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Objective:To observe and analyze the atypical magnetic resonance imaging (MRI) findings and misdiagnosis reasons of primary central nervous system lymphoma (PCNSL), and to explore the value of conventional MRI signs combined with minimum apparent diffusion coefficient value (ADCmin) and imaging features of magnetic resonance spectroscopy (MRS) in the diagnosis and differentiation of atypical PCNSL.Methods:The clinical and imaging data of 15 patients with atypical PCNSL confirmed by clinical and pathological findings from Lianyungang Second People′s Hospital and the Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2020 was collected. All cases were examined by plain MRI, enhanced and diffusion weighted imaging (DWI), and 3 cases were examined by MRS. The conventional MRI features, DWI signal features and MRS imaging features of 15 cases of atypical PCNSL were observed and analyzed, and the MRI findings of atypical PCNSL and the causes of misdiagnosis were summarized and analyzed. The ADCmin of tumor parenchyma, the mean ADC values of proximal peritumor, distal peritumor and contralateral white matter were detected and compared to explore the variation rules of ADC values in different regions.Results:Of the 15 cases of PCNSL, 14 cases were single and 1 case was multiple, with a total of 21 lesions. (1) Single lesions in rare sites: 4 cases in the superficial part of the brain, 1 case in the bridge arm, 1 case in the cerebellar hemisphere, 1 case in the suprasellar saddle, and 1 case in the third ventricle. (2) Atypical MRI findings: cystic degeneration or necrosis in 5 lesions (5/21), accompanied by hemorrhage in 1 lesion (1/21); There were 3 isosensitive lesions on DWI, and isosensitive lesions on ADC false color images. There were 5 ring enhancement lesions and 3 sheet enhancement lesions. (3) Multi-center growth pattern: 1 case with a total of 7 lesions, located in the right thalamus, basal ganglia and corona radiata, showing multiple nodules and ring enhancement. 1H-MRS examination showed that choline (Cho) peak increased, creatine (Cr) peak decreased, N-acetyl aspartate (NAA) peak decreased, and obvious Lip peak appeared in all the 3 cases with single lesions. 2 cases showed high Lip peak as the first peak. The ADCmin values of tumor parenchyma, proximal peritumor, distal peritumor and contralateral white matter showed a parabola pattern of first rise and then decline, as follows: (0.54±0.06)×10 -3 mm 2/s, (1.55±0.10)×10 -3 mm 2/s, (1.45±0.09)×10 -3 mm 2/s, (0.85±0.03)×10 -3 mm 2/s, overall difference was statistically significant ( F=630.570, P<0.001). The pairwise comparison was statistically significant (all P<0.05). Conclusions:Atypical PCNSL is easy to be misdiagnosed. Conventional MRI feature analysis combined with DWI and MRS imaging features and comparison of ADC values in different tumor areas are helpful for the diagnosis and differentiation of PCNSL and are expected to improve diagnostic accuracy.
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Objective:Four methods were used to count platelets to recommend suitable retest methods for abnormal blood platelet count.Methods:A total of 300 patients who received treatment in the Second People's Hospital of Lianyungang during August-September 2020 were included in this study. They were divided into low-value, median-value, and high-value groups ( n = 100/group) according to blood platelet counts determined by the electrical impedance method. The consistency in blood platelet counting was analyzed between flow cytometry and electrical impedance method, Neubauer chamber method, and modified blood smear method. Results:There was no significant difference in blood platelet count between the electrical impedance method [low-value group: (86.1 ± 10.3) × 10 9/L, median-value group: (221.8 ± 41.8) × 10 9/L, high-value group: (441.3 ± 51.4) × 10 9/L, Neubauer chamber method [low-value group: (85.2 ± 10.1) × 10 9/L, median-value group: (219.3 ± 37.7) × 10 9/L, high-value group: (443.1 ± 54.5) × 10 9/L, modified blood smear technique [low-value group: (86.1 ± 10.1) × 10 9/L, median-value group: (218.1 ± 37.7) × 10 9/L, high-value group: (442.6 ± 53.3) × 10 9/L], and flow cytometry [low-value group: (85.4 ± 10.1) × 10 9/L, median-value group: (220.7 ± 42.0) × 10 9/L, high-value group: (440.9 ± 50.0) × 10 9/L] (all P > 0.05). The Bland-Altman analysis revealed that the electrical impedance method, Neubauer chamber method and modified blood smear method, and flow cytometry showed consistency in blood platelet count. Conclusion:The modified blood smear method showed consistency with the electrical impedance method, Neubauer chamber method, and flow cytometry in blood platelet counting. It does not require a special instrument and can help observe cell morphology for blood platelet counting. In addition, the blood smears are easy to be preserved. The modified blood smear technique should be the first choice for re-checking blood platelet counts.
