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Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.
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Objective:To investigate the cognitive-related networks of patients with different cognitive impairment related to white matter lesions (WMLs), and explore the correlation between the altered functional connectivity and the executive function.Methods:Patients with white matter lesions in Beijing Tiantan Hospital from January 2016 to December 2020 were selected , who were divided into WML-non-dementia vascular cognitive impairment (WML-VCIND) group( n=19)and WML-vascular dementia (VaD) group( n=19). At the same time, 24 normal control group (NC) with no cognitive impairment with age, gender and education level matched were enrolled. The Stroop B, Stroop C, trail making test(TMT-B) and verbal fluency test (VFT) were used to evaluate the executive function of all subjects. The ICA method was used to identity four cognitive-related RSNs: frontoparietal network (FPN), salience network (SN), default network (DMN), and dorsal attention network (DAN). Using SPSS 20.0 software, the functional connectivity (FC) of the regions of interest of the selected RSNs among the three groups were compared by analysis of covariance, and correlation between the altered FCs and executive function scores were explored by Spearman correlation analysis. Results:(1) The FC of the medial prefrontal cortex (MPFC)-left inferior parietal lobe (IPL.L) in the VaD group(0.267±0.320) was significantly lower than that in the NC group (0.520±0.253)( P=0.005). The FC of MPFC-posterior cingulate (PCC) was significantly lower in the VaD group(0.655±0.284) than that in the VCIND group(0.810±0.232) ( P=0.017). The FC of MPFC-left insula and MPFC-left dorsolateral prefrontal cortex (DLPFC.L)was significantly higher in the VaD group(0.411±0.277, 0.545±0.311)than that in the VCIND group(0.239±0.308, 0.353±0.270)( P=0.044, 0.028). The FC of the left superior parietal lobe (SPL.L)-right dorsolateral prefrontal cortex (DLPFC.R) in the VCIND group(0.488±0.157) was significantly higher than that in the NC group(0.301±0.257) ( P=0.010). The FC of MPFC-left insula and MPFC-DLPFC.L was higher in NC group than that in VaD group ( P=0.020, 0.037). (2) The FC of MPFC-PCC was negatively correlated with Stroop C score ( r=-0.279, P=0.036), and TMT-B score ( r=-0.313, P=0.018). The FC of MPFC-IPL.L was negatively correlated with Stroop B score ( r=-0.311, P=0.018), Stroop C score( r=-0.308, P=0.020) and TMT-B score ( r=-0.367, P=0.005), while positively correlated with VFT score ( r=0.357, P=0.006). The FC of SPL.L-DLPFC.R was positively correlated with the Stroop B score ( r=0.305, P=0.021). Conclusion:There are certain differences in the functional connectivity between brain areas within the cognitive related brain networks, and the differences in FC between different brain areas are correlated with executive function scores. The changes of the FC may indicate possibly decline in executive function, which can explain the mechanism of cognitive declines.
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This article is a summary of the Second China Breast Milk Science Conference, which was held in Beijing from August 5 to 7, 2022, with the theme of "Data sharing, method sharing and science sharing". The purpose of the conference is to summarize the latest progress in breast milk research, identify the unresolved issues, and jointly discuss the direction of future breast milk research. Firstly, we summarize the contents and purpose of breast milk scientific research and prospect of breast milk science. The second part focuses on the research status of breast milk composition and its health effects, and puts forward the future research direction. The third section focuses on the health effects of breastfeeding and scientific support and key aspects of breastfeeding promotion actions. The fourth part elaborates the specific methods of current scientific research of breast milk and emphasize the importance of method standardization and the idea of future methodological research. The fifth part consists of the strategy of feeding infants with medical conditions and ways to better promote the growth and development of these infants. The last part introduces the innovation, deficiencies, and future research directions of infant formula production technology in China. This conference demonstrate the importance of multidisciplinary communication, discussions and collaborations in clinical medicine, nutrition, perinatal health, food science, and policy-making in the scientific research of breast milk, and provides guidance for future multidisciplinary research on the physiology of lactation, the composition of breast milk, breastfeeding, and infants and young children nutrition.
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Here we try to explore the nutrition issues in existing birth cohort studies, and give suggestions to future cohorts, which including pregnant and lactating mothers and their babies, on nutritional survey, the way to collect breast milk samples, breast milk composition analysis and breastfeeding patterns. Also, we put forward some aspects for researchers to consider on the follow-up timepoints of children, design of mother-child dyads, and dietary intake and feeding or eating behavior of those babies in relevant cohort studies.
