Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects

BACKGROUND Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed.AIM To evaluate the cross-sectional area(CSA) of the median nerve using B-mode ultrasonography(USS) and the presence of peripheral neuropathy(PN) in a cohort of adult diabetic Nigerians.METHODS Demographic and anthropometric data of 85 adult diabetes mellitus(DM) and 85 age-and sex-matched apparently healthy control(HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument(MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile(FLP), fasting blood glucose(FBG) and glycated haemoglobin(HbA1 c) while their MN CSA was evaluated at a point 5 cm proximal to(5 cmCATL) and at the carpal tunnel(CATL) by high-resolution Bmode USS. Data was analysed using SPSS version 22.RESULTS The mean MN CSA was significantly thicker in DM subjects compared to the HC at 5 cmCATL(P < 0.01) and at the CATL(P < 0.01) on both sides. The presence of diabetic peripheral neuropathy(DPN) further increased the MN CSA at the CATL(P < 0.05) but not at 5 cmCATL(P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control.CONCLUSION Thickening of the MN CSA at 5 cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at5 cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.

Ultrasonographic measurement of median nerve cross-sectional area reference values in a healthy Han population from Guiyang,China

High-resolution ultrasonography was used to analyze the nerve cross-sectional area （CSA） of the median nerve at 7 sites： the wrist crease, pisiform bone, hamate bone, 6 cm proximal to the tip of the wrist crease, proximal forearm （where the nerve enters the pronator teres muscle）, 4 cm proximal to the tip of the medial epicondyle, and mid-humerus （mid-point between elbow crease and axilla） in 200 healthy volunteers from Guiyang, China. Results showed similar CSA values between the left and right sides, but the CSA 6 cm proximal to the tip of the wrist crease, proximal forearm, 4 cm proximal to tip of the medial epicondyle, and mid-humerus in males was greater than that of females. Moreover, CSA values at the wrist crease, pisiform bone, and hamate bone were greater in the middle-aged and old groups when compared to the young group, and correlated with body mass and height. Thus, reference values of median nerve CSA of the upper limbs can facilitate the analysis of abnormal nerve conditions.

Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

Usefulness of the acromioclavicular joint cross-sectional area as a diagnostic image parameter of acromioclavicular osteoarthritis

BACKGROUND Acromioclavicular joint(ACJ)space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis(ACJO).However,the morphology of the ACJ space is irregular because of osteophyte formation,subchondral irregularity,capsular distention,sclerosis,and erosion.Therefore,we created the ACJ cross-sectional area(ACJCSA)as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.AIM To hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.METHODS ACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance(S-MR)imaging that revealed no evidence of ACJO.Oblique coronal,T2-weighted,fat-suppressed SMR images were acquired at the ACJ level from the two groups.We measured the ACJCSA and the ACJ space width(ACJSW)at the ACJ on the S-MR images using our imaging analysis program.The ACJCSA was measured as the cross-sectional area of the ACJ.The ACJSW was measured as the narrowest point between the acromion and the clavicle.RESULTS The average ACJCSA was 39.88±10.60 mm;in the normal group and 18.80±5.13 mm;in the ACJO group.The mean ACJSW was 3.51±0.58 mm in the normal group and 2.02±0.48 mm in the ACJO group.ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals.Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm^(2),with 91.4%sensitivity and 90.0%specificity.CONCLUSION The optimal ACJSW cutoff score was 2.37 mm,with 88.6%sensitivity and 96.7%specificity.Even though both the ACJCSA and ACJSW were significantly associated with ACJO,the ACJCSA was a more sensitive diagnostic image parameter.

Correlation between current and cross-sectional area of parallel fixed-movable dual electrodes in ESC

Electroslag casting with parallel fixed-movable dual electrodes is a new method for achieving better quality of castings in complex mold cavities.In this work,a mathematical model,y=kx^2+(k+1)x,was established to describe the ideal correlation between the current ratio(y)and the cross-sectional area ratio(x)of the dual electrodes,where k is the filling ratio.Investigation was conducted on the electroslag casting process with dual electrodes of various cross-sectional areas,but at a constant k value.The experimental results indicated that the ideal correlation was obtained at the stable casting stage,and the fitting results were consistent with the experimental results at certain k values.The experimental findings show that better castings can be obtained when the current ratio is greater than 1.536 and the cross-sectional area ratio is greater than 0.5.