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Objective@#To preliminarily establish the reference interval for serum creatinine in healthy adults aged 20-79 years in city of Lianyungang.@*Methods@#A total of 34 577 cases of reference individuals were selected from physical examination population by using the principle of complete randomization, and the concentration of serum creatinine was detected by AU5821 automatic biochemical analyzer with its matching reagents.According to the standards of CLSI C28-A3 and WS/T 402-2012 " Clinical Laboratory Test Project Reference Interval Formulation" , the reference interval of serum creatinine was established.@*Results@#There was statistically significant difference of serum creatinine in gender and age between healthy adults in this area (male group: 78[72-84]μmol/L, female group: 61[56-66]μmol/L; aged 20-59 of male group: 78[72-84]μmol/L, aged 60-79 of male group: 77[70-85]μmol/L; aged 20-59 of female group: 60[56-65]μmol/L, aged 60-79 of female group: 63[58-69]μmol/L) (Z=120.93, Z=31.53, Z=28.45; all P<0.05). Therefore, the reference interval of serum creatinine was established based on gender and age, and its reference interval was 61-97μmol/L (aged 20-59 of male), 60-106μmol/L (aged 60-79 of male), 47-76μmol/L (aged 20-59 of female) and 49-86μmol/L (aged 60-79 of female), respectively.@*Conclusion@#Establishment of reference interval in serum creatinine plays an important role in the auxiliary diagnosis, progression and prognosis evaluation of various kidney diseases.
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Objective To investigate the value of serum amyloid A (SAA) and retinol binding protein (RBP) in diagnosis of early type 2 diabetic kidney disease (DKD).Methods A total of 182 type 2 diabetic patients hospitalized in department of Endocrinology and Nephrology of Lianyungang Second People's Hospital from January to December 2017 were randomly collected as subjects.According to urinary albumincreatinine ratio (UACR),all subjects were divided into three groups of normal albuminuria group (NA,60 cases),microalbuminuria group (MA,63 cases) and clinical proteinuria (CP,59 cases).In the same period,60 healthy persons were selected as normal control (NC).The levels of serum SAA and RBP were detected by automatic biochemical analyzer.Receiver operating curve (ROC) was used to analysis the diagnostic efficiency of DKD and the risk factors of DKD were further estimated.Results The levels of SAA were (6.88±2.82) and (37.21±20.58) mg/L in control group and case group.And levels of serum SAA in the NA group,MA group and CP group were (16.33±5.98),(40.97± 15.62),(54.43±22.91) mg/L respectively.The levels of RBP were (37.56± 10.51) and (69.26±21.23) mg/L in control group and case group.And levels of RBP in the NA group,MA group and CP group were (52.66 ± 14.31),(69.66 ± ± 15.52),(85.70± 19.51) mg/L respectively.The concentrations of serum SAA and RBP in type 2 diabetic patients were significantly higher than those normal controls (t =10.36,P＜0.05;t =11.11,P＜0.05) and increased with DKD progression (F =83.6,P＜ 0.05;F =59.2,P＜ 0.05).Diagnostic sensitivity of serumSAA,RBP in DKD was 81.8％ and 84.1％ respectively.Diagnostic sensitivity of combined detection was 90.9％.Regression analysis showed that SAA,RBP and UACR were independent risk factors for DKD (OR (95％ CI) =1.391 (1.068-1.812),1.212 (1.085-1.353),1.148 (1.038-1.270);all P ＜0.05).Conclusion Both of serum SAA and RBP were significantly elevated in diabetic patients with renal injury so that they had great value in early diagnosis of DKD.