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Objective:To assess the age-related differences in the management strategies and outcomes of patients with acute coronary syndrome (ACS) under the chest pain center model.Methods:Clinical data of 2 833 patients with ACS were enrolled in the retrospective observational registry between January 2017 and June 2019 at 11 hospitals with chest pain centers in Chengdu. The patients were divided into four groups according to their ages: < 55 years old group ( n = 569), 55-64 years old group ( n = 556), 65-74 years old group ( n = 804), ≥ 75 years old group ( n = 904). The collected data included the patients' demographic characteristics, cardiovascular risk factors, medical history, symptoms and signs of onset, experimental examination, types of ACS and the time from the symptom to the hospital (S-to-D), etc., and the clinical characteristics, management strategies, all-cause mortality in the hospital, and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) within 1 year after discharge were compared. The primary end point was the clinical outcome of ACS patients in different age groups, including all-cause deaths in the hospital and the incidence of MACCE within 1 year after discharge. The secondary end point was the proportion of ACS patients underwent percutaneous coronary intervention (PCI) in different age groups. Multivariate Logistic regression was used to analyze the risk factors of all-cause deaths in ACS patients. Kaplan-Meier curve was used to express the incidence of MACCE within 1 year after discharge in different age groups. Multivariate Cox regression was used to analyze the factors affecting the incidence of MACCE within 1 year after discharge of ACS patients. Results:As age increased, the proportion of male patients gradually decreased, and the percentages of male patients aged < 55 years old, 55-64 years old, 65-74 years old, and ≥ 75 years old were 87.2% (496/569), 77.0% (428/556), 66.4% (534/804), and 60.1% (543/904), respectively; and ACS patients combined with hypertension, diabetes, coronary heart disease, and stroke history were more common [the percentages of patients with hypertension aged < 55 years old, 55-64 years old, 65-74 years old, ≥ 75 years old were 41.3% (235/569), 52.2% (290/556), 59.7% (480/804), and 66.9% (605/904); the percentages of diabetes were 18.6% (106/569), 25.5% (142/556), 27.0% (217/804), and 28.2% (255/904); the percentages of coronary heart disease were 10.1% (57/564), 13.9% (77/555), 17.6% (141/803), and 23.7% (213/899); the percentages of stroke were 0.7% (4/564), 4.0% (22/552), 4.5% (36/801), and 8.6% (77/894)]. But the percentages of patients with a history of active smoking, typical chest pain/chest tightness and dyslipidemia were significantly reduced [the percentages of smoking history were 60.2% (340/565), 48.0% (266/554), 33.7% (270/801), and 21.7% (195/899), typical chest pain/chest tightness were 96.9% (536/553), 96.4% (516/535), 91.8% (716/780), 90.2% (776/860); the percentages of dyslipidemia were 11.2% (63/565), 9.2% (51/553), 5.7% (46/802), and 4.9% (44/896)], the time of S-to-D was significantly prolonged [minutes: 176.0 (73.5, 557.0), 194.5 (89.3, 682.3), 221.0 (98.8, 940.5), and 270.0 (115.0, 867.0)], hemoglobin (Hb) level was significantly reduced(g/L: 145.44±17.43, 135.95±19.25, 129.75±19.03, 122.19±20.55), and the incidence of non-ST-segment elevation myocardial infarction (NSTEMI) increased significantly [18.6% (106/569), 20.5% (114/556), 26.6% (214/804), 26.5% (240/904)], and the differences were statistically significant (all P < 0.05). The proportion of Killip grade Ⅲ -Ⅳ were the highest in patients aged ≥ 75 years old, 9.0% and 12.6%, respectively. Compared with the groups aged < 55 years old, 55-64 years old, and 65-74 years old, the proportion of patients aged ≥ 75 years old who underwent PCI was the lowest, and the all-cause mortality in the hospital and the incidence of 1-year MACCE of patients underwent PCI were significantly lower than those of patients underwent conservative treatment [6.0% (28/463) vs. 10.4% (45/434), 14.6% (43/294) vs. 24.3 % (55/226), both P < 0.05]. As age increased, the hospital all-cause mortality and the 1-year MACCE incidence increased (all-cause mortality rates in < 55 years old, 55-64 years old, 65-74 years old, ≥ 75 years old groups were 0.9%, 2.2%, 5.5%, 8.3%, and the 1-year MACCE incidences were 5.0%, 6.7%, 13.9%, 18.7%, both P < 0.01). The multivariate Logistic regression analysis showed that age, cardiogenic shock, ST-segment elevation myocardial infarction (STEMI), the number of vascular disease and underwent PCI were the independent risk factors of all-cause mortality [the odds ratio ( OR) and 95% confidence interval (95% CI) were 1.644 (1.356-1.993), 11.794 (7.469-18.621), 2.449 (1.419-4.227), 1.334 (1.096-1.624), 0.391 (0.247-0.619), all P < 0.001]. Cox regression analysis showed that age, STEMI, the number of vascular disease and underwent PCI were independent risk factors of the occurrence of MACCE within 1 year after discharge [hazard ratio ( HR) and 95% CI were 1.354 (1.205-1.521), 1.387 (1.003-1.916), 1.314 (1.155-1.495), 0.547 (0.402-0.745), all P < 0.05]. Conclusions:In the chest pain center model, compared with other age of ACS patients, the proportion of NSTEMI in elderly patients group aged ≥ 75 years old was higher, the proportion of PCI was lower, and the clinical outcome was worse. However, the prognosis of elderly patients receiving PCI treatment was better than the patients receiving conservative treatment.
