Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry / 中华医学杂志(英文版)

BACKGROUND@#Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.@*METHODS@#To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks.@*RESULTS@#A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor.@*CONCLUSIONS@#Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

IKKβ mediates homeostatic function in inflammation via competitively phosphorylating AMPK and IκBα

Inhibitor of nuclear factor kappa-B kinase subunit beta (IKKβ) is one of important kinases in inflammation to phosphorylate inhibitor of nuclear factor kappa-B (IκBα) and then activate nuclear factor kappa-B (NF-κB). Inhibition of IKKβ has been a therapeutic strategy for inflammatory and autoimmune diseases. Here we report that IKKβ is constitutively activated in healthy donors and healthy Ikkβ C46A (cysteine 46 mutated to alanine) knock-in mice although they possess intensive IKKβ-IκBα-NF-κB signaling activation. These indicate that IKKβ activation probably plays homeostatic role instead of causing inflammation. Compared to Ikkβ WT littermates, lipopolysaccharides (LPS) could induce high mortality rate in Ikkβ C46A mice which is correlated to breaking the homeostasis by intensively activating p-IκBα-NF-κB signaling and inhibiting phosphorylation of 5' adenosine monophosphate-activated protein kinase (p-AMPK) expression. We then demonstrated that IKKβ kinase domain (KD) phosphorylates AMPKα1 via interacting with residues Thr183, Ser184, and Thr388, while IKKβ helix-loop-helix motifs is essential to phosphorylate IκBα according to the previous reports. Kinase assay further demonstrated that IKKβ simultaneously catalyzes phosphorylation of AMPK and IκBα to mediate homeostasis. Accordingly, activation of AMPK rather than inhibition of IKKβ could substantially rescue LPS-induced mortality in Ikkβ C46A mice by rebuilding the homeostasis. We conclude that IKKβ activates AMPK to restrict inflammation and IKKβ mediates homeostatic function in inflammation via competitively phosphorylating AMPK and IκBα.

Development of a Clinical Decision Support System for Severity Risk Prediction and Triage of COVID-19 Patients at Hospital Admission: an International Multicenter Study

Key pointsO_ST_ABSQuestionC_ST_ABSHow do nomograms and machine-learning algorithms of severity risk prediction and triage of COVID-19 patients at hospital admission perform? FindingsThis model was prospectively validated on six test datasets comprising of 426 patients and yielded AUCs ranging from 0.816 to 0.976, accuracies ranging from 70.8% to 93.8%, sensitivities ranging from 83.7% to 100%, and specificities ranging from 41.0% to 95.7%. The cut-off probability values for low, medium, and high-risk groups were 0.072 and 0.244. MeaningThe findings of this study suggest that our models performs well for the diagnosis and prediction of progression to severe or critical illness of COVID-19 patients and could be used for triage of COVID-19 patients at hospital admission. IMPORTANCEThe outbreak of the coronavirus disease 2019 (COVID-19) has globally strained medical resources and caused significant mortality for severely and critically ill patients. However, the availability of validated nomograms and the machine-learning model to predict severity risk and triage of affected patients is limited. OBJECTIVETo develop and validate nomograms and machine-learning models for severity risk assessment and triage for COVID-19 patients at hospital admission. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort of 299 consecutively hospitalized COVID-19 patients at The Central Hospital of Wuhan, China, from December 23, 2019, to February 13, 2020, was used to train and validate the models. Six cohorts with 426 patients from eight centers in China, Italy, and Belgium, from February 20, 2020, to March 21, 2020, were used to prospectively validate the models. MAIN OUTCOME AND MEASURESThe main outcome was the onset of severe or critical illness during hospitalization. Model performances were quantified using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. RESULTSOf the 299 hospitalized COVID-19 patients in the retrospective cohort, the median age was 50 years ((interquartile range, 35.5-63.0; range, 20-94 years) and 137 (45.8%) were men. Of the 426 hospitalized COVID-19 patients in the prospective cohorts, the median age was 62.0 years ((interquartile range, 50.0-72.0; range, 19-94 years) and 236 (55.4%) were men. The model was prospectively validated on six cohorts yielding AUCs ranging from 0.816 to 0.976, with accuracies ranging from 70.8% to 93.8%, sensitivities ranging from 83.7% to 100%, and specificities ranging from 41.0% to 95.7%. The cut-off values of the low, medium, and high-risk probabilities were 0.072 and 0.244. The developed online calculators can be found at https://covid19risk.ai/. CONCLUSION AND RELEVANCEThe machine learning models, nomograms, and online calculators might be useful for the prediction of onset of severe and critical illness among COVID-19 patients and triage at hospital admission. Further prospective research and clinical feedback are necessary to evaluate the clinical usefulness of this model and to determine whether these models can help optimize medical resources and reduce mortality rates compared with current clinical practices.

