorporeal shock-wave therapy.     

Edaravone inhibits autophagy after neuronal oxygen-glucose deprivation/recovery injury

Purpose of the study: Edaravone is an oxygen free radical scavenger that is widely used to treat ischemic injury to the nervous system. This study investigated the effect of edaravone pretreatment on neurons subjected to oxygen-glucose deprivation/recovery (OGD/R) injury.

Materials and methods: Common neurons were subjected to oxygen and glucose deprivation for 1 h, followed by oxygen and glucose recovery for 0.5, 2, 6 and 12 h to establish the OGD/R model. Autophagy was assessed by electron microscope observation of autophagosomes, cell immunofluorescence, mRFP-GFP-LC3 virus cell fluorescence and western blotting analyses of the autophagy-related proteins. The findings showed that at OGD/R 2 h autophagy was high. Next, neurons were pretreated with different concentrations of edaravone (0, 5, 10, 25, 50 and 100 μM) before establishing the OGD/R model. Western blotting was used to analyze the expression of autophagy-related proteins. The CCK-8 assay was used to analyze cell viability after pretreatment with different concentrations of edaravone. Optimal inhibition of autophagy was achieved with the concentration of edaravone 50?μM. Neurons pretreated with 50?μM edaravone and established OGD/R model were analyzed for autophagy levels.

Results: At every OGD/R time point autophagy was lower in neurons pretreated with edaravone than in those not pretreated with the drug. The difference was statistically significant without OGD/R 12 h.

Conclusions: Pretreatment with edaravone may reduce the level of autophagy in neurons subjected to OGD/R injury.     

Assessment of kidney function in chronic kidney disease by combining diffusion tensor imaging and total kidney volume

Objective

This study aimed to investigate the value and feasibility of combining fractional anisotropy (FA) values from diffusion tensor imaging (DTI) and total kidney volume (TKV) for the assessment of kidney function in chronic kidney disease (CKD).

Materials and methods

Fifty-one patients were included in this study. All MRI examinations were performed with a 3.0 T scanner. DTI was used to measure FA values, and TKV was obtained from DTI and T2-weighted imaging (T2WI). Patients were divided into three groups (mild, moderate, severe) according to eGFR, which was calculated with serum creatinine. Differences in the FA values of the cortex and medulla were analysed among the three groups, and the relationships of FA values, TKV, and the product of the FA values and TKV with eGFR were analysed. Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficiency of the FA values, TKV, and the product of the FA values and TKV for kidney function in different CKD stages.

Results

Medullary FA values (m-FA), TKV, and the product of the m-FA values and TKV (m-FA-TKV) were significantly correlated with eGFR (r?=?0.653, 0.685, and 0.797, respectively; all P?<?0.001). ROC curve analysis showed that m-FA-TKV exhibited better diagnostic performance than m-FA values (P?=?0.022).

Conclusion

m-FA-TKV obtained by DTI significantly improves the accuracy of kidney function assessment in CKD patients.

     

Percutaneous nephrostomy versus retrograde ureteral stent for acute upper urinary tract obstruction with urosepsis

PurposeWe aimed to compare the efficacy of percutaneous nephrostomy (PCN) versus retrograde ureteric stent (RUS) for acute upper urinary tract obstruction with urosepsis.Materials and methodsWe performed a random study, comparing PCN to RUS, for the treatment of patients requiring emergency drainage due to acute upper urinary tract obstruction with urosepsis between January 2019 to March 2020. Data collected included patient characteristics, stone material, microbiological characteristics, and laboratory data. Statistical analysis was performed by the student's t-test or Mann-Whitney U test or chi-squared test and Fisher exact test.ResultsAt first, a total of 75 patients were eligibly assessed for enrollment. Among them, 3 cases were excluded for declining to participate and 7 cases were failed treated with RUS. At last, 35 PCN (53.85%) and 30 RUS (46.15%) patients were analyzed. There were 24 (36.92%) men and 41 (63.08%) women. The median age was 65 years. Emergency decompression was achieved by PCN in 35 (53.85%) patients and by RUS in 30 (46.15%). Urine culture was positive in 32 (49.23%) patients, of which 17 (53.13%) had E. coli. Postoperative C-reactive protein value and normal temperature recovery time in the PCN group were significantly lower than in the RUS group(P < .05).ConclusionPCN had a better outcome than RUS in emergency drainage with urosepsis, especially for patients with severe inflammation and fever.     

Anti-leucine-rich glioma inactivated protein 1 encephalitis with sleep disturbance as the first symptom: A case report and review of literature

BACKGROUNDAnti-leucine-rich glioma inactivated protein 1 (anti-LGI1) encephalitis is an infrequent type of autoimmune encephalitis (AE) characterized by acute or subacute cognitive and psychiatric disturbance, facio-brachial dystonic seizures (FBDSs), and hyponatremia. Anti-LGI1 AE has increasingly been considered a primary form of AE. Early identification and treatment of this disease are clearly very important.CASE SUMMARYHere, we report that a male patient developed severe anti-LGI1 encephalitis, which was initially misdiagnosed as a sleep disturbance. He was hospitalized for epileptic seizures and typical FBDSs half a month after he developed sleep disturbances. LGI1 antibodies were detected in his cerebrospinal fluid and serum (1:100 and 1:3.2, respectively), which led to the diagnosis of classic anti-LGI1 AE. No obvious abnormality was observed on brain computed tomography images. T2-weighted fluid-attenuated inversion recovery and T2-weighted scans of brain magnetic resonance imaging (MRI) showed slightly elevated signals within the left basal ganglia area. No tumor was detected within the brain of this patient using MRI. After hormone and antiepileptic drug treatment, the patient’s symptoms improved significantly.CONCLUSIONAnti-LGI1 antibody-associated encephalitis has characteristic clinical manifestations, such as cognitive impairment, psychiatric symptoms, seizures, sleep disorders, hyponatremia, and FBDSs. LGI1 antibodies are present in the serum and/or cerebrospinal fluid, but their production is sensitive to immunosuppressants, and this disease has a relatively good prognosis. In particular, we should be aware of the possibility of anti-LGI1 antibody-associated encephalitis in adolescents with sleep disorders to avoid missed diagnoses and misdiagnoses.