Sensory Ataxic Guillain-Barré Syndrome with Dysgeusia after mRNA COVID-19 Vaccination

Guillain-Barré syndrome (GBS) has occasionally occurred in people who have received coronavirus disease 2019 (COVID-19) vaccines. Dysgeusia is rare symptom of GBS. We herein report a rare case of sensory ataxic GBS with dysgeusia just after the second dose of the Pfizer-BioNTech COVID-19 vaccine. Although autoantibodies against glycolipids were not detected, immunotherapy with intravenous immunoglobulin and methylprednisolone pulse therapy effectively ameliorated the symptoms. Our report suggests that the COVID-19 vaccine may induce various clinical subtypes of GBS, including a rare variant with sensory ataxia and dysgeusia.     

Translation,validation and exploration of the factor structure in the French version of the Posttraumatic Cognitions Inventory (PTCI)

Le Posttraumatic Cognitions Inventory (PTCI) is one of the most used instruments to assess posttraumatic cognitions. Since its release, many studies have tried to validate and translate this questionnaire, but they had difficulty to confirm its structure and then suggested alternatives. Faced with no consensus, a short version in nine statements was developed and showed good psychometric properties. To date, no French version of the PTCI has been validated, thereby preventing studies from investigating the role of posttraumatic cognitions in French speaking populations.ObjectivesIn order to validate a French version of the PTCI, this study investigates two objectives using two French speaking samples: (1) test 10 factor structures identified in prior studies, and (2) assess the other psychometric properties of the best fitting factor structure.MethodThe PTCI was translated in French using a reverse translation method and administered to 202 university students and 114 aid workers. Suitability indexes of the appropriate factor structures previously identified in prior studies were examined. Internal consistency, correlations between subscales and convergent, divergent and discriminant validities in the most appropriate structure were evaluated.ResultsResults support that only Wells et al.''s short 9-item version of the PTCI and three factors shows excellent suitability indexes. This version also outlines an excellent internal consistency and solid convergent, divergent, and discriminant validities.ConclusionsThis study confirms the empirical validity, fidelity, and utility of Wells et al.''s short version of the PTCI. This is the first PTCI French validation, which is a major advantage when it comes to assess posttraumatic cognitions in French trauma victims.     

HMGB1下调的作用：通过抑制神经元细胞自噬和凋亡减轻大鼠脑出血后的神经元损伤

目的探讨高迁移率族蛋白1（HMGB1）在大鼠脑出血后对神经元细胞自噬和凋亡的作用机制。方法将20只Wistar大鼠随机分为4组（5只/组）：假手术组（Sham组）、脑出血组、HMGB1中和抗体治疗（anti-HMGB1）组、control IgG组。模型组选择颅内纹状体注射0.2 U/mL胶原酶Ⅳ建立脑出血大鼠模型。Sham组颅内注射2 μL生理盐水，术后尾静脉注射PBS，6 h后再次注入等量PBS；anti-HMGB1组术后尾静脉注射1 mg/kg anti-HMGB1单克隆抗体，6 h后再次注入等量抗体；control IgG组术后尾静脉1 mg/kg anti-IgG单克隆抗体，6 h后再次注入等量抗体。采用改良神经损害程度（mNSS）评分评估大鼠神经功能和损伤程度。TUNEL染色检测纹状体神经元凋亡。Western blot检测血肿周围脑组织神经元细胞HMGB1、自噬蛋白（Beclin-1、LC3-Ⅱ和LC3-Ⅰ）和凋亡相关蛋白（Bcl-2、Bax和cleaved caspase-3）的表达。免疫组化检测纹状体组织中HMGB1阳性表达。ELISA检测血清HMGB1含量变化。结果造模成功后，脑出血组中mNSS评分增加（P < 0.05），给予anti-HMGB1单克隆抗体后，mNSS评分减少（P < 0.05）。与Sham组相比，脑出血组大鼠纹状体神经元凋亡率增加（P < 0.001），Beclin-1、LC3-Ⅱ、Bax和cleaved caspase-3的表达增加（P < 0.05），而LC3-Ⅰ和Bcl-2的表达减少（P < 0.05），HMGB1含量增加（P < 0.05）。给予anti-HMGB1单克隆抗体后，大鼠纹状体神经元凋亡率减少（P < 0.05），Beclin-1、LC3-Ⅱ、Bax和cleaved caspase-3的表达减少（P < 0.05），而LC3-Ⅰ和Bcl-2的表达增加（P < 0.05），HMGB1含量减少（P < 0.05）。结论anti-HMGB1单克隆抗体下调HMGB1水平改善大鼠脑出血后的神经功能，其机制可能是抑制大鼠脑出血后的神经元细胞自噬和凋亡。     

