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OBJECTIVE: This study aims to investigate the application value of three-dimensional arterial spin labeling (ASL) perfusion imaging in detecting cerebral hemodynamics of neonates with hypoxic-ischemic encephalopathy (HIE). METHODS: Sixty normal full-term neonates and 60 HIE neonates were enrolled in this study and were respectively divided into three groups: the 1–3 days group, the 4–7 days group, and the 8–15 days group. The brains of these neonates were scanned with the 3D ASL sequence, and cerebral blood flow (CBF) images were obtained. The CBF values of the bilateral symmetrical brain regions and brain stem were measured on CBF images, and the values were averaged. The cerebral blood flow of HIE neonates in the 1–3 days group, the 4–7 days group, and the 8–15 days group was compared with normal neonates at matched ages, and the characteristics of cerebral hemodynamics in HIE neonates at different ages were summarized. RESULTS: The CBF values of the basal ganglia, thalamus, and brainstem in the 1–3 days HIE group were higher than normal neonates at matched ages, and the CBF value of the frontal lobe was lower than the normal group, and the differences were statistically significant (P 0.05). CONCLUSION: Early hyperperfusion of the basal ganglia and thalamus is helpful for early diagnosis and prognosis of HIE.

Xiwu Yan,1– 3 Ting Meng,2,3 Huaijun Liu,2 Jinfeng Liu,3 Juan Du,1 Cheng Chang3 1Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China; 2Key Laboratory of Cognitive Impairment Research, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China; 3Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of ChinaCorrespondence: Cheng Chang; Xiwu Yan, Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210000, People’s Republic of China, Tel +86 13851821996 ; +86 18013930106, Email yxwssg@126.com; chch1967@163.comBackground: Epidemiological studies suggest that the incidence of hypertension in China is causally related to cognitive impairment. However, there is a dearth of information available regarding important factors for the association, including disease duration, therapeutic options, and risk factors associated with mild cognitive impairment (MCI) in patients with hypertension.Methods: We selected a diverse cohort of 572 patients with hypertension and assessed cognitive function using MoCA. Potential risk factors were investigated by a structured questionnaire. Risk factors associated with the hypertension-induced MCI occurring conversion of were analyzed using multifactorial regression analysis.Results: MCI was observed in 256 of 572 individuals, which increased with age (OR=1.15, 95% CI 1.10– 1.20), but was decreased with high education status (OR=0.47, 95% CI 0.32– 0.71). Risk factors independently associated with MCI were diabetes (OR=2.40, 95% CI 1.53– 3.76), hyperlipidemia (OR=1.49, 95%=1.01– 2.16), high salt diet (OR=2.27, 95% CI 1.34– 3.84), and physical activity:> 2h/week (OR=0.65, 95%0.44– 0.94). However, controlling blood pressure to “normal” target values helped decrease the incidence of MCI (OR=0.44, 95% CI 0.30– 0.65): this was not age dependent.Conclusion: Our results suggest that it is necessary to promote the education of the middle-aged and elderly Chinese population to correctly and effectively use anti-hypertensives to control hypertension to a normal range to prevent cognitive.Keywords: hypertension, mild cognitive impairment, control, risk factors

To investigate the relationship between the epicardial adipose tissue density (EATD) and the coronary plaque components as assessed by coronary computed tomographic angiography (CCTA). The study cohort included 240 patients with chest pain or precardiac discomfort (mean age 62.01 ± 7.45 years, 55.83% male). Patients were assigned to the high-risk plaque (HRP) group (n = 133) or non-HRP group (n = 107). All patients underwent CCTA to assess plaque composition, and quantitative analysis of EATD and epicardial adipose tissue volume (EATV). Age, gender, EATV, EATD, diabetes history and family history were all correlated with HRP. There was no linear correlation between EATD and EATV among the subjects (R2 = 0.008, p = 0.177), but there was a curvilinear correlation (R2 = 0.102, p < 0.001). After adjusting other traditional factors, and we observed robust associations of EAT volume and density with HRP (all p < 0.05). For per 1 standard deviation increase in EATD, the risk of HRP was 3.120 times the risk than that of non-HRP. For per 1 standard deviation increase in EATV, the risk of HRP was 1.499 times the risk than that of non-HRP. The receiver operating characteristic curve showed that EATD was more predictive of HRP than EATV (AUC = 0.761, 95% CI 0.701-0.822). Our study found that EATD and EATV are both independent factors affecting the presence of HRPs, and EATD had a high predictive value for the presence of HRP.

BACKGROUND In epidemiological studies, hypertension is related to the difference in the incidence of cognitive impairment, but the evidence is currently inconsistent regarding the association of disease duration, treatment, control, and life risk factors with mild cognitive impairment (MCI) in patients with hypertension. METHODS We selected 572 patients with hypertension treated in six medical centers in Nanjing from 2017 to 2020. The cognitive function of participants was assessed using MoCA. Potential risk factors were investigated by a structured questionnaire. Risk factors associated with the conversion of MCI occurring in hypertension were analyzed using multifactorial regression analysis. RESULTS MCI was observed in 256 of 572 individuals. MCI was more likely with increasing age (OR=1.15, 95%CI 1.10-1.20), and high education was better at preventing MCI (OR=0.47, 95%CI 0.32-0.71) among baseline clinical characteristics. Risk factors independently associated with MCI were diabetes (OR=2.40, 95%CI 1.53-3.76), Hyperlipidemia (OR=1.49, 95%=1.01-2.16), high salt diet (OR=2.27, 95%CI 1.34-3.84), and physical activity:༞2h/week (OR=0.65, 95%0.44-0.94). Controlling blood pressure to target values helped prevent MCI(OR=0.44, 95%CI 0.30-0.65), and these results were similar when stratified by age. CONCLUSION Our results suggest that it is necessary to popularize hypertension knowledge and a healthy lifestyle, and optimize treatment to achieve the goal of preventing cognitive decline in the middle-aged and elderly.

