The correlation between NOTCH3 gene polymorphism and white matter lesions / 中华急诊医学杂志

Objective To investigate the correlation between NOTCH3 polymorphic locus rs1043994 and white matter lesions (WML). Methods The enrolled subjects were elderly in the outpatient clinic for health check-up from January 2015 to January 2017. According to the results of cranial MR examination, 337 elderly people were divided into the WML group (n=172) and normal control group (n=165). The inclusion criteria were: (1) age ≥ 50 years old; (2) those who can cooperate with head MRI examination; (3) those who understand the study and agree to retain blood samples for SNP testing. Exclusion criteria were: (1) previous neurological diseases such as cerebrovascular disease, intracranial infection, dementia, and trauma; (2) having a history of mental illness; (3) suffering from serious diseases such as liver and kidney dysfunction, heart disease, tumors. The clinical data of the subjects were collected and the peripheral venous blood was extracted for DNA extraction. The cognitive function was evaluated by the Mini-mental State Examination. The genotyping of the subjects was carried out by restriction endonuclease. The correlation between rs1043994 polymorphism and WML was analyzed by Logistic regression. Results There was no significant difference in gender, education level, diabetes, hyperlipidemia, smoking, uric acid and Hcy between the two groups (P>0.05). Compared with the control group, the WML group had a higher average age and a higher proportion of hypertension (P<0.05), and the Mini-mental State Examination scores between the two groups were statistically significant different (P<0.01). The genotypes (AA, AG, GG) frequency and allele (A, G) frequency distribution of rs1043994 were statistically different between the two groups (P<0.05). Multivariate Logistic regression analysis showed that age (P=0.001), hypertension (P=0.012) and AA genotype (P=0.019) were independent risk factors of WML (P<0.05). The risk of WML in AA genotype is 2.512 times higher than that in AG/GG genotype. Conclusions The rs1043994 polymorphism of NOTCH3 gene is associated with WML in the elderly population, and the A allele is a susceptibility gene for WML. The rs1043994 polymorphism of the NOTCH3 gene may be a genetic risk factor for WML in the Chinese elderly population.

Adult-onset neuronal intranuclear inclusion disease: a case report and review of literature / 中华神经科杂志

The clinical, pathological features and diagnostic methods of one case of adult-onset neuronal intranuclear inclusion disease (NIID) were analyzed. The patient was 61-year-old female presented with progressive cognitive impairment, episodic unconsciousness, stroke-like attack and paroxysmal digestive tract symptoms. Diffusion-weighted images showed high signals at the cerebral cortico-medullary junction with lace-type distribution, which persisted. Skin biopsy revealed intranuclear inclusion bodies in adipocytes, fibroblasts, and sweat gland cells. This case suggests that adult neuronal nuclear inclusion disease is a chronically progressive neurodegenerative disease with a highly clinical heterogeneity. The subcortical lace sign and eosinophilic intranuclear inclusion bodies by skin biopsy contribute to the diagnosis.

Protective effects of mangiferin on cerebral ischemia-reperfusion injury and its mechanisms.

The aim of our study was to investigate the protective properties of mangiferin, a natural glucosyl xanthone found in both mango and papaya on the cerebral ischemia-reperfusion injury and the underlying mechanism. Wistar male rats were subjected to middle cerebral artery occlusion for 2h followed by 24h of reperfusion. Mangiferin (25, 50, and 100mg/kg, ig) or 0.5% carboxymethyl cellulose sodium was administered three times before ischemia and once at 2h after the onset of ischemia. Neurological score, infarct volume, and brain water content, some oxidative stress markers and inflammatory cytokines were evaluated after 24h of reperfusion. Treatment with mangiferin significantly ameliorated neurologic deficit, infarct volume and brain water content after cerebral ischemia reperfusion. Mangiferin also reduced the content of malondialdehyde (MDA), IL-1ß and TNF-α, and up-regulated the activities of superoxide dismutase (SOD), glutathione (GSH) and IL-10 levels in the brain tissue of rats with the cerebral ischemia-reperfusion injury. Moreover, mangiferin up-regulated the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and its downstream anti-oxidant protein heme oxygenase-1 (HO-1). The results indicate that mangiferin can play a certain protective role in the cerebral ischemia-reperfusion injury, and the protective effect of mangiferin may be related to the improvement on the antioxidant capacity of brain tissue and the inhibition of overproduction of inflammatory cytokines. The mechanisms are associated with enhancing the oxidant defense systems via the activation of Nrf2/HO-1 pathway.

