Large-scale functional connectivity predicts cognitive impairment related to type 2 diabetes mellitus

BACKGROUND Large-scale functional connectivity(LSFC)patterns in the brain have unique intrinsic characteristics.Abnormal LSFC patterns have been found in patients with dementia,as well as in those with mild cognitive impairment(MCI),and these patterns predicted their cognitive performance.It has been reported that patients with type 2 diabetes mellitus(T2DM)may develop MCI that could progress to dementia.We investigated whether we could adopt LSFC patterns as discriminative features to predict the cognitive function of patients with T2DM,using connectome-based predictive modeling(CPM)and a support vector machine.AIM To investigate the utility of LSFC for predicting cognitive impairment related to T2DM more accurately and reliably.METHODS Resting-state functional magnetic resonance images were derived from 42 patients with T2DM and 24 healthy controls.Cognitive function was assessed using the Montreal Cognitive Assessment(MoCA).Patients with T2DM were divided into two groups,according to the presence(T2DM-C;n=16)or absence(T2DM-NC;n=26)of MCI.Brain regions were marked using Harvard Oxford(HOA-112),automated anatomical labeling(AAL-116),and 264-region functional(Power-264)atlases.LSFC biomarkers for predicting MoCA scores were identified using a new CPM technique.Subsequently,we used a support vector machine based on LSFC patterns for among-group differentiation.The area under the receiver operating characteristic curve determined the appearance of the classification.RESULTS CPM could predict the MoCA scores in patients with T2DM(Pearson’s correlation coefficient between predicted and actual MoCA scores,r=0.32,P=0.0066[HOA-112 atlas];r=0.32,P=0.0078[AAL-116 atlas];r=0.42,P=0.0038[Power-264 atlas]),indicating that LSFC patterns represent cognition-level measures in these patients.Positive(anti-correlated)LSFC networks based on the Power-264 atlas showed the best predictive performance;moreover,we observed new brain regions of interest associated with T2DM-related cognition.The area under the receiver operating characteristic curve values(T2DM-NC group vs.T2DM-C group)were 0.65-0.70,with LSFC matrices based on HOA-112 and Power-264 atlases having the highest value(0.70).Most discriminative and attractive LSFCs were related to the default mode network,limbic system,and basal ganglia.CONCLUSION LSFC provides neuroimaging-based information that may be useful in detecting MCI early and accurately in patients with T2DM.

Summary on Professor QIAO Bao-zhang's Experience in Syndrome Differentiation and Treatment for Pancreatic Cancer

Objective:To summarize clinical experience of Professor QIAO Bao-zhang in treatment for pancreatic cancer,and to provide reference for clinicians.Methods:Through learning from Professor QIAO during his clinical practice and listening to his lectures,Professor QIAO Bao-zhang's clinically proved cases of treating pancreatic cancer based on syndrome differentiation were organized and summarized.From aspects like etiology,pathogenesis,treatment principles and treatment methods of pancreatic cancer,Professor QIAO's experience in diagnosis and treatment for this disease was analyzed and explored,and characteristics of medication were summarized.Two typical cases were selected as proof,and his treatment ideas and methods were explored.Results:Professor QIAO believes that the pathogenesis is mostly deficiency of vital Qi(正气),and stagnation of phlegm,heat and dampness in Zang-Fu(脏腑)and meridians.Around intermingled deficiency and excess,syndrome differentiation and treatment were performed.Due to treatment methods such as strengthening vital Qi to eliminate pathogenic factor,clearing heat,eliminating dampness and resolving phlegm,as well as removing toxicity and resolving hard mass,progress of malignant tumors was inhibited and recurrence and metastasis of malignant tumors were delayed.Conclusion:Professor QIAO's experience in treating pancreatic cancer is worth learning.

