Objective To evaluate the efficacy of PET-CT brain imaging and resting-state fMRI in preoperative localization of temporal lobe epileptic (TLE)focus.Methods PET-CT and resting-state fMRI were performed in 17 patients with refractory TLE,who then underwent surgical treatment.Seventeen healthy volunteers matched with gender and age were recruited as the control group.The resting-state fMRI images were post processed by SPM5 software.Regional homogeneity(ReHo) values of the whole brain and bilateral hippocampus were obtained and analyzed.PET-CT images were analyzed by visual analysis method and asymmetry index method and the standardized uptake value (SUV) of bilateral hippocampus were obtained.The ReHo values and SUV of the bilateral hippocampus were compared by two independent samples t-test,and analyzed by receiver operating characteristic curve (ROC) for optimized diagnostic threshold.Pearson correlation analysis was employed for evaluating the correlation between the SUV and ReHo values of bilateral hippocampus.The consistency between the diagnostic accuracy of PET-CT and resting-state fMRI was assessed by Kappa consistency test.The outcome of the patient group was compared with that of the control group,and with the pathological results,to evaluate the diagnostic value of the two modalities for preoperative localization of temporal lobe epileptic focus.Results Regional or comprehensive low metabolism of 18F-FDG in temporal lobes was presented in all 17 patients,and 11 patients out of 17 showed lateral decreased ReHo value.The diagnostic accuracy of the two examinations was 70.6％ (12/17) and 64.7％ (11/17) for PET-CT and resting-state fMRI respectively compared with pathological results,and could be increased to 76.5％ (13/17) when the two methods were combined for diagnosis.The ReHo values of the TLE group (0.34 ± 0.12)were significantly lower than those of the control group (0.46 ± 0.07) (t =3.230,P =0.003).The sensitivity and specificity of resting-state fMRI were 88.2％ and 94.1％ respectively when the ReHo value was 0.36.There was significant difference between the SUV of the affected (4.17 ±0.63) and healthy side(4.77 ±0.56) of hippocampus in TLE group(t =2.930,P =0.006).The sensitivity and specificity of PET-CT were 88.2％ and 64.7％ respectively when SUV was 4.23.The two values could be used as a threshold in the localization of temporal lobe epileptic focus.Consistency of lesion detection was revealed between PET-CT and resting-state fMRI though it was not high,and the Kappa value was 0.49.However,no correlation was detected between the SUV and ReHo value using Pearson correlation test(r =0.280,P =0.314).Conclusion Combined PET-CT brain imaging and resting-state fMRI as a multi-modality imaging method might improve the diagnostic accuracy of the TLE focus's localization.

Objective To explore the clinical features of critical cases of coronavirus disease 2019 (COVID-19). Methods The clinical data of nine patients who were diagnosed with critical COVID-19 in Hainan General Hospital from January 21, 2020 to February 6, 2020 were retrospectively analyzed. RT-PCR testing for 2019 novel coronavirus (2019-nCoV) was performed with multi-sites synchronize specimens including pharyngeal swab, blood, excrement, and urine. The serum levels of leucocyte, C-reactive protein, procalcitonin and lactic acid between the improved group (five cases) and the deteriorated group (four cases) were compared. The t test was used for comparison of normally distributed continuous data between groups. Results There were eight males (88.9%) and 1 female enrolled. The patients aged 28-77 years old, with an age of (52.9±18.0) years. By March 4, 2020, all five cases in improved group were cured and discharged, three cases in deteriorated group died and 1case remained in critical condition. All multi-sites specimens of patients in improved group turned negative in 2-4 weeks of illness onset, while those of cases in deteriorated group showed sustained viral nucleic acid positive (up to 48th day of illness onset). The white blood cell counts ((13.52±8.24)×10 9 /L vs (10.49±4.46) ×10 9 /L), C-reactive protein ((139.71±87.46) mg/L vs (78.60±55.40) mg/L) and procalcitonin ((2.32±4.03) ng/mL vs (0.28±0.58) ng/mL) , lactic acid ((3.70±4.14) mmol/L vs (2.33±0.53) mmol/L) in deteriorated group were all significantly higher than those in improved group ( t =2.908, 5.009, 4.391 and 2.942, respectively, all P <0.01). A rapid rise of serum IL-6 level up to 8 500 pg/mL was observed in one patient three days prior to death. Conclusion Among the patients with critical COVID-19, serum levels of inflammatory cytokines of the death cases are higher than those of improved and discharged cases.