Patients’ knowledge of perioperative care

Background  

Patient knowledge of perioperative care, particularly the role of the anaesthetist, appears limited.     

Functional magnetic resonance imaging study of writer’s cramp

Background Writer＇s cramp is a type of task specific idiopathic focal dystonia and has an incompletely understood pathophysiology. The present study utilized functional magnetic resonance imaging （fMRI） to investigate what type of brain activity correlates with writer＇s cramp and its physiological mechanism.Methods Ten patients with writer＇s cramp were age and gender matched with ten nealthy control suojects in a block design. Subjectswere scanned by fMRI while performing three consecutive, visually instructive, tasks with MR Vision 2000： （1） suppositional writing, （2） writing with finger and （3） writing with a pencil. Data was analysed using AFNI software for groups of patients and controls.Results The patients with writer＇s cramp showed significant activations of contralateral basal ganglion （especially the putamen）, motor cortex （primary sensorimotor cortex, supplementary motor cortex, premotor cortex） and ipsilateral cerebellar hemisphere in writing with a pencil compared with controls; whereas there was no obvious difference between patients and controls during writing with finger. Furthermore, these differences exist in the stibtractive activated maps for ＂writing with a pencil＂ minus ＂writing with finger＂ of patients, when the activation of subcortical area and insula in controls disappeared.Conclusions Abnormal activations of contralateral basal ganglion, motor cortex and ipsilateral cerebellar hemisphere of the patients with writer＇s cramp suggest dysfunction of basal ganglion and subcortical-cortical loop might play a pathophysiological role in writer＇s cramp.     

Evaluation of cardiac structures and function in hypertrophic cardiomyopathy with magnetic resonance imaging

Objective：To assess the capability of magnetic resonance imaging（MRI） in evaluating the cardiac structures and function in the hypertrophic cardiomyopathy（HCM）. Methods：Fourteen healthy volunteers and eighteen cases with HCM verified by history, clinical presentation, electrocardiogram and echocardiography（ECG） were performed with MRI. The myocardial thickness of interventricular septum at the basal segment and that of posterolateral free wall of the left ventricle（LV） were measured. Some indexes for evaluating cardiac ftmction were measured using ARGUS auto-quantitative program. Results：The myocardial thickness of septum at the basal segment had significant difference between the HCM patients and the healthy volunteers. There was no significant difference between MRI and ECG in examining end-diastolic volume, ejection fraction of the LV. Conclusion：MRI can fully provide more information on the abnormalities of cardiac anatomy and function; thus, it is of great value in clinical application.     

Clinical application of functional magnetic resonance imaging in China

Functional magnetic resonance imaging （fMRI） has been widely used in basic research in the past decade, and more clinically in recent years. Unlike conventional MRI that demonstrates the anatomy and morphology of the brain, fMRI provides the functional information of the brain, including neuronal activation, perfusion, diffusion, metabolism, and fiber connection. Since the publication of the pioneer study by Ogawa et all in 1990, blood oxygenation level dependent （BOLD） technique has been adopted by neuroscientists and psychologists in research into the mechanisms of motion, vision, hearing, language, memory, and functions of the brain. Soon after, clinical studies with BOLD technique were conducted in some fields like surgery （surgical Dlanning）.     

Initial experience with circumferential pulmonary vein ablation guided by fusion of magnetic resonance imaging with three-dimensional electroanatomic mapping

Catheter ablation for the treatment of atrial fibrillation （AF） has been a focal target ofelectrophysiological study in recent years. Up to date, circumferential pulmonary vein ablation （CPVA） guided by three-dimensional （3-D） electreanatomic mapping （Carto, USA） has been one of the most favourable procedures for the treatment of AF. However, it is still difficult to acquire the detailed information on number, location, and branching pattern of all pulmonary veins （PVs） when the 3-D electroanatomic mapping system is used alone.     

Infertile men’s needs and assessment of fertility care

Introduction: Male infertility is potentially a severe, low-control stressor. There is limited knowledge of the expectations, needs, and assessment of fertility care among men with severe infertility. The aim of this study was to explore experience, expectations, needs, and assessment of fertility care among Danish men having severe male-factor infertility.