To investigate the relationship between the epicardial adipose tissue density (EATD) and the coronary plaque components as assessed by coronary computed tomographic angiography (CCTA). The study cohort included 240 patients with chest pain or precardiac discomfort (mean age 62.01 ± 7.45 years, 55.83% male). Patients were assigned to the high-risk plaque (HRP) group (n = 133) or non-HRP group (n = 107). All patients underwent CCTA to assess plaque composition, and quantitative analysis of EATD and epicardial adipose tissue volume (EATV). Age, gender, EATV, EATD, diabetes history and family history were all correlated with HRP. There was no linear correlation between EATD and EATV among the subjects (R

BACKGROUND Respiratory function usually worsens in the elderly with aging. This study aimed to retrospectively investigate tracheal changes caused by "normal aging" through use of low-dose CT (LDCT) in non-smoking asymptomatic urban residents and the related factors influencing tracheal changes. MATERIAL AND METHODS A total of 733 Chinese subjects who underwent LDCT were recruited. The trachea shape, width, and calcification degree of the tracheal wall were measured and compared between males and females and among different age groups. The effects of age, sex, trachea morphology, BMI, BP, GLU, TC, TG, HDL, and LDL on the width and calcification of tracheal wall were analyzed by multiple linear regression. RESULTS Significant sex differences in trachea shape were found, as type II and type I were found mainly in the males and females, respectively. The values of anterior-posterior inner diameter (AP), left-right inner diameter (LR), width, and calcification score of tracheae in the males were higher than that in the females. In both males and females, trachea AP, wall width, and calcification scores increased with age, but this trend was not observed in tracheal LR. Age, sex, and trachea shape had significant effects on the width and calcification scores of tracheal walls, and trachea calcification was one of the factors influencing tracheal wall width. CONCLUSIONS Tracheal aging can be evaluated by measuring trachea shape, thickness, and the degree of calcification of the tracheal wall by LDCT, while sex and age should be taken into consideration comprehensively for judging normal trachea aging. In addition, obesity may aggravate trachea aging.

Neurite outgrowth is the basis for wiring during the development of the nervous system. Dl-3-n-butylphthalide (NBP) has been recognized as a promising treatment to improve behavioral, neurological and cognitive outcomes in ischemic stroke. However, little is known about the effect and mechanism of NBP on the neurite outgrowth. In this study, we used different methods to investigate the potential effects of NBP on the neurite extension and plasticity of immature and mature primary cortical neurons and explored the underlying mechanisms. Our results demonstrated that in immature and mature cortical neurons, NBP promoted the neurite length and intersections, increased neuritic arborization, elevated numbers of neurite branch and terminal points and improved neurite complexity and plasticity of neuronal development processes. Besides, our data revealed that NBP promoted neurite extension and branching partly by activating Shh signaling pathway via increasing Gap43 expression both in immature and mature primary cortical neurons. The present study provided new insights into the contribution of NBP in neuronal plasticity and unveiled a novel pathway to induce Gap43 expression in primary cortical neurons.

BACKGROUND This study aimed to investigate the added value of NeuroGam software analysis in the localization diagnosis of epileptogenic zone during interictal phase of seizures. MATERIAL AND METHODS The clinical data of 67 patients, clinically diagnosed as epilepsy, were analyzed retrospectively. Visual analysis and NeuroGam software analysis were used for independent analysis. The 2 methods were used to compare the efficacy indicator of the diagnosis of epileptogenic zone, and the receiver operating characteristic (ROC) curve evaluated the diagnostic efficacy. RESULTS Through the final clinical diagnostic comprehensive localization, among 67 epilepsy patients, the epileptogenic zone in 51 cases could be located distinctly, and those in 16 cases could not be located. Compared to the visual analysis, the NeuroGam software analysis was more sensitive in the location of epileptogenic zone (χ²=4.876, P=0.027). The area under the ROC curve (AUC) and 95% confidence interval (CI) of the NeuroGam software and visual analyses was 0.760 and 0.689, (0.613, 0.908) and (0.547, 0.832), respectively. However, the consistency of the 2 methods was poor (Kappa=0.367, P=0.001). Compared to visual analysis, the NeuroGam software analysis exerted more advantages in the localization diagnosis of the epileptogenic zone (P

To explore therapeutic effect of nerve growth factor (NGF) on cerebral infarction by establishing canine middle cerebral artery occlusion (MCAO) infarct model. The magnetic resonance imaging (MRI) technology was used to study effects of NGF on cerebral infarction, and the results of MRI indexes (such as diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI)) were compared with the results of pathology, cell biology and molecular biology. The clinical manifestations of the canine infarction model treated by NGF were significantly improved within 7 days compared with control group. The therapeutic evaluation of NGF effect could be determine by canine cerebral infarction treated by NGF within 6 hours according to DWI and PWI. From 6 hours to 7 days, therapeutic evaluation of NGF could be determine by T1WI, T2WI and FLAIR. DWI and PWI could find the change of cerebral ischemia at the early stage, provide advantages for qualitative diagnosis of early-stage cerebral infarction and observation of efficacy in early treatment, initially showing that their great potential for NGF role on cerebral ischemia and mechanism.

