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Objective:To investigate the diagnostic value of prognostic nutritional index (PNI) and C-reactive protein to albumin ratio(CAR) in Crohn′s disease complicated with intra-abdominal infection (CD-IAI).Methods:From January 2016 to December 2021, the clinical data of 61 patients with Crohn′s disease (CD) and 61 patients with CD-IAI diagnosed at Nanfang Hospital, Southern Medical University were retrospectively analyzed. Crohn′s disease activity index (CDAI), Crohn′s disease endoscopic index of severity (CDEIS), laboratory parameters(white blood cell count, neutrophil ratio, platelet count, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, prothrombin time (PT), fibrinogen, activated partial thromboplastin time (APTT)), PNI and CAR were compared between CD patients and CD-IAI patients. From January to May in 2022 another 30 patients with CD and 13 patients with CD-IAI diagnosed at Nanfang Hospital, Southern Medical University were selected to verify the accuracy of PNI and CAR in predicting CD-IAI. The optimal cut-off values of PNI and CAR in predicting CD-IAI, area under the curve (AUC), Youden index, sensitivity and specificity were calculated by receiver operating characteristic curve (ROC). Spearman correlation was used to analyze the correlation between PNI, CAR, CDAI, and CDEIS, and logistic regression was performed to analyze the influencing factors of CD-IAI. Independent sample t test and Mann-Whitney U test were used for statistical analysis. Results:CDAI and CDEIS were higher in CD-IAI patients than those of CD patients(256.68±8.50 vs.144.87±7.83; 3.80 (1.80, 5.40) vs. 1.20 (0.20, 2.80)), and the differences were statistically significant( t=-9.67, Z=-4.02, both P<0.001). The white blood cell count, neutrophil ratio, platelet count, CRP, PCT, D-dimer, PT, fibrinogen, and APTT of CD-IAI patients were all higher than those of CD patients (7.81×10 9/L (5.98×10 9/L, 11.39×10 9/L) vs. 5.94×10 9/L (4.86×10 9/L, 7.11×10 9/L); (73.43±10.67)% vs. (62.30±11.03)%; 360.00×10 9/L (266.50×10 9/L, 456.00×10 9/L) vs. 294.00×10 9/L (222.50×10 9/L, 356.00×10 9/L); 44.27 mg/L (16.82 mg/L, 82.65 mg/L) vs. 3.42 mg/L (0.59 mg/L, 18.33 mg/L); 0.07 μg/L (0.04 μg/L, 0.22 μg/L) vs. 0.04 μg/L (0.02 μg/L, 0.05 μg/L); 0.75 mg/L (0.32 mg/L, 2.00 mg/L) vs. 0.26 mg/L (0.15 mg/L, 0.46 mg/L); 11.90 s (11.40 s, 12.90 s) vs. 11.20 s (10.45 s, 11.70 s); 4.58 g/L (3.59 g/L, 5.59 g/L) vs. 2.99 g/L (2.17 g/L, 4.23 g/L); 30.40 s (28.30 s, 32.80 s) vs. 28.00 s (25.45 s, 31.10 s)), and the differences were statistically significant ( Z=-4.48; t=-5.66; Z=-2.71, -6.47, -3.78, -4.87, -4.87, -5.44 and -2.74; all P<0.01). The serum albumin level of CD-IAI patients was lower than that of CD patients (34.10 g/L (31.40 g/L, 36.90 g/L) vs. 39.00 g/L (35.10 g/L, 43.20 g/L)), and the difference was statistically significant( Z=-3.91, P<0.001). The PNI of CD-IAI patients was lower than that of CD patients (41.65, (38.58, 44.58) vs. 47.80 (40.45, 52.98)), while CAR was higher than that of CD patients (1.29 (0.48, 2.67) vs. 0.10 (0.01, 0.46)), and the differences were statistically significant ( Z=-3.83 and -6.44, both P<0.001). The results of Spearman correlation analysis showed that PNI was negatively correlated with CAR, CDAI, and CDEIS ( r=-0.64, -0.53 and -0.50, all P<0.001), and CAR was positively correlated with CDAI and CDEIS ( r=0.63 and 0.52, both P<0.001). The results of logistic regression analysis showed that high level of PNI was a protective factor for CD-IAI ( OR= 0.911, 95% confidence interval 0.864 to 0.961), and high level of CAR was a risk factor for CD-IAI ( OR=2.846, 95% confidence interval 1.745 to 4.644). The results of ROC indicated that the AUC value of combined PNI and CAR in the diagnosis of CD-IAI was 0.829 ( P<0.001), Youden index was 0.541, the sensitivity was 0.934, and the specificity was 0.607. The sensitivity and specificity of optimal cut-off value of the combination of PNI and CAR in predicting CD-IAI were 0.692 and 0.967. Conclusions:PNI and CAR have certain diagnostic value in CD-IAI. The risk of CD-IAI is high when PNI <45.550 and CAR >0.466.