The clinical efficacy of ω-3 fatty acids immune nutrition therapy in patients with acute ischemic stroke / 中国基层医药

Objective To explore the clinical value of ω-3 fatty acids (ω-3PUFA)immune nutrition therapy for the patients with acute ischemic stroke,and analyze its mechanism.Methods 40 patients with acute ischemic stroke were selected.They were divided into the treatment group and the control group,each group in 20 cases. The patients of the control group were given indwelling tube admitted to hospital within 24 hours,given the homogenized meal configured by nutriology department.The treatment group received ω-3PUFA enteral nutrition based on the control group.The neurologic recovery,nutritional status,lipid levels and the incidence of complications were evalua-ted.Results The total effective rate of the treatment group was 90.0%,which was higher than that of the control group (60.0%,χ2 =4.8,P <0.05).The incidence rate of complication of the treatment group was 30.0%,which was lower than the control group (65.0%,χ2 =4.91,P <0.05).The indicators such as NIHSS score,GCS score, TSF and AMC in the treatment group were better than those in the control group[(13.38 ±1.21)points vs.(10.12 ± 1.33)points;(12.9 ±2.6)points vs.(14.1 ±1.7)points;(14.06 ±7.16)mm vs.(14.8 ±4.18)mm;(26.32 ± 1.42)mm vs.(29.40 ±1.08)mm,t =3.51,6.44,3.22,5.19;all P <0.05].TG and LDL -C in the treatment group were lower than those in the control group[(1.60 ±0.71)mmol/L vs.(1.41 ±0.67)mmol/L;(3.11 ±0.60)mmol/L vs.(2.67 ±0.66)mmol/L,t =5.97,4.22;all P <0.05 ].Conclusion The clinical curative effect is better for application of ω-3PUFA on immune nutrition treatment for the patients with acute ischemic stroke.The patients'nerve function,blood lipid levels and nutritional status were significantly improved,and the complications were reduced.

Effect of etomidate combined with dezocine in middle aged and old women in painless curettage / 中国基层医药

was 60.0%,50.0%,3.3% and 0.0% higher than those of group P,the difference between the two groups had statis-tical significance(χ2 =6.405,20.000,all P <0.05));group E after operation from the room time for(30.6 ±5.2) min,longer than those of the group P (21.4 ±3.3)min(t =7.118,P <0.05).Conclusion Effect of etomidate com-bined with dezocine anesthesia while postoperative nausea,dizziness and other complications,but the effects on respi-ration,circulation is small,suitable for middle aged and old women painless curettage.

Comparison of 18F-FDG PET/CT and contrast enhanced ultrasound for detection of hepatocellular carcinoma recurrence after therapy / 中华核医学与分子影像杂志

