ABSTRACT
Objective:To summarize the clinical characteristics and therapeutic efficacy of central nervous system (CNS) aspergillosis.Methods:The clinical manifestations, laboratory examination, neuroimaging features, treatment and prognosis of 37 cases of CNS aspergillosis diagnosed and treated in the First Medical Center of People′s Liberation Army General Hospital from January 2000 to January 2021 were retrospectively analyzed. According to the correlation between intracranial lesions and paranasal sinus lesions, they were divided into two groups: rhino-cerebral aspergillosis (RA, n=21) group and cerebral aspergillosis (CA, n=16) group. Results:Only 16.2% (6/37) of CNS aspergillosis patients had a clear background of immunosuppression, but 35.1% (13/37) were complicated with diabetes. The most common clinical manifestations were headache (73.0%, 27/37), cranial nerve involvement (59.5%, 22/37) and fever (37.8%, 14/37). Cerebrospinal fluid characteristics included increased pressure (53.8%, 14/26), increased white blood cell count (46.7%, 14/30), decreased glucose (30.0%, 9/30), increased protein (70.0%, 21/30), and high positive results of the metagenomic next-generation sequencing (mNGS) of pathogenic microorganism (7/10). Cranial magnetic resonance imaging showed that commonly involved sites were sinus, orbital apex, posterior orbit, cavernous sinus (43.2%, 16/37) and cerebral lobes (27.0%, 10/37). Treatment options included antifungal drugs alone (64.9%, 24/37), combination of drugs and surgery (27.0%, 10/37) and surgery alone (8.1%, 3/37). Compared with the CA group, RA group had fewer males [47.6% (10/21) vs 14/16, χ2=6.34, P=0.012] and older age [(54.2±19.4) years vs (38.4±18.4) years, t=2.50, P=0.017], and was more prone to headache [85.7% (18/21) vs 9/16, χ2=4.00, P=0.046) and cranial nerve involvement [81.0% (17/21) vs 5/16, χ 2=9.31, P=0.006]. The misdiagnosis rate of these patients in the early stage was 73.0% (27/37). A total of 29 patients (85.3%, 29/34) were treated with voriconazole successively, and the course of treatment was 3.0 (0.5, 10.4) months. Compared with salvage therapy, the mortality of primary therapy was lower (4/17 vs 9/12, χ2=7.54, P=0.006). All patients were followed up to December 2021, and 17 patients died, with a mortality rate of 45.9% (17/37). Conclusions:CNS aspergillosis may have no definite immunosuppressive background. Some of CNS aspergillosis patients are complicated with diabetes, and the clinical manifestations of the disease lack specificity, with high misdiagnosis rate in the early stage, no inflammatory changes in cerebrospinal fluid, and high positive rate of mNGS for pathogenic microorganism. Early and long-term application of voriconazole can significantly reduce the mortality rate.
ABSTRACT
Objective:To observe any effect of alternate side whole body vibration on the muscle strength, balance and walking ability of persons with sarcopenia.Methods:Forty elderly persons with sarcopenia were randomly divided into an experimental group and a control group, each of 20. Both groups received conventional balance and lower-limb muscle strength training, but the experimental group also received 9-14Hz whole body vibration treatment with an amplitude of 2-3mm, 5 one-minute groups a day, 5 times a week. Before and after 8 weeks of treatment, both groups′ lower limb strength, 6m step speed, exercise ellipse area, exercise track length, and Up and Go test (TUGT) time were measured.Results:In the experimental group the average bilateral iliopsoas muscle strength and all the other measurements had improved significantly. In the control group, the exercise ellipse area with the eyes closed and the exercise track length with the eyes open and all the other measurements had improved significantly compared with before the training. But all of the experimental group′s outcomes were, on average, significantly better than those of the control group.Conclusion:Low frequency vibration training can better improve the muscle strength, balance and walking ability of elderly persons with sarcopenia. It can be used for prevention as well as treatment.