Survey on deep learning for pulmonary medical imaging / 医学前沿

As a promising method in artificial intelligence, deep learning has been proven successful in several domains ranging from acoustics and images to natural language processing. With medical imaging becoming an important part of disease screening and diagnosis, deep learning-based approaches have emerged as powerful techniques in medical image areas. In this process, feature representations are learned directly and automatically from data, leading to remarkable breakthroughs in the medical field. Deep learning has been widely applied in medical imaging for improved image analysis. This paper reviews the major deep learning techniques in this time of rapid evolution and summarizes some of its key contributions and state-of-the-art outcomes. The topics include classification, detection, and segmentation tasks on medical image analysis with respect to pulmonary medical images, datasets, and benchmarks. A comprehensive overview of these methods implemented on various lung diseases consisting of pulmonary nodule diseases, pulmonary embolism, pneumonia, and interstitial lung disease is also provided. Lastly, the application of deep learning techniques to the medical image and an analysis of their future challenges and potential directions are discussed.

CT features of intrapulmonary lymph nodes: a comparative study with pathology / 中华放射学杂志

Objective To explore the CT features and pathology of intrapulmonary lymph nodes (IPLNs), so as to improve the understanding and diagnosis of IPLNs. Methods A total of 38 patients (49 IPLNs) who were confirmed by the surgery and pathology were retrospectively analyzed, including 21 males and 17 females with a mean age of (56±8) years. All the patients underwent MSCT scan and 1.0 mm thin layer reconstruction before surgery. Double-blind method was used to analyze CT signs and the corresponding histopathological changes were compared. Results (1) Location: all IPLNs were located below the level of tracheal carina with 17 were on the left lung, and 32 were on the right lung. (2) Shape: 34 IPLNs were round, 15 were triangular or prism and so on. (3) Size: the maximum diameter of IPLNs ranged from 0.26 to 1.28 cm (0.66±0.23 cm), of which 45 cases were≤1.0 cm. (4) Quantity: 28 IPLNs were solitary and 10 were multiple. (5) Density: All 48 IPLNs were solid nodules with a median CT value of 43 HU (range from 19 to 106 HU), and there were no calcification, vacuoles and air bronchial signs were showed. (6) Margin and pleura: all the 48 IPLNs boundaries were clear and smooth, and 45 pieces were less than 1.0 cm from the pleura, of which 20 were close to the pleura or inter-lobar fissure. (7) Other: no"satellite focal", pleural depression syndrome, and vascular bundle sign were showed;22 peripheral fine lines of IPLNs were visible. (8) Pathology: IPLNs were dark brown or gray-black nodules with well-defined borders, coated, tough, hard, and carbon deposition could be seen in most cases. Conclusion IPLNs are benign nodules in the lung, which have certain CT features and typical pathological changes. Based on the CT performance and characteristics, it is helpful to make correct diagnosis of IPLNs before operation.

Brain volume changes in patients with maintaining hemodialysis and the correlation with sleep quality, anxiety and depression / 中国医学影像技术