Aim Our objective is to explore key changes in brain functions in relation to minimal hepatic encephalopathy (MHE). We incorporated both resting-state functional magnetic resonance imaging (fMRI) and arterial spin labeling (ASL) to enhance the detection of MHE. Methods We undertook fMRI scanning for 56 MHE patients and 66 healthy controls. Region functional connectivity was carried out to assess the connectivity status between pairs of regions among 90 brain regions. Additionally, blood flow (BF) status was measured by ASL for all subjects. Spearman's correlation test was implemented to identify any correlation among z-values, results from number connection test type A, and digit symbol tests. Finally, the receiver operating characteristic curve was generated for assessing the accuracy of BF in MHE diagnosis. Results The corresponding functional connectivity was significantly different between MHE and control groups in 15 regions. For MHE patients, BF showed an increasing pattern in regions of interest. Blood flood in the putamen was positively correlated with number connection test type A neuropsychological performance, whereas it was negatively correlated with the digit symbol test. Blood flood in the right putamen showed the highest value of area under the curve with a sensitivity of 85.7% and specificity of 89.4%. Conclusion Connectivity impairment resulting from ganglia-thalamo-cortical circuits may play important roles in mediating the development of MHE patients. An increase in the BF, particularly in the right putamen, may be considered as evidence for the presence of MHE.

Objective This study aims to perform a metaanalysis to assess the diagnostic performance and clinical utility of the dynamic magnetic resonance imaging (MRI) in discrimination of benign and malignant pulmonary nodules. Materials and methods We searched PubMed, EMBASE, and Cochrane Library from January 1995 to May 2015 for studies evaluating the diagnostic accuracy of dynamic MRI in discriminating benign from malignant pulmonary nodules. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) were calculated. Potential publication bias was investigated. Results Twelve studies with 524 malignant and 284 benign nodules were included in this metaanalysis. The publication bias was not significant. Summary receiver operating characteristic curve showed that AUC was 0.94 [95% confidence interval (CI), 0.83–0.98], with pooled sensitivity of 0.95 (95% CI: 0.90, 0.97), specificity of 0.87 (95% CI: 0.72, 0.95), PLR of 7.6 (95% CI: 3.2, 18.0), NLR of 0.06 (95% CI: 0.03, 0.11), and DOR of 133 (95% CI: 45, 393), respectively. Conclusion Dynamic contrast-enhanced MRI is valuable for discrimination of benign from malignant pulmonary nodules and is especially useful for exclusion of malignant pulmonary nodules.

Because most tested drugs are active against only one of the damaging processes associated with stroke, other mechanisms may cause cellular death. Thus, a combination of protective agents targeting different pathophysiological mechanisms may obtain better effects than a single agent. The major objective of this study was to investigate the effect of combination therapy with vascular endothelial growth factor (VEGF) and nerve growth factor (NGF) after controlled ischemic brain injury in rabbits.Methods:Animals were randomly assigned to one of the following groups: sham group, saline-treated control group or NGF+VEGF-treated group. Animals received an intracerebral microinjection of VEGF and NGF or saline at 5 or 8 hours after ischemia. The two specified time points of administration were greater than or equal to the existing therapeutic time window for monoterapy with VEGF or NGF alone (3 or 5 hours of ischemia). Infarct volume, water content, neurological deficits, neural cell apoptosis and the expression of caspase-3 and Bcl-2 were measured.Results:Compared with saline-treated controls, the combination therapy of VEGF and NGF significantly reduced infarct volume, water content, neural cell apoptosis and the expression of caspase-3, up-regulated the expression of Bcl-2 and improved functional recovery (bothpConclusions:These results showed that the combination therapy with VEGF and NGF provided neuroprotective effects. In addition, the time window of combination treatment should be at least 8 hours after ischemia, which was wider than monotherapy.RÉSUMÉ:Les effets d’une polythérapie combinant agents neuro-protecteurs et agents vasoprotecteurs dans les cas d’ischémie cérébrale.Contexte:Étant donné que la plupart des médicaments préalablement testés tendent à n’agir contre seulement un des processus de dommage associés aux AVC, il est possible que d’autres processus entraînent une mort cellulaire. À cet effet, il se pourrait qu’une combinaison d’agents protecteurs ciblant divers mécanismes physiopathologiques permette d’obtenir de meilleurs résultats qu’un simple agent. Après avoir suscité de façon contrôlée des lésions cérébrales ischémiques chez des lapins, l’objectif principal de la présente étude a donc été de se pencher sur l’impact d’une polythérapie combinant la protéine dite « facteur de croissance de l’endothélium vasculaire » (ou « VEGF » en anglais) avec le « facteur de croissance des nerfs » (ou « NGF » en anglais).Méthodes:Les animaux ont été attribués au hasard à l’un des groupes suivants : ceux ayant reçu un traitement fictif ; ceux, du groupe témoin, ayant bénéficié d’un traitement à base de solution saline ; et finalement ceux ayant été traités au moyen des VEGF et NGF. À noter que les lapins ont reçu une micro-injection intracérébrale de VEGF et de NGF ou de solution saline 5 heures ou 8 heures à la suite de leur AVC. Ces deux délais d’administration des VEGF et NGF sont équivalents ou supérieurs aux délais actuels d’administration des VEGF ou NGF à titre de monothérapie (3 heures ou 5 heures à la suite d’un AVC). Tant le volume des infarctus, le contenu en eau, les déficits neurologiques ainsi causés, l’apoptose des neurones que l’expression des protéases caspase 3 et des protéines Bcl-2 ont été mesurés.Résultats:Si on la compare au traitement à base de solution saline administré au groupe témoin, la polythérapie à base de VEGF et de NGF, lorsqu’administrée 5 heures ou 8 heures à la suite de l’AVC, a su réduire de façon notable le volume des infarctus, le contenu en eau, l’apoptose des neurones et l’expression des protéases caspase 3. Elle a également permis de réguler à la hausse l’expression des protéines Bcl-2 en plus d’entraîner une amélioration de la récupération fonctionnelle (p< 0,01 pour ces deux aspects). Ainsi donc, plus tôt l’on opte pour cette polythérapie, meilleure sera la neuroprotection encourue.Conclusions:Ces résultats démontrent que la polythérapie à base de VEGF et de NGF procure des effets neuroprotecteurs. Quant au délai d’administration de ce traitement combinatoire, il devrait être d’au moins 8 heures à la suite d’un AVC, ce qui est plus élevé que la monothérapie.