Intraoperative awake anesthesia applied for tumor excision in cerebral functional areas

Objective:To observe the feasibility and safety of awake anesthesia for tumor excisions in pa- tients with brain tumors involving cerebral functional areas.Methods:Fifty patients with brain tumors in- volving cerebral functional areas,ASAⅠ-Ⅱgrade,were enrolled in this study.Propofol and remifentanil were used for total intravenous anesthesia,and a laryngeal mask airway(LMA)was inserted for the air- way opening and synchronized intermittent mandatory ventilation(SIMV).At the surgeon's request for an intraoperative wake-up test,the propofol infusion was stopped advance of 10-15 min,the remifentanil in- fusion rate was decreased to 0.050-0.075μg/kg from 0.10-0.20μg/kg per min for easing surgical pain. The LMA was removed until the patient awakened.The anesthesiologist then kept up an on-going neuro- logical examination.After that,anesthesia was re-deepened and LMA was re-inserted until the whole surgery was accomplished.Results:Forty-six of 50 patients(92%)were successfully awakened and 4 (8%)failed to complete the intraoperative wake-up test because of dyspnea,over-sedation,or severe hy pertension.No severe complications occurred during the whole process.Conclusions:During the awake anesthetic period,the intraoperative wake-up test combined with navigation,evoked potential and ultra- sound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.

Reflections on the New Classification of Tumors by the WHO and Changes in Esophageal Cancer in a High-risk Area

ABSTRACT In year 2000, a book entitled the Pathology and Genetics of Tumors of the Digestive System was published by the WHO, presenting some new diagnostic criteria and treatment principles. I have analyzed the epidemiologic change of tumors in over 30 years in the high-risk area with esophageal cancer. The following phenomenon was found： accompanied by the sharp decrease in the incidence and mortality of esophageal cancer, there was an increase in the incidence and death rate of stomach cancer involving cardiac cancer. This fact should be considered when analyzing the sharp decrease in esophageal cancer incidence and mortality rate. More attention was given to diagnosis of cardiac cancer; at the same time it is more practical to improve the early screening of cancers. To observe the development of high and low - grade intraepithelial neoplasms will be an urgent task for esophageal cancer research in the high risk area, according to WHO＇s new classification.

Preoperative functional MRI localization of language areas in Chinese patients with brain tumors Validation with intraoperative electrocortical mapping

Ten Chinese patients with brain tumors involving language regions were selected. Preoperative functional MRI was performed to locate Broca＇s or Wernicke＇s area, and the cortex that was essential for language function was determined by electrocortical mapping. A site-by-site comparison between functional MRI and electrocortical mapping was performed with the aid of a neuronavigation device. Results showed that the sensitivity and specificity of preoperative functional MRI were 80.0% and 85.0% in Broca＇s area and 66.6% and 85.2% in Wemicke＇s area, respectively. These experimental findings indicate that functional MRI is an accurate, reliable technique with which to identify the location of Wernicke＇s area or Broca＇s area in patients with brain tumors.

Health-related quality of life evaluated by tumor node metastasis staging system in patients with hepatocellular carcinoma

AIM: To investigate and evaluate the change in healthrelated quality of life (HRQoL) by tumor node metastasis (TNM) staging system in patients with hepatocellular carcinoma (HCC). METHODS: A total of 140 patients diagnosed with HCC between June 2008 and April 2009 in our department were enrolled to this study. One hundred and thirty-five (96.5%) patients had liver cirrhosis secondary to hepatitis B virus (HBV) infection, 73 (54.07%) of them being HBV DNA positive; the other etiologies of liver cirrhosis were alcoholic liver disease (1.4%), hepatitis C (1.4%) or cryptogenic (0.7%). All subjects were fully aware of their diagnosis and provided informed consent. HRQoL was assessed before treatment using the functional assessment of cancer therapy-hepatobiliary (FACT-Hep) questionnaire. Descriptive statistics were used to evaluate demographics and disease-specific characteristics of the patients. One-way analysis of variance and independent samples t tests were used to compare the overall FACT-Hep scores and clinically distinct TNM stages. Scores for all FACT-Hep items were analyzed by frequency analyses. The mean scores obtained from the FACT-Hep in different Child-Pugh classes were also evaluated. RESULTS: The mean FACT-Hep scores were reduced significantly from TNM StageⅠto Stage Ⅱ, Stage ⅢA, Stage ⅢB group (687 ± 39.69 vs 547 ± 42.57 vs 387 ± 51.24 vs 177 ± 71.44, P = 0.001). Regarding the physical and emotional well-being subscales, scores decreased gradually from Stage Ⅰ to Stage ⅢB (P = 0.002 vs Stage Ⅰ; P = 0.032 vs Stage Ⅱ; P = 0.033 vs Stage ⅢA). Mean FACT-Hep scores varied by Child-Pugh class, especially in the subscales of physical well-being, functional well-being and the hepatobiliary cancer (P = 0.001 vs Stage I; P = 0.036 vs Stage Ⅱ; P = 0.032 vs Stage ⅢA). For the social and family well-being subscale, only Stage ⅢB scores were significantly lower as compared with Stage Ⅰ scores (P = 0.035). For the subscales of functional well-being and hepatobiliary cancer, there were significant differences for Stages ⅡΙ, ⅢA and ⅢB (P = 0.002vs StageⅠ). CONCLUSION: HRQoL of patients with HCC worsens gradually with progression of TNM stages. The most impaired subscales of HRQoL, as measured by FACT-Hep, were physical and emotional well-being.