Objective To investigate the changes of cerebral volume in end stage renal disease (ESRD) patients with maintaining hemodialysis using voxel based morphometry (VBM),and to observe the correlation of these changes with sleep quality,anxiety and depression.Methods Twenty ESRD patients received maintaining hemodialysis (patient group) and twenty-one normal volunteers (normal control group) underwent MRI and neuropsychological scale evaluations,including the Montreal Cognitive Assessment Scale (MoCA),Pittsburgh Sleep Quality Index Scale (PSQI),Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS).The changes of cerebral volume between the two groups were compared,and the correlation between the changed area of cerebral volume in patient group and the score of neuropsychological scale was analyzed.Results Compared with normal control group,significantly decreased volume in the gray matter of the left middle temporal gyrus,right middle frontal gyrus and left medial frontal gyrus were observed in patient group (all P＜0.001,AlphaSim multiple corrections).The differences of MoCA,PSQI,SAS and SDS between the two groups were statistically significant (all P＜0.05).In patient group,the decreased gray matter volume of the left middle temporal gyrus negativity correlated with PSQI,SDS and SAS (r=-0.588,-0.456,-0.489;P =0.006,0.043,0.029),of the right middle frontal gyrus negativity correlated with SDS and SAS (r=-0.495,-0.466;P=0.026,0.038),of the left medial frontal gyrus positively correlated with MoCA (r=0.462,P=0.040),and negatively correlated with PSQI (r=-0.588,P=0.006).Conclusion Multiple grey matter atrophy and complicated neurocognitive dysfunction were noticed in ESRD patients with maintaining hemodialysis,and the associated poorer sleep quality,anxiety or depression severity might closely related to the decreased volume of corresponding brain gray matter.

Research progresses of resting-state functional MRI in patients of end-stage renal disease patients with cognitive impairment / 中国医学影像技术

End-stage renal disease (ESRD) is often complicated with damage of multi-organ function,among them,cognitive impairment has been noticed with a high prevalence.The abnormal intrinsic brain activity patterns in resting state is one of the manifestations of cognitive impairment in ESRD.Resting-state functional MRI (rs-fMRI) is divided into two categories,i.e.functional separation and functional integration,reflecting the changes of neural activity of the brain in different aspects.With advantages of non-invasive,no radiation and high spatio-temporal resolution,rs-fMRI has gradually become an effective method in studying the neurophysiological mechanisms of cognitive impairment.The pathophysiology and research progresses of rs-fMRI in ESRD with cognitive impairment were reviewed in this article.

Magnetic resonance spectroscopy study of the left posterior cingulate cortex in type 2 diabetic encephalopathy patients / 实用放射学杂志

Objective To analyze the changes of metabolites in the left posterior cingulate cortex (PCC)in patients with type 2 diabetes mellitus (T2DM),diabetic encephalopathy(DE)and healthy control(HC),to discuss the pathogenesis and to provide the biological information for the early diagnosis of DE.Methods 46 patients with clinical diagnosis of T2DM and 26 matched HC were received single-voxel MRS on the left PCC using Siemens Verio 3.0T MR scanner.Participants were divided into two groups based on MoCA scoring criteria and diabetic retinopathy,including DM group (n=31)and DE group (n=15).All T2DM patients were received fasting blood glucose,glycated hemoglobin (HbAlc)and other clinical labortory tests before MR scans.SPSS 21.0 software package was used for statistical analysis.Results (1)Ins and Ins/Cr were increased gradually in DE compared with HC and DM groups(P＜0.05).(2) NAA/Ins ratio in DE group was significant lower than that in DM and HC group,but no significant difference was observed between DM and DE groups(P＞0.05).No significant differences exsited in NAA/Cr among these three groups(P＞0.05).Conclusion MRS can be more sensitive to detect DE patients on the left PCC-related metabolic abnormalities and help DE with early screening and preliminary clinical diagnosis.The increase Ins/Cr in the left PCC area is more sensitive to the brain injury of T2DM and can refelect the progress degree.It is necessary to expand the sample size to verify its diagnostic efficacy and early warning of the brain injury.

Facile synthesis of Ti4+ -immobilized affinity silica nanoparticles for the highly selective enrichment of intact phosphoproteins.

Currently, great challenges to top-down phosphoproteomics lie in the selective enrichment of intact phosphoproteins from complex biological samples. Herein, we developed a facile approach for synthesis of Ti4+ -immobilized affinity silica nanoparticles and applied them to the selective separation and enrichment of intact phosphoproteins based upon the principle of metal(IV) phosphate/phosphonate chemistry. The as-prepared affinity materials exhibited high selectivity and adsorption capacities for model phosphoproteins (328.9 mg/g for ß-casein, 280.5 mg/g for ovalbumin, and 225.8 mg/g for α-casein), compared with nonphosphoproteins (79.28 mg/g for horseradish peroxidase, 72.70 mg/g for BSA, and 27.28 mg/g for lysozyme). In addition, the resuability of the affinity silica nanoparticles was evaluated, and the results demonstrated a less than 10% loss of adsorption capacity after six adsorption-regeneration cycles. The practicability of the affinity materials was demonstrated by separating phosphoproteins from protein mixtures and drinking milk samples, and the satisfactory results indicated its potential in phosphoproteomics analysis.