超声S-Detect技术在乳腺肿块诊断中的价值

目的探讨超声S-Detect技术在乳腺肿块病灶诊断中的应用价值。方法采用S-Detect技术及常规超声对62例女性患者总计85个乳腺肿块进行诊断，以术后病理结果为金标准，对比分析常规超声与S-Detect技术的诊断效能。结果低年资医师常规超声诊断效能低于S-Detect技术（P < 0.05），中年资、高年资医师常规超声诊断效能与S-Detect技术无显著差异（P>0.05）。S-Detect技术与高年资医师诊断结果呈正相关（r=0.97）。S-Detect技术长轴切面和长轴垂直切面的诊断效能无显著差异（P>0.05）。中年资医师常规超声诊断直径≤20 mm乳腺肿块的效能优于S-Detect技术（P < 0.05），但诊断直径>20 mm乳腺肿块的效能低于S-Detect技术（P < 0.05）。结论S-Detect技术可用于乳腺良恶性肿块的鉴别诊断，其诊断效能可达到中、高年资医师BI-RADS分类的诊断水平，但在诊断直径不足20mm乳腺肿块时的效能并不十分理想。     

基于多模态MRI脑影像的超分辨率重建

目的探讨基于多模态脑影像数据的超分辨率合成模型将低分辨率的厚层数据重建成为高分辨率的薄层数据。方法使用真实成对的多模态低-高分辨率MRI数据(2D-T1，2D-T2 FLAIR和3D-T1)设计结构约束的图像超分辨率重建网络，从不同模态的低分辨率MRI提取重要特征重建更高分辨率的T1图像。将T1作为主要模态使用图像全部信息，T2 FLAIR作为补充模态选取皮层下核团为关键区域进行信息增强。通过比较超分辨率重建图像与真实的高分辨率图像之间的灰度和结构相似性来确定网络的学习方向，同时通过脑分割工具获取重建图像和金标准图像的大脑解剖学结构信息，并将其作为重要约束条件来让重建模型自适应的学习大脑的组织结构特征，从而有效提升模型的重建性能。结果在整体图像质量评价方面，该模型在149例测试集上的重建图像的平均PSNR值为33.11，SSIM为0.996，质量优于本文的其余对比方法生成的结果。在大脑解剖结构方面，我们的方法可以重建出较为清晰的脑沟、脑回以及皮层下核团，可视化结果显示了根据医学图像特性加入解剖学结构信息的有效性。分别使用单模态T1和多模态T1、T2 FLAIR进行图像重建的结果说明了有效选择第二模态关键区域的可行性。同时，在高分辨率图像作为金标准的情况下，使用本文提出的方法重建得到的超分辨率图像与使用低分辨率图像相比，在大脑灰质、白质和脑脊液上的体积测量平均精度有了较大的提升，灰质体积平均误差从3%降到1%，白质从18%降为了2%，脑脊液从35%降为了8%。结论基于多模态的MRI脑影像超分辨率模型加入了同一组织的不同模态信息与解剖学信息，相比现有的方法，可以重建出更为接近真实高分辨率的图像，有望将其应用于临床诊疗流程中。     