Methods: Semi-structured qualitative interview study with 10 men with very low sperm quality initiating intracytoplasmic sperm injection (ICSI) treatment at the Fertility Clinic, Copenhagen University Hospital, Hvidovre, Denmark. Five of the men participated in a follow-up interview after their first ICSI treatment. The data collection took place during November 2014 to May 2015. Data were analysed using qualitative content analysis.

Results: Two themes were found: ‘The maze’ and ‘Desire for care’. It felt like an eternity for the men from the referral until treatment started. The men did not understand the process, and it was like being in a maze. The men saw fatherhood as something to strive for. They felt that they could not do what a man is supposed to do, and they felt pushed aside and that treatment focused on the women. The men appreciated the staff’s kindness and professionalism but desired the staff to address emotional subjects too.

Conclusion: The process from referral to treatment felt like a maze for these men. They needed the staff to give them the opportunity to speak of the psychosocial consequences of severe male-factor infertility.     

Liver specific magnetic resonance imaging contrast medium for evaluation of focal liver lesions – Initial experience at a service hospital

Background

Contrast enhanced MRI is today considered the investigation modality of choice in detection and characterization of focal liver lesions. The conventional MRI contrast media like Gadolinium (Gd) chelates undergo elimination through the urinary pathway and are not selectively concentrated or metabolized in the liver. Gadobenate dimeglumine (Chemical name: Gadolinium-BOPTA) is a promising newer liver specific MRI contrast medium having additional properties of selective uptake and biliary excretion by hepatocytes. Our study was designed as a pilot study to evaluate the utility of Gd-BOPTA in detection and characterization of focal liver lesions.

Methods

Fifty-three consecutive patients with focal liver lesions (excluding only simple hepatic cysts) detected on ultrasonography and CT abdomen, were prospectively subjected to standardized MRI protocol for the liver, using Gd-BOPTA as the intravenous contrast medium. An additional T1W axial scan of the liver was incorporated in the study protocol, at a delay of 2 h post-contrast, in all patients.

Results

In the study population, the combination of USG and contrast enhanced CT abdomen findings were adequate to reach a definitive diagnosis in 70% of the patients. The liver specificity of Gd-BOPTA contributed to improved lesional characterization in 9/50 patients (18%) on the delayed phase images.

Conclusion

The study revealed that the liver specific properties of Gd-BOPTA can be used to obtain additional information to improve characterization of focal hepatic lesions, when delayed phase scans are included in the study protocol.     

Cloning and sequencing genes related to preeclampsia

PreeclamPsia is a major cOmPlication of humanpregnancies, affecting 5% to 7% of pregnant women. Itis among the most significant causes of maternal and fe-tal morbidity and mortality, clinically characterized bythe onset of hyPertension and proteinuria. The etiologyofpreeclampsia remains speculative1'l. The accumulatedevidences strongly suggest that failure or incompletetrophoblastic invasion(end of the first, beginning of thesecond trimester)of ti1e spiral arteries, resulting in nar-rowed sp…     

Liver specific magnetic resonance imaging contrast medium for evaluation of focal liver lesions – Initial experience at a service hospital

Background

Contrast enhanced MRI is today considered the investigation modality of choice in detection and characterization of focal liver lesions. The conventional MRI contrast media like Gadolinium (Gd) chelates undergo elimination through the urinary pathway and are not selectively concentrated or metabolized in the liver. Gadobenate dimeglumine (Chemical name: Gadolinium-BOPTA) is a promising newer liver specific MRI contrast medium having additional properties of selective uptake and biliary excretion by hepatocytes. Our study was designed as a pilot study to evaluate the utility of Gd-BOPTA in detection and characterization of focal liver lesions.

Methods

Fifty-three consecutive patients with focal liver lesions (excluding only simple hepatic cysts) detected on ultrasonography and CT abdomen, were prospectively subjected to standardized MRI protocol for the liver, using Gd-BOPTA as the intravenous contrast medium. An additional T1W axial scan of the liver was incorporated in the study protocol, at a delay of 2 h post-contrast, in all patients.

Results

In the study population, the combination of USG and contrast enhanced CT abdomen findings were adequate to reach a definitive diagnosis in 70% of the patients. The liver specificity of Gd-BOPTA contributed to improved lesional characterization in 9/50 patients (18%) on the delayed phase images.