Spatial-temporal distribution of smear positive pulmonary tuberculosis in Liangshan Yi autonomous prefecture, Sichuan province, 2011-2016 / 中华流行病学杂志

Objective To analyze the spatial and temporal distribution of smear positive pulmonary tuberculosis (PTB) in Liangshan Yi autonomous prefecture in Sichuan province from 2011 to 2016. Methods The registration data of PTB in 618 townships of Liangshan from 2011 to 2016 were collected from"Tuberculosis Management Information System of National Disease Prevention and Control Information System". Software ArcGIS 10.2 was used to establish the geographic information database and realize the visualization of the analysis results. Software OpenGeoda 1.2.0 was used to conduct the analyses on global indication of spatial autocorrelation (GISA) and local indication of spatial autocorrelation (LISA). Software SaTScan 9.4.1 was used for spatio-temporal scanning analysis. Results From 2011 to 2016, the registration rate of smear positive PTB in Liangshan declined from 56.97/100000 (2666 cases) to 21.11/100000 (1038 cases). The global spatial autocorrelation coefficient Moran's I ranged from 0.25 to 0.45 and the difference was significant (all P=0.000). Local autocorrelation analysis showed that"high-high"area covered 43, 34, 37, 34, 42 and 61 townships from 2011 to 2016, respectively, mainly in Leibo county. Spatial temporal clustering analysis found one class Ⅰ clustering in the area around Bagu township of Meigu county and two class Ⅱ clustering in the areas around Liumin and Hekou township of Huili county, respectively (all P=0.000). Conclusion Obvious spatial temporal clustering of smear positive PTB distribution was found in Liangshan from 2011-2016. Hot spot areas with serious smear positive PTB epidemic and high spread risk were mainly found in northeastern Liangshan, including townships in Leibo and Meigu counties. Targeted TB prevention and control should be conducted in these areas.

Spatial-temporal distribution of smear positive pulmonary tuberculosis in Liangshan Yi autonomous prefecture, Sichuan province, 2011-2016 / 中华流行病学杂志

Objective To analyze the spatial and temporal distribution of smear positive pulmonary tuberculosis (PTB) in Liangshan Yi autonomous prefecture in Sichuan province from 2011 to 2016. Methods The registration data of PTB in 618 townships of Liangshan from 2011 to 2016 were collected from"Tuberculosis Management Information System of National Disease Prevention and Control Information System". Software ArcGIS 10.2 was used to establish the geographic information database and realize the visualization of the analysis results. Software OpenGeoda 1.2.0 was used to conduct the analyses on global indication of spatial autocorrelation (GISA) and local indication of spatial autocorrelation (LISA). Software SaTScan 9.4.1 was used for spatio-temporal scanning analysis. Results From 2011 to 2016, the registration rate of smear positive PTB in Liangshan declined from 56.97/100000 (2666 cases) to 21.11/100000 (1038 cases). The global spatial autocorrelation coefficient Moran's I ranged from 0.25 to 0.45 and the difference was significant (all P=0.000). Local autocorrelation analysis showed that"high-high"area covered 43, 34, 37, 34, 42 and 61 townships from 2011 to 2016, respectively, mainly in Leibo county. Spatial temporal clustering analysis found one class Ⅰ clustering in the area around Bagu township of Meigu county and two class Ⅱ clustering in the areas around Liumin and Hekou township of Huili county, respectively (all P=0.000). Conclusion Obvious spatial temporal clustering of smear positive PTB distribution was found in Liangshan from 2011-2016. Hot spot areas with serious smear positive PTB epidemic and high spread risk were mainly found in northeastern Liangshan, including townships in Leibo and Meigu counties. Targeted TB prevention and control should be conducted in these areas.

