ABSTRACT
Objective:To investigate the clinical characteristics, treatment methods, prognosis and relapse of anti-N-methyl-D-aspartate receptor(NMDAR) encephalitis in children.Methods:The clinical data of 20 children with NMDAR encephalitis treated in Heji Hospital Affiliated to Changzhi Medical College of Shanxi Province from June 2016 to June 2019 were retrospectively analyzed.The clinical symptoms and auxiliary examination results, combination of tumor, treatment, relapse and prognosis were analyzed.Results:There were 17 females, 3 males, the age of onset was (5.9±3.5)years, which presented acute or subacute onset, the first symptom was convulsion in 12 cases.Clinical symptoms: 18 cases of abnormal mental behavior, 18 cases of dyskinesia, 17 cases of epileptic seizure and 17 cases of language barrier.No tumor was found.The electroencephalogram was abnormal, the delta brush was visible in 4 cases, and 3 cases were recurrent cases, cranial MRI showed no significant abnormalities in 4 cases and abnormal in 16 cases.There were 8 cases of recurrence, 7 cases of single recurrence and 1 case of 3 recurrence.These 17 cases were treated with Rituximab.All 20 cases were improved, 2 cases with left epilepsy, 1 case with left hemiplegia.Conclusion:Anti-NMDAR encephalitis has a high incidence in female children and can occur in children of all ages.Convulsions are the most common first symptom.The common clinical symptoms are in order: mental behavior abnormalities, dyskinesia, seizures, and language barrier, the tumor merger rate is low, the abnormal delta brush is significant for disease severity.The recurrence rate of anti-NMDAR encephalitis is high, those who did not use second-line immunotherapy are higher.Rituximab is effective for patients with poor first-line immunotherapy and patients with recurrence.
ABSTRACT
Objective To investigate the feasibility of using low Kv,low iodine contrast Agent concentration (dual low)CT scan techniques in Coronary CTA (CCTA).Methods Seventy-six patients undergoing CCTA were divided into Group A and Group B , randomly.Group A (38 patients)was the dual-low group,which was scanned with tube voltage of 100 kVp,and injected with iso-osmolarity contrast agent visipaque 270 (270 mg I/mL),with iterative reconstruction technique (ASIR 40%).Group B (38 pa-tients)was scanned with 120 kVp,and low osmolarity contrast agent omnipaque 350 (350 mg I/mL)and FBP reconstruction,The images are assessed double-blindly by two experienced radiologists.Five ROIs were placed onto the ascending root of aorta (AO), left main artery(LM),left anterior descending (LAD),left circumflex artery(LCX),right coronary artery (RCA),and the image qualities are evaluated objectively using CT values,noise,signal noise ratio (SNR),contrast noise ratio (CNR),and compared sta-tistically using Paired t-test.The radiation dosages,such as CTDIvol,DLP and ED were also recorded and compared with Paired t-test.Results CTDIvol,DLP and ED of Group A (dual low)decreased 35.7%,38.6% and 38.6% respectively compared with Group B,the iodine intake decreased 22.9%.While the image qualities of the two groups were not significantly different,all images are good enough for diagnosis,with Group A slightly better than Group B in radiologists’scores.Conclusion Voltage 100 kVp, combined with low contrast agent concentration of 270 mg I/mL can fully satisfy the diagnostics need in CCTA,and significantly lower both the radiation dosage and iodine intake.