Cytokines and chemokines in viral encephalitis: A clinicoradiological correlation

Japanese encephalitis (JE) is the commonest encephalitis in South East Asia associated with high morbidity and mortality. Neuronal injury is attributed to a number of proinflammatory cytokines. This study evaluates cerebrospinal fluid (CSF) cytokines and chemokines in encephalitis and correlates these with clinical and magnetic resonance imaging (MRI) findings. We examined 14 patients with encephalitis (8 JE, 1 dengue, 5 nonspecific encephalitis) and 10 healthy controls. CSF cytokines (IL-1β, IL-6, IL-10, IL-12p70, TNF-α, IL-8) and chemokines (IP-10, MCP-1, MIG, IL-8 and RANTES) were estimated using Cytometric Bead Array, compared with controls and were correlated with severity of encephalitis, radiological findings and presence of movement disorders. Median age of the patients was 25.5 (range 6–55 years); 6 had seizures, 10 movement disorders and 6 out of 11 had MRI abnormalities. The MRI abnormalities included thalamic involvement in 5, basal ganglia and mid brain in 3 each and cortical involvement in 2 patients. Both the patients with cortical involvement had seizures and 5 of the 10 patients with movement disorders had thalamic, basal ganglia and/or mid brain involvement. There was significant increase in IL-6 (p = 0.01), RANTES (p = 0.02) and IL-8 (p = 0.02) in encephalitis compared to controls but there was no difference in IL12p70, TNF-α, IL-10, IL-1β and MCP-1. Cytokines and chemokines did not correlate with severity of encephalitis, radiological changes and presence of movement disorders. CSF IL-6, IL-8 and RANTES were significantly higher in encephalitis patients compared to controls.     

Spinal cerebrospinal fluid leaks detected by radionuclide cisternography and magnetic resonance imaging in patients suspected of intracranial hypotension

PurposeAlthough many studies have described various features of neuroimaging tests associated with intracranial hypotension, few have examined their validity and reliability. We evaluated the association between CSF leaks detected by radionuclide cisternography and abnormal MRI findings in the accurate diagnosis of intracranial hypotension.Patients/methodsWe retrospectively assessed 250 patients who were suspected of intracranial hypotension and underwent subsequent radionuclide cisternography. We obtained 159 sagittal and 153 coronal T2-weighted MRI images and 101 gadolinium-enhanced T1-weighted MRI images. We assessed the CSF leaks in relation to a sagging brain, the maximum subdural space in sagittal and coronal images, and dural enhancement.ResultsOverall, 186 (74%) patients showed CSF leaks on radionuclide cisternography. A sagging brain was observed in 21 (13%) of the 159 patients with sagittal MRIs. A sagging brain was not associated with CSF leaks (14% vs. 10%; p = 0.49). Compared to patients without CSF leaks, those with CSF leaks tended to have a larger maximum subdural space in both the sagittal (3.7 vs. 4.1 mm) and coronal (2.5 vs. 2.8 mm) images; however, the differences were not significant (p = 0.18 and p = 0.53, respectively). Dural enhancement was observed only in one patient, who presented with CSF leaks on radionuclide cisternography.ConclusionsOur study, which included a relatively large population, did not find any association between the findings of radionuclide cisternography and MRI. Future research should focus on identifying more valid neuroimaging findings to diagnose intracranial hypotension accurately.     

Effects of melanotan II, a melanocortin agonist, on grooming and exploration in rats after repeated restraint/immobilization

We wanted to verify the magnetic resonance imaging (MRI) abnormalities that occur in the central nervous system (CNS) of cobalamin-deficient (Cbl-D) rats. The rats were made Cbl-D by means of total gastrectomy or feeding a Cbl-D diet. MR images of the cervical tract of the vertebral canal were recorded using a vertical spectrometer, and the volume of cerebrospinal fluid (CSF) in this part of the vertebral canal was calculated. The findings of the present study demonstrate that: (i) there was a significant decrease in cervical tract CSF volume regardless of the way in which the vitamin deficiency was induced; (ii) this volume normalized in the totally gastrectomized rats after chronic Cbl treatment; (iii) no blood-brain or blood-CSF barrier lesions were found in Cbl-D rats, using either MRI with a paramagnetic contrast agent or calculating the albumin CSF/serum concentration quotient. Cbl deficiency decreases CSF volume in the cervical tract of the vertebral canal of the rat, without apparently impairing the blood-brain barrier.     