Rotational animal brain injury models dynamically and quantitatively detected by diffusion tensor imaging correlated with β-amyloid precursor protein expression / 中华放射学杂志

Objective To investigate dynamic regulation of quantifying fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values in rotational brain injury models of rabbit using diffusion tensor imaging (DTI), and its correlation with β?amyloid precursor protein (β-APP). Methods Forty-two 6-month-old New Zealand rabbits were randomly divided into three groups, including control group (n=6), mild injured group (n=18) and severe injured group (n=18), and preformed on autonomous rapidly rotational brain injury device. The rotational angles of 45° for mild injured group and 90° for severe injured group were condemned, and MRI and pathology were conducted at 6 h, 12 h, 24 h, 48 h, 72 h and 1 week after injury (3 rabbits per subgroup). Routine sequences and DTI technique were performed on 3.0 T MRI. FA and ADC values in subcortical white matter, corpus callosum and brain stem were measured. Independent t?test was performed to evaluate the significance of the intergroup difference in FA and ADC values in mild and severe injured groups of verious brain regions by timing, one?way ANOVA was performed to evaluate its timing variation and its correlation with the number of the β-APP positive axons was analyzed by Pearson correlation analysis. Results FA and ADC values of the severe injured group were lower than that of the mild in most brain regions(P<0.05), and the difference in mild injured group was smaller than that in severe injured group. Both FA and ADC values in brain stem of the severe injured group were lower at 6 h after injury compared to mild injured group, which were sensitive to injury. Furthermore, FA and ADC values in each brain regions of mild and severe injured groups showed similar dynamic trends, namely gradually decreasing by time, and FA values were more sensitive to injury than ADC values. FA values in subcortical white matter and brain stem reduced in severe injured group at 6 h after injury compared with that before injury(P<0.05), and decreased in various brain area of both injured groups at 12 h after injury(P<0.05). Meanwhile, ADC values in all regions were declined in the severe injured group at 12 h after injury(P<0.05), and decreased in various regions in both injured groups at 24—48 h after injury(P<0.05)except for subcortical white matter in mild injured group. There were statistically negative correlations between FA and ADC values and the number of β-APP positive axons in 12—48 h after injury in most regions(P<0.05). Conclusions DTI can quantitatively detect and assess the pathological process in white matter and axons of TBI in earlier stage of the brain injury, and can be applied in evaluation and quantitative diagnose in these patients.

Correlation between venous blood phase values detected by enhanced gradient echo T2 star weighted angiography sequence and neurological severity scale scores in mild and severe traumatic brain injury models of rabbits / 中华放射学杂志

Objective To explore the change of venous blood phase values detected by enhanced gradient echo T2 star weighted angiography(ESWAN)sequence in mild and severe traumatic brain injury (TBI) models of rabbits in diverse phases and investigate their association with neurological severity scale (NSS) scores. Methods Fifty-one New Zealand rabbits, which were randomly divided into control group (n=3) ,mild injured group (n=24) , and severe injured group (n=24) by random digital table method, underwent routine MRI and ESWAN sequence at the time points of baseline, 1 h, 6 h, 12 h, 24 h, 48 h, 72 h, 1 week, and 2 weeks after injury(3 rabbits per subgroup)respectively. Blood phase values in veins of interest were recorded. Observation of behavior characteristics and abnormalities, followed by NSS, was executed post injury, and the correlation between venous blood phase values and NSS scores was statistically analyzed. Two independent-samples t-test was applied to compare venous blood phase values of diverse measured veins in each group separately at every time ponits. One-way ANOVA was used to analyze venous blood phase values varying over time of measured vessels in each injured group. Least significant difference t-test was applied to compare blood phase values within the subgroups with each other at each time point. NSS scores of mild and severe injured groups were compared by two independent-samples t-test. Correlations between venous blood phase values and NSS scores in each vein and group was analyzed with Spearman correlation analysis. Results Blood phase values in veins of interest presented an inclination of descending, which was more obvious in severe injured groups than in the mild. Change of venous blood phase values over time featured continuing reduction in earlier phases which reached to the minimum in 24-48h, and then increased gradually, especially in VMV, VLV, DSS, and MDVB (P<0.05). ICV and DCV also showed similar trend. Values of NSS scores in the two group were (15.5 ± 3.1) and (33.2 ± 6.5) respectively (t=3.543,P=0.001). Blood phase values in most of the measured veins correlated with NSS scores (P<0.05) after 6h post injury, especially significant during 24-72h among all the measured veins(P<0.05). Higher accuracy and sensitivity were presented in the supratentorial or superficial veins compared with subtentorial or profound veins. Conclusions It is feasible to evaluate oxygen saturation of veins after TBI by measuring venous blood phase values on ESWAN images. The method is effective in the assessment of the degree of injury and clinical status, indicating a favorable application prospect.

