Regional alterations in cortical thickness and white matter integrity in amyotrophic lateral sclerosis

Previous neuroimaging studies have revealed that both gray matter (GM) and white matter (WM) are altered in several morphological aspects in amyotrophic lateral sclerosis (ALS). However, the relations between GM and WM measures and their contributions to clinical features remain in doubt. In this study, we acquired high-resolution diffusion tensor imaging along with structural magnetic resonance imaging data on 20 patients with clinical evidence of ALS and 21 matched healthy controls. WM microstructural metrics and cortical thickness were measured to characterize the whole brain WM and GM degenerative patterns. Probabilistic diffusion tractography was used to reconstruct the tracts from the WM regions characterized by fractional anisotropy (FA) decrease in patients. Decreased FA and increased radial diffusivity was observed in WM regions of the bilateral corticospinal tracts (CST) and callosal motor fibers in the ALS patients, while the superior longitudinal fasciculus exhibited a changing trend. Cortical thinning was found in the anatomically congruent regions, including the motor-related cortices (i.e., bilateral precentral gyri, dorsal premotor cortices, and left supplementary motor area), prefrontal and occipito-parietal regions. However, there was no significant relationship between FA reduction and cortical thinning. Finally, patients with faster clinical progression showed more severe cortical thinning of the left precentral gyrus and FA reduction of the left CST. Together, these findings suggest that ALS is multisystem degeneration involving both the widespread cortices and the underlying WM fibers. GM and WM changes might play distinct roles in the disease progression.     

Frequency-specific alterations in the fractional amplitude of low-frequency fluctuations in amyotrophic lateral sclerosis

This study used resting-state functional magnetic resonance imaging and fractional amplitude of low-frequency fluctuations (fALFF) method to investigate low-frequency spontaneous neural activity at the bands of slow-5 (0.01–0.027 Hz) and slow-4 (0.027–0.073 Hz) in 20 patients with amyotrophic lateral sclerosis (ALS) and 20 healthy controls. We determined that, at slow-5 band, patients with ALS showed increased fALFF in the right middle frontal gyrus and decreased fALFF in the left middle occipital gyrus. However, compared with healthy controls, patients with ALS exhibited higher fALFF in the right caudate nucleus, left superior frontal gyrus, and right anterior cingulate cortex and lower fALFF in the right inferior occipital gyrus and bilateral middle occipital gyrus at slow-4 band. Furthermore, the fALFF value in the left superior frontal gyrus at slow-4 band was negatively correlated with functional rating scale-revised score. Our results demonstrated that the fALFF changes in ALS were widespread and frequency dependent. These findings may provide a novel way to look into the pathophysiology mechanisms underlying ALS.     

心肌内控制释放bFGF血管再生治疗对急性心肌梗死犬心脏局部功能的影响

目的 :采用超声心动图评价心肌内控制释放碱性成纤维细胞生长因子 (bFGF)的血管再生治疗对急性心肌梗死 (AMI)犬局部收缩与舒张功能的影响。方法 :18只成年健康杂种犬于麻醉开胸后暴露心脏 ,结扎左前降支 (LAD)制作AMI模型。动物平均分为 3组 ,单纯心肌梗死 (MI)组 ,直接关胸 ;激光心肌血运重建 (TMR)组 ,于AMI 30min后行透壁心肌打孔 ;bFGF组 ,则于AMI 30min后行非透壁心肌打孔 ,并随后向孔道内注射含有bFGF的纤维蛋白胶 (FG)。 8周后行超声心动图检查评价局部收缩与舒张功能。结果 :与MI组相比 ,TMR组和bFGF组室间隔和 (或 )左心室前壁的局部室壁增厚率 (△T % )更大 ,局部半轴缩短率 (△H % )更高 ,左室前壁的运动幅度 (MA)更大 (均P <0 .0 5 )。而与TMR组相比 ,bFGF组室间隔与左室前壁的△T %更大 ,左室前壁的MA更大 (均P <0 .0 5 )。另外 ,采用组织多普勒成像 (DTI)技术评价左心室前壁局部舒张功能发现 ,bFGF组的左室前壁运动频谱E/A比值明显高于MI组 ,而TMR组与MI组相比无明显差异。结论 :采用FG在心肌内控制释放bFGF的血管再生治疗能显著改善犬AMI局部的收缩与舒张功能 ,其疗效明显优于TMR。     

恶性血液病并发急性阑尾炎时外科手术的可行性探讨

目的探讨恶性血液病患者外科手术的可行性。方法对３例急性白血病及１例骨髓增生异常综合征并发急性阑尾炎患者进行阑尾切除术，术前术中输注浓缩红细胞及浓缩血小板，使血红蛋白维持在８０ｇ／Ｌ以上，血小板２０×１０９／Ｌ以上直至切口愈合。结果阑尾手术后４例患者切口愈合良好，无一例出现严重手术并发症。结论恶性血液病患者在外周血细胞极低时通过输注成分血可以保证手术的安全。     

Dynamic alterations of spontaneous neural activity in patients with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a multi-system disease featured by movement disorder. Studies on ALS using static neuroimaging indexes demonstrated inconsistent results. However, recent work indicated that the intrinsic brain activity was time-varying, and the abnormal temporal dynamics of brain activity in ALS remains unknown. Resting-state functional magnetic resonance imaging data were first obtained from 54 patients with ALS and 54 healthy controls (HCs). Then the dynamic regional homogeneity (d-ReHo) was calculated and compared between the two groups. Correlation analyses between altered d-ReHo and clinical scores were further performed. Compared with HCs, ALS patients showed higher d-ReHo in the left lingual gyrus while lower d-ReHo in the left rectus gyrus and left parahippocampal gyrus. Moreover, the d-ReHo in the left lingual gyrus exhibited correlation with disease progression rate in ALS at a trend level. Our findings suggested that altered dynamics in intrinsic brain activity might be a potential biomarker for diagnosing of ALS.

