ABSTRACT
Objective:To evaluate the value of curative effect in neuromyelitis spectrum disease (NMOSD) based on circulatory function evaluation of intracerebral glymphatic system by using diffusion tensor imaging analysis along the perivascular space.Methods:The clinical and imaging data of 23 patients diagnosed with NMOSD at Tianjin Medical University General Hospital from March 2018 to December 2019 were retrospectively analyzed in this study. The clinical data included expanded disability status scale (EDSS), average relapse rate (ARR) and retinal nerve fiber layer (RNFL) thickness at baseline and 1 year follow-up after treatment. Among the 23 NMOSD patients, there were 22 females and 1 male, aged from 21 to 71 (45±13) years old. All the patients underwent MR scans at both baseline and 1 year after treatment, and the scanning sequences included cerebral 3D-T 1WI, T 2WI, diffusion tensor imaging and cervical spinal sagittal 3D-T 2WI, and the cervical spinal cord volume and bilateral diffusion tensor imaging analysis along the perivascular space index (ALPS index) were calculated. The partial correlation test was used to analyze the correlations between ALPS index and the clinical indicators such as EDSS, ARR, and bilateral RNFL, with the control variables as gender, age, years of education and course of disease. The multiple linear regression model was used to analyze the independent predictors for ALPS index and EDSS after treatment. Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate the diagnostic value of NMOSD treatment outcome by using ALPS index. Results:When controlling for gender, age, years of education and course of disease, there were significant negative correlations between right ALPS index and EDSS ( r=-0.50, P=0.048), bilateral average ALPS index and EDSS ( r=-0.53, P=0.034), left ALPS index and ARR ( r=-0.58, P=0.018), while there was significant positive correlations between right ALPS index and RNFL ( r=0.88, P=0.008) at 1 year follow-up after treatment. Multiple linear regression analysis showed that cervical spinal cord volume was an independent impact factor of bilateral average ALPS indexes (β=0.24, 95%CI 0.10-0.38, P=0.002), and bilateral average ALPS indexes (β=-3.22, 95%CI -5.97--0.48, P=0.024) and right RNFL (β=-0.05, 95%CI -0.08--0.02, P=0.002) at baseline were the independent impact factors of EDSS after treatment. ROC curve analysis showed that the bilateral average ALPS index at baseline had the best efficacy in predicting the curative effect of NMOSD patients with AUC=0.92. Conclusions:After treatment, NMOSD patients with severe clinical disability, high frequency of disease attack, poor visual performance, and severe cervical spinal cord atrophy have more serious impairment of intracerebral glymphatic system circulatory function. The ALPS index could help in predicting the clinical curative effect of NMOSD patients.
ABSTRACT
Objective:To explore the experience of the treatment of patella inferior pole fracture with non excitation tension band technique.Methods:From April 2009 to December 2019, 76 patients with inferior patellar fracture were treated with non excitation tension band technique. There were 42 males and 34 females; The age was 35.48 ± 18.12 years (17-66 years), with an average of 35 years. There were 45 cases on the left and 31 cases on the right. Causes of injury: fall injury in 46 cases, bicycle injury in 16 cases and traffic accident injury in 14 cases. The time from injury to operation was 0.25-5 d, with an average of 3.2 d. There were 18 cases of open fractures, 64 cases of articular surface fractures and 52 cases of comminuted fractures. Open fracture patients were debridement first, and all cases were fixed with non excitation tension band technique. The intraoperative fracture reduction, postoperative fracture healing and internal fixation were observed. The knee function was evaluated according to the degree of claudication, the use of supports, the feeling of joint strangulation, joint instability, pain, swelling, stair climbing and squatting.Results:All 76 patients successfully completed the operation and were followed up for 18.24 ± 6.18 months (range 12-24 months). There was no wire fracture during and after operation. All incisions healed in the first stage after operation, and there was no deep venous thrombosis of lower limbs. The X-ray film showed that there was no further fracture and fracture displacement after operation, and there was no Kirschner wire slip before the internal fixation was taken out. Only one case had steel wire relaxation due to buckle (which did not affect fracture healing). All fractures healed well, with an average of 7.5 weeks, and the fracture line basically disappeared. 12 months after operation, according to Lysholm knee score standard, the knee function of patients was evaluated. The score of 76 cases was 95.40±4.60 points (range 82-100 points): excellent in 54 cases, good in 21 cases and fair in 1 case. The excellent and good rate was 98.7%. According to the visual analogue scale (VAS) pain score standard, the patients were scored for postoperative pain. The score of 76 cases was 0.09±2.05 points (range 0-3 points): 4 cases had mild pain, with an average score of 0.09.Conclusion:The results of the treatment of patellar inferior pole fracture with tension free band technique are satisfactory, the pain caused by tissue irritation by the internal fixation was lower, clinical application can be popularized.