Exposed Cross-section of the Archaean Lower Crustin the Shanxi-Hebei-Inner Mongolia Border Region:Problems and Prospects

The Archaean lower crust represented by granulite facies rocks, which is rare in China, is found to be exposed in the Shanxi-Hebei-Inner Mongolia border region. Studies of the regional structure and deformation and metamorphism of the region indicate that there occurred at least two phases of deformation and metamorphism in the region. Early-phase nearly E-W-directed deformational structure is well preserved in the Zhangjiakou-Xuanhua area. Observations of the features of the geological structure from north to south (in the Hengshan metamorphic terrain) have revealed a possible exposed cross-section through the Archaean lower crust. The structure was superimposed by a NE-SW-trending high-temperature ductile shear zone in the Datong area in the late phase, thus reworking the Archaean sequence.

Optimal Minimum Number of CT Slices Required to Measure Cross Sectional Areas of Small Pulmonary Vessels

The cross-sectional area (CSA) of small pulmonary vessels can be quantified by CT, which is a reliable method of evaluating vascular alterations in such vessels. However, the optimal number of slices required for accurate quantitation remains unknown. We evaluated relationships among all slices at 10-mm interval and all slices at 3-cm interval, 6-cm interval, and 3-slices and found the closest correlation (0.939) between all slices at 10-mm intervals and 3-cm intervals. Thus, all slices at 3-cm intervals are suitable for accurately measuring CSA.

Mobile Phone Usage and the Risk of Brain Tumors

Purpose: This literature review investigated the possible association between the use of mobile phones and brain tumors. Methods: In brief, 11 publications were retrieved from JSTOR, PubMed, Google Scholar and Summon in order to compare the association between the usage of mobile phones in patients with a brain tumor and those without. Papers published in English, and after 2001 were selected for. There was no limit on age, gender, geographical location and type of brain tumor. Results: For regular mobile phone usage, the combined odds ratios (OR) (95% confidence intervals) for three studies are: 1.5 (1.2 - 1.8), 1.3 (0.95 - 1.9), and 1.1 (0.8 - 1.4), respectively. Furthermore, the odds ratio did not increase, regardless of mobile phone use duration. Additionally, Lonn et al. (2005) observed that the risk also did not significantly increase when assessing the laterality (ipsilateral or contralateral) of the tumor in relation to side of head used for the mobile phone. Kan et al. (2007) observed an OR of 1.22 when comparing analog phone to digital phone use. Conclusion: This review concludes that there is no current association between mobile phone use and the development of brain tumors. Although certain studies speak in favor of an increased risk, many are plagued with either: sampling bias, misclassification bias, or issues concerning risk estimates. Further research needs to be done in order to evaluate the long-term effect of mobile phone usage on the risk of developing a brain tumor.