Autoantibody profiling on high-density protein microarrays for biomarker discovery in the cerebrospinal fluid

Detection of autoantibodies, which are involved in tissue injury and/or the reporters from the immune system of various pathologic events, has an important potential for diagnosis, prognosis, disease staging and treatment selection. This explains the interest for new proteomics technologies, such as the high-density protein microarray used here, that allow a high-throughput, multiplexed and sensitive detection of specific autoantibodies. So far, most of the research has been performed on blood. In this note, we focus on the cerebrospinal fluid in an attempt to address autoimmune events associated with neurological disorders. Importantly, the cerebrospinal fluid is quite different from the blood in terms of protein composition and concentration. We had therefore to adapt the available blood protocols. We present here the result of our optimization that will be useful to carry out full scale immunological studies of the cerebrospinal fluid using high-density protein microarrays.     

Diagnostic tools to tackle infectious causes of encephalitis and meningoencephalitis in immunocompetent adults in Europe

Background

Encephalitis and meningoencephalitis imply inflammation of the brain parenchyma, and comprise many diagnostic entities, such as various infections and causes of dysimmunity. The cause remains unknown in around 50% of cases.

断层成像技术对脊柱创伤的诊断价值

目的：探讨断层成像技术MRI在脊椎骨折和脊髓损伤中的诊断价值.方法：回顾性分析89例脊柱创伤患者的临床和MRI资料,MRI检查使用1.5T扫描仪,行矢状位T1WI和T2WI、横切位T2WI、脂肪抑制（STIR）扫描.结果：89例中,骨挫伤3例、小骨折5例、Chance骨折4例、单纯性脊椎压缩性骨折33例、爆裂骨折26例、骨折脱位18例,合并脊髓损伤43例 脊椎骨折和脊髓损伤分别具有较为特征性的MRI表现.结论：断层成像技术MRI可清晰地显示脊椎骨挫伤、骨折、脱位、椎管狭窄、椎间盘突出、韧带损伤和脊髓损伤,对脊柱创伤的诊断有重要价值.     

Evaluation of encephalic ventricular volume from the magnetic resonance imaging scans of thirty-eight human subjects

Summary Accurate volume determination of the encephalic ventricles is of importance in several clinical conditions, including Alzheimer's presenile dementia, schizophrenia, and benign intracranial hypertension. Previous studies have investigated the accuracy with which magnetic resonance imaging (MRI) can be used in clinical practice to evaluate the encephalic ventricles. However, adequate evaluation of pathological conditions depends on a sufficient amount of morphometric data from normal subjects. To begin establishing this data base for normal subjects, we evaluated the MRI scans of 38 subjects found to have no apparent pathology and calculated the ventricular volume in each case by using methods previously developed in our laboratory. The results were then compared with published volumes determined from studies that used either ventricular casts or computerized tomographic scans. The average total ventricular volume for all 38 subjects was 17.4 cm³, while that for males was 16.3 cm³ and that for females was 18.0 cm³. A small but significant correlation was found between age of subject and ventricular volume, with ventricular size increasing with age.

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Evaluation du volume des ventricules cérébraux à partir des images obtenues en résonance magnétique nucléaire chez 38 sujets humains

Résumé La détermination exacte du volume des ventricules cérébraux est importante en clinique comme par exemple dans la démence présénile d'Alzheimer, la schizophrénie et l'hypertension intracrânienne bénigne. Des études antérieures ont étudié la fiabilité de la résonance magnétique nucléaire en pratique clinique pour évaluer le volume des ventricules cérébraux. Toutefois une évaluation correcte dans les conditions pathologiques implique une bonne connaissance des données morphométriques du sujet normal. Pour établir ces données sur « le sujet normal », nous avons étudié les coupes obtenues en IRM chez 38 sujets apparemment indemnes de toute pathologie; nous avons calculé le volume ventriculaire dans chaque cas en utilisant des méthodes mises au point auparavant dans notre laboratoire. Les résultats ont été ensuite comparés avec ceux obtenus par d'autres études utilisant soit des moules ventriculaires, soit des coupes tomographiques computérisées. Le volume ventriculaire total moyen chez 38 sujets est de 17,4 cm³, mais il est chez les sujets masculins de 16,3 cm³ et chez les sujets de sexe féminin de 18 cm³. Une corrélation faible mais significative a été trouvée entre l'âge du sujet et le volume ventriculaire, étant entendu que la taille du ventricule augmente avec l'âge.