Pulmonary sclerosing pneumocytoma images under MSCT and 18F-FDG PET/CT and its misdiagnosis

Objective:To investigate the manifestations of pulmonary sclerosing pneumocytoma by multi-slice spiral CT (MSCT) and ^18F-FDG PET/CT in order to improve the accuracy of preoperative diagnosis. Methods:42 cases of PSP confirmed by pathology after operation were retrospectively analyzed. The distribution, size, shape, special signs and metabolic characteristics of lesions were observed. The relationship between the maximum diameter of lesions and clinical symptoms and the correlation between the maximum diameter of lesions and the maximum standardized uptake value (SUVmax) were analyzed. Results:MSCT plain scan was performed in 36 cases, enhanced in 29 cases, MSCT observed vessel marginal sign in 21 cases, air crescent sign in 9 cases, halo sign in 7 cases, calcification in 20 cases, transfissure sign in 6 cases, pleural plain scan in 23 cases;mean value of CT plain scan (36.50±21.65) HU, mean arterial phase of enhanced CT (73.13±37.22) HU, venous phase (74.78±18.36) HU;There was no significant difference in the maximum diameter of lesions between the symptomatic group and the asymptomatic group (P=0.283);^18F-FDG PET/CT in 16 cases, showed 1 case of low uptake (6.25%), 6 cases of moderate uptake (37.50%), 9 cases of high uptake (56.25%) and 3 cases of hilar and mediastinal lymph node hypermetabolism. There was no significant difference between the size of typical lesions and SUVmax(P=0.212);There was no significant correlation between the size of atypical lesions and SUVmax (P=0.253), and between the size of typical and atypical lesions and SUVmax (P=0.066). There were 8 cases of PSP diagnosed correctly before operation, with an accuracy of 19.05%, 2 cases of hamartoma, 3 cases of inflammatory pseudotumors, 3 cases of tuberculoma, 3 cases of metastasis and 10 cases of malignant tumors. Conclusion:The metabolic characteristics of PSP lesions in MSCT such as "blood vessel marginal sign", "air crescent sign", "halo sign", "transfissure sign", "calcification", "pleura sticking" and 18F-FDG PET/CT can show malignant tumors, which provide important basis for the diagnosis of PSP.

Rationale and Study Design for Evaluating the Efficacy and Safety of Intracardiac Echocardiography-Guided Minimal-Fluoroscopy Ablation in Patients with Paroxysmal Atrial Fibrillation:A Non-Inferior,Multi-Center,Prospective Randomized Controlled Trial(PAF-ICE Trial)

The feasibility and safety of intracardiac echocardiography(ICE)-guided catheter ablation for atrial fibrillation(AF)using a minimal/zero-fluoroscopy approach have recently been reported.This approach helps to reduce ionizing radiation exposure and orthopedic complications resulting from using lead aprons.The objectives of this planned prospective,multicenter randomized controlled trial(RCT)(paroxysmal AF(PAF)-ICE trial;ChiCTR2000033624)are to evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF and the impact on occupational hazards among lab staff.Patients will be randomized in a 1:1 ratio to 2 groups:minimal fluoroscopy group(n=216)and traditional approach group(n=216).In the minimal fluoroscopy group,an ICE catheter will be used for geometry/anatomic construction,transseptal puncture,catheter tracking,and effusion monitoring.Pulmonary vein isolation(PVI)will be performed using an open-irrigated radiofrequency SmartTouch Surround Flow or SmartTouch catheter(Biosense Webster,Diamond Bar,California,USA),and confirmed by a multipolar Lasso or PentaRay catheter(Biosense Webster).In the traditional approach group,an ICE catheter will not be used.Transseptal puncture will be performed under fluoroscopic guidance,with all geometries constructed by mapping the catheters.The primary efficacy endpoint is freedom from AF recurrence(without antiarrhythmic medications)at 12months after ablation.Other endpoints include duration of lead apron use,measures of intra-procedural efficiency,and peri-procedural complications.This RCT will evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF,also evaluate the benefits to lab staff(regarding reducing occupational hazards)related to this“minimal/zero-fluoroscopy”and“leadless”mode.