Conclusion

The study revealed that the liver specific properties of Gd-BOPTA can be used to obtain additional information to improve characterization of focal hepatic lesions, when delayed phase scans are included in the study protocol.     

The research of myelinization of normal fetal brain with magnetic resonance imaging.

ＴｈｅｒｅｓｅａｒｃｈｏｆｍｙｅｌｉｎｉｚａｔｉｏｎｏｆｎｏｒｍａｌｆｅｔａｌｂｒａｉｎｗｉｔｈｍａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅｉｍａｇｉｎｇＷａｎｇＺｈｏｎｇｑｉｕ王中秋，ＣｈｅｎＪｕｎｋｕｎ陈君坤，ＱｉｎＺｈｉｈｏｎｇ秦志宏ａｎｄＺｈａｎｇＪｉ...     

Preliminary evaluation of magnetic resonance fresh blood imaging for diagnosis of Budd-Chiari syndrome

Background Budd-Chiari syndrome （BCS） is a rare disease with portal hypertension caused by the blockage of the hepatic vein and/or the inferior vena cava （IVC）. Angiography is the ＂golden standard＂ for diagnosis, but it is an invasive examination. To assess the diagnostic value of a fresh blood imaging （FBI） relative to BCS, we used a magnetic resonance angiography （MRA） with an FBI sequence for a preoperative evaluation of the BCS patients in this study. Methods Fifty patients who were suspected of having BCS after they had been checked by a B-ultrasound were studied. 2D and 3D FBI were performed on a 1.5T superconductive MR scanner. Original images were rebuilt using a maximal intensity projection （MIP） method on the console. Two doctors reviewed all images before they learned of the angiography results. We then compared the diagnoses obtained from the FBI and angiography results to evaluate the diagnostic value of the FBI. Results Forty-one patients were diagnosed as BCS and 9 as non-BCS based on an angiography. The FBI correctly diagnosed 38 patients, incorrectly diagnosed 1 patient, and missed diagnosis in 3 patients. Thus, the diagnostic sensitivity of the FBI is 93% （38/41）, the specificity is 89% （8/9） and the accuracy is 92% （46/50）. The FBI images of the 13 membranous stenoses of the IVC showed a sudden stenosis of the post-liver segment of the IVC. The Images of the 5 patients with a membranous obstruction of the IVC showed IVC thickening and an absence of blood signals in the post-hepatic segment of the IVC. The images of the 4 patients with the segmental thrombosis of the IVC showed abnormal and intermittent signals in the IVC. The images of the 6 patients with a simple hepatic vein obstruction showed obstructive hepatic veins. The images of the 6 patients with the stenosis of both the IVC and the hepatic veins showed the stenosis of the IVC, the thickening of the hepatic veins and the formation of a compensatory circulation within the liver. Lastly, the images of the 7 patients showed a combination of the IVC thrombosis with stenosis or with the obstruction of one or two hepatic veins. Conclusions An FBI can show a membranous stenosis, and an obstruction and thrombosis of the IVC. In addition, it can also demonstrate the thickening of the flexural hepatic vein and the development of intra-hepatic compensatory branches with slow blood flow. Thus, it can guide the puncturing and opening of the hepatic vein involved in an interventional therapy for BCS patients.     

Cloning and expression of a novel partial cDNA related to hypertension.

ＣｌｏｎｉｎｇａｎｄｅｘｐｒｅｓｉｏｎｏｆａｎｏｖｅｌｐａｒｔｉａｌｃＤＮＡｒｅｌａｔｅｄｔｏｈｙｐｅｒｔｅｎｓｉｏｎＣｈｅｎＫｕａｎｇＨｕｅｉｈ陈光慧，ＷａｎｇＦｕｑｉａｎｇ王富强，ＺｈａｎｇＪｉｈｕｉ张吉辉，ＸｉａｎｇＨｕａ向华，ＤｏｎｇＧａｎ...     