Analysis of hepatitis B virus genotype in regions in Guangxi with high incidence of primary liver cancer / 实用医学杂志

Objective To explore the distribution and characteristics of hepatitis B virus (HBV) genotype in the region in Guangxi with high incidence of primary liver cancer (PLC). Methods 103 pairs of samples from the sex- and age-matched members with HBsAg-positive from PLC-clustering families (the experimental group) and carcinoma-free families (control group) were collected. Nested polymerase chain reaction (PCR) and sequencing methods were applied for the analysis of HBV genotype. Results Four HBV genotypes: B, C, B/C and D, were detected, the percentages of them in the two groups were 31.1%, 63.1%, 1.9%, 1.9% and 30.1%, 55.3%, 6.8%, 2.9%, respectively, showed no significant differences (P > 0.05). HBeAg positive rates were significantly different between genotype C and B (P 0.05). Conclusions The main genotypes were types B and C besides a small number of combined genotypes B/C and D in the regions of Guangxi with a high incidence of PLC. There may be few relationships between HBV genotypes and the high incidence of PLC for familial clustering in Guangxi.

Rs-fMRI changes of posterior cingulate cortex in type 2 diabetes mellitus patients with cognitive im-pairment / 中华行为医学与脑科学杂志

Objective To investigate the resting?state functional alteration in posterior cingulate cortex ( PCC) in Type 2 diabetes ( T2DM) patients with cognitive impairment and to determine the relation?ship of rs?fMRI changes with cognitive decline. Methods Resting?state functional magnetic resonance ima?ging was performed T2DM patients with impaired cognition ( n=19) and healthy control subjects ( n=20) . The amplitude of low frequency fluctuations ( ALFF) and regional homogeneity ( ReHo) values were calcu?lated in left PCC to represent the spontaneous brain activity. Using left PCC as a seed region,the functional connectivity of the whole brain was mapped. In addition,correlation analysis was conducted among ALFF,Re?Ho,and neuropsychological test scores. Results The ALFF values of left PCC (0.72±0.37) was decreased compared with the control group(1.09±0.46),but the ReHo value(1.12±0.10)was not significantly changed compared with control group (1.14±0.11). The functional connectivity was decreased with the left medial temporal lobe,left superior and middle temporal gyrus,right superior frontal gyrus,and right supplementary motor area ( SMA) ,while it was increased with the left middle frontal gyrus,inferior frontal gyrus and right cerebella. MoCA scores were positively correlated with the ALFF values of left PCC. Conclusion In resting state,the spontaneous activity and functional connectivity of PCC is altered in T2DM patients with cognitive impairement;and the function of PCC contributes to the cognitive decline associated with T2DM.The decrease of ALFF value of PCC may help to detect the cognitive decline of T2DM.

Comparative proteomics analysis of differential proteins in respond to doxorubicin resistance in myelogenous leukemia cell lines.