ABSTRACT
ObjectiveTo investigate the immediate effect of wearing a soft ankle brace on dynamic and static balance function and biomechanics of affected lower limbs during walking in chronic ankle instability (CAI) patients. MethodsFrom January to August, 2021, 40 CAI patients from Musculoskeletal Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University were measured dynamic and static balance indexes with Zebris FDM-System and Y balance test, before and after wearing a soft ankle brace; while the kinetics indexes and surface electromyography of the affected lower extremities during walking were collected with Zebris FDM-System and a surface electromyography telemeter simultaneously. ResultsThe velocity and area of center of pressure reduced in both open and closed eye modes (|t| > 2.876, P < 0.01), the Y-balance scores increased in all the directions (|t| > 21.212, P < 0.001) after wearing brace; while the peak pressures and impulses increased in the midfoot and medial forefoot regions (|t| > 2.057, P < 0.05), and decreased in the lateral heel, lateral forefoot and toe regions (|t| > 2.464, P < 0.05), and the root mean square of surface electromyography increased in the tibialis anterior and lateral gastrocnemius (|t| > 2.159, P < 0.05) during walking. ConclusionWearing soft brace can immediately improve dynamic and static balance of CAI patients, and optimize plantar kinetic distribution and enhance activation of the anterior tibial and the lateral head of gastrocnemius of the affected limb during walking, to improve motor control of CAI patients.
ABSTRACT
Objective:To explore the imaging manifestations of central nervous system aspergillosis (CNSAG).Methods:The cranial imaging changes of five CNSAG patients admitted to the First Medical Center of People′s Liberation Army General Hospital from 2013 to 2019 were analyzed and their imaging characteristics were summarized.Results:There were four males and one female with the minimum age of 20 years old and maximum age of 59 years old. Among the five cases, two cases mainly occurred in the cavernous sinus and three cases in the cerebral parenchyma. Long T 1-weighted and long T 2-weighted signals were observed in all the lesions of the cerebral parenchyma, while equal or short T 1-weighted, equal or long T 2-weighted signals were observed in the lesions of the cavernous sinus. Magnetic resonance imaging (MRI) of the brain of all cases showed multiple ring enhancement, which could form serrate or lace-like arrangement along the periphery of the lesion and gather together to form "honeycomb" enhancement characteristics. The degree of peripheral enhancement was more obvious, and the scope of enhancement increased after the disease was aggravated. High diffusion weighted imaging (DWI) signal can be seen in the ring enhanced focus, which is the MRI feature of abscess, and high DWI signal can be seen at the edge of the enhanced ring. Susceptibility weighted imaging showed low bleeding signal, no characteristic changes in the spectrum, and decreased perfusion in the central area. Computer tomography scan showed normal or equal density mass lesions, obvious edema or complicated infarction showed irregular low-density shadow, and bleeding showed high-density shadow. Conclusion:MRI showed mixed signal and circular enhancement, computer tomography showed normal or isodense mass lesions, or irregular low-density shadow, and bleeding signs could be found in CNSAG.
ABSTRACT
Objective:To explore the diagnostic application and characteristics of contrast-enhanced ultrasound in exertional rhabdomyolysis (ERM).Methods:Three cases of ERM patients admitted to Department of Neurology, the First Medical Center of Chinese People′s Liberation Army General Hospital in August 2019 were selected and clinical data of the patients were collected including medical history, serum muscle enzyme, electromyography, magnetic resonance imaging (MRI) and dynamic contrast-enhanced ultrasound of the thigh muscles within one week after onset.Results:All three patients had muscle soreness and dark urine after exercise and their serum muscle enzyme level exceeded five times of normal value which could be definitely diagnosed as ERM. Skeletal muscle MRI showed equal or slightly longer T 1, longer fat-suppressed T 2 weighted fluid attenuated inversion recovery images, and high diffusion weighted imaging signal. In this group, one case of femur muscle MRI showed adductor longus and semitendinosus myopathy, other two cases showed quadriceps. All cases′ MRI score was grade one. Echogenic enhancement can be seen in normal ultrasound of diseased skeletal muscle. Contrast-enhanced ultrasound showed a dynamic strengthening process in which the central area was firstly strengthened, then strengthened in peripheral area. Dynamic contrast-enhanced ultrasound showed characteristic changes in ERM with early and obvious enhancement in the central area and uneven enhancement in the central area. Conclusions:Dynamic contrast-enhanced ultrasonography of ERM lesions has its characteristic changes. The enhancement of the central area of the lesion appeared early and obvious while the surrounding area appeared late and weak, showing the characteristic of "water ripple" concentric circle reinforcement. This enhancement characteristic suggested that ERM skeletal muscle was unevenly damaged and the central area was more obvious.