Voxel-based morphometry has been used in the study of alterations in brain structure in type 1 diabetes mellitus patients. These changes are associated with clinical indices. The age at onset, pathogenesis, and treatment of type 1 diabetes mellitus are different from those for type 2 diabetes mellitus. Thus, type 1 and type 2 diabetes mellitus may have different impacts on brain structure. Only a few studies of the alterations in brain structure in type 2 diabetes mellitus patients using voxel-based morphometry have been conducted, with inconsistent results. We detected subtle changes in the brain structure of 23 cases of type 2 diabetes mellitus, and demonstrated that there was no significant difference between the total volume of gray and white matter of the brain of type 2 diabetes mellitus patients and that in controls. Regional atrophy of gray matter mainly occurred in the right temporal and left occipital cortex, while regional atrophy of white matter involved the right temporal lobe and the right cerebellar hemisphere. The ankle-brachial index in patients with type 2 diabetes mellitus strongly correlated with the volume of brain regions in the default mode network. The ankle-brachial index, followed by the level of glycosylated hemoglobin, most strongly correlated with the volume of gray matter in the right temporal lobe. These data suggest that voxel-based morphometry could detect small structural changes in patients with type 2 diabetes mellitus. Early macrovascular atherosclerosis may play a crucial role in subtle brain atrophy in type 2 diabetes mellitus patients, with chronic hyperglycemia playing a lesser role.

Paraquat (PQ) is a common herbicide and PQ poisoning is a major medical problem in Asia. However, few studies have focused on the acute neurotoxic changes caused by PQ. Here we report the acute neurotoxicological findings of rats treated with lethal dose of PQ. In substantia nigra (SN) and striatum we found obvious microglia (labeled by Iba-1) activation within one week. In SN and hippocampus, we detected increased oxidative stress in the neurons based on NeuN/8-OHdG immunofluorescence double labeling and laser cofocal microscopy. Moreover, we provided ultrastructural evidences of astrocyte edema and neurons apoptosis in rat brain by electron microscopy. Further studies will be needed with non-lethal dose of PQ to confirm these results and demonstrate the direct CNS toxicity of PQ.

Aberrant expression of Fos-related antigen-1 (Fra1) is commonly elevated in various malignant cancers and is strongly implicated in invasion and metastasis. However, the molecular mechanisms underlying its dysregulation in human glioma remain poorly understood. In the present study, we demonstrate that up-regulation of Fra1 plays a crucial role in the glioma aggressiveness and epithelial–mesenchymal transition (EMT) activated by Wnt/β-catenin signal pathway. In glioma cells, activation of Wnt/β-catenin signalling by Wnt3a administration obviously induced EMT and directly activated the transcription of Fra1. Phenotype experiments revealed that up-regulation of Fra1 induced by Wnt/β-catenin signalling drove the EMT of glioma cells. Furthermore, it was found that the cisplatin resistance acquired by Wnt/β-catenin signalling activation depended on increased expression of Fra1. Analysis of clinical specimens verified a positive correlation between Fra1 and β-catenin as well as a poor prognosis in glioma patients with double-high expressions of them. These findings indicate that an aberrant Wnt/β-catenin signalling leads to the EMT and drug resistance of glioma via Fra1 induction, which suggests novel therapeutic strategies for the malignant disease.

Our objective is to explore key changes in brain functions in relation to minimal hepatic encephalopathy (MHE). We incorporated both resting-state functional magnetic resonance imaging (fMRI) and arterial spin labeling (ASL) to enhance the detection of MHE.We undertook fMRI scanning for 56 MHE patients and 66 healthy controls. Region functional connectivity was carried out to assess the connectivity status between pairs of regions among 90 brain regions. Additionally, blood flow (BF) status was measured by ASL for all subjects. Spearman's correlation test was implemented to identify any correlation among z-values, results from number connection test type A, and digit symbol tests. Finally, the receiver operating characteristic curve was generated for assessing the accuracy of BF in MHE diagnosis.The corresponding functional connectivity was significantly different between MHE and control groups in 15 regions. For MHE patients, BF showed an increasing pattern in regions of interest. Blood flood in the putamen was positively correlated with number connection test type A neuropsychological performance, whereas it was negatively correlated with the digit symbol test. Blood flood in the right putamen showed the highest value of area under the curve with a sensitivity of 85.7% and specificity of 89.4%.Connectivity impairment resulting from ganglia-thalamo-cortical circuits may play important roles in mediating the development of MHE patients. An increase in the BF, particularly in the right putamen, may be considered as evidence for the presence of MHE.

Paraquat (PQ) is an organic heterocyclic herbicide that is widely used throughout the world. Epidemiological and neuropathological studies have shown that chronic exposure to PQ increases the risk of Parkinson's disease. Patients with acute PQ poisoning show damage to the lungs, liver, and kidneys, and some also show symptoms of central nervous system (CNS) toxicity. However, few studies have focused on the acute neurotoxic changes caused by PQ. Dynamic pathological changes in the human brain cannot be explored in animal models. Thus, to elucidate the impact of acute PQ poisoning on the CNS, neuroimaging studies of poisoned victims, and especially survivors, should be performed. This study reports the first application of magnetic resonance imaging (MRI) techniques on patients with acute PQ poisoning, including survivors. We found significant abnormal signals in the brains of two patients during the acute post-poisoning phase. Using susceptibility weighted imaging (SWI), we documented changes in the corrected phase values for the extrapyramidal ganglia of survivors, and these values correlate with excessive iron deposition. Our diffusion tensor imaging (DTI) results were suggestive of microstructural changes in the extrapyramidal ganglia and hippocampus after PQ poisoning. These neuroimaging results provide an indirect demonstration that acute PQ neurotoxicity exerts a sustained effect during the acute and recovery stages of poisoning.