BACKGROUND: Chemoresistance remains a significant challenge in chronic myelogenous leukemia (CML) management, which is one of the most critical prognostic factors. Elucidation the molecular mechanisms underlying the resistance to chemoresistance may lead to better clinical outcomes. RESULTS: In order to identify potential protein targets involved in the drug-resistant phenotype of leukemia, especially the chronic myelogenous leukemia (CML), we used a high-resolution "ultra-zoom" 2DE-based proteomics approach to characterize global protein expression patterns in doxorubicin-resistant myelogenous leukemia cells compared with parental control cells. Ultra-high resolution of 2DE was achieved by using a series of slightly overlapping narrow-range IPG strips during isoelectric focusing (IEF) separation. A total number of 44 proteins with altered abundances were detected and identified by MALDI-TOF or LC-MS/MS. Among these proteins, enolase, aldolase, HSP70 and sorcin were up-regulated in doxorubicin-resistant myelogenous leukemia cell line, whereas HSP27 was down-regulated. Some of the results have been validated by Western blotting. Both enolase and aldolase were first reported to be involved in chemoresistance, suggesting that process of glycolysis in doxorubicin-resistant myelogenous leukemia cells was accelerated to some extent to provide more energy to survive chemical stress. Possible roles of most of the identified proteins in development of chemoresistance in myelogenous leukemia cells were fully discussed. The results presented here could provide clues to further study for elucidating the mechanisms underlying drug resistance in leukemia. CONCLUSIONS: As a whole, under the chemical stress, the doxorubicin-resistant myelogenous leukemia cells may employ various protective strategies to survive. These include: (i) pumping the cytotoxic drug out of the cells by P-glycoprotein, (ii) increased storage of fermentable fuel, (iii) sophisticated cellular protection by molecular chaperones, (iv) improved handling of intracellular calcium, (v) increased glucose utilization via increased rates of glycolysis. In the present study, proteomic analysis of leukemia cells and their drug resistant variants revealed multiple alterations in protein expression. Our results indicate that the development of drug resistance in doxorubicin-resistant myelogenous leukemia cells is a complex phenomenon undergoing several mechanisms.

Analysing optimal dose of pediatric brachial plexus anesthesia under ultrasound / 局解手术学杂志

Objective To investigate optimum dose of anesthesia in pediatric axillary brachial plexus branch block under ultrasound-guided. Methods Forty-eight children from May 2012 to May 2013 in hand surgery of our hospital,whose age was from 6 to 12 years,were randomly divided into four groups, each group has 12 cases. The doses of Ropivacaine were different in different groups. Group A was 0. 25 mL/kg,group B was 0. 2 mL/kg,group C was 0. 15 mL/kg,group D was 0. 10 mL/kg. And Ketamine was added to the treatment ac-cording to the incidence of anesthesia intraoperative. Evaluating the effect of anesthesia according to the situation of nerve block,observing an-esthesia duration time,dosage of anesthesia and rates of complications. Results The blocking effect of group A,B and C in each nerve area was correspond after 30 min,and anesthesia efficiency was higher than group D,but additional rate was lower than group D,the differences were statistically significant (P<0. 05). The block time in group D was shorter than the other groups,and the dose of Ketamine was most, and the block onset,perfect time were longer than the other groups (P<0. 05). But the differences between group A,B,C were not signifi-cant. Two cases in group D converted to general anesthesia. Four groups did not occur complication related narcotic drug. Conclusion In pediatric brachial plexus block used Ropivacaine under ultrasound-guided would get complete branch block,the exact effect of anesthesia, smaller dosage of local anesthesia. When the dosage of Ropivacaine was 0. 15 mL/kg could achieve a better anesthesia effect.

Deep cerebral venous morphology and oxygenation content in patients with multiple sclerosis using susceptibility weighted imaging / 中华放射学杂志

Objective To evaluate the deep brain venous blood oxygen content changes in patients with multiple sclerosis(MS) using susceptibility weighted imaging (SWI), and to explore the ability of SWI in reflecting the clinical condition. Methods Forty-four MS patients were prospectively enrolled in the study. All the clinical-proved patients meeting the McDonald standards (2005 revised) underwent conventional MRI, SWI, and 12 cases of them underwent MRI review from 12 to 16 months interval. all the patients' clinical condition were quantified according to the expanded disability status scale(EDSS). The score was 0.5—6.5. Sixty-five age- and gender- matched healthy volunteers underwent conventional MRI and SWI. The blood oxygen content of the deep brain venous were estimated by the veins phase value, and differential phase values of blood vessels and surrounding tissues (Δφ) were processed with SPIN software. The blood vessels consist of bilateral BV, SMCV, ICV, STV and FMV, PMV, OMV. The difference of Δφvalue in different veins between MS patients and the controls was compared using independent sample t-test, and the Δφ value comparison of MS patients in different time were performed by using paired t test; The correlation ofΔφvalue between MS and EDSS was analyzed using Spearman correlation. Results TheΔφvalue of BV, SMCV, ICV, STV were 856.6 ± 246.4, 600.6 ± 155.2, 965.9 ± 205.4, 844.2 ± 149.7 in MS, and 767.6±145.1, 536.2±123.5, 892.8±156.3, 783.1±148.5 in controls, respectively. TheΔφvalue was higher in MS patients than the controls (t=2.157, 2.303, 2.005, 2.103,P<0.05). The twelve patients'Δφvalues of BV, ICV,STV were 729.4±275.1, 906.1±219.2, 737.2±159.1 in the first time, and 923.2±211.6, 1017.3±211.1, 919.3 ± 165.9 in the second time, and all the values increased in the review of the interval of 12 to 16 months (t=-3.092,-6.420,-3.972,P<0.05). The phase value of PMV and OMV had significant positive correlation with EDSS scores(r=0.638, 0.642,P<0.01). Conclusions The state of hypoxia of the brain parenchyma appears in MS patients, and hypoxia may become worse with the extension of course. The extent of hypoxia can reflect the disability of the patients.