ABSTRACT
Objective To explore the association between fatty liver and type 2 diabetes mellitus (T2DM) in the baseline-population of Jinchang cohort study.Methods Data from all the participants involved in the baseline-population of Jinchang cohort study was used,to compare the risks of T2DM in fatty liver and non fatty liver groups and to explore the interaction between family history or fatty liver of diabetes and the prevalence of T2DM.Results Among all the 46 861 participants,10 574 were diagnosed as having fatty liver (22.56％),with the standardized rate as 20.66％.Another 3 818 participants were diagnosed as having T2DM (8.15％) with standardized rate as 6.90％.The prevalence of T2DM increased in parallel with the increase of age (trendx2 =2 833.671,trend P＜ 0.001).The prevalence of T2DM in the fatty liver group was significantly higher than that in the non-fatty liver group,both in men or women and in the overall population.Compared with the group of non-fatty liver,the risks of T2DM in fatty liver group were seen 1.78 times higher in males,2.33 times in women and 2.10 times in the overall population,after adjustment for factors as age,levels of education,smoking,drinking,physical exercise,BMI,family history of diabetes and some metabolic indicators (pressure,TC,TG,uric acid,ALT,AST,gamma-glutamyl transferase).Date from the interaction model showed that fatty liver and family history of diabetes present a positive additive interaction on T2DM (RERI=1.18,95％CI:0.59-1.78;AP=0.24,95％CI:0.14-0.34;S=1.43,95％CI:1.21-1.69).Conclusions Fatty liver could significantly increase the risk of T2DM and a positive additive interaction was also observed between fatty liver and family history of diabetes on T2DM.It was important to strengthen the prevention program on T2DM,in order to effectively control the development of fatty liver.
ABSTRACT
Objective To explore the association between fatty liver and type 2 diabetes mellitus (T2DM) in the baseline-population of Jinchang cohort study.Methods Data from all the participants involved in the baseline-population of Jinchang cohort study was used,to compare the risks of T2DM in fatty liver and non fatty liver groups and to explore the interaction between family history or fatty liver of diabetes and the prevalence of T2DM.Results Among all the 46 861 participants,10 574 were diagnosed as having fatty liver (22.56％),with the standardized rate as 20.66％.Another 3 818 participants were diagnosed as having T2DM (8.15％) with standardized rate as 6.90％.The prevalence of T2DM increased in parallel with the increase of age (trendx2 =2 833.671,trend P＜ 0.001).The prevalence of T2DM in the fatty liver group was significantly higher than that in the non-fatty liver group,both in men or women and in the overall population.Compared with the group of non-fatty liver,the risks of T2DM in fatty liver group were seen 1.78 times higher in males,2.33 times in women and 2.10 times in the overall population,after adjustment for factors as age,levels of education,smoking,drinking,physical exercise,BMI,family history of diabetes and some metabolic indicators (pressure,TC,TG,uric acid,ALT,AST,gamma-glutamyl transferase).Date from the interaction model showed that fatty liver and family history of diabetes present a positive additive interaction on T2DM (RERI=1.18,95％CI:0.59-1.78;AP=0.24,95％CI:0.14-0.34;S=1.43,95％CI:1.21-1.69).Conclusions Fatty liver could significantly increase the risk of T2DM and a positive additive interaction was also observed between fatty liver and family history of diabetes on T2DM.It was important to strengthen the prevention program on T2DM,in order to effectively control the development of fatty liver.