显微镜下经Wiltse入路治疗椎间孔区神经鞘瘤的疗效分析

目的探讨经Wiltse入路与传统后正中入路对胸腰椎椎间孔区神经鞘瘤的手术疗效。方法回顾性分析57例胸腰椎椎间孔区神经鞘瘤患者的临床资料,根据手术方式不同分为Wiltse入路组(n=32)和后正中入路组(n=25),两组患者在性别、年龄、肿瘤部位等方面差异无统计学意义(均P>0.05)。比较两组患者的手术时间、术中出血量、手术切口长度、术后住院时间及术后并发症等,通过疼痛视觉模拟量表(visualanaloguescale,VAS)评分评估两组术前疼痛情况及术后疼痛缓解程度,并观察两组患者症状的恢复情况。结果两组患者手术均顺利完成,病理结果均为神经鞘瘤。Wiltse入路组手术时间、术中出血量及术后住院时间明显少于后正中入路组,两组差异具有统计学意义(均P<0.05)。与术前比较,Wiltse入路组术后第1个月和第3个月的VAS评分均有明显改善(均P<0.05)。术后第3个月VAS评分,Wiltse入路组明显低于后正中入路组,差异具有统计学意义(P=0.029)。定期随访复查MRI,肿瘤均无复发。结论与传统后正中入路比较,Wiltse入路具有手术时间短、术中出血少、术后恢复快、住院时间短以及保护关节突关节和韧带复合体等优点。采用Wiltse入路治疗胸腰椎椎间孔区神经鞘瘤具有良好临床疗效和明显手术优势。

乙型肝炎患者血清miR-129-5p、miR-335-5p水平变化及临床意义

目的 探讨乙型肝炎患者血清微小RNA(miRNA)-129-5p、miR-335-5p水平对乙型肝炎相关肝癌的诊断价值。方法 选取2021年1月至2024年2月中山大学孙逸仙纪念医院收治的乙型肝炎相关肝癌患者100例(肝癌组)、乙型肝炎肝硬化患者50例(肝硬化组)和慢性乙型肝炎(CHB)患者50例(CHB组),采用qPCR检测血清miR-129-5p、miR-335-5p水平。多因素Logistic回归分析血清miR-129-5p、miR-335-5p水平与乙型肝炎相关肝癌的关系;受试者工作特征(ROC)曲线分析血清甲胎蛋白(AFP)、mi R-129-5p、miR-335-5p水平对乙型肝炎相关肝癌的诊断价值。结果 肝癌组血清miR-129-5p、miR-335-5p水平低于肝硬化组、CHB组,肝硬化组血清miR-129-5p、miR-335-5p水平低于CHB组(P <0.05)。调整混杂因素后,血清miR-129-5p高、miR-335-5p高为乙型肝炎相关肝癌的独立保护因素(P <0.05)。血清AFP、miR-129-5p、miR-335-5p水平联合诊断乙型肝炎相关肝癌的曲线下面积(AUC)为0.984,大于AFP、miR-129-5p、miR-335-5p、miR-129-5p+miR-335-5p诊断的0.812、0.814、0.820、0.876(P <0.05)。结论 乙型肝炎患者血清miR-129-5p、miR-335-5p水平降低与乙型肝炎相关肝癌独立相关,血清miR-129-5p、miR-335-5p联合AFP诊断乙型肝炎相关肝癌的价值较高。

Close relationship between mediators of inflammation and pancreatic cancer:Our experience

In this editorial,we focus specifically on the mechanisms by which pancreatic inflammation affects pancreatic cancer.Cancer of the pancreas remains one of the deadliest cancer types.The highest incidence and mortality rates of pancreatic cancer are found in developed countries.Trends of pancreatic cancer incidence and mortality vary considerably worldwide.A better understanding of the etiology and identification of the risk factors is essential for the primary prevention of this disease.Pancreatic tumors are characterized by a complex microenvironment that orchestrates metabolic alterations and supports a milieu of interactions among various cell types within this niche.In this editorial,we highlight the foundational studies that have driven our understanding of these processes.In our experimental center,we have carefully studied the mechanisms of that link pancreatic inflammation and pancreatic cancer.We focused on the role of mast cells(MCs).MCs contain pro-angiogenic factors,including tryptase,that are associated with increased angiogenesis in various tumors.In this editorial,we address the role of MCs in angiogenesis in both pancreatic ductal adenocarcinoma tissue and adjacent normal tissue.The assessment includes the density of c-Kit receptor-positive MCs,the density of tryptase-positive MCs,the area of tryptasepositive MCs,and angiogenesis in terms of microvascularization density.