ABSTRACT
Objective To investigate the effect of different hypoglycemic methods on tibial osteotomy (HTO)in patients with diabetes mellitus,and to seek a more scientific and reasonable clinical intervention model.Methods From February 2016 to January 2017,sixty patients with knee osteoarthritis and diabetes mellitus were randomly divided into the control group and the observation group,with 30 cases in each group.Patients in the control group were treated with Acarbose and Aspartic Insulin 30 injection method for blood glucose intervention.Patients in the observation group were treated with vildagliptin and Aspartic Insulin 30 injection.The changes of fasting blood glucose(FPG),postprandial 2 h blood glucose(2 hPG),glycosylated hemoglobin(HbAlc),body mass index(BMI)and other indicators of the two groups were measured before treatment,before surgery and 6 months after surgery,and the adverse reactions of the two groups of patients were compared.Results Repeated measures analysis of variance showed that there were statistically significant differences in FPG and 2 hPG of the two groups collected before treatment,before surgery and 6 months after surgery(F=85.40,617.06; P<0.05).Independent sample t test showed that HbAlc in the control and the observation group((7.9±0.9)%,(7.5±0.8)%)were significantly lower than those before treatment((9.8 ±1.5)%,(9.5±1.2)%)(t=5.95,7.60,P<0.05),at 6 months after surgery,BMI((25.83±1.78)kg/m2) in the observation group was significantly lower than that in the control group((27.35 ± 2.41)kg/m2)(t=2.78,P<0.05).The number of adverse reactions in the observation group was 2 cases(6.67%),significantly lower than that of the control group of 13 cases(43.33%),the difference between the two groups was statistically significant(χ2=10.756,P<0.05).Conclusion Vildagliptin combined with Aspartic Insulin 30 injection can not only effectively control the perioperative blood glucose levels in patients with HTO,but also can help the patients to control the body weight and reduce the incidence of adverse reactions.This method has a positive effect on the recovery of HTO.
ABSTRACT
Objective To investigate the imaging features of hippocampus and entorhinal cortex in the normal,mild cognitive impairment(MCI) and Alzheimer's disease (AD),and explore the value of diagnosing MCI and AD by using the method of MRI measuring the volume of hippocampus and entorhinal cortex.Method One hundred and twenty-two people including 42 cases of MCI,38 cases of AD,and 42 cases of noroal cognition(NC) were selected as our subjects from health examination persons both in hospital and outpatient service.All were performed general examination and neuropsychological scale evaluation.The volume of hippocampus and entorhinal cortex were measured by using MRI.The correlation between the volumetric changes of hippocampus and entorhinal cortex with scores of mini-mental state examination (MMSE) and Montreal Cognitive Assessment(MoCA) was analyzed.Results The volume of hippocampus and entorhinal cortex in the MCI group,AD group and NC group were (6.29 ± 1.13)cm3 and (2.71 ± 0.51) cm3,(6.27 ± 1.11) cm3 and (2.09 ±0.68) cm3,(7.01 ±0.92) cm3 and (3.12 ±0.34) cm3 respectively.The volume of MCI group was obviously smaller than that of NC group (P ＜ 0.05).The volume of AD group was smaller than that of NC group(P ＜0.01).The volume of AD group was obviously smaller than that of MCI group(P ＜0.01).There was positive correlation between hippocampus volume,the volume of entorhinal cortex and MMSE scores (r =0.770,0.811 ; P ＜ 0.01).Meanwhile,hippocampal volume,volume of entorhinal cortex were positive correlated with MoCA (r =0.810,0.842; P ＜ 0.01).Conclusion The atrophy of entorhinal cortex and hippocampus is closely related to cognitive disorder.The MRI measuring of the volume of entorhinal cortex and hippocampus has a potential value in diagnosing and distinguishing of MCI and NC.
ABSTRACT
Objective To evaluate the killing effect and the uptake of 125I-UdR on human lymphoma Raji and Daudi cell lines. Methods The amount of 125I-UdR in the cells and cell nuclei were determined after incubation of different time in RPMI 1640 culturing medium containing different concentrations of 125I-UdR. The killing effects of 125I-UdR on Raji and Daudi cell lines were estimated through MTT assay and cell cycle was analyzed by propidium iodide (PI) staining. Results The amounts of 125I-UdR in Raji and Dandi cells and cell nuclei were much higher than that of Na125I(P < 0.05). The amounts of 125l-UdR in Raji and Daudi cells were 14414±95 and (6916± 53.69) Bq/106 cell when the concentration was 100 kBq/ml. The amounts of Na125I were 68± 3.8 and (324±32.8) Bq/106 cell. The uptake of 125I-UdR in Raji and Daudi cells and cell nuclei increased with the 125I-UdR concentration and incubated time. The cell surviving fractions of 125I-UdR groups was much lower than that of Na125I groups (P < 0.05). When the concentration was 500 kBq/ml and incubated time was 48 hours, the Raji and Dandi cell surviving fractions of125I-UdR groups were (19.78 ± 1.39)% and (43.17 ± 2.69) % ;those of Na125I groups were (79.10 ± 1.79) % and (80.36 ± 6.12) %. The surviving fractions of 125I-UdR groups reduced with the 125I-UdR concentration. Conclusions 125I-UdR can be specially ingested by Raji and Daudi cells and incorporated into DNA, then the cells will be killed. The uptake of 125I-UdR is dose and time dependent.