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Objective:To explore the lesion characteristics and predictors of invasive coronary angiography (ICA)-verified obstructive lesions with fractional flow reserve (FFR)>0.80, that is, anatomy-function mismatch.Methods:A total of 515 obstructive vessels in 419 coronary disease patients from 11 Chinese medical centers undergoing coronary CT angiography and ICA and FFR were retrospectively analyzed. All vessels had one target lesion with diameter stenosis ≥50 % by ICA. There were 229 vessels in the match group (FFR≤0.80) and 286 vessels in the mismatch group (FFR>0.80). The lesion characteristics including lesion territory, the distance of the coronary artery ostium to the proximal end of the lesion, minimum lumen area, reference lumen area, plaque length and burden, plaque volume and component volume, remodeling index and plaque morphological complexity were measured and compared between the two groups. Optimal thresholds of quantitative plaque characteristics were defined by Yoden index. Logistic regression analysis was used to analyze the predictors of anatomy-function mismatch. Area under receiver operating characteristic curve (AUC) was used to analyze the ability of different lesion features to predict mismatched lesions.Results:The coronary stenosis, plaque burden and length, plaque volume (including each component volume) in the mismatch group were smaller than those in the match group, and FFR, minimum lumen area were larger (all P<0.05). Left anterior descending artery (LAD) lesion and severe complex plaque were more common in the match group than the mismatch group with a statistically significant difference. Univariate logistic regression analysis showed that LAD lesion, minimum lumen area>4 mm 2, plaque burden and length, plaque calcification volume<27 mm 3, plaque lipid volume<30 mm 3, plaque fiber volume<150 mm 3 and plaque morphological complexity were predictiors of anatomic function mismatched lesions; Multivariate logistic regression showed that the minimum lumen area>4 mm 2 (OR=3.371, 95%CI 1.903-5.973, P<0.001), plaque lipid volume<30 mm 3 (OR=3.014, 95%CI 1.691-5.373, P<0.001), plaque morphological complexity (mild OR=17.772, 95%CI 8.072-39.128, P<0.001, moderate OR=6.383, 95%CI 3.739-10.896, P<0.001) were independent predictors of mismatched lesions. The AUC of the model based on the minimum lumen area, plaque lipid volume and morphological complexity was 0.824, which was superior to either of the plaque feature alone ( P<0.001). Conclusions:The minimum lumen area, lipid volume and plaque morphological complexity are independent predictors of the anatomical-functional mismatch lesions, and the combination can significantly improve the prediction value.
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A 31-year-old woman was admitted to Peking Union Medical College Hospital presented with intermittent vomiting and abdominal pain for 2 years, and recurrence with paroxysmal dizziness for 1 month. This patient was diagnosed with systemic lupus erythematosus (SLE) 2 years ago with involvement of gastrointestinal and urinary tracts. One month ago, repeated vomiting and nausea recurred. No laboratory and imaging abnormalities were found in central nervous system and gastrointestinal evaluation. Orthostatic hypotension and fluctuation of blood pressure were recorded during hospitalization. Combined with sexual dysfunction, left adie pupil, anhidrosis and abnormal sympathetic skin response, autonomic nerve dysfunction related to SLE was diagnosed. After treated with pulse glucocorticoids and intravenous immunoglobulin, the patient′s symptoms improved remarkably. Orthostatic hypotension in SLE patients may link to autonomic nerve dysfunction.
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Objective To compare the consistency between single-(I-GFR-SS) and dual-(I-GFR-DS) sample methods with three-sample method (I-GFR-TS) of iohexol plasma clearance in chronic kidney disease (CKD) patients for choosing the optimizing project of glomerular filtration rate (GFR) measurement.Methods The multiple-sample methods were performed in 174 patients with CKD admitted to the Department of Nephrology,Shanghai Ruijin Hospital from August 2017 to July 2018.Plasma concentrations of iohexol were measured three times at different time points after receiving 5 ml iohexol (300 g/L) intravenous injection,according to estimated GFR (eGFR) grouping.The first blood sample was collected at 2 hours,and the time for the last sample was delayed from 4 hours to 6 hours with reduction of eGFR.The synchronized Gates (99mTc-Gates-GFR) method was detected as control.With I-GFR-TS as the golden standard,the accuracies of I-GFR-DS,I-GFR-SS and 99mTc-Gates-GFR were compared.Results The median differences of I-GFR-DS,I-GFR-SS and 99mTc-Gates-GFR in overall patients were-0.15,-1.00,6.76 ml· min-1· (1.73 m2)-1 comparing with I-GFR-TS;P10(percentage of the GFRmeasurements that was within 10％ of the standard method) were 95.4％,74.1％,28.7％,and P30 were 100％,93.7％,72.4％ separately.In the patients with eGFR ＜ 30 ml· min-1· (1.73 m2)-1,I-GFR-SS was more accurate when last point collecting extended to 6 h from 4 h [P10:43.5％ vs 17.4％,P=0.055;P30:73.9％ vs 43.5％,P＜0.05].Conclusions The dual-sample plasma clearance of iohexol is recommended in clinical practice,and the single-sample method can be a secondary option because of its slightly poor accuracy but more convenient.Sample-collection protocol should be adjusted according to eGFR especially in moderate-to-severe CKD patients.The Gates method is not recommended.
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Objective To investigate the characteristics of electroencephalogram (EEG) in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods In this retrospective study, patients with anti-NMDAR encephalitis who admitted to Xuanwu Hospital of Capital Medical University from January 2012 to June 2015 were enrolled. All patients accepted EEG monitoring at least once, and tumor screening, symptomatic therapy, as well as immunotherapy. Outcomes were assessed by modified Rankin Scale (mRS) 6 and 12 months after immunotherapy, and mRS score 0-2 was defined as favorable outcome. Results Forty-one patients aged (27±12) (13-58) years were enrolled, 19 of whom were male. All patients received EEG monitoring 55 times totally. Among 41 patients in disease peak period, 39 patients (95.1%) had abnormal EEG, 2 patients had normal EEG. The abnormality of brain MRI scan accounted for 51.2%. Abnormal EEG included diffuse slowing (12 patients, 29.3%), epileptic discharges (9 patients, 22.0%), rhythmic delta activity (6 patients, 14.6%), extreme delta brush (EDB) (6 patients, 14.6%), focal slowing (4 patients, 9.8%), and rhythmic delta frequency activity without EDB (2 patients, 4.9%). Clinical items did not show statistically significant difference between the patients with EDB and those without EDB. The patients with normal EEG, epileptic discharges, rhythmic delta activity, or rhythmic delta frequency activity without EDB all had favorable outcomes after 12 months′ treatments. Conclusions The great majority of patients with anti-NMDAR encephalitis had abnormal EEG. EEG could sensitively reflect the changes of brain function and could be helpful in early diagnosis and treatment of this disease. The most common electrographic pattern was found to be diffuse slowing in patients with anti-NMDAR encephalitis. EEG of some patients showed EDB.