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Objective:To explore the clinical application value of each sequence by analyzing the characteristics of labyrinthine signal on MRI in patients with unilateral sudden deafness.Methods:Totally 52 patients of unilateral sudden deafness with inner ear MRI were analyzed retrospectively at Beijing Tongren Hospital, Capital Medical University from January 2016 to July 2019, all of which could find abnormalities in the labyrinth, including 17 cases of plain scan and 35 cases of enhanced scan, with sequences including plain T 1WI, enhanced T 1WI, plain and enhanced delayed 3D fluid attenuation inversion recovery (3D-FLAIR). The affected labyrinthine signal characteristics of each sequence were analyzed and the involvement sites were judged. The ability of each sequence to show labyrinthine abnormal signal was evaluated and scored. The Friedman test and Wilcoxon signed rank sum test were used to compare the subjective scores of the ability to show labyrinthine high signal in different sequences in plain and enhanced patients, respectively. Fisher′s exact probability method was used to analyze the relationship between the affected sites and the recovery of hearing, tinnitus and vertigo symptoms. Results:Fifty-two patients (100%, 52/52) showed labyrinthine high signal on T 1WI, 8 (15.4%, 8/52) showed higher signal and 3 (5.8%, 3/52) showed low signal on T 2WI. Thirty-five (100%, 35/35) showed high signal on enhanced T 1WI, among which 27 had enhancement (77.1%, 27/35). Fifty-two (100%, 52/52) showed significant high signal of the affected labyrinth on 3D-FLAIR (17 plain scan, 35 enhanced scan). The scores were 2 (2, 2), 3 (2, 3), 3 (3, 4) and 4 (4, 4) of T 1WI, enhanced T 1WI, plain and enhanced 3D-FLAIR respectively. The overall difference in subjective scores of plain T 1WI, enhanced T 1WI and enhanced 3D-FLAIR in enhanced patients was statistically significant (χ2=64.528, P<0.001), and the comparison between the two was statistically different (all corrected P<0.05). The plain 3D-FLAIR score was higher than the plain T 1WI in patients with a statistically significant difference ( Z=-3.729, P<0.001). Twenty-seven cases (51.9%, 27/52) exhibited high signal at the ampulla of semicircular canals, with a statistically significant difference in the distribution of hearing recovery or not ( P=0.001). Conclusions:Both T 1WI and 3D-FLAIR sequences can effectively identify the labyrinthine high signal, but the latter was better than the former of its ability to display, especially delayed enhanced 3D-FLAIR. The high signal at the ampulla of semicircular canals was a characteristic predictor of non-recovery of hearing.
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OBJECTIVE To summarize surgical treatment effects and to discuss surgical strategy for Small acoustic neuroma.METHODS The clinical data of 26 patients with small acoustic neuroma treated with surgery in our department were analyzed retrospectively.25 patients with preoperative hearing grading of C and D received the labyrinthine approach acoustic neuroma resection,and 1 patient with preoperative hearing grading of B received middle fossa approach acoustic neuroma resection.The preoperative and postoperative hearing level,incidence of tinnitus,balance disturbance and weakness of facial muscles were analyzed retrospectively.The control and recurrence of the tumor,the incidence of complications were recorded.RESULTS Total resection was achieved in 25 cases (96％),and in 1 cases achieved sub total resection due to the fact that the tumor was too adhesive to the facial nerve The follow-up time ranged from 6 months to 7 years with 7 cases lost contact.No deaths nor intracranial infection were encountered.Cerebrospinal fluid rhinorrhea was found in 1 cases after the operation and eustachian tube blockage was performed.All patients(100％) had their facial nerve reserved and 16 patients (88％) had their cochlea nerve reserved.17patients(89.5％) had intact facial nerve function and 2 patients suffered from level Ⅲ facial nerve paralysis (House-Brackmann grade) post operatively.6 patients suffered from vertigo pre-operatively and 5 of them reported disappearance of vertigo after the surgery.Of the 13 patients who did not have vertigo before the surgery,1 patient complained sense of dizziness and unsteady walking post-operatively.5 patients (33.3％) reported disappeared or alleviated tinnitus,8 patients (53％) had the same degree of tinnitus and 2 patients reported worsened tinnitus post-operatively.For patients who did not have tinnitus before the surgery,no tinnitus was reported post-operatively.CONCLUSION treatment strategy for small acoustic neuroma requires personalized setting based on the age of the patient,the combined systemic disease,the severity of the symptoms and the growth rate of the tumor.For patients without practical hearing,the tumor could be removed with labyrinthine approach,and the integrity of the cochlear nerve should be preserved as far as possible,for further reconstruction of hearing ability and cochlear implantation.
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Objective To promote the migratory ability and immunological effect of bone marrow-derived dendritic cells ( BMDC) loaded with breast carcinoma antigen. Methods DCs were cultured by the medium containing rmGM-CSF and rmIL-4. After loaded with breast carcinoma antigen, DCs were stimulated with PGE2 for 1day. CD86, CD80, and CCR7 were measured by flow cytometry. The expression of CCR7 on surface of BMDC was also detected by RT-PCR and Western blotting. The chemotaxis assay was measured by migration through a polycarbonate filter in transwell chambers. The competence of inducing mixed lymphocyte response (MLR) and specific cytotoxic T lymphocyte ( CTL) were detected with MTT. The effect of DC blocking tumor growth in breast carcinoma model were also studied. Results Compared with control group, PGE2 upregulated surface markers of CD86, CD80, and CCR7 (P