     

Volume determinations of the encephalic ventricles with CT and MRI

Summary The volume of the encephalic ventricles was determined from magnetic resonance imaging (MRI) scans. Since there are many conditions in which the encephalic ventricles become enlarged such as Alzheimer's disease and hydrocephalus, accurate measurement of the ventricles provides a valuable and safe means of aiding the diagnosis of such conditions and also provides important follow-up information in affected patients. The objective was pursued in a three phase study. This paper presents the data obtained from the first phase. This first phase demonstrated the possibility of measuring fluid filled spaces by MRI in three phantom preparations (small, medium, and large ventricles). The results were compared with those obtained from computerized tomography (CT) scans of the same preparations. These volumetric calculations were done with the aid of a Calcomp 9,000 digital analyzer programmed to compensate for the scale factor and slice thickness of the images. The phantom study showed that the results obtained from the MRI scans were better than those obtained from the CT scans in measuring the volume of water-filled cavities (ventricles) in gelatin phantoms. The average percent difference between volumes obtained by an imaging procedure compared to the actual volume as determined by water displacement was 15.8% for CT scanning and a more impressive 8.3% for MRI.

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Mesure du volume des ventricules cérébraux

Résumé Le volume des ventricules cérébraux a été mesuré à partir d'explorations en résonance magnétique. Il existe de nombreuses conditions pathologiques qui peuvent provoquer un élargissement ventriculaire, telles que la maladie d'Alzheimer et l'hydrocéphalie. La mesure précise de la taille des ventricules peut être d'importance pour le diagnostic de ces affections. Elle fournit également d'excellents critères de surveillance des patients porteurs de telles maladies. Notre objectif a été poursuivi au cours d'études séparées en 3 parties. Ce travail rapporte les résultats obtenus durant la première phase de cette étude. Celle-ci démontre qu'il est possible de mesurer les espaces liquidiens en IRM sur 3 fantômes ventriculaires (cavités petites, moyennes et larges). Les résultats ont été comparés avec ceux obtenus en examen tomodensitométrique des mêmes préparations. Des calculs volumétriques ont été obtenus à l'aide d'un analyseur numérique Calcomp 9 000 programmé pour corriger les facteurs d'agrandissement et les épaisseurs de coupe. L'étude des résultats des mesures de volume des cavités ventriculaires obtenus sur ces fantômes démontre que ceux-ci sont plus précis en coupes IRM qu'en coupes tomodensitométriques. La différence moyenne entre ces volumes obtenus en imagerie et les volumes réels calculés par mesure d'espaces liquidiens était de 15,8 % pour les coupes scanographiques et 8,3 % pour l'IRM.

     

磁流体的制备以及在生物医学工程应用的研究进展

磁流体技术是物理、化学和纳米技术等学科的交叉产物,在密封、阻尼、热交换、磁回路、传热器、电声器及生物医学方面获得了广泛应用.尤其是磁流体在生物医学工程上的应用研究,是当前交叉学科发展中一个热点领域,已经引起各国研究者的高度重视.综述了磁流体的一般制备方法及在免疫分析、生物分离、酶固定化、磁控靶向给药、肿瘤磁热疗、磁控血管栓塞及磁共振成像造影剂等生物医学工程上的应用.目前国外已经开发出相关产品,但价格昂贵,国内这方面研究仍处于实验性阶段.随着各学科间不断交叉互助,磁流体必将在生物医学工程领域发挥其巨大的作用.     