Objective To compare the efficiency of 18F-FDG PET/CT and contrast enhanced ultrasound (CEUS) in detection of HCC recurrence after surgery or radiofrequency ablation (RFA).Methods Twenty-seven HCC patients (22 males,5 females; average age:47 years) were included in this study,of which 15 patients underwent surgery and 12 patients underwent RFA therapy.18F-FDG PET/CT and CEUS were performed within 2 weeks in all patients to detect recurrence.Final diagnosis was made by pathology or clinical follow-up (＞6 months),and the sensitivity,specificity and accuracy of 18F-FDG PET/CT and CEUS were calculated and compared.McNemar test was used for data analysis.Results Twenty-five patients were diagnosed with HCC recurrence,including 11 cases with extrahepatic metastases.Another 2 patients had extrahepatic metastases without HCC recurrences.The sensitivity,specificity and accuracy in detection of liver lesion with 18F-FDG PET/CT were 92.0％ (23/25),2/2 and 92.6％ (25/27),respectively.While with CEUS,the corresponding values were 60.0％ (15/25),2/2 and 63.0％ (17/27),respectively.In CEUS positive group,the sensitivity and accuracy were 100％(15/15) for both methods.In CEUS negative group,the sensitivity,specificity and accuracy of 18 F-FDG PET/CT in detection of liver lesion were 8/10,2/2 and 83.3％(10/12),respectively.The sensitivity and accuracy of 18F-FDG PET/CT were significantly higher than those of CEUS (0,16.7％(2/12) ; x2 =5.373,5.250,both P＜0.05).Moreover,the sensitivity of 18 F-FDG PET/CT in detecting extrahepatic metastasis was 100％ (13/13).Conclusions 18 F-FDG PET/CT is more sensitive and accurate than CEUS (especially in CEUS negative cases) in detecting recurrence of HCC after surgery or RFA.18F-FDG PET/CT also could be useful for detection of extrahepatic metastasis.

Application of 13N-NH3 PET in the evaluation of hypometabolic brain lesions on 18F-FDG PET / 中华核医学与分子影像杂志

Objective To investigate the usefulness of 13N-NH3 PET in detecting brain lesions which show hypometabolism on 18F-FDG PET.Methods 13N-NH3 PET imaging was performed for a prospective study in 18 patients with brain lesions that showed hypometabolism compared with normal brain tissue on 18F-FDG PET scans.Fourteen patients underwent 18 F-FDG PET imaging for initial diagnosis and 4 patients for detection of astrocytoma recurrence (13 males,5 females,age 20-68 (42.4 ± 12.6) years).Ten gliomas,1 metastatic tumor,1 dysembryoplastic neuroepithelial tumor (DNT) and 6 non-neoplastic lesions (including 3 cases of radiation necrosis,2 cases of encephalitic foci,and 1 case of ischemic lesion)were verified by histopathological examination (n =13) or clinical follow-up (n =5).The tumor-to-contralateral brain tissue ratios (T/C) were calculated by the ROI method.The diagnostic efficacy of 13N-NH3 PET was evaluated.Paired t test and two-sample t test were performed to analyze the differences of T/C between different groups.Results Seven (5 astrocytomas and 2 glioblastomas) of 12 brain tumors (sensitivity:58％,7/12) showed increased 13N-NH3 uptake (higher uptake than the contralateral brain tissue),while 3 low-grade gliomas,1 metastatic tumor,and 1 DNT showed decreased 13N-NH3 uptake (no uptake or lower uptake than the contralateral brain tissue).The uptake ratio of 13N-NH3 was significantly higher than that of 18 F-FDG (1.24 ± 0.66 vs 0.67 ± 0.24,t =-3.740,P ＜ 0.05) in the tumors.All six non-neoplastic lesions showed decreased 13N-NH3 uptake (specificity:6/6).The T/C ratios of 18F-FDG and 13N-NH3 in the non-neoplastic lesions were 0.68 ±0.15 and 0.70 ±0.19,respectively,and there was no significant difference between them (t =-0.246,P ＞ 0.05).The T/C ratio of 13N-NH3 in the tumors was significantly higher than that in the non-neoplastic lesions (1.24 ± 0.53 vs 0.70 ± 0.19,t =2.624,P ＜ 0.05).Conclusion 13N-NH3 PET imaging may be helpful to detect and differentiate brain tumors with hypometabolism as detected by 18 F-FDG PET imaging from non-neoplastic lesions with high specificity,especially for cerebral astrocytomas,but the sensitivity is relatively limited.