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Objective:To compare the differences in the delineation of the gross tumor volume (GTV) and lymph nodes of nasopharyngeal carcinoma (NPC) patients using computerized tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT), and to investigate the optimal standard uptake value (SUV; relative to the MRI-based delineation) for the automatic delineation of GTV using PET. Methods:A total of 53 NPC patients proposing to receive radiotherapy were selected for this study. The CT, MRI, and PET images of each patient were obtained before radiotherapy. Then GTV and positive lymph nodes were delineated on these three types of images. They were individually named GTV MRI, GTV CT, GTV PET2.5 (SUV=2.5), Lymph MRI, Lymph CT, and Lymph PET2.5 and compared. The GTV ∩2.5 (overlapped GTV) was obtained through the alignment of MRI and PET/CT images. Meanwhile, GTV was delineated on PET images using thresholds of SUV=4.0, 4.5, 5.0, and 5.6, obtaining GTV PET4.0, GTV PET4.5, GTV PET5.0, and GTV PET5.6. Then their volume and Dice similarity coefficients (DSCs) were compared. Results:Compared to GTV MRI, GTV CT decreased by 1.73% ( P>0.05) and GTV PET2.5 increased by 21.34% ( t=-3.52, P < 0.05) in the three types of images. The volume of Lymph PET2.5 was 1.61 and 1.87 times the volume of Lymph MRI and Lymph CT, respectively ( t=-4.12, -5.18; P< 0.05). The volume of high-SUV lymph nodes was 4.07 times the volume of lymph nodes with low SUVs or SUV=0 ( t=5.50, P< 0.05) on PET images. The DSC between GTV PET4.0and GTV MRI was 0.78 ± 0.27, which was lower than that between GTV PET2.5 and GTV MRI (0.84 ± 0.18). However, GTV PET4.0 approximated to GTV ∩2.5 ( P>0.05). Conclusions:Compared to CT and 18F-FDG PET/CT, MRI shows more accurate boundaries of GTV and lymph nodes. When 18F-FDG PET/CT was adopted to automatically delineate GTV, the GTV delineated using SUV=4.0 was closer to GTV MRI.
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Objective:To compare the mid-term clinical efficacy of total hip replacement (THR) and closed reduction and external fixation (CREF) in treatment of intertrochanteric fractures in the elderly.Methods:A retrospective case-control study was conducted to analyze the clinical data of 155 elderly patients with unilateral intertrochanteric fractures admitted to Second Affiliated Hospital of Army Medical University from June 2011 to June 2019, including 63 males and 92 females, aged 70-98 years [(80.1±7.0)years]. According to Jensen-Evans classification, the type of fracture was type I in 2 patients, type II in 21, type III in 24, type IV in 36, type V in 67, and type R in 5. A total of 85 patients were treated by THR (THR Group) and 70 patients by CREF (CREF group). The operation time, intraoperative blood loss, blood transfusion rate, length of hospital stay, postoperative complication rate, Harris hip score at postoperative 1 year, excellent and good rate of hip joint function, and 12-item short form health survey (SF-12) physical component summary score (SF-12PCS) of postoperative quality of life, mortality rate within 1 year and survival rate were compared between the two groups.Results:The follow-up time was 1.0-9.5 years [(3.9±2.4)years]. A total of, 140 patients were followed up for more than one year, 2 patients were lost, 13 patients died within 1 year after surgery. The operation time [77(60, 100)minutes] and intraoperative blood loss [(290.6±182.3)ml] in THR group were significantly longer or more than those in CREF Group [55(50, 70)minutes, (30.5±25.0)ml] ( P<0.05). The blood transfusion rate [78%(66/85)] in THR group was significantly higher than that in CREF Group [21%(15/70)] ( P<0.05). The length of hospital stay and incidence of postoperative complications were similar between the two groups ( P>0.05). One year after operation, the Harris hip score [(84.4±15.1)points], excellent and good rate of hip joint function [76%(63/83)] and SF-12 PCS score [(16.2±1.0)points] in THR group were significantly higher than those in CREF group [(69.0±21.6)points, 43%(27/63), (14.1±2.2)points] ( P<0.05). The mortality within 1 year after operation was similar between the two groups ( P>0.05). The survival curve analysis showed that the survival status in THR group was better than that in CREF group ( P<0.05). Conclusion:Compared with CREF, THR has better joint function and quality of life, as well as a higher overall survival rate when applied to treat intertrochanteric fractures in the elderly patients.