As the prevalence of coronary computed tomographic angiography (CCTA), it is meaningful that CCTA can provide not only the structural details of artery, but also functional information of vessel elasticity. Our aim was to explore the elasticity characteristics of ascending aorta (AA), descending aorta (DA), main pulmonary artery (MPA), left pulmonary artery (LPA), right pulmonary artery (RPA), and their relationship between each other using 640 slice-volume computed tomography (CT). Furthermore, this study will also observe their relations with age. A total of 42 subjects that were free of cardiovascular disease, high blood pressure, diabetes, and hyperlipidemia underwent CCTA on 640 slice-volume CT and were enrolled in this study. The subjects were divided into 2 groups: Group 1, age .05). The elasticity characteristics of AA, DA, MPA, LPA, and RPA could be well shown by 640 slice-volume CT. The elasticity relativity was observed and was different between AA and DA, AA and MPA, LPA and MPA, LPA and RPA. An obvious age-related decrease in vascular elasticity was found in AA, DA, MPA, and LPA, which should be taken into consideration in clinical trials and treatments for the elasticity-related cardiovascular diseases.

Objective: To investigate the role of the calcar femorale in stress distribution in the proximal femur. Methods: Twenty-five specimens of proximal femurs were fixed to simulate single-limb stance. Strain gauges were applied to record the strain under different loads. Strain values of 27 selected sites in the proximal femur were recorded and analyzed at the level of 100 N, 200 N, 300 N, 400 N, 500 N, 600 N and 700 N, respectively before and after disruption of the calcar femorale. Results: When a normal load was being borne, strain values measured in the posterior and medial aspects of the proximal femur were greater than those measured in the anterior and lateral aspects, no matter whether the calcar femorale was disrupted or not. However after disruption of the calcar femorale, strain values in the posterior and medial aspects of the proximal femur increased significantly, whereas those of the anterior and lateral aspects decreased significantly. Conclusion: The calcar femorale redistributes stress in the proximal femur by decreasing the load in the posterior and medial aspects and increasing the load in the anterior and lateral aspects.

Caspase-12 has been localized to endoplasmic reticulum (ER) and showed to involve ER stress-induced apoptosis. In the present work we investigated the temporospatial alterations of caspase-12 immunoreactivity in the penumbra following cerebral ischemia/reperfusion in rabbit. Transient cerebral ischemia was produced by intraluminal occlusion of the middle cerebral artery for 2 h followed by 1 h, 6 h, 1 day, 3 days, 7 days and 14 days of reperfusion. Caspase-12 immunohistochemistry was first increased in the penumbra 1 h after reperfusion, with a peak at day 1 to day 3, and then gradually decreased to basal level at day 14. The number of TUNEL-positive cells and ultrastructural observation of brain sections in the penumbra showed a similar change at the same time points. ER mediated by caspase-12 participated in apoptosis induced by cerebral ischemia/reperfusion injury, which may provide a new area for therapeutic intervention to ameliorate outcomes following cerebral ischemia.

Pelvic fractures are an uncommon injury in pediatric trauma patients, but the morbidity and mortality associated with these injuries can be profound. Of the posterior pelvic ring disruptions, the posterior dislocation of sacroiliac joint, which is the traditional dislocation of the sacroiliac joint, occurs in most incidences of pediatric trauma patients. There are few reports, however, on the "anterior" dislocation of sacroiliac joint, in which the ilium dislocates anterior to the sacrum and often combines with symphyseal diastasis and fractures of pubic rami and ilia. The distinct fracture-dislocation of sacroiliac joint is a subtype of completed posterior pelvic fracture. Literature review contains little information about such type of dislocation. We present four cases of pediatric trauma patients with the "anterior" dislocation of sacroiliac joint. After a thorough literature review of existing classification of pelvic fractures, we name it as the anterior dislocation of sacroiliac joint.

Femoral fracture is a major cause of morbidity and mortality in elderly persons. Surgery, the main choice of treatment of femoral fracture, may result in some complications severely affecting patients' daily activities due to femoral malalignment. The lesser trochanter is an important anatomical structure of the femur which could be used as an anatomical landmark during and after operation to evaluate femoral alignment. To predict femoral rotational malalignment during surgery, the relationship between the height and width of the lesser trochanter and femoral rotation at different angles was investigated.Fifty healthy adult volunteers (25 men and 25 women) were enrolled in this study and a total of 900 radiographs of proximal femurs were taken in the following positions: neutral position, 5 degrees, 10 degrees, 15 degrees, and 20 degrees internal rotation, and 5 degrees, 10 degrees, 15 degrees, and 20 degrees external rotation, respectively. The cranio-caudal and transverse diameters of the lesser trochanter were obtained on a PACS Workstation.The height and width of the lesser trochanter increased with external rotation and decreased with internal rotation and the values showed statistical significance between different positions or different genders. Between 20 degrees of internal rotation to 20 degrees of external rotation, the mean height increased from 0.58 cm to 1.23 cm in men and from 0.44 cm to 1.19 cm in women. The corresponding mean values for width were from 2.53 cm to 4.44 cm in men, and from 2.08 cm to 3.86 cm in women, respectively. The height and width of the lesser trochanter were both highly correlated to the position of femur and the linear relationship was established approximately. The morphological alteration of lesser trochanter also changed obviously when the femurs rotated.The height and width of the lesser trochanter is linearly related to femoral rotation and could be used as a reference for prevention of femoral malalignment during surgery.