基于术前MRI特征及定量参数列线图预测乳腺癌患者淋巴血管侵犯

目的开发基于术前磁共振成像(magnetic resonance imaging,MRI)特征及表观扩散系数(apparent diffusion coefficient,ADC)的列线图预测浸润性乳腺癌淋巴血管侵犯(lymphovascular invasion,LVI)。材料与方法回顾性分析141例浸润性乳腺癌患者资料,其中2019年3月至2021年7月的66例患者作为训练组,2021年7月至2022年12月的75例患者作为验证组。评估病灶MRI特征(肿块形状、边缘、内部强化形式、瘤周水肿等)及测量ADC。采用卡方检验、独立样本t检验及Mann-Whitney U检验分析LVI阳性组和LVI阴性组间影像学特征和瘤内、瘤周ADC平均值、最大值及最小值的差异。采用多因素逻辑回归分析确定与LVI相关的独立危险因素,建立预测LVI的列线图模型。结果LVI阳性组和LVI阴性组间在肿瘤大小、Ki-67表达以及淋巴结转移率方面的差异具有统计学意义(P<0.05)。多因素逻辑回归分析显示,肿块形态[P=0.014,优势比(odds ratio,OR)=0.142(0.030~0.679)]、内部强化形式[P=0.046,OR=0.157(0.025~0.965)]、肿瘤最大径[P=0.037,OR=4.372(1.093~17.488)]、扩散加权成像(diffusion-weighted image,DWI)边缘征[P=0.024,OR=0.193(0.047~0.803)]及瘤周瘤内ADC比值[P=0.010,OR=1.056(1.013~1.101)]是LVI的独立预测因素。基于MRI特征和瘤周瘤内ADC比值的综合预测模型在训练组及验证组中的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)分别为0.867、0.872,特异度分别为88.6%、84.6%,精确度分别为74.2%、69.7%。校准曲线表明,列线图在训练组和验证组中预测值与实际值吻合较好。结论基于术前MRI影像特征及ADC的列线图评估乳腺癌LVI状态具有较高的预测效能,有助于临床在指导手术、制订个性化治疗方案及评估预后等方面的决策。

Prevalence estimates for primary brain tumors in China： a multi-center cross-sectional study

Background Although the first leading cause of death in China was malignant neoplasms （mortality, 374.1 per 100 000 person-years）, the full impact of primary brain tumors （PBT） on the healthcare system is not completely described because there are a few well documented reports about the epidemiologic features of brain tumors. This study aimed to report a comprehensive assessment on the prevalence of PBT. Methods A multicenter cross-sectional study on brain tumor （MCSBT） in China was initiated in five regional centers： Daqing （northeast）, Puyang （north of China）, Shiyan （center of China）, Ma＇anshan （center of China） and Shanghai （southeast）. Prevalence rate was calculated by counting the number of people living with a PBT between October 1,2005 and September 30, 2006 and dividing by the total population of the five communities at January 1, 2006. Estimates of prevalence were expressed as percentages and grouped according to gender and to age in fifteen-year categories. Within these strata, the rates were estimated with 95% confidence intervals （C/） using the accurate calculation of CI for Poisson distribution. A chi-square test was used to compare the various frequencies with a 〈0.05. Age-standardized prevalence with the direct method was calculated with the ten-year age-specific prevalence and the age distribution of population prospects： the 2008 revision. Results We estimated that the overall prevalence of PBT was 24.56 per 100 000 （95% CI, 14.85 to 34.27）, and the overall prevalence of PBT in female population （30.57 per 100 000 and its 95% Cl ranged from 19.73 to 41.41） was higher than that in male population （18.84 per 100 000 and its 95% Cl ranged from 10.33 to 27.35）. However, the discrepancy between genders was not statistically significant because the 95% Cl overlapped. Of 272 cases of newly diagnosed PBT, the proportion of histological subtypes by age groups, gender was statistically different （X2=52.6510, P 〈0.0001）. More than half of all reported tumors （52.57%） were either gliomas or meningiomas. For the youngest （aged from 0-19） strata of the population, glioma appeared to occur more than other subtypes, accounting for 55.56% of all of cases. The majority of brain tumors presented in those aged from 20 to 59 years was pituitary adenomas （45.12%） and gliomas （31.10%）. Opposed to brain tumors in adults and teenage, gliomas only accounted for 22.22%. Meanwhile, the median ages at diagnosis of the patients with PBT were similar between males and females except for pituitary adenomas （male： 59 years old; female： 45 years old）. Conclusions Age standardized prevalence of PBT is 22.52 per 100 000 （95% CI, 13.22 to 31.82） for all populations, 17.64 per 100 000 （95% CI, 9.41 to 25.87） for men, and 27.94 per 100 000 （95% Cl, 17.58 to 38.30） for women. Age standardization to China＇s 2010 population yielded an estimated population of 304 954 cases with PBT. Our prevalence estimates provide a conservative basis on which to plan health care services and to develop programmatic strategies for surviving. Inthe future, it would be helpful to have long-term observed survival rates that would make the assumptions and the resulting imprecision in the current estimates unnecessary.