Value of (18)F-FDG PET/CT and CECT in detecting postoperative recurrence and extrahepatic metastasis of hepatocellular carcinoma in patients with elevated serum alpha-fetoprotein / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the clinical value of (18)F-FDG PET/CT and contrast-enhanced computed tomography (CECT) in detecting residual tumor or tumor recurrence and metastasis in patients with hepatocellular carcinoma (HCC) who show an elevated serum alpha-fetoprotein (AFP) level after surgical intervention.</p><p><b>METHODS</b>The data of (18)F-FDG PET/CT and CECT, which were performed at an interval within 2 weeks, were reviewed in 54 HCC patients showing elevated AFP levels after surgical interventions of the tumor. The patients were followed up for at least 6 months and the imaging findings were confirmed by pathological examination, follow-up imaging examination, or serum AFP level monitoring.</p><p><b>RESULTS</b>Forty-five patients were found to have focal intrahepatic HCC recurrence after surgical interventions, and 9 patients were free of HCC recurrence. Twenty-three patients developed extrahepatic metastasis, among whom 19 also had intrahepatic tumor recurrence and 4 had extrahepatic metastasis only. The sensitivity, specificity, and accuracy of (18)F-FDG PET/CT in the detection of HCC recurrence were 88.9% (40/45), 77.8% (7/9), and 87.0% (47/54), respectively, as compared with those of 57.8% (26/45), 100% (9/9), and 64.8% (35/54) by CECT detection.</p><p><b>CONCLUSION</b>Compared with CECT, (18)F-PET/CT shows a high sensitivity and accuracy in detecting postoperative tumor residual or recurrence in the liver, and can also be an effective modality for detecting extrahepatic lesions in HCC patients.</p>

Usefulness of (13)N-NH (3) PET in the evaluation of brain lesions that are hypometabolic on (18)F-FDG PET.

We investigated the usefulness of (13)N-NH(3) PET in characterizing brain lesions which show hypometabolism on (18)F-FDG PET. (13)N-NH(3) PET was performed in 18 patients with brain lesions (in 14 for initial diagnosis and in 4 for detection of astrocytoma recurrence) that showed hypometabolism compared with normal brain tissue on (18)F-FDG PET. The diagnoses were ten gliomas, one metastatic tumor, one dysembryoplastic neuroepithelial tumor (DNT), and six non-neoplastic lesions (including three cases of radiation necrosis, two cases of encephalitic foci, and one ischemic lesion). Diagnosis was verified by histopathological examination in 13 patients or was established by clinical follow-up and additional investigations in the remainder. Seven of 12 brain tumors (58%, sensitivity) showed increased (13)N-NH(3) uptake despite hypometabolism on (18)F-FDG PET. The three low-grade gliomas, one metastatic tumor, and one DNT showed decreased (13)N-NH(3) uptake. The mean (±SD) uptake ratio of (13)N-NH(3) was significantly higher than that of (18)F-FDG (1.24 ± 0.57 vs. 0.67 ± 0.21, P < 0.01) in the tumors. By contrast, all six non-neoplastic lesions showed decreased (13)N-NH(3) uptake (100% specificity). The mean (±SD) uptake ratio of (18)F-FDG and (13)N-NH(3) in the non-neoplastic lesions was 0.68 ± 0.15 and 0.70 ± 0.19, respectively, and there was no significant difference between them (P > 0.05). The mean (±SD) uptake ratio of (13)N-NH(3) in the tumors was significantly higher than that in the non-neoplastic lesions (1.24 ± 0.53 vs. 0.70 ± 0.19, P < 0.05). The preliminary results of this study suggest that (13)N-NH(3) PET may be helpful to detect and differentiate brain tumors which show hypometabolism on (18)F-FDG PET from non-neoplastic lesions with high specificity, especially for cerebral astrocytomas, but the sensitivity is relatively limited.