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Objective To investigate the clinical value of serum lipoprotein (a) and free fatty acid (FFA) in the diagnosis of type 2 diabetic nephropathy (DN).Methods From January to October of 2016,120 cases with type 2 diabetes in the Second People's Hospital of Lianyungang were selected.According to urinary albumin creatinine ratio (UACR),the patients were divided into three groups:normal albuminuria group (NA),microalbuminuria group (MA) and macroalbuminuria group (LA).And 40 healthy subjects were selected as control group.The levels of serum lipoprotein (a) and FFA were measured,and the correlation was analyzed by Pearson analysis.Furthermore,the receiver operating curve was used to evaluate the positive diagnostic rate of DN.Results The levels of lipoprotein (a) in the NA,MA,LA and control group were (212.8 ±69.0)mg/L,(281.7 ±70.5)mg/L,(337.2 ±71.5)mg/L and (187.4 ± 74.0)mg/L,respectively.The levels of lipoprotein (a) in the MA and LA groups were significantly higher than those in the NA and control groups (F =35.08,P ＜ 0.05).The levels of FFA in the four groups were (0.63 ±0.15)mmol/L,(0.84 ±0.13) mmol/L,(1.07 ±0.19) mmol/L and (0.47 ±0.10) mmol/L,respectively.The level of FFA in the DN group was higher than that of the control group,the difference was statistically significant (F =102.13,P ＜ 0.05),and increased with the progression of DN.Pearson correlation analysis showed that the serum lipoprotein (a) was positively correlated with FFA (r =0.64,P ＜0.05).The positive rates of serum lipoprotein (a) and FFA were 64.2％ and 73.3％ in early diagnosis of DN,the positive rate of combined detection was 84.2％ (P ＜ 0.05).Conclusion Serum lipoprotein (a) and FFA levels are significantly increased in diabetic patients with renal injury.Both of them have important clinical value in early diagnosis of type 2 DN.
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Objective To investigate the diagnostic values of serum free fatty acids (FFA) and urine podocalyxin (PCX) in the patients with type 2 diabetic nephropathy(DN).Methods A total of 120 patients with type 2 diabetes mellitus (DM) were enrolled,and they were divided into three groups,normal albumin group(NA),microalbuminuria group(MA) and heavy albuminuria group(HA),based on the urinary albumin-creatinine ratio(UACR).In addition,40 healthy persons participated in medical examination were selected as the control group.Serum FFA levels were detected by a biochemical analyzer and urine PCX levels by ELISA.The correlation between them was analyzed by Pearson correlation,and their diagnostic values in type 2 DN were evaluated by the receiver operating characteristic curve (ROC).Results Serum FFA levels in the NA,MA,HA and control groups were (0.61 ± 0.14),(0.81 ± 0.13),(0.95 ± 0.18) and (0.49 ± 0.11) mmol/L,respectively,and urine PCX levels were (1.86 ± 0.45),(4.47 ± 1.48),(6.72 ± 1.40)and(1.38 ±0.24) ng/mL,respectively.The levels of serum FFA and urine PCX in type 2 DM patients were significantly higher than those in the control group(P ＜ 0.05),and increased with the progression of type 2 DM.Pearson correlation analysis showed that serum FFA levels were positively correlated with urine PCX levels(r =0.73,P ＜ 0.05).The sensitivity of serum FFA,urine PCX and combined detection in the diagnosis of type 2 DN were 74.1％,80.6％ and 89.5％,respectively,and the latter significantly higher than the former two (P ＜ 0.05).Conclusion Serum FFA and urine PCX levels increase significantly in diabetic patients with renal injury,and both of them have important clinical values in the diagnosis of type 2 DN.
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Objective To investigate the predictive value of plasma lipoprotein phospholipase A2 (Lp -PLA2 )and D -dimer in patients with hypertension complicated with stroke.Methods 70 hypertensive patients with stroke were selected as A group,72 patients with simple hypertension were selected as B group,and 71 healthy sub-jects were selected as C group.The light transmitting method was used to detect serum Lp -PLA2 ,and immunoturbi-dimetry was used to detect plasma D -dimer.The clinical value of the two joint detection and single detection in prediction of hypertension complicated with stroke was analyzed.Results The plasma Lp -PLA2 and D -dimer levels of A group were (471.88 ±181.49)ng/mL,(982.54 ±373.28)μg/mL,which were higher than those of B group[(195.17 ±34.74)ng/mL,(263.57 ±29.70)μg/mL]and C group[(122.94 ±46.25)ng/mL,(96.44 ± 8.49)μg/mL](F =189.7,171.1,all P =0.000).The plasma Lp -PLA2 level of A group was positively correlated with D -dimer(r =0.692,P 252g/mL forecast hypertension stroke risk sensitivity was 83.3% and specificity was 98.6%,the plasma Lp -PLA2 >176.36ng/mL forecast hypertension stroke risk sen-sitivity was 92.9% and specificity was 83.1%,and the combined prediction of hypertension stroke risk sensitivity was 87.6%,specificity was 93.5%.Conclusion The plasma levels of Lp -PLA2 and D -dimer are significantly increased in hypertensive patients with stroke,and the combined detection of the two indicators can improve the prediction of stroke risk in patients with hypertension.