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Objective@#To investigate the status of knowledge about acquired immune deficiency syndrome(AIDS) among college freshmen in Jiangsu Province, and to analyze the influences of AIDS-related knowledge on their sexual attitudes and behaviors.@*Methods@#A total of 8 633 freshmen from 20 colleges and universities in Jiangsu Province were enrolled by multi-stage stratified sampling. The questionnaire for young students about the eight items of AIDS basic knowledge were used to investigate the AIDS-related knowledge, sexual attitudes and behaviors. Multivariate Logistic regression model was used to analyze the influencing factors of the AIDS-related knowledge and to adjust the influences of AIDS-related knowledge on sexual attitudes and behaviors.@*Results@#The overall qualified rate of AIDS-related knowledge among college freshmen in Jiangsu Province was 87.6% and the qualified rate of 8 items were between 59.8% and 98.3%. The types of schools, nationality, mother s education level and whether only child or not were identified as independent factors for qualified rate of AIDS-related knowledge(P<0.05). The awareness of AIDS-related knowledge had significant impacts on the sexual attitudes and behaviors of college freshmen. Students with insufficient knowledge were more likely to approve premarital sexual behaviors(OR=1.31, 95%CI=1.11-1.63), willing to use condoms consistently(OR=1.67, 95%CI=1.43-1.92) and to accept the HIV tests(OR=4.54, 95%CI=3.13-6.52). Students with unqualified knowledge were more likely to have sexual behavior(OR=1.89, 95%CI=1.42-2.49), while those with sexual experiences and insufficient AIDS knowledge were more likely to use condoms consistently(OR=2.13, 95%CI=1.22-3.78).@*Conclusion@#The education on AIDS-related knowledge for teenagers was helpful to construct correct sexual concepts and develop healthy sexual behaviors. However, the AIDS-related knowledge of college freshmen in Jiangsu Province is not sufficient and needed to improve.
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OBJECTIVE@#To explore the genetic etiology of a patient with glycogen accumulation type Ⅰa with gout as the main clinical feature.@*METHODS@#Clinical data of the patient was collected. The patient and her parents were subjected to next generation sequencing (NGS). Suspected pathogenic variation was verified by Sanger sequencing.@*RESULTS@#The patient, a 30-year-old women, mainly manifested hyperuricemia, chronic gouty arthritis, fasting hypoglycemia, hypertriglyceridemia, hyperlactatemia, hepatomegaly, urolithiasis, and gradually developed liver nodules and renal dysfunction. NGS revealed that she has carried c.648G>T (exon 5) and c.260delG (exon 2) compound heterozygous variants of the G6PC gene, which were respectively inherited from her father (phenotypically normal) and mother (with hyperuricemia). The c.260delG variant was unreported previously. Bioinformatic analysis indicated that both variants are pathogenic.@*CONCLUSION@#The compound heterozygous variants of the G6PC gene probably underlay the glycogen storage disease Ⅰa in this patient. G6PC gene mutations should be excluded in young women with hyperuricemia and /or gout.