13N-NH3: a selective contrast-enhancing tracer for brain tumor.

PURPOSE: The purpose of this study is to determine whether there is a qualitative and quantitative relationship between the breakdown of the blood-brain barrier, defined radiologically by the contrast enhancement of MRI, and the uptake of N-NH3 in brain tumors. METHODS: The results of N-NH3 PET in 42 patients suspected of having brain tumors were compared with the findings of contrast-enhanced MRI. A histopathological diagnosis was carried out in 33 patients, and a clinical diagnosis was performed in the remaining patients. PET and MRI images were visually inspected, and the contrast index (CI) of MRI and the uptake index (UI) of N-NH3 were measured. RESULTS: Contrast enhancement of MRIs was seen in 20 of 29 brain tumors (69%). Increased uptake of N-NH3 was seen in 24 of 29 brain tumors (83%). Nineteen of 20 contrast-enhancing brain tumors exhibited the increased uptake of N-NH3 (95%). Areas of the increased N-NH3 uptake corresponded to areas enhanced on MR images in the majority of cases. Five out of nine nonenhancing tumors exhibited increased uptake of N-NH3 (56%). The contrast enhancement of MRIs was seen in nine of 13 nonneoplastic lesions (69%). None of the nonneoplastic lesions showed increased uptake of N-NH3, yielding a specificity of 100% for brain tumors (0 of 13). CI for tumor tissue was 1.46+/-0.64. UI of N-NH3 for tumor tissue was 1.64+/-0.71. CI and UI for tumor tissue were significantly correlated (r=0.86, P<0.01). A statistically significant difference in uptake levels of N-NH3 between contrast-enhancing tumors and nonenhancing tumors (1.88+/-0.66, n=20 vs. 1.11+/-0.52, n=9, P<0.01) was observed. UI was higher in brain tumors compared with the nonneoplastic lesions (1.64+/-0.71 vs. 0.71+/-0.19, P<0.01). CONCLUSION: N-NH3 is a potential selective contrast-enhanced tracer for brain tumor, and may prove especially useful for evaluating the contrast-enhancing lesions on MRI to distinguish brain tumors from nonneoplastic lesions.

Differentiation of recurrent astrocytoma from radiation necrosis: a pilot study with 13N-NH3 PET.

UNLABELLED: Differentiation of posttherapy radiation necrosis from recurrent brain tumor remains a challenging diagnostic problem. The combination of the imaging modalities on the basis of different physiologic mechanisms could improve diagnostic accuracy. The present study assessed the role of (13)N-NH(3) PET in differentiating recurrent cerebral astrocytoma from radiation necrosis. METHODS: Seven patients, who were previously treated with conventional external-beam radiation therapy after surgical resection for cerebral astrocytomas, and showed the enhancing brain lesions on T1-weighted gadiolinium-enhanced MR studies performed in 6 months or above after the radiotherapies, were examined prospectively with (13)N-NH(3) and FDG PET. Five lesions with tumor recurrence and two with radiation necrosis were histologically verified by either surgical resection or stereotactic biopsy. One lesion of radiation necrosis was confirmed clinicoradiologically. RESULTS: In all eight lesions the (13)N-NH(3) PET scans were concordant with the final diagnosis (100%, 8/8). The lesions with recurrent tumor showed moderately to markedly increased (13)N-NH(3) uptake (grade = 4-5). The lesions with radiation necrosis showed absent or less (13)N-NH(3) uptake than surrounding area (grade = 1-2). The FDG PET scans were concordant with the final diagnosis in six of eight lesions (75%, 6/8), and there were one false-negative result and one false-positive result. The diagnostic result of (13)N-NH(3) PET was discordant with FDG PET in two lesions. One lesion with gliosis and radiation necrosis showed slightly increased FDG uptake (grade = 4), but less (13)N-NH(3) uptake (grade = 2). The other lesion with anaplastic astrocytoma showed moderately increased (13)N-NH(3) uptake (grade = 4), but slightly less FDG uptake than surrounding area (grade = 2). CONCLUSIONS: The recurrent astrocytomas showed increased (13)N-NH(3) uptake, and the radiation necrosis showed absent or less (13)N-NH(3) uptake, and (13)N-NH(3) seem superior to (18)F-FDG for this purpose, suggesting that (13)N-NH(3) is a promising tracer for separating radiation necrosis from astrocytoma recurrence. However, the patient population in this study was small. Thus, the further studies are needed to settle this issue.

