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Objective:To investigate the global and local changes of neurovascular coupling in arteriosclerotic cerebral small vessel disease (aCSVD) and the correlation with cognitive function.Methods:Forty-three patients with confirmed aCSVD from the outpatient department or ward of the Department of Neurology, the First Affiliated Hospital of Anhui Medical University between June 2020 and June 2021 were enrolled in this study. Meanwhile, 48 healthy subjects were selected as controls. Cognitive evaluation, resting-state functional magnetic resonance imaging and 3D pseudo-continuous arterial spin labeling magnetic resonance imaging scanning were performed in all subjects. The global cerebral blood flow-regional homogeneity (ReHo) correlation coefficient and the cerebral blood flow/ReHo ratio were used to evaluate global and local neurovascular coupling. Meanwhile, correlations between the cerebral blood flow/ReHo ratio and neuropsychological assessments were explored in aCSVD patients.Results:Global cerebral blood flow-ReHo coupling was decreased in aCSVD patients compared to healthy controls [aCSVD patients: 0.942(0.933, 0.950), healthy controls: 0.947(0.939, 0.954), Z=-2.11, P=0.035]. aCSVD patients showed decreased cerebral blood flow/ReHo ratio in the right lingual gyrus ( t=-4.45, P<0.05) and increased cerebral blood flow/ReHo ratio in the left ( t=4.91, P<0.05) and right ( t=4.72, P<0.05) inferior parietal lobule. Cerebral blood flow/ReHo ratio of the right inferior parietal lobule was negatively correlated with total score ( r=-0.33, P=0.031) and praxis score ( r=-0.43, P=0.004) in Cambridge Cognitive Examination-Chinese Version subitems and positively correlated with scores of Stroop Color Word Test (SCWT)-color ( r=0.33, P=0.032), SCWT-word ( r=0.34, P=0.025) and Trail Making Test-B ( r=0.31, P=0.043) in aCSVD patients. While the cerebral blood flow/ReHo ratio of the right lingual gyrus was negatively correlated with Visual Replicate-Immediate Recall score ( r=-0.36, P=0.017). Conclusion:aCSVD patients showed abnormal global and local neurovascular coupling, which was associated with attention, executive function, and visual space function.
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Small cell lung cancer (SCLC) has the biological characteristics of high recurrence and metastasis. The brain is the common site of SCLC extrapulmonary metastasis. Prophylactic cranial irradiation (PCI) can effectively reduce the incidence of brain metastasis and prolong the overall survival of patients with limited SCLC. Nevertheless, nearly one third of patients develop brain metastases after PCI. This article reviews the risk factors of brain metastasis after PCI, aiming to determine which subgroup of patients with limited SCLC can benefit from PCI and provide reference for the clinical application of PCI.
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ObjectiveTo observe the clinical characteristics and influential factors of pulmonary hypertension (PH) in maintenance hemodialysis (MHD) patients.MethodsOne hundred and two patients with MHD patients whose therapy time were all more than one year were enrolled from June 2008 to May 2009.Pulmonary arterial systolic pressure (PASP) and parameters related with cardiac structure and function were checked out by echocardiography.These patients were divided into two groups according to PASP:PH group[PASP≥35 mm Hg( 1 mm Hg =0.133 kPa)] and non-PH group(PASP ＜ 35 mm Hg).Gender,age,dialysis time,dialysis access and urine volume during dialysis was recorded.The blood biochemistry,parathyroid hormone(PTH),hemoglobin,postdialysis urea nitrogen was recorded too and Kt/V was calculated.ResultsPH was detocted in 26 MHD patients (25.5％,26/102).Right atrium transverse diameter,right atrium long diameter and pulmonary artery internal diameter in PH group [(32.00 ± 8.13),(41.00 ±9.15),(24.38 ± 3.88) mm] were higher than those in non-PH group [(27.44 ± 4.43),(36.45 ±8.88 ),(21.78 ± 2.46) mm] and LVEF in PH group [(55.59 ± 7.88 )％] was lower than that in non-PH group [(59.09 ± 5.69)％] (P ＜ 0.01 or ＜ 0.05).There were significant differences in calcium-phosphorus product,PTH,serum phosphorus and hemoglobin between PH group and non-PH group [(61.36 ± 17.83)mg2/dl2 vs.(53.24 ± 18.28) mg2/dl2,(365.95 ± 178.65) ng/L vs.(287.02 ±209.91 ) ng/L,(2.24 ±0.60)mmol/L vs.( 1.95 ± 0.68) mmol/L,(98.65 ± 25.69) g/L vs.( 114.29 ± 22.31 ) g/L] (P ＜ 0.05 ).Logistic regression found that PTH levels,hemoglobin and calcium-phosphorus product were the major risk factors for PH.ConclusionsMorbidity of PH in MHD patients is obviously high.Secondary hyperparathyroidism,anemia and high calcium-phosphorus product level may take part in the pathogenesis of PH in MHD patients.