Background: Medial temporal lobe atrophy (MTA) is an early sign of Alzheimer's disease (AD). The current method of choice for measuring MTA is volumetric measurement based on 3D magnetic resonance imaging (MRI), but this complicated method has not been implemented clinically. Purpose: To investigate whether simple computed tomography (CT) linear measurements of the brain could be of value in AD workup. Material and Methods: Fifty-nine healthy control subjects and 248 AD subjects were recruited. They were evaluated using a comprehensive clinical workup. A series of linear CT measurements were obtained from brain CT. Results: In discriminant analysis, the temporal horn ratio and the suprasellar cistern ratio were the atrophy factors that contributed most significantly to the diagnoses. Combined with other clinical factors (apolipoprotein E4 genotype), a correct AD classification of 90.2% was achieved. Conclusion: CT linear measurements could be of value in the workup of AD patients, considering the inexpensiveness and availability of CT as well as the simplicity of linear measurements.

Approximately one-quarter of ischemic strokes involve the vertebrobasilar arterial system that includes the upstream flow confluence and downstream flow divergence. A patient-specific hemodynamic analysis is needed to understand the posterior circulation. The objective of this study is to determine the distribution of hemodynamic parameters in the vertebrobasilar system, based on computer tomography angiography images. Here, the interplay of upstream flow confluence and downstream flow divergence was hypothesized to be a determinant factor for the hemodynamic distribution in the vertebrobasilar system. A computational fluid dynamics model was used to compute the flow fields in patient-specific vertebrobasilar models (n = 6). The inlet and outlet boundary conditions were the aortic pressure waveform and flow resistances, respectively. A 50% reduction of total outlet area was found to induce a ten-fold increase in surface area ratio of low time-averaged wall shear stress (i.e., TAWSS ≤ 4 dynes/cm2). This study enhances our understanding of the posterior circulation associated with the incidence of atherosclerotic plaques.

Background Acute organophosphate poisoning can cause injuries of multiple visceras; especially, central nervous system injury can increase risk factors of patients with severe acute organophosphate poisoning. An application of modern image may increase diagnostic rate of brain injury in an earlier period and provide evidences for clinical treatment. Objective To reveal imaging manifestations, pathological characteristics and multi-ways injured mechanism of brain injury due to acute organophosphate poisoning. Design Contrast observational study. Setting Department of Medical Image, the Second Hospital of Hebei Medical University. Materials The experiment was carried out in the Department of Nerve Molecule Imaging Medicine and Laboratory of Neurology, the Second Hospital of Hebei Medical University from August 2003 to February 2004. A total of 30 healthy cats weighing 2.8–3.5 g and of both genders were selected from Animal Experimental Center of Hebei Medical University. Methods Thirty healthy cats were randomly divided into control group ( n =5) and intoxication group ( n =25). Cats in the control group were subcutaneously injected with 0.3 mL/kg saline at four points; while, cats in the intoxication group were subcutaneously injected with 400 g/L 0.3 mL/kg O,O-dimethyl-S-(methoxycarbonylmethyl) thiophosphate at four points. Two minutes after intoxication, cats received muscular injection with 0.5 mg/kg atropine sulfate, and then, brain tissues were collected from parietal lobe, basal ganglia, hippocampus, cerebellum and brain stem were observed at 3, 6, 24 hours, 3 and 7 days after intoxication respectively under optic microscope and electron microscope and expressions of acetylcholinesterase (AChE), choline acetyltransferase (ChAT), glial fibrillary acidic protein (GFAP), glutamic acid (Glu) and γ-amino butyric acid after immunohistochemical staining. Main outcome measures Results of MRI examinations; histological changes under optic microscope and electron microscope; expressions of AChE, ChAT, GFAP, Glu and γ-amino butyric acid after immunohistochemical staining. Results All 30 healthy cats were involved in the final analysis. Imaging and pathological observation: Image manifestations of brain injury induced by acute organophosphate poisoning showed as cerebral edema and symmetry signal abnormality of bilateral basal ganglia; while, pathological manifestations also showed as cerebral edema. Observation of immunohistochemical staining: As compared with the control group, after organophosphate poisoning, area of AChE immune-positive cells was decreased obviously ( P P > 0.05); in addition, positive cells of GFAP were increased remarkably ( P P P Conclusion Multi-ways injured mechanism invovled in acute organophosphate poisoning. An application of modern image can increase diagnostic rate of brain injury in an earlier period and provide evidences for clinical treatment.

Background Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating haemodynamically significant coronary artery disease. We aimed to systematically analyse the diagnostic performance and clinical utility of myocardial perfusion MRI for coronary artery disease (CAD) using fractional flow reserve (FFR) as the standard reference. Methods We searched PubMed, EMBASE, and Cochrane Library to July 2015 for studies using perfusion MR as a diagnostic test for CAD versus FFR. The meta-analysis was performed based on Cochrane guideline. Results We identified 20 studies with 1,570 patients. Pooled analyses were performed at per-patient level (1,041 patients) and per-territory level (2,690 coronary territories). The sensitivity, specificity, area under sROC curve were 0.88 (95% CI: 0.85, 0.91), 0.88 (95% CI: 0.84, 0.90), and 0.94 (95% CI: 0.92, 0.96) at per-patient level, and 0.86 (95% CI: 0.81, 0.90), 0.88 (95% CI: 0.84, 0.92), and 0.93 (95% CI: 0.91, 0.95) at per-territory level. Post-test probability was altered by positive (likelihood ratio) LR of 7.1 (95% CI: 5.6, 9.0) and negative LR of 0.13 (95% CI: 0.10, 0.17) based on Bayes' theorem. Conclusions Diagnostic accuracy of myocardial perfusion MRI for CAD is high and can alter the post-test probability of CAD.