PET Imaging of cerebral astrocytoma with 13N-ammonia.

UNLABELLED: We performed this study in order to assess the clinical potential of (13)N-ammonia PET in patients with cerebral astrocytoma. METHODS: Dynamic 13N-ammonia PET was performed in 25 patients with suspected cerebral gliomas or recurrent cerebral astrocytomas (19 male and 6 female patients; age range 18-64 years) detected by MRI. The histopathological diagnoses were made for all cases either by biopsy or craniotomy, except for one patient with brain infarction and one patient with brain radiation necrosis confirmed by repeated MRI imaging. PET images were visually inspected, and the tumor-to-white matter count (T/W) ratios and the perfusion index (PI) of the tumors were determined. RESULTS: Six out of nine cases of low-grade gliomas were detected with 13N-ammonia PET, and three non-astrocytoma low-grade gliomas were not detected with 13N-ammonia PET. All 11 high-grade astrocytomas exhibited markedly increased uptake of 13N-ammonia. The five non-neoplastic lesions exhibited low uptake, low T/W ratios and low PI. The significant differences were observed between high-grade and low-grade gliomas with respect to both the T/W ratios and PI (T/W ratios: 5.92+/-2.27, n=11 vs. 1.66+/-0.61, n=9, P<0.01; PI: 5.22+/-1.67, n=11 vs. 1.60+/-0.54, n=9, P<0.01). There were the significant differences between the T/W ratios and PI in low-grade astrocytomas and that in non-neoplastic lesions (T/W ratios: 2.00+/-0.42, n=6 vs. 0.97+/-0.11, n=5, P<0.01; PI: 1.89+/-0.37, n=6 vs. 0.99+/-0.03, n=5, P<0.01). CONCLUSIONS: There is a substantial uptake of 13N-ammonia in cerebral astrocytomas. 13N-ammonia PET may enable differentiation between low- and high-grade astrocytomas, and has the potential to enable differentiation between low-grade astrocytomas and non-neoplastic lesions.

Nuclide imaging in hyperparathyroidism: diagnostic value / 中华内分泌代谢杂志

Objective To evaluate the diagnostic value of three nuclide imaging methods in patients with hyperparathyroidism. Methods Thirty five patients with hyperparathyroidism underwent 201 Tl/ 99m TcO-4 (8 cases), double phase 99m Tc MIBI imaging methods (27 cases) and 99m Tc MIBI/ 99m TcO-4 substraction imaging (20 cases). Abnormal increase of radioactivity in substraction imaging or delay imaging denoted positive result. All data of nuclide imaging were evaluated according to final clinical results and were compared with ultrasound or CT. Results 35 cases of hyperparathyroidism were proved, including 31 adenomas (ectopic 1), 3 hyperplasia and 1 carcinoma. The sensitivity of 201 Tl/ 99m TcO-4 , double phase 99m Tc MIBI imaging and 99m Tc MIBI/ 99m TcO-4 substraction imaging was 62.5%, 88.9%,90.0%, respectively. The specificity of 3 nuclide imaging methods was 100%. The sensitivity and specificity of ultrasound were 74.3%, 85.7%, respectively. The sensitivity of CT was 78.6%. The results showed that 99m Tc MIBI/ 99m TcO-4 was superior to other imaging. Conclusion An accurate diagnosis of hyperparathyroidism and preoperative anatomic localization can be determined by means of nuclide imaging.