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Objective To explore the long-term dialysis therapies suitable for Chinese patients by comparison of the long-term clinical effect of daily ambulatory peritoneal dialysis ( DAPD ) and hemodialysis (HD) on patients with end-stage renal failure.Methods Forty-six outpatients and inpatients with end-stage renal failure were enrolled from our hospital and divided into group A (24 patients) and group B (22 patients) randomly.Participants in group A received HD treatmant,including conventional HD,hemodiafiltration (HDF),hemoperfusion (HP),etc.For three times in total 12 - 15 h each week;patients in group B received DAPD with a daily dialysate dose of 6 - 8 L and a replacement in every 3 - 4 h for each bag of peritoneal dialysate,as well as a break overnight.The subsequent long-term monitoring was performed,and the following variables were compared for the patients in these two groups:sufficiency of dialysis (i.e.Kt/V),nutritional status [ including SGA and sALB ),complication control ( including Hb,CO2CP,K+,Ca2+,P-,iPTH and blood pressure (MAP) ],infection incidence,employment rate and annual medical expense.The evaluation on daily activities of living was also performed using Barthel Index (BI) and the presence of depressive dsymptoms was assessed by HAMD.Results Patients in both group A and group B could survive under long-term dialysis,and there was no statistically significant difference in sufficiency of dialysis (Kt/V),nutritional status (SGA and sALB ),complication control ( Hb,CO2 CP,K +,Ca2 +,P -,and MAP) and infection incidence ( P ＞ 0.05 ).One year after dialysis,the urine volume [ (274 ± 102) ml vs.( 205 ± 86 ) ml,P =0.017 ],BI ( 82 ± 13 vs.73 ± 11,P =0.044) and employment rate (40.9％ vs.12.5％,P=0.044) of the patients in group B were higher than those of the patients in group A,but the ultra-filtration volume [ ( 1162 ± 124 ) ml vs.( 1542±136 ) ml,P ＜ 0.001 ],iPTH [ (77.5 ± 12.7 ) ng/L vs.( 104.4±11.3 ) ng/L,P ＜ 0.001 ],HAMD ( 8 ± 3 vs.18 ± 4,P ＜ 0.001 ) and annual medical expense [ (7.67±1.48 ) ng/L vs.( 11.35 ± 2.52 ) ng/L thousand yuan,P ＜ 0.001 ] were lower than those of the patients in group A.Five years after dialysis,B1 ( 80 ± 13vs.71 ± 14,P =0.029 ) and employment rate ( 36.4％ vs.8.3％,P =0.032 ) in group B were greater than those in group A,while iPTH [ (83.8 ± 13.4) ng/L vs.( 123.8 ± 12.4) ng/L,P ＜ 0.001 ],HAMD ( 8±2 vs.19 ± 2,P ＜ 0.001 ),and annual medical expense [ ( 10.32±1.64 ) thousand yuan vs.( 13.47 ±2.38 ) thousand yuan,P ＜ 0.001 ] were lower than those in group A,and there was no statistically significant difference in survival rate (70.8％ vs.86.4％,P=0.289) and dialysis duration [ ( 56.82 ± 6.13 ) mouths vs.(57.35 ± 6.30) months,P =0.774 ] between the two groups ( P ＞ 0.05 ).Conclusion The comparison between the patients treated by long-term DAPD and those treated by conventional HD shows that DAPD has a satisfactory clinical effect in the aspects of sufficiency of dialysis,maintainence of nutritional status,control of complications,regulation of blood pressure and decrease of infection incidence,and it is also superior in reducing depressive symptoms,ensuring better quality of life and mitigating economic burden of patients.
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During the catastrophe of Wenchuan Earthquake on May 12,2008 in Sichuan province and the post-earthquake rescue,shining spirit of Bethune recurred among medical staffs.Based on the real scenes in Huaxi Hospital of Sichuan University,this paper clarifies a new definition of Bethune's spirit which combines the spirit of times,spirit of post-earthquake rescuing,and Bethune's spirit.