Probing bundle-wise abnormalities in patients infected with human immunodeficiency virus using fixel-based analysis: new insights into neurocognitive impairments / 中华医学杂志(英文版)

BACKGROUND@#Changes in white matter (WM) underlie the neurocognitive damages induced by a human immunodeficiency virus (HIV) infection. This study aimed to examine using a bundle-associated fixel-based analysis (FBA) pipeline for investigating the microstructural and macrostructural alterations in the WM of the brain of HIV patients.@*METHODS@#This study collected 93 HIV infected patients and 45 age/education/handedness matched healthy controls (HCs) at the Beijing Youan Hospital between January 1, 2016 and December 30, 2016.All HIV patients underwent neurocognitive evaluation and laboratory testing followed by magnetic resonance imaging (MRI) scanning. In order to detect the bundle-wise WM abnormalities accurately, a specific WM bundle template with 56 tracts of interest was firstly generated by an automated fiber clustering method using a subset of subjects. Fixel-based analysis was used to investigate bundle-wise differences between HIV patients and HCs in three perspectives: fiber density (FD), fiber cross-section (FC), and fiber density and cross-section (FDC). The between-group differences were detected by a two-sample t -test with the false discovery rate (FDR) correction ( P <0.05). Furthermore, the covarying relationship in FD, FC and FDC between any pair of bundles was also accessed by the constructed covariance networks, which was subsequently compared between HIV and HCs via permutation t -tests. The correlations between abnormal WM metrics and the cognitive functions of HIV patients were explored via partial correlation analysis after controlling age and gender.@*RESULTS@#Among FD, FC and FDC, FD was the only metric that showed significant bundle-wise alterations in HIV patients compared to HCs. Increased FD values were observed in the bilateral fronto pontine tract, corona radiata frontal, left arcuate fasciculus, left corona radiata parietal, left superior longitudinal fasciculus III, and right superficial frontal parietal (SFP) (all FDR P <0.05). In bundle-wise covariance network, HIV patients displayed decreased FD and increased FC covarying patterns in comparison to HC ( P <0.05) , especially between associated pathways. Finally, the FCs of several tracts exhibited a significant correlation with language and attention-related functions.@*CONCLUSIONS@#Our study demonstrated the utility of FBA on detecting the WM alterations related to HIV infection. The bundle-wise FBA method provides a new perspective for investigating HIV-induced microstructural and macrostructural WM-related changes, which may help to understand cognitive dysfunction in HIV patients thoroughly.

Meta-analysis of the effects of femtosecond laser-assisted cataract surgery on corneal endothelial cells / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To systematically evaluate the effects of femtosecond laser-assisted cataract surgery and conventional ultrasound cataract surgery(CUCS)on corneal endothelial cells.METHODS: Databases such as PubMed, Cochrane Library, Web of Science, Embase, CNKI, CBM, VIP and WanFang Data were searched for randomized controlled trials(RCT)from the establishment of the database to November 2021 on the effects of femtosecond laser cataract surgery and conventional ultrasound cataract surgery on corneal endothelial cells. Language is limited to Chinese or English. The literatures were evaluated by the Manual of Systematic Evaluation of Cochrane Interventions and the modified Jadad Scale. Stata 15.0 software was used for statistical analysis.RESULTS: A total of 13 RCT were included, including 1 446 eyes in the FLACS group and 1 472 eyes in the CUCS group. The Meta-analysis results showed that the cumulative dissipated energy(CDE)in FLACS group was obviously lower than that in CUCS group [WMD=-3.84, 95%CI (-6.30, -1.38), P=0.002]. The effective phacoemulsification time(EPT)in the FLACS group was obviously lower than that in the CUCS group [WMD=-3.03, 95%CI(-4.00, -2.05), P&#x003C;0.001]. The density of corneal endothelial cells in both the FLACS group after surgery at 1 and 3mo was higher than that in CUCS group [WMD=121.76, 95%CI(79.31, 164.20), P&#x003C;0.001; WMD=76.04, 95%CI(19.25, 132.82), P=0.009]; The thickness of the central cornea in the CUCS group was significantly thicker than that in the FLACS group at 1wk after the surgery [WMD=-9.89, 95%CI (-18.60, -1.18), P=0.026]; The incidence of postoperative corneal edema in the FLACS group was less than that in the CUCS group [RR=0.46, 95%CI(0.32, 0.66), P&#x003C;0.001]. There were no differences in the percentage of hexagonal cells and coefficient of variation of corneal endothelial cells between the two groups.CONCLUSION: Compared with conventional ultrasound cataract surgery, femtosecond assisted cataract surgery can significantly reduce the phacoemulsification energy and the duration of the phacoemulsification energy, and significantly reduce the loss of corneal endothelial cells in the early postoperative period, while reducing the occurrence of postoperative corneal edema.

Study of resting-state fMRI on brain function connection in smokers / 中国医学影像技术

Objective To analyze the function connection of the brain in smokers with resting-state fMRI.Methods Resting-state fMRI data of 53 smokers (smoking group) and 53 non-smokers (control group) were observed.The subjects in smoking group were divided into small or large amount smoking subgroup,as well as mild or severe addiction subgroup.The fractional amplitude of low-frequency fluctuation (fALFF) values of all subjects were calculated,and the differences of fALFF values and whole brain functional connectivity were observed.Results Compared with control group,fALFF significantly increased in the left limbic lobe,and decreased in the right superior temporal gyrus in smoking group.Compared to small amount smoking subgroup,fALFF significantly increased in the right superior temporal gyrus,and decreased in the bilateral limbic lobe in large amount smoking subgroup.Compared with mild addiction subgroup,fALFF significantly increased in the bilateral middle frontal gyrus,and decreased in the left limbic lobe in severe addiction subgroup.There are many increased and decreased functional connectivity brain areas in smoking group compared with control group.Conclusion There are many activity changes in addiction related brain areas and less in emotion control areas in smokers,and some brain areas activation changes are related to smoking amount and addiction level.