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BACKGROUND@#Improving and maintaining the health of mothers and newborns is indisputably a global priority, especially during a pandemic. This study intends to examine the factors associated with cesarean section (CS) during lockdown time.@*METHODS@#A total of 678 women who just gave birth within 7 days were enrolled from maternal and children hospitals in nine cities of China from April to May 2020. The delivery modes and potential influencing factors were investigated. The subgroup analysis and sensitivity analysis were used to examine the association of CS and risk factors among populations with different characteristics and to control for possible confounding, respectively.@*RESULTS@#The overall rate of cesarean delivery was 37.3%. In multi-variant model, maternal age > 30 years (OR, 95% CI = 1.71, 1.21-2.41), higher pre-gestational BMI (OR, 95% CI = 1.16, 1.10-1.23), living in regions with confirmed COVID-19 cases > 500 (OR, 95% CI = 2.45, 1.74-3.45), and excess gestational weight gain (OR, 95% CI = 1.73, 1.17-2.55) were associated with cesarean delivery. These trends of associations were not changes in sensitivity analysis and subgroup analysis. Cesarean delivery occurred more in women who got more nutrition instruction during the pandemic period in the univariant model; however, this association showed insignificance in the multiple-variant analysis.@*CONCLUSION@#A high cesarean delivery rate was found in uninfected women who experienced lockdown in their third trimester. During the COVID-19 pandemic, more medical support should be provided in severely affected regions to ensure and promote health in pregnancy.
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Objective:To analyze the characteristic of nerve tracts in different stages of cognitive impairment caused by white matter hypertensities, applying diffusion tensor imaging-peak width of skeletonized mean diffusivity as evaluation indicator.Methods:Demographic characteristics and vascular risk factors of all subjects were recorded.Screened out 50 subjects without WMH and whose MoCA scale was more than or equal 26 points as normal control group.Then, we assessed 85 patients with WMH using the MoCA scale and clinical dementia assessment. Of 85 patients, 45 cases were divided into the normal cognition group, 23 cases were assigned into non-dementia vascular cognitive impairment group, and 17 cases into the vascular dementia group.The diffusion tensor imaging-peak width of skeletonized mean diffusivity marking method was used to compare the integrity of white matter fibers in WMH patients with varying degrees of cognitive impairment and normal control group.Results:The difference of PSMD among the four groups was statistically significant(CN group: 3.558±0.157, VCIND group: 4.128±0.222, VaD group: 5.469±0.000, NC group: 2.612±0.105, F=42.479, P<0.05). PSMD in WMH groups were higher than that in NC group (all P<0.05). There was no significant difference between WMH-VCIND group and WMH-CN group ( P=0.067). The PSMD of WMH-VAD group was higher than that of WMH-CN group and WMH-VCIND group (both P<0.05). Conclusion:PSMD can accurately detect white matter fiber damage caused by WMH.The degree of WMH combined cognitive decline was not completely consistent with the degree of PSMD increase.Compared with the cases with normal WMH cognition, PSMD was not significantly increased when WMH was combined with VCIND, while PSMD was significantly increased when WMH was combined with VaD.DTI-PSMD value as imaging marker can provide objective basis for clinical diagnosis of WMH-VaD.
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Objective:To explore abnormal microstructural changes of white matter in patients with white matter lesions(WML) using diffusion tensor imaging(DTI), and to determine the association of such abnormalities of DTI parameters with executive function.Methods:Totally 34 patients with WML were recruited from the department of Neurology, Beijing Tiantan Hospital, Capital Medical University from March 2012 to May 2019.All patients with WML were scored with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA), and assessed with Montreal cognitive assessment (MoCA) and clinical dementia rating(CDR). They were divided into WML-cognitive normal group, WML-vascular cognitive impairment-non dementia group and WML-Dementia group.The Stroop color and word test (SCWT), trail making test-A (TMTA), digit symbol test and verbal fluency test were carried out to evaluate executive function.In addition, the healthy elderly without WML lesions were selected as the control group after they were examined by MRI, and all brains of the subjects went through DTI with Siemens 3.0 T MR.The data were collected and analyzed by voxel based analysis (VBA). The anisotropy and mean diffusion coefficient of DTI in the region of interest (ROI) and other regions in the brain were studied in the four groups, and their correlation with scores of executive function in WML patients was analyzed.Results:(1)In these executive function test, there were significant differences between the patients with cognitive impairment (WML-VAD group, WML-VCIND group) and normal cognition group(WML-CN group, NC group), such as SCWT(B)(65.54±6.24 vs 43.67±0.95, 76.75±2.13 vs 43.67±0. 