CT features in peripheral lung cancer with thin-walled cavity / 中华放射学杂志

Objective To study the CT features of peripheral lung cancer with thin-walled cavity, and to improve the understanding and diagnostic accuracy of this type of lung cancer. Methods Thirty-one patients (male:18, female:13, average age(56 ± 12)years old) with surgically proven peripheral lung cancer with thin-walled cavity were studied retrospectively. There were 28 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 case of sarcomatoid carcinoma. All patients had MSCT examination, and the CT features of the solid lesion and thin-walled cavity of the lung cancer were analyzed. The relationship between solid lesion and thin-walled cavity location, cavity wall thickness and uniformity, wall nodules, vascularstructures close to the outer wall, septum or air-fluid level inside the cavity, and dynamic changes of the lesions were all evaluated. Results (1) Solid lesion:mostly located in both upper and middle lobes of the lung in 21cases (67.7%). Lobulation, speculation and vessel convergence sign were observed in 27 cases (87.1%), 21 cases(67.7% )and 16 cases(51.6%) respectively. Twenty cases showed as ground glass nodule (GGN) (64.5%), with pure GGN in 11 cases(35.5%). (2) Cavitary lesion: The average diameter was (2.7 ± 1.3) cm, the cavity located in the periphery of the solid lesions in 26 cases (83.9%),and in 20 cases (64.5%) located in the lateral or superior and inferior lateral aspect of the solid lesion;The cavity wall was uniform in17 cases (54.8%) and the wall thickness<2 mm were seen in 16 cases (51.6%), 2-3 mm were observed in 10 cases (32.3%);Wall nodules were seen in five cases (16.1%);Blood vessels adjacent to outer wall were found in 12 cases (38.7%);There was no air-fluid level in the cavity in all the cases;But septum with uneven thickness or small vessels were seen in the cavity in 27 cases (87.1%). Conclusions The majority of peripheral lung cancer with thin-walled cavity was adenocarcinoma, characteristic CT features of thin-walled cavitary lesions may be helpful in the diagnosis of this type of lung cancer.

Effect of non-bioartificial liver support system on serum manganese levels in patients with hepatic encephalopathy / 临床肝胆病杂志

ObjectiveTo investigate the effect of plasma exchange with non-bioartificial liver support system on serum manganese levels in patients with hepatic encephalopathy and its clinical significance. MethodsA total of 22 inpatients with hepatic encephalopathy who were admitted to our hospital from October 2007 to July 2011 were treated with plasma exchange, and were divided into improvement group and aggravation group based on prognosis. The serum manganese level was dynamically determined using graphite furnace atomic absorption spectrophotometry, and the changes in manganese levels after treatment and relief or worsening of disease were analyzed. Comparison between the two groups was made using t test. ResultsAfter treatment, the 22 patients all showed significantly reduced manganese levels (22.6±6.9 μg/L vs 36.4±10.6 μg/L, t=4.789, P=0.000). After treatment, 8 cases improved and 14 cases aggravated, and the improvement group showed a significantly lower manganese level than the aggravation group (18.9±6.3 μg/L vs 39.2±9.8 μg/L, t=4.816, P=0000). ConclusionNon-bioartificial liver support system can reduce serum manganese levels in patients with hepatic encephalopathy, and the serum manganese level may influence the disease progression.