A model of focal cerebral ischemic infarction was established in dogs through middle cerebral artery occlusion of the right side. Thirty minutes after occlusion, models were injected with nerve growth factor adjacent to the infarct locus. The therapeutic effect of nerve growth factor against cerebral infarction was assessed using the hemisphere anomalous volume ratio, a quantitative index of diffusion-weighted MRI. At 6 hours, 24 hours, 7 days and 3 months after modeling, the hemisphere anomalous volume ratio was significantly reduced after treatment with nerve growth factor. Hematoxylin-eosin staining, immunohistochemistry, electron microscopy and neurological function scores showed that infarct defects were slightly reduced and neurological function significantly improved after nerve growth factor treatment. This result was consistent with diffusion-weighted MRI measurements. Experimental findings indicate that nerve growth factor can protect against cerebral infarction, and that the hemisphere anomalous volume ratio of diffusion-weighted MRI can be used to evaluate the therapeutic effect.

A total of 50 healthy volunteers aged between 18 and 54 years underwent phase-contrast cine MRI to assess cerebrospinal fluid flow characteristics in different regions of the vertebral canal. The results revealed that the cerebrospinal fluid peak flow velocity and peak flow rate in the systolic phase were significantly greater than those in the diastolic phase at the same level in the subarachnoid space of the cervical spinal canal. The ventral peak flow velocity and peak flow rate were significantly greater than the post-lateral peak flow velocity and flow rate, while there were no differences between left and right post-lateral subarachnoid peak velocity and flow rate. Moreover, there were no significant differences in peak flow velocity and peak flow rate between the systolic and diastolic phases, ventral, right post-lateral or left post-lateral peak flow velocity and peak flow rate at the same level in the subarachnoid space of the cervical spinal canal among different age groups (18-24, 25-34, 35-44, ≥ 45 years).

Administration of vascular endothelial growth factor (VEGF) has been shown to increase cerebral blood flow and reduce neurological damage after experimental ischemic brain injury. The purpose of this study was to examine the optimal dose and time window for the neuroprotective effect of VEGF when administrated after focal ischemia/reperfusion injury in rabbits. Focal cerebral ischemia/reperfusion was induced by the middle cerebral artery occlusion (MCAO) method. In a dose response experiment, low (1.25 ng/μL), middle (2.5 ng/μL) and high (5.0 ng/μL) doses of VEGF were administered 2h after MCAO by the route of perifocal region. The VEGF at a dose of middle (2.5 ng/μL) displayed excellent effects on neuroprotective efficacy for focal cerebral ischemia/reperfusion injury. In another experiment, 2.5 ng/μL VEGF was administered at times varying from 2 to 8h after MCAO. Infarct volume, water content and neurological deficits were significantly reduced when VEGF was given at 2 and 3h after injury. The protective effect was less when the same dose was given at the later times. Thus, the present findings indicated that VEGF reduced ischemic neuronal danger with a therapeutic time window within the first 3h of transient MCAO and may be useful in the treatment of acute ischemic stroke in humans.

In the present study, we evaluated the neuroprotection time window for nerve growth factor (NGF) after ischemia/reperfusion brain injury in rabbits as related to this anti-apoptosis mechanism. Male New Zealand rabbits were subjected to 2 h of middle cerebral artery occlusion (MCAO), followed by 70 h of reperfusion. NGF was administered after injury to evaluate the time window. Neurological deficits, infarct volume, neural cell apoptosis and expressions of caspase-3 and Bcl-2 were measured. Compared to saline-treated control, NGF treatment at 2, 3 and 5 h after MCAO significantly reduced infarct volume, neural cell apoptosis and expression of caspase-3 (P < 0.01), up-regulated the expression of Bcl-2 and improved functional recovery (P < 0.01). However, treatment at latter time points did not produce significant neuroprotection. Neuroprotection treatment with NGF provides an extended time window of up to 5 h after ischemia/reperfusion brain injury, in part by attenuating the apoptosis.

Background: Although cerebrospinal fluid (CSF) biomarkers and medial temporal lobe atrophy (MTA) contribute to the diagnosis of Alzheimer disease (AD), they may not be specific. Relatively little is known about how they correlate with each other. Purpose: To identify the validity of the radiological linear measurements of brain atrophy in AD diagnosis by examining the correlation with CSF biomarkers and by examining if specificity could be improved in classification of AD from controls, when the linear measurements are combined with the CSF biomarkers. Material and Methods: 59 controls (20 male/39 female, age 73±8 years), 162 pure AD patients (49/113, 74±7 years), and 86 AD patients with minor cerebrovascular changes (CVC) (31/55, 77±5 years), aged between 52 and 94 years, were recruited from the Malmö Alzheimer Study. AD patients were subgrouped into “pure AD” and “AD + CVC” in order to clarify the possible influence of CVC on atrophy or CSF biomarkers in AD patients. Abeta42, T-tau, and P-tau in CSF were examined. Computed tomography (CT) linear measurements were performed, which included temporal horn ratio and suprasellar cistern ratio that reflect MTA. Results: Compared with the 14 significant correlations between the CT measurements and three CSF biomarkers in the pure AD group, there was only one significant correlation in the AD + CVC group and one in the control group. In particular, P-tau correlates with temporal horn ratio only in pure AD. When the CT measurements were added with CSF biomarkers as independent variables in discriminant analysis, the percentage of correct classification of AD + CVC from controls increased from 79.5% (only CSF biomarkers) to 84.6% (combined CT measurements with CSF biomarkers). However, little was changed in the pure AD group. Conclusion: P-tau correlates with the linear CT measure of MTA only in pure AD without CVC. Combined with the measure of MTA, the specificity of CSF biomarkers can be increased, but only in AD + CVC. The linear measurements of MTA are of value in AD diagnosis.