Pregnancy management for a woman with extensive vulvar and pelvic malformations caused by Klippel–Trénaunay syndrome

Klippel–Trénaunay syndrome (KTS) is a rare congenital disorder defined by a triad of capillary malformation, venous malformation, and soft tissue or bone hypertrophy most commonly affecting unilateral lower limbs. Due to the rarity of KTS, evidence‐based guidelines for the management of pregnancy in people with KTS are still lacking. A 34‐year‐old woman (gravidity 1; parity 0) presented at 25 weeks of gestation with malformations of the right side of her body. The extent of the KTS affecting the vulva, pelvis, and right leg was remarkable. As the prenatal MRI showed massive vascular malformations of the pelvis and vulva, we performed an elective cesarean section to avoid severe perinatal hemorrhage during a vaginal delivery. Intraoperatively, we observed varices on the parietal peritoneum within the vesico‐uterine pouch and the isthmocervical transition of the uterus, which were not identifiable in the preoperative MRI. Although KTS patients have been discouraged from pregnancy in the past because of a high risk for complications, successful and uncomplicated pregnancies are possible. For this purpose, we believe a multidisciplinary strategy that is crucial.     

咽异物感伴有咽喉反流患者抗反流治疗的临床观察

目的 观察抗反流治疗对咽异物感伴有咽喉反流的临床疗效。 方法 将门诊以咽异物感自评超过3分,患病1个月以上的患者,进行反流症状指数量表(RSI)及反流临床表现量表(RFS)评分,对RSI超过13分及RFS超过7分的患者进行抗反流治疗,以能持续治疗8周以上为有效观察对象,共104例。分析入组患者反流各症状发生率、反流临床表现各体征发生率,并进行疗效评定。 结果 104例咽异物感患者多有反流症状清嗓动作(92/104,88.46%),主要反流体征为后连合肥厚(97/104,93.27%),红斑/充血(89/104,85.57%),喉内黏稠分泌物(87/104,83.65%),喉室阻塞(73/104,70.19%)等,经抗反流治疗,有效61例,有效率为58.65%;RSI治疗前后比较,差异有统计学意义(t=1.975,P<0.05);RFS治疗前后比较,差异无统计学意义(t=1.258,P>0.05)。 结论 咽异物感伴反流症状的患者,通过反流治疗是有效的。对于有咽异物感的患者,经过长期治疗效果不明显,应考虑是否有咽喉反流的可能。     

大同地区489例变应性鼻炎并发支气管哮喘患者的相关性研究

目的:探讨本地Ⅸ变应性鼻炎(AR)并发支气管哮喘(BA)的发病率,以及AR并发BA患者在年龄、不同分型、并发症3方面的疾病相关性.方法:通过随机抽取、体格榆查、必要的实验室手段、填写调查问卷几种方法,确诊本地区489例AR,并依据BA的诊断标准,将其分为2组,I组(对照组)为仅有AR的患者298例,Ⅱ组(试验组)指AR并发BA者191例,进行2组对比分析.结果:①本组资料表明;AR并发BA者占39%;②哮喘-鼻息肉-阿司匹林过敏(ASA)三联症,2组差异有统计学意义(P<0.01);③年龄组人数分布,10～19岁及40～49岁2组差异有统计学意义(P<0.05);④疾病分型,中重度间歇性AR、轻度持续性AR、中重度持续性AR三型实验组和对照组间差异有统计学意义(P<0.05);⑤其他手要伴发病及症状2组分布情况,如变应性咽炎、鼻窦炎、结膜炎、分泌性中耳炎、肥厚性鼻炎、皮肤病、胃肠道不适症状、不明原因头痛2组差异有统计学意义(P<0.05),以上差异件都表明实验组高于对照组.结论:本地区AR并发BA者人数较高,并发BA者以10～19岁及40～49岁者较多,分型以中重度间歇性AR、轻度持续性AR、中重度持续性AR3型比较多见,并发BA者伴发疾病人数增加.