Magnetic resonance imaging of Alzheimer’s disease: from diagnosis to therapeutic evaluation

Alzheimer＇s disease（AD）is a devastating late-life dementia that produces progressive loss of memory and mental faculties in elderly people.It is important to identify the earliest evidence of AD and to monitor the development of this disease for us to make positive response to its management.Magnetic resonance imaging（MRI）is powerful to image the tissue or organ without damnification.MRI can be employed to diagnose the early AD development and monitor the key biomarker development in AD.MRI may be helpful not only in diagnosing early AD,but also in evaluating its development.This article reviews the progress of MRI on the diagnosis and detection of AD,and makes comments on its therapeutic application.     

Volumetric magnetic resonance imaging classification for Alzheimer’s disease based on kernel density estimation of local features

Background The classification of Alzheimer's disease (AD) from magnetic resonance imaging (MRI) has been challenged by lack of effective and reliable biomarkers due to inter-subject variability.This ar...     

Paediatric palliative care at home: a single centre’s experience

INTRODUCTION

There is increased awareness of paediatric palliative care in Malaysia, but no local published data on home care services. We aimed to describe the paediatric experience at Hospis Malaysia, a community-based palliative care provider in Malaysia.

METHODS

We conducted a retrospective case note review of patients aged up to 21 years who were referred to Hospis Malaysia from 2009 to 2013.

RESULTS

A total of 137 patients (92 male, 45 female) with a median age of 140 (3–250) months were included in this study. The majority (71.5%) had malignancies. At referral, 62 patients were still in hospital and 17 died prior to discharge. A total of 108 patients received home visits. At the first home visit, 89.8% of patients had at least one physical symptom. Pain was the most common (52.5%) symptom. Patients had various supportive devices: 39 were on feeding tubes, ten had tracheostomies, five were on bilevel positive airway pressure and ten had urinary catheters. 66 families discussed the preferred location of care at end-of-life. Among those who died, 78.9% died at home, as they preferred (p < 0.001). Regression analysis showed no statistically significant association between a home death and age, diagnosis and number of home visits. Bereavement follow-up occurred for 93.3% of families.

CONCLUSION

Community care referrals tend to occur late, with 25.5% of patients dying within two weeks of referral. At referral, patients often had untreated physical symptoms. The majority of families preferred and had a home death.     

Gender and magnetic resonance imaging classification-related differences in clinical and biochemical characteristics of Cushing＇s disease： a single-centre study

Background Cushing＇s disease （CD） presents a remarkable preponderance in female gender,and a significant minority of patients with CD presented with negative magnetic resonance imaging （MRI） findings.The aim of this study was to evaluate gender-related and MRI classification-related differences in clinical and biochemical characteristics of CD.Methods We retrospectively studied 169 patients with CD,comprising 132 females and 37 males,and 33 patients had no visible adenoma on MRI.Results We observed that male and MRI-positive patients presented with high adrenocorticotropic hormone （ACTH） values （P ＜0.05）.Female patients presented with higher prevalence of hirsutism and hyperpigmentation and lower prevalence of purple striae （P ＜0.05）.The prevalence of buffalo-hump and hypertension was greater in MRI-negative patients （P ＜0.05）.In addition,male patients with CD presented at a younger age compared with females （P ＜0.05）.Patients with fatigue and hypokalaemia presented significantly higher urinary-free cortisol,ACTH and cortisol levels compared with patients without these symptoms （P ＜0.05）.The prevalence of LH reduction,hyper total cholesterol （TC） and hyper low-density lipoprotein was more frequent in MRI-positive patients （P ＜0.05）.Hyper-TC levels and PRL reduction were more frequent in males （P ＜0.05）.T3,T4 and FT3 levels negatively correlated with age at diagnosis （r=-0.310,P ＜0.01; r=-0.191,P ＜0.05; r＝-0.216,P ＜0.05）.T3,T4,FT3 and FT4 levels significantly negatively correlated with 8-am plasma cortisol levels （r=-0.328,P ＜0.01; r=-0.195,P ＜0.05; r=-0.333,P ＜0.01; r＝-0.180,P ＜0.05）.Females presented higher total protein level （P ＜0.01） and lower blood urea nitrogen and serum creatinine levels （P ＜0.01）,compared with male patients.Conclusions Carefulness and caution are required in all patients with CD,because of the complexity of clinical and biochemical characteristics in CD patients of different gender and MRI cl     

In vivo hydrogen-1 magnetic resonance spectroscopy study of human intracranial tumors.

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