95, 65.54±6.24 vs 43.66±1.81, 76.75±2.13 vs 43.66±1.81), SCWT(C)(88.58±6.76 vs 61.63±1.31, 96.37±1.47 vs 61 63±1.31, 88.58±6.76 vs 66.31±8.19, 96.37±1.47 vs 66.31±8.19), TMTA(40.47±2.76 vs 30.92±0.47, 44.24±1.43 vs 30.92±0.47, 44.24±1.43 vs 31.99±2.07, 40.47±2.76 vs 31.99±2.07), TMTB(88.66±6.55 vs 80.34±0.61, 96.70±1.72 vs 80.34±0.61, 88.66±6.55 vs 83.10±5.91, 96.70±1.72 vs 83. 10±5.91), Digit Symbol Test(39.25±5.63 vs 47.00±2.55, 31.27±3.93 vs 47.00±2.5, 39.25±5.63 vs 48.86±4.34, 31.27±3.93 vs 48.86±4.34) and Verbal Fluency Test(8.94±1.00 vs 11.71±0.47, 6.64±0.81 vs 11.71±0.47, 8.94±1.00 vs 10.86±0.69, 6.64±0.81 vs 10.86±0.69) scores ( P<0.05); In the patients with cognitive impairment, there were significant differences between WML-VAD group and WML-VCIND group, such as SCWT(B), SCWT(C), TMTA, TMTB, digit symbol test and verbal fluency test scores ( P<0.05); There were significant differences between WML-CN patients and NC group in the scores of SCWT (C), verbal fluency test( P<0.05). (2)FA values in the genu of corpus callosum and the inferior longitudinal fasciculus were negatively correlated with the time of SCWT (B), SCWT (C) and the TMTA( r=-0.436--0.471), but positively correlated with the scores of digit symbol test and verbal fluency test( r=0.428-0.573). MD values in the genu of corpus callosum, the superior/inferior longitudinal fasciculus and the inferior fronto-occipital fasciculus were positively correlated with the time of SCWT (B), SCWT (C) and TMTA( r=0.432~0.609), but negatively correlated with the scores of digit symbol test and verbal fluency test( r=-0.424--0.630, all P<0.003125 after emendation). Conclusion:The executive function of patients with WML-Dementia decreases significantly.The more serious the damage of white matter microstructure, the more serious the damage of executive of function.
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Objective@#To discuss the feasibility and effectiveness of using micro-CT in bone-implant contact (BIC) evaluation in dogs, and to provide reference for clinical and scientific research.@*Methods@#Bilateral mandibular second premolar and first molar of six male Beagle dogs were extracted. After 3 months′ healing, eight implants were placed in bilateral mandible of each dog, four on each side. Dogs were sacrificed at 2 weeks, 4 weeks and 8 weeks after implant placement, two on each time point. Samples were scanned with micro-CT and digitally reconstructed. Bone-implant interface was analyzed at different analysis regions (25, 50 and 100 μm from implants′ surface), different detection range models were obtained (each time point consists 48 models), and BIC was evaluated, and the results were counted as micro-CT25, micro-CT50, and micro-CT100 groups. Then undecalcified slides were made (three slides for each sample) and stained with toluidine blue for observation and analysis of BIC using an optical microscope, and the results were counted as optical microscope groups. The advantages and disadvantages, evaluation efficiency and BIC of different methods were analyzed.@*Results@#To evaluate BIC of single sample, it took about 90 minutes by micro-CT, which was much lower than the time of 14 days by optical microscope. The success rates of modeling of micro-CT25, micro-CT50, and micro-CT100 groups all were 100.0% (48/48), and total success rate of micro-CT group was 100.0% (144/144). For optical microscope groups, the success rates of making slides 2, 4, 8 weeks were 89.6% (43/48), 93.8% (45/48) and 93.8% (45/48), respectively, and total success rates of optical microscope group was 92.4% (133/144). At 2, 4,8 weeks after implantation, BIC in micro-CT25 group was significantly smaller than that in optical microscope group at the same time point (P<0.05). However, at 2, 4,8 weeks after implantation, BIC of the micro-CT50 and micro-CT100 groups showed no significant difference with optical microscope groups at the same time point (P>0.05). A significant correlation (P<0.001, each) was seen between slides and micro-CT (25, 50, 100 μm groups) concerning BIC (r=0.680, r=0.892, r=0.713), and error bias was -19.4%, -0.9%, 3.0%, respectively. The probability within the 95% limits of agreement were 97.9%.@*Conclusions@#Micro-CT is a faster, simpler and more efficient way to analyze BIC at the implant-bone interface than optical microscope observation. BIC analysis by selecting 50 μm from implants′ surface as analysis region using micro-CT is in consistent with that using the optical microscope.