MRI对胰腺导管内乳头状粘液瘤良恶性的诊断价值

目的 探讨MRI对胰腺导管内乳头状粘液性肿瘤（IPMN）良恶性的鉴别诊断价值。方法 收集2012年1月~2018年6月我院经手术病理证实的IPMN患者24例,均行MRI检查（包括MRI平扫、三期增强以及MRCP）,分析IPMN MRI表现、IPMN良恶性因素,并采用ROC曲线分析IPMN肿瘤最大径及胰管扩张直径与肿瘤良恶性关系。结果 24例IPMN患者中,良性14例,恶性10例。良性与恶性在性别、肿瘤分型、病变位置间比较,差异无统计学意义（P＞0.05）;恶性年龄大于良性,差异有统计学意义（P＜0.05）。IPMN恶性肿瘤最大径为（55.70±10.73）mm,大于良性的（34.20±7.65）mm,差异有统计学意义（P＜0.05）;IPMN肿瘤最大径与肿瘤良恶性关系ROC曲线分析得出:曲线下面积（AUC）为0.87,肿瘤最大径最佳临界值为46.40 mm,敏感度为85.68%,特异性为83.35%。IPMN恶性主胰管扩张最大径为（8.91±3.22）mm,大于良性的（4.82±1.33）mm,差异有统计学意义（P＜0.05）;IPMN胰管扩张直径与肿瘤良恶性关系ROC曲线分析得出:AUC为0.88,胰管扩张最大径最佳临界值为7.35 mm,敏感度为70.00%,特异性为85.73%。结论 MRI能很好显示胰管扩张、囊性病变、管壁内结节等特征,在评估IPMN良恶性中具有敏感性。     

In vivo validation of numerical prediction of blood flow in arterial bypass grafts

In planning operations for patients with cardiovascular disease, vascular surgeons rely on their training, past experiences with patients with similar conditions, and diagnostic imaging data. However, variability in patient anatomy and physiology makes it difficult to quantitatively predict the surgical outcome for a specific patient a priori. We have developed a simulation-based medical planning system that utilizes three-dimensional finite-element analysis methods and patient-specific anatomic and physiologic information to predict changes in blood flow resulting from surgical bypass procedures. In order to apply these computational methods, they must be validated against direct experimental measurements. In this study, we compared in vivo flow measurements obtained using magnetic resonance imaging techniques to calculated flow values predicted using our analysis methods in thoraco–thoraco aortic bypass procedures in eight pigs. Predicted average flow rates and flow rate waveforms were compared for two locations. The predicted and measured waveforms had similar shapes and amplitudes, while flow distribution predictions were within 10.6% of the experimental data. The average absolute difference in the bypass-to-inlet blood flow ratio was 5.4±2.8%. For the aorta-to-inlet blood flow ratio, the average absolute difference was 6.0±3.3%. © 2002 Biomedical Engineering Society. PAC2002: 8761Lh, 8719Uv     

Patient-specific computational fluid dynamic simulation of a bilateral bidirectional Glenn connection

Computational fluid dynamics (CFD) have been used to investigate the hemodynamic performance in cavopulmonary anastomosis and resulted in improved operative design. In this study, CFD simulations were performed in a patient-specific bilateral bidirectional Glenn (BBDG) connection model and the power losses as well as flow features at different levels of predetermined pulmonary flow splits were calculated and compared. The control volume power loss varied between 0.64 and 1.02 mW when the flow ratio of left pulmonary artery/right pulmonary artery changed from 80:20 to 20:80. The flow patterns within the connection area and the static pressures in the four vessels differed from each other as the pulmonary flow split changed. Power loss and flow patterns of this BBDG connection were influenced by the pulmonary flow split.     

全脊柱MRI对强直性脊柱炎急性炎症的诊断价值

目的 探讨全脊柱MRI在强直性脊柱炎（AS）急性炎症诊断中的应用价值。方法 选取2017年7月~2019年2月我院58例明确诊断为AS的住院患者,所有患者均行全脊柱MRI扫描,分析图像质量以及AS脊柱急性炎症的发病部位、数目及MRI特征。结果 全脊柱MRI图像分辨率高,能清楚显示椎体、椎间盘、椎小关节、肋椎关节等解剖结构。58例患者均出现脊柱急性炎症,包括44例椎角炎、12例椎间盘炎、44例肋椎关节炎、43例椎小关节炎、33例棘突附着点炎,其MRI表现为相应部位出现斑片状、条状或片状水肿信号。结论 全脊柱MRI能清晰显示AS脊柱急性炎症病灶,对治疗决策有重要价值。     