     

fMRI功能导航下切除汉语运动性语言区附近病变

目的探讨功能磁共振(functional magnetic resonance imaging,fMRI)导航在汉语运动性语言区附近病变手术中的应用价值。方法对43例大脑皮层运动性语言区附近病变患者,通过组块设计的汉语朗读任务,利用血氧水平依赖性功能磁共振成像(BOLD-fMRI)获得运动性语言区激活,利用磁共振弥散张量成像技术(diffusion tensori maging,DTI)获得白质纤维束走行,将结构影像、fMRI功能影像与DTI的各项异性系数(FA)图像同时传入导航系统,术中定位fMRI确定的语言区,在唤醒状态利用皮层电刺激技术进行语言区验证,避开运动性语言区在显微镜下切除病变。结果本组患者29例术前语言功能正常,14例有不同程度语言功能障碍。38例获得了有效的fM-RI语言区激活,进行了36例核心激活脑区与皮层电刺激比较:25例为重叠关系,11例为邻近关系。手术全切除17例,次全切除14例,大部份切除12例。术后语言功能8例较术前好转,31例无变化,4例出现短暂性运动性失语。结论汉语朗读任务所获得的fMRI运动性语言区激活具有良好的敏感性与准确性;fMRI导航手术可以提高汉语运动性语言区附近病变切除程度,减少术后运动性失语的发生。     

乳腺癌患者新辅助化疗后静息态脑功能活动变化的短期纵向研究

目的本研究旨在探索初诊乳腺癌患者新辅助化疗(neoadjuvant chemotherapy,NAC)1周期后脑的自发性和同步性功能活动的短期纵向变化.材料与方法本研究共纳入36名行NAC的乳腺癌患者,分别于行NAC前(timepoint 0,TP0)和行NAC第1周期后(timepoint 1,TP1)进行静息态功能...     

双能量CT定量参数预测实性肺腺癌气道播散

目的 观察双能量CT （DECT）定量参数术前预测实性肺腺癌气道播散（STAS）状态的价值。方法 回顾性分析52例经手术病理确诊实性肺腺癌患者的DECT及病理学资料,评估其STAS状态（阳性或阴性）;对比STAS阳性、阴性实性肺腺癌CT表现（最大径、周围不透明影、空气支气管征、胸膜凹陷征）及DECT定量参数的差异。针对差异有统计学意义的DECT定量参数绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评估DECT定量参数单独及联合预测实性肺腺癌STAS的效能,并以二元logistic回归分析筛选实性肺腺癌STAS的独立预测因子。结果 52例中,25例STAS阳性,27例STAS阴性,其间病灶CT表现差异均无统计学意义（P均>0.05）,DECT定量参数中的动脉期碘浓度（IC_A）、动脉期标准化碘浓度（NIC_A）及静脉期碘浓度（IC_V）差异均有统计学意义（P均<0.05）。IC_A、NIC_A及IC_V预测实性肺腺癌STAS的AUC为0.82、0.83及0.73;IC_A和NIC_A均为实性肺腺癌STAS的独立预测因子,其联合AUC为0.89。结论 DECT定量参数可有效预测实性肺腺癌STAS。     

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

ObjectiveTo objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer.Materials and MethodsThis retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Z_eff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis.ResultsLow keV MEI (+) at 40–50 keV showed increased CNR and SNR_{breast lesion} compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNR_{breast lesion}: 40 keV, 21.01; 50 keV, 16.28; vs. PEI, 10.77; p < 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Z_eff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively).ConclusionCompared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.     

肝针缝合在剖宫产术时子宫收缩乏力性出血中的临床应用观察

目的:探讨剖宫产术时用肝针"8"字缝合子宫治疗子宫收缩乏力性出血的疗效.方法:2002年1月至2008年12月在我院行剖宫产而发生子宫收缩乏力性出血的产妇62例,32例采用肝针"8"字缝合术止血法(肝针缝合组);30例采用传统止血方法,其中15例采用宫腔填塞止血法(宫腔填塞止血组),15例采用盆腔血管结扎法(盆腔血管结扎组).比较3组的术中、术后情况.结果:肝针缝合组与官腔填塞止血组和盆腔血管结扎组在平均手术时间、平均术中出血量、切除子宫数、术后感染、二次手术例数等方面比较差异均有统计学意义(P＜0.05),但宫腔填塞止血组与盆腔血管结扎组之间比较,差异无统计学意义(P＞0.05).结论:肝针缝合用于剖宫产术中子宫收缩乏力性出血,术中能有效止血、减少出血量、缩短手术时间.