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Objective To explore abnormal microstmctural changes of white matter in patients with white matter lesions using diffusion tensor imaging(DTI),and to determine the association of such abnormalities of DTI parameters with cognitive function.Methods The objects who have already confirmed with WML were collected from March 2012 to February 2018 through magnetic resonance imaging (MRI) scan from the neurology department of Beijing Tiantan Hospital.Use The hamilton depression scale(HAMD) and the hamilton anxiety scale (HAMA) to eliminate anxiety and depression,and divided into WML-CN group,WML-VCIND group and WML-VAD group with Mini-mental state examination (MMSE),Montreal Cognitive Assessment (MOCA)and clinical dementia rating(CDR).In addition,select the healthy elderly people without WML by MRI scan as the normal control group.All of the subjects were detected with the superconduct magnetic resonance imaging system (German SIEMENS 3.0T) for the DTI scanning.Original images were processed with VBA.Then explore the changes of FA and MD of DTI in whole brain and regions of interest in NC group,WML-CN group,WML-VCIND group and WWML-VAD group,and its correlation with the severity of cognitive impairment in patients with WML.Results The damage degree of the fiber microstructure of brain white matter was significantly correlated with the total grade point of MoCA (P＜0.01).In figure FA,the variance analysis of F test results showed that the significant brain areas were the splenium of the corpus callosum,the genu of corpus callosum,bilateral posterior internal capsule,retrolenticular part of internal capsule,anterior thalamic radiation,partial inferior longitudinal fasciculus and inferior fronto-occipital fasciculus,cingulate,external capsule,upper and posterior part of the radiation crowns,partial superior longitudinal fasciculus,etc.(P＜0.05 after FWE correction based on TFCE method).In Figure MD,the variance analysis of F test results showed that the statistically significant brain areas mainly included the left external capsule and hook,partial genu and splenium of corpus callosum,Bilateral,bilateral inferior fronto-occipital fasciculus,inferior longitudinal fasciculus,anterior thalamic radiation,retrolenticular part of internal capsule,cingulate,etc (P＜ 0.05 after FWE conection based on TFCE).Conclusion No matter whether cognitive impairment exists in patient with WML or not,all DTI parameters are different from those of normal people.The integrity of white matter fiber has been damaged with different degrees.The more severe the cognitive impairment in the external manifestations of patients with WML,the greater the damage to the intrinsic white matter microstructure.
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Objective To study the effect of white matter lesions location on cognitive function by comparing the correlation between the anatomical location of white matter lesions and cognitive function in leukoaraisosis(LA)patients. Methods A total of 75 LA patients with different degrees of white matter le-sion were randomly recruited.The modified Scheltens scale,Manolio scale and Fazekas scale were utilized to assess the severity of white matter lesions(WMLs)by two physicians.Montreal cognitive assessment (MoCA)was used to evaluate the cognitive function.The correlation between WMLs location and cognitive function was analyzed by spearman rank correlation analysis.The t-test was used to test the differences of periventricular white matter lesions with cognitive impairment(PWMLs-CI)and periventricular white matter lesions with cognitive normal(PWMLs-CN)in each goup. Results For Fazekas scale,PWMLs were signifi-cantly correlated with the decrease scores of MoCA score(r=-0.388,P=0.007),visuospatial and executive (r=-0.466,P=0.000),delayed recall(r=-0.461,P=0.001),abstraction(r=-0.355,P=0.011)and ori-entation(r=-0.337,P=0.016)(P<0.05).For Scheltens scale,PWMLs was negatively correlated with MoCA score(r=-0.390,P=0.003),visuospatial and executive(r=-0.464,P=0.000),delayed recall(r=0.484, P=0.000),attention(r=-0.375,P=0.008)and orientation(r=-0.342,P=0.013)(P<0.05),but not in deep white matter lesions(DWMLs)(P>0.05).Compared with PWMLs-CN,executive function(42.13 ± 0.89),attention(16.36±1.24)and visuospatial(2.25±0.31)in PWMLs-CI had statistical significance(P<0.05). Conclusion White matter lesions location affect cognitive function,PWMLs are more closely related to cognitive impairement,characterized by executive function,attention and visuospatial aspects.