口周岛状皮瓣动脉构筑的显微解剖学研究

目的　为口周岛状皮瓣切取提供更精准的解剖学资料。 方法　采用63例（126侧）头颈部铸型标本,观察口周动脉的来源、走行、分支分布、变异和动脉构筑特点。 结果　口周的血供主要来自上唇动脉、下唇动脉、唇颏动脉和颏下动脉升支。上唇动脉多于口角平面以上（68.25%）或以下（22.22%）起自面动脉,形成面动脉的1条分支（44.44%）或终支（49.21%）,左、右侧呈对称（51.59%）或不对称（46.83%）分布;偶见缺如（1.59%）。下唇动脉多于下颌骨下缘上方（43.65%）或口角平面下方（28.89%）起自面动脉,形成面动脉的1条分支（61.90%）或终支（25.40%）,呈对称（44.44%）或不对称（47.62%）分布;缺如者占（7.94%）。两侧上、下唇动脉相互吻合,围绕口裂形成动脉环,营养口裂、鼻区及颏区。唇颏动脉于下颌下缘附近起自面动脉,多为1支（约55%）或缺如（约30%）,也可见2支（约10%）或3支（约5%）。颏下动脉在颏下中部发出2 ~ 12支升支,与下唇动脉降支和唇颏动脉形成唇颏血管丛,营养颏部皮肤。 结论　口周区域血供来源较多、吻合丰富,在口周形成动脉环及动脉网。但口周动脉的起始、走形和分布变异较大,动脉构筑形式不定,在切取口周岛状皮瓣时,术前超声探查十分必要。     

静脉窦蛛网膜颗粒与年龄关系的MRI研究

目的　研究静脉窦内蛛网膜颗粒（arachnoid granulation,AG）随年龄变化的规律。 方法　按年龄分组收集360例核磁共振检查颅内未见异常的患者临床及影像资料,观察静脉窦内AG的分布、各年龄组AG的形状、大小和数量及同例患者AG形态随年龄变化情况。 结果　经MRI检查发现,AG最常出现的部位是横窦,其次是上矢状窦、直窦、窦汇,海绵窦未见;未成年组随着年龄的增加,AG的直径逐步增大,数量逐步增多,分叶型AG数量也增多;中青年组AG直径、数量随着年龄的增加而波动于某范围内,形状基本保持不变,能检测出AG的患者的例数及AG直径与未成年组相比均有统计学意义;老年组随着年龄的增加,AG直径减小,数量减少,分叶型AG数量也呈减少趋势,能检测出AG的患者例数及AG直径与中青年组相比均有统计学意义。 结论　不同年龄段人群的蛛网膜颗粒数量、大小及形状有所差异,这些变化可能与生长发育、衰老及脑脊液吸收调节有密切关系。     

Predicting flow in aortic dissection: Comparison of computational model with PC-MRI velocity measurements

Aortic dissection is a life-threatening process in which the weakened wall develops a tear, causing separation of wall layers. The dissected layers separate the original true aortic lumen and a newly created false lumen. If untreated, the condition can be fatal. Flow rate in the false lumen is a key feature for false lumen patency, which has been regarded as one of the most important predictors of adverse early and later outcomes. Detailed flow analysis in the dissected aorta may assist vascular surgeons in making treatment decisions, but computational models to simulate flow in aortic dissections often involve several assumptions. The purpose of this study is to assess the computational models adopted in previous studies by comparison with in vivo velocity data obtained by means of phase-contrast magnetic resonance imaging (PC-MRI).Aortic dissection geometry was reconstructed from computed tomography (CT) images, while PC-MRI velocity data were used to define inflow conditions and to provide distal velocity components for comparison with the simulation results. The computational fluid dynamics (CFD) simulation incorporated a laminar–turbulent transition model, which is necessary for adequate flow simulation in aortic conditions. Velocity contours from PC-MRI and CFD in the two lumens at the distal plane were compared at four representative time points in the pulse cycle.The computational model successfully captured the complex regions of flow reversal and recirculation qualitatively, although quantitative differences exist. With a rigid wall assumption and exclusion of arch branches, the CFD model over-predicted the false lumen flow rate by 25% at peak systole. Nevertheless, an overall good agreement was achieved, confirming the physiological relevance and validity of the computational model for type B aortic dissection with a relatively stiff dissection flap.     