Tostudy the correlation between dynamic changes of regional cerebral blood flow (rCBF) and nuclear factor-kappa beta (NF-kappabeta) expression in the region of perihematoma after intracerebral hemorrhage (ICH).Twenty-seven healthy domestic cats were divided into control group (n = 3) and ICH group (n = 24) at random. They were observed at 3 hr, 6 hr, 12 hr, 24 hr, 48 hr, 72 hr, 7 days, and 15 days, respectively, for the dynamic changes of rCBF in the perihematomal region using perfusion-weighted imaging (PWI), and NF-kappabeta expressions using immunohistochemistry method.In the perihematomal region, a noticeable decrease in rCBF had been observed within 12 hr, i.e. in a hypoperfusion state. However, cats then presented reperfusion or hyperperfusion during 12-24-hr period, and marginally hypoperfusion after 48 hr. NF-kappabeta positive cells were first found at 3-6 hr and peaked at 12-48 hr. At 72 hr to 7 days they showed a decreasing trend and nearly disappeared at 15 days.NF-kappabeta expression was significantly increased due to ischemia reperfusion in the perihematomal region after cerebral ischemia, and the resulting inflammatory and immune reaction were the major causes for ischemia reperfusion injury in the perihematomal region.

Researchers suggest that endoplasmic reticulum (ER) stress cause apoptosis after ischemia. Caspase-12 has been localized to the ER and is a signal for apoptosis. We sought to clarify the role of caspase-12 in the vascular endothelial growth factor (VEGF) induced neuroprotective effect. Transient focal cerebral ischemia was produced by occluding left middle cerebral artery in rabbit. The expressions of caspase-12 and caspase-3 were detected by immunohistochemistry. Neuronal apoptosis was detected by TUNEL staining. We confirmed that the number of apoptotic cells and the expressions of caspase-12 and caspase-3 significantly increased during reperfusion. VEGF inhibited the cell apoptosis and the expressions of caspase-12 and caspase-3. These results suggest that VEGF may protect neurons from apoptosis by inhibiting ER stress pathway.

Injury to the superior gluteal artery (SGA) is usually associated with acetabular fractures or posterior pelvic ring injuries. The diagnosis is suspected in cases of initial hemodynamic instability which is refractory to resuscitation. The initial presentation is often dramatic and is caused by direct injury to the artery at the time of traumatic impact. In these cases, patient management at most trauma centers follows a pre-arranged algorithm which decreases the likelihood of a missed diagnosis. Delayed arterial bleeding, however, is rare and potentially catastrophic since most algorithms are not designed to detect these infrequent occurrences. We present two such cases due to initial blunt buttock trauma combined with an anterior pelvic ring fracture and a L2 spine fracture which resulted in delayed massive bleeding from the SGA. Delayed arterial bleeding should be considered in late onset shock associated with pelvic or lumbar vertebrae body fractures or direct buttock injury. If active bleeding is suspected, urgent arteriography with embolization is the treatment of choice.

Traumatic injuries of the inferior gluteal artery are rare, the majority of which are aneurysms due to sharp or blunt trauma. We report the rare case of a "near miss" event of a patient with an acute hemorrhagic mass in the right buttock caused by blunt trauma to the inferior gluteal artery without "hard" clinical signs of vascular injury. Despite the unusual presentation, diffuse injury of the inferior gluteal artery branches was diagnosed by ultrasonography and angiography. This article highlights the importance of considering an arterial injury following blunt trauma to the buttock with subsequent pain and swelling. Appreciation of this rare injury pattern is necessary in order to facilitate rapid diagnosis and appropriate treatment.

To observe the morphology and anatomic variations of the circle of Willis and its clinical significance. To measure and establish the normal reference parameters of average diameters of its component vessels in the healthy Chinese by using 3D-TOF MR angiograms and to determine whether age-or sex-related differences exists in the circle' anatomy. MRA was performed in 153 healthy subjects. According to its integrity, Willis'circle was divided into four types: (1) Type I, showing an intact circle. (2) Type II, having a complete anterior circulation but an incomplete posterior circulation. (3) Type III, having an incomplete anterior circulation but a complete posterior circulation. (4) Type IV, having an incomplete anterior and posterior circulation. Based on the development of the components of the circle, each type was subdivided into four subtypes: typical, variable, hypoplastic and mixed. The statistically significant differences were not found in each type or subtypes between the different age and sex groups. Result of 153 cases, Type I, II, III and IV was found in 53 (34.64%), 73 (47.71%), 8 (5.23%), and 19 (12.42%) respectively. The display rate of the anterior and the posterior communicating arteries was 87.58%o (134/153) and 65.34% (100/153) respectively. Display rate of fetaltype posterior cerebral artery(PCA) was 20.92%. 3D-TOF MR angiography has important clinical significance for evaluating morphology and anatomic variations of circle of Willis. The normal values of diameter of cerebral arteries on MR angiograms may play a reference role in diagnosing cerebral vascular diseases.

Purpose To investigate correlations between altered spontaneous brain activity, diabetic vascular disease, and cognitive function for patients with type 2 diabetes mellitus (T2DM) using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Rs-fMRI was performed for T2DM patients (n = 26) and age-, gender-, and education-matched non-diabetic control subjects (n = 26). Amplitude of low frequency fluctuations (ALFF) were computed from fMRI signals to measure spontaneous neuronal activity. Differences in the ALFF patterns between patients and controls, as well as their correlations with clinical variables, were evaluated. Results Compared with healthy controls, T2DM patients exhibited significantly decreased ALFF values mainly in the frontal and parietal lobes, the bilateral thalumi, the posterior lobe of the cerebellum, and increased ALFF values mainly in the visual cortices. Furthermore, lower ALFF values in the left subcallosal gyrus correlated with lower ankle-brachial index values (r = 0.481, p = 0.020), while lower ALFF values in the bilateral medial prefrontal gyri correlated with higher urinary albumin-creatinine ratio (r = −0.418, p = 0.047). In addition, most of the regions with increased ALFF values in the visual cortices were found to negatively correlate with MoCA scores. Conclusions These results confirm that ALFF are altered in many brain regions in T2DM patients, and this is associated with the presence of diabetic vascular disease and poor cognitive performance. These findings may provide additional insight into the neurophysiological mechanisms that mediate T2DM-related cognitive dysfunction, and may also serve as a reference for future research.