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Objective To explore the clinical characteristics of cognitive impairment in different age groups with the same severity of white matter lesions.Methods This study involved 110 consecutively recruited patients with white matter lesions(WMLs)from the Department of Neurology at Beijing Tiantan Hospital from August 2014 to March 2017.Patients were aged from 50 to 85 with a mean age of 63.1±9.7,and they were divided into an elderly group with a mean age of 71.6±5.2 (range:65-85 years)and a middle aged group with a mean age of 54.8 ± 3.4 (range:50-60 years).The severity of white matter lesions was evaluated with the Fazekas scale.MoCA was used to evaluate the cognitive function of patients.Results For Fazekas 1,the MoCA score was 25.5 ± 2.2 in the elderly group and 28.1 ± 1.4 in the middle aged group(t =6.946,P =0.000);the score for visuospatial and execution abilities was 3.8 ± 0.9 in the elderly group and 4.5 ± 0.6 in the middle aged group(t =3.7 2 6,P =0.0 2 3);the score for delayed memory was 2.7 ± 1.5 in the elderly group and 4.0 ± 1.0 in the middle aged group(t =4.365,P =0.018).For Fazekas 2,the MoCA score was 22.5±2.5 in the elderly group and 24.1 ± 1.5 in the middle aged group(t =3.361,P =0.034);the score for visuospatial and execution abilities was 2.8 ± 1.2 in the elderly group and 3.8 ± 0.8 in the middle aged group(t=6.473,P=0.007);the score for concentration was 4.6± 1.3 in the elderly group and 5.6±0.5 in the middle aged group(t=0.491,P=0.721).For Fazekas 3:the MoCA score was 15.2 ± 3.4 in the elderly group and 19.4 ± 2.8 in the middle aged group(t =4.709,P =0.001);the score for visuospatial and execution abilities was 1.8 ± 1.1 in the elderly group and 2.8± 1.4 in the middle aged group(t =1.563,P =0.043);the score for concentration was 3.3± 1.1 in the elderly group and 4.4± 1.4 in the middle aged group(t=2.231,P=0.026);the score for orientation was 4.2 ± 1.3 in the elderly group and 5.7 ± 0.5 in the middle aged group (t=3.255,P =0.000).Conclusions WMLs can increase the risk of vascular cognitive impairment and cause decline in multiple cognitive functions in both middle aged and elderly people.Cognitive dysfunction in age-related WMLs is mainly characterized by impairment in visuospatial and execution abilities.
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@#Objective To study the relationship between executive function and activities of daily living for patients with periventricular white matter lesions (PWMLs). Methods From January, 2016 to January, 2017, 35 PWMLs patients and 35 normal controls were collected. Their executive function and activities of daily living were assessed with neuropsychological tests and Activities of Daily Living Scale (ADL).Results Compared with the normal control group, the scores of Mini-Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA) significantly decreased (t>13.726, P<0.001), the times of Trail-Making Test and Stroop Colour Word Test significantly lengthened, the Verbal Fluency Test score decreased (t=6.891, P=0.013) and the Digit-Symbol Substitution Test score did not improve (t=3.372, P=0.072) in PWMLs group. The Z score of executive function was positively correlated with ADL score (r=0.438, P=0.008).Conclusion The executive function and activities of daily living are impaired in PWMLs patients, and their activities of daily living is related to the severity of the executive function impairment.
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@#The most important characteristic of post-stroke anomic aphasia is disorder in nomenclature, but the location of brain injury has been unclear. In recent years, it was found that, based on T1WI of MRI, the location is uncertain in chronic anomic aphasia after stroke, but it is mostly in temporal lobe of the dominant hemisphere in acute stage. Based on diffusion tensor imaging, the subcortical white matter, especially the left subfrontal white matter plays an important role in the naming process. The fMRI studies found that anomic aphasia is related to the destruction of the connections among some specific gray matter brain regions, named brain network theory. The cognitive psychology theory suggested that language processing can be further divided into different steps, each step is responsible for different brain regions; for different kinds of words, such as verbs and nouns, the processing involves different regions.
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@#Objective To explore the connection of fibers among functional language areas in the normals and the patients with subcortical aphasia using diffusion tensor imaging (DTI) and diffusion tensor fiber tractography (DT-FT). Methods From June, 2016 to May, 2017, 20 healthy subjects and three stroke patients whose lesion located in subcortical structures were included. There were two patients with Broca's aphasia and one with conductive aphasia from the Western Aphasia Battery. They were scanned with DTI and DT-FT, while the fractional anisotropy (FA) of functional language areas and contralateral mirror areas were measured, and the relevant fibers were observed. Results The structures of functional language areas were complicated and extensively connected with other cortex and subcortical structures in healthy subjects, with few differences among individuals. FA was lower in the functional language areas and arcuate fasciculus than in the mirror regions in patients, and the fibers were damaged, distorted or shifted.Conclusion Structures related to language are very complicated, which involve cortex, lots of white matter tracts, subcortical structure and others. The damage, transformation or transposition of fibers in functional language areas may be the mechanism of subcortical aphasia.
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Anterior teeth are the main zones that reflect oral aesthetics. The histological structure, outside appearance, relative ratios, and other characteristics of tissues must be understood to obtain relatively ideal and natural restoration effects. A collaboration of different disciplines must be implemented to obtain harmonious and stable restoration outcomes that help the majority appreciate beauty. This article aims to discuss the role of periodontics in this collaboration and introduce several common techniques.