Correlation study between cerebral microbleeds and white matter lesions in patients with ischemic cerebrovascular disease / 中华行为医学与脑科学杂志

Objective To explore distribution characteristics and risk factors of cerebral microbleeds (CMBs),and the correlation between CMBs and white matter lesions (WML) in patients with ischemic cerebrovascular disease(ICVD).Methods 180 patients with ICVD in neurology department of Hebei General Hospital from February 2015 to January 2017 were recruited.Those patients were underwent brain magnetic resonance imaging (MRI),and magnetic susceptibility weighted imaging (SWI).Recorded the baseline data and risk factors of high blood pressure,diabetes,hyperlipidemia,and high homocysteine were recorded.Patients with CMBs were counted and graded to understand the characteristics of CMBs distribution.Logisitic regression analysis was used to analyze the influencing factors.ICVD patients were divided into CMBs group and non CMBs group.CMBs group was further divided into 4 groups according to the severity,which was divided into level 1-3.The correlation between CMBs influencing factors and classification was further studied.Then patients with ICVD were divided into WML group and non WML group.WML group scored each region with age-related white matter changes rating scale (ARWMCrs).The correlation between WML and CMBs classification was further studied.Results (1) The overall prevalence of CMBs in patients with ICVD was 61.7％ (111/180).The most common location of CMBs in patients with ICVD was the cortical and subcortical regions (80/111,72.1％),followed by the basal ganglia and thalamus regions (61/111,55.0％),and the infratentorial regions(38/111,34.2％).The difference between them were significant (x2 =32.061,P=0.000).In cortical and subcortical regions of CMBs,temporal lobe was the most common (61.3％).(2) Age(B=0.046,Or=1.047,95％CI =1.017～ 1.077,P=0.002) and the high homocysteine (B =1.458,Or=4.299,95％ CI =2.114 ～ 8.744,P＜0.001) were the risk factors for CMBs.(3) Four classification of CMBs was positively correlated with and WML total score (r=0.393,P=0.393).Conclusion The temporal lobe was the most common region for CMBs in patients with ICVD.Age and high homocysteine were risk factors for CMBs.With the increase of WML total score,severity of CMBs was also increased.

Comparison of primary coronary percutaneous coronary intervention between diabetic men and women with acute myocardial infarction

This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention [PCI] in female diabetic patients complicated with acute myocardial infarction [AMI]. A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A [52 females] and group B [117 males]. The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B [P < 0.05]. Smoking history, PCI history, and pre-infarction angina were distinctly lower in group A than in group B [P < 0.05]. Thrombolysis in myocardial infarction 3 [TIMI3] flow and TIMI myocardial perfusion grade 3 [TMPG3] after PCI were markedly lower in group A than in group B [P < 0.001]. Group A had a higher incidence of complications, such as severe arrhythmia, cardiac function Killip III/IV, cardiogenic shock, major, moderate and mild bleed event, as well as a 30-day mortality rate, compared with group B [P < 0.05]. In summary, our study demonstrated that female diabetic patients with AMI had lower TIMI3 flow and TMPG3 following PCI than male patients, while there was higher incidence of complications and 30-day mortality rate. Therefore, more attention should be paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors

Reformation and exploration of selective courses optimization in computer class for medical colleges based on Java language / 中华医学教育探索杂志

Computer selective courses in medical colleges based on C language are facing many problems. First, C language lacks continuity with follow-up courses and well combines with professional courses, which result in loss of interest of students and few students would like choose this selective course. Second, the computer selective courses are miscellaneous and discontinuous, which occupies much time and therefore necessitate integration and optimization. The reformations and implementation schemes are proposed to optimize computer selective courses based on Java language. On the one land, different computer selective courses are optimized, credit hours are compressed, and selective interests of the students are improved. In addition, the practicability and scalability of computer selective courses are enhanced combining the characteristics of medical science specialty.

Treatments of oropharyngeal anterior wall cancer by transhyoid surgery radiotherapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy.</p><p><b>METHODS</b>A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy.</p><p><b>RESULTS</b>All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%.</p><p><b>CONCLUSIONS</b>The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.</p>

Application of damage control surgery for severe abdominal trauma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of damage control surgery(DCS) for severe abdominal trauma.</p><p><b>METHODS</b>Forty-six patients with severe abdominal trauma were treated according to DCS principles and 58 patients were not. Clinical data of the two groups were analyzed retrospectively. DCS included simple surgery, resuscitation, and definitive operation.</p><p><b>RESULTS</b>Perioperative morality was 15.2%(7/46) in the DCS group and 34.5%(20/58) in the non-DCS group, and the difference was statistically significant(χ²=4.954, P=0.026). The perioperative complication rate was 37.0%(17/46) in the DCS group and 67.2%(39/58) in the non-DCS group, and the difference was statistically significant(χ²=9.468, P=0.002).</p><p><b>CONCLUSION</b>Damage control surgery can reduce perioperative morbidity and mortality in patients with severe abdominal trauma, and its efficacy is satisfactory.</p>

Dependablited analysis of clinical characteristic of acute pancreatitis with hyperlipemia / 中国基层医药

Objective To analyze the clinical characteristic of acute pancreatitis with hyperlipemia.Methods 276 patients with acute pancreatitis were divided into two groups:hyperlipemia group and normal group under the diagnostic code.The etiological factor and clinical characteristic were compared between the two groups,also the scores of APACHEⅡ,Ranson and CT after control lipid were compared.Results The factor of food and drink and the rate of SAP in group HL compared with those in group normal were significantly different (P