中药常山、蜀漆古今文献考证

目的探究常山、蜀漆的基原、产地、性味归经、功效、毒性特点,以期为常山、蜀漆的研究与合理应用提供参考。方法以第5版中华医典数据库、读秀数据库、中医智库在线古籍数据库为检索范围,考证常山、蜀漆的基原、产地、性味归经、功效、毒性,同时结合现代文献研究进行分析。结果发现常山、蜀漆别名较多,分布广泛,喜阴凉湿润环境,以四川产量最大,质量最优。常山的性味与归经在历代古籍中未发现明显变化,但蜀漆性味记载存在分歧,且归经论述较少,未得统一。古籍载常山、蜀漆功效多为截疟、涌吐,现代药理研究发现两者还具有抗球虫、抗肿瘤、解热、降压、抗流感病毒等药理作用。但因两者均存在一定毒性,为保证安全用药,传统多通过炮制及配伍进行减毒存效,现代多从其活性成分本身的结构修饰及致毒机理实现减毒增效。结论古今文献梳理发现常山及蜀漆,除截疟外还具有抗肿瘤等多种药理活性,研发前景良好,但囿于其存在一定的毒性,制约了其临床应用,传统临床多通过炮制、配伍减毒存效,现代学者尝试通过结构修饰和改变给药途径减毒增效,为其减毒增效提供了新的思路和方向。

基底节区生殖细胞瘤的诊断及鉴别诊断

目的总结并分析基底节区生殖细胞瘤的临床及影像学特征,提高对该病的早期诊断水平。方法收集2013年1月至2023年9月北京协和医院收治的基底节区生殖细胞瘤患者的临床及影像资料,对其进行回顾性分析。结果18例基底节区生殖细胞瘤患者(男16,女2)多表现为偏侧肢体无力。所有患者AFP均正常,7例(7/18)血清β-HCG升高,8例(8/15)脑脊液β-HCG升高。共发现19个病灶(1例双侧),MRI表现为Ⅰ型的有7例,T2WI呈斑片状稍高信号,无强化;7例为Ⅱ型,表现为斑片状、类圆形T1WI低信号,T2WI高信号,结节状强化(病灶<3cm);5例为Ⅳ型,表现为囊实性团块影,显著强化(病灶≥3cm)。14例(14/18)出现同侧大脑脚萎缩,8例(8/18)出现同侧大脑半球萎缩。结论基底节区生殖细胞瘤好发于10-14岁男性,影像分型不同但各具特点,结合偏侧肢体无力的临床表现及血清和脑脊液肿瘤标志物(AFP、β-HCG)检查可早期诊断。

DSI Studio软件结合DTI在脑功能区肿瘤术后运动功能评估中的应用

目的研究DSI Studio结合弥散张量成像(diffusion tensor imaging,DTI)应用于脑功能区肿瘤患者术后运动功能预后评估的价值。方法选择2018年1月~2022年8月于郑州大学第二附属医院行手术治疗且病理确诊的41例脑功能区肿瘤患者纳入研究。所有患者均完成3.0T磁共振成像常规序列及DTI检查,分别测量患侧及健侧内囊后肢皮质脊髓束(corticospinal tract,CST)投射区DTI参数,分析与患者MRC肌力评分及CST分级的相关性。结果患侧FA值明显低于健侧FA值(P<0.001),患侧ADC值明显高于健侧ADC值(P<0.001);患侧FA值、偏侧rFA值与CST分级呈负相关(P<0.01);ADC值、rADC值与CST分级呈正相关性(P<0.01);患侧FA值、偏侧rFA值与手术前后肌力评分程度呈正相关(P<0.01);ADC值、rADC值与CST分级呈负相关性(P<0.01);患者术前CST分级与对侧肌力呈负相关;患侧FA值,rFA值、ADC值、rADC值和CST分级受试者工作特征曲线下的面积分别是0.820(P<0.01)、0.796(P<0.01)、0.698(P<0.05)、0.638(P>0.05)、0.708(P<0.05)。结论DTI参数与肌力评分及CST分级对脑功能区肿瘤患者的术后运动功能预后的评估具有一定价值。