Does subthalamic nucleus stimulation affect the frontal limbic areas? A single-photon emission computed tomography study using a manual anatomical segmentation method

Among the basal ganglia nuclei, the subthalamic nucleus (STN) is considered to play a major role in output modulation. The STN represents a relay of the motor cortico-basal ganglia-thalamo-cortical circuit and has become the standard surgical target for treating Parkinson’s patients with long-term motor fluctuations and dyskinesia. But chronic bilateral stimulation of the STN produces cognitive effects. According to animal and clinical studies, the STN also appears to have direct or indirect connections with the frontal associative and limbic areas. This prospective study was conducted to analyse regional cerebral blood flow changes in single-photon emission computed tomography imaging of six Parkinson’s patients before and after STN stimulation. We particularly focused on the dorsolateral prefrontal cortex and the frontal limbic areas using a manual anatomical MRI segmentation method. We defined nine regions of interest, segmenting each MR slice to quantify the regional cerebral blood flow on pre- and postoperative SPECT images. We normalised the region-of-interest-based measurements to the entire brain volume. The patients showed increased activation during STN stimulation in the dorsolateral prefrontal cortex bilaterally and no change in the anterior cingulate and orbito-frontal cortices. In our study, STN stimulation induced activation of premotor and associative frontal areas. Further studies are needed to underline involvement of the STN with the so-called limbic system.     

Evidence for different immune responses to HIV in CSF and serum?

Summary A case of acquired immune deficiency syndrome (AIDS) and a case of AIDS-related complex (ARC) are described. In both instances comparative Western blot analysis of cerebrospinal fluid (CSF) and serum samples show evidence of qualitative differences in antibody-binding patterns to viral polypeptides.Abbreviations ABTS [2.2-azino-di-(3-ethyl-benzthiazoline sulfonate (6))] - AIDS Acquired immune deficiency syndrome - ARC AIDS-related complex - BCIP 5-Bromo-4-chloro-3-in-dolylphosphate - CT Computerized tomography - CMV Cytomegalo virus - CNS Central nervous system - CSF Cerebrospinal fluid - EEG Electroencephalogram - ELISA Enzyme linked immunosorbent assay - HIV Human immune deficiency virus - NBT Nitro blue tetrazolium - n.d. not determined - TPHA Treponema pallidum hemagglutination assay - VDRL Venereal Disease Research Laboratories Test     

Diagnostic accuracy of droplet digital PCR analysis of cerebrospinal fluid for tuberculous meningitis in adult patients

ObjectivesTuberculous meningitis (TBM) is difficult to diagnose. Digital PCR (dPCR) is a novel method which can quantify trace nucleic acids. This study sought to evaluate the diagnostic accuracy of dPCR analysis of cerebrospinal fluid (CSF) for TBM.MethodsWe collected CSF specimens from hospitalized TBM and non-TBM patients. Total CSF DNA was purified and the concentrations of Mycobacterium tuberculosis insert sequence 6110 (IS6110) and gyrase subunit B (gyrB) were quantified using droplet dPCR. The receiver operating characteristic curves of dPCR were established and the diagnostic performances were obtained. We also compared the sensitivity of dPCR with routine diagnostic tests.ResultsA total of 101 patients were recruited, 68 of whom suffered from TBM (26 definite, 34 probable and eight possible TBM) and 33 from non-TBM. The sensitivity of IS6110-dPCR assay for total TBM was higher than that of gyrB-dPCR assay (57.4% (44.8–69.3%) vs. 22.1% (12.9–33.8%)), and there was no significant difference for specificity between them (97.0% (84.2–99.9%) vs. 100% (89.4–100.0%)). The sensitivity of IS6110-dPCR in definite TBM was higher than that in probable and possible TBM (73.1% vs. 52.9% and 25.0%, respectively). IS6110-dPCR assay showed a higher sensitivity than smear microscopy (53.3% vs. 6.7%), mycobacterial culture (50.0% vs. 12.5%), IS6110-quantitative PCR (53.1% vs. 21.9%) and Xpert MTB/RIF (70.4% vs. 29.6%). Long anti-tuberculosis treatment time was found to be significantly associated with negative dPCR results.ConclusionCSF IS6110-dPCR assay is a rapid and sensitive molecular test, which has the potential to be used to enhance the diagnosis of TBM.