OBJECTIVETo evaluate the reliability and accuracy of arcuate fasciculus (AF) navigation for AF localization and reconstruction.

METHODSReconstruction of the AF and assessment of the aphasia quotient (AQ) were performed in 43 cases before and after surgical removal of lesions in the language area of the brain. The minimal distance between the AF and the lesion (D(1)), preoperative AQ (AQ(1)), the minimal distance between the AF and the surgical cavity (D(2)), and the postoperative AQ (AQ(2)) were measured. Linear correlation analysis was conducted between D(1) or D(2) and the corresponding AQ(1) or AQ(2) to assess the relationship between the AF and language function. The language function of each patient was evaluated postoperatively.

RESULTSThe AF was successfully reconstructed in all the cases. The tractography results of the identical AF generated by 3 different users showed good congruency. A positive linear correlation was demonstrated between D(1) and AQ(1) (P<0.001) and between D(2) and AQ(2) (P=0.001). Only two patients (4.7%) showed language deficits at postoperative follow-up.

CONCLUSIONAF navigation is a reliable and accurate technique for AF reconstruction and localization and helps to preserve the language function after surgical removal of lesions in the language area of the brain.

Adolescent ; Adult ; Diffusion Tensor Imaging ; Female ; Humans ; Language Disorders ; diagnosis ; Male ; Middle Aged ; Nerve Fibers ; Neuronavigation ; Reproducibility of Results ; Young Adult

Objective To investigate the value of multi-phase contrast enhanced MR in the diagnosis and differential diagnosis of thyroid nodules. Methods From September 2015 to January 2018,176 patients with 257 thyroid nodules(109 malignant and 148 benign)preoperatively evaluated by multi-phase contrast enhanced MR were included in the present study.The final diagnoses for all cases were proved by the final pathological reports in our hospital.The diagnostic value of multi-phase contrast enhanced MR in thyroid nodules was analyzed retrospectively. Results The outflow ring sign can be regarded as a specific sign of papillary thyroid carcinoma (χ2＝125.03,P＝0.000)and the diagnostic sensitivity,specificity,positive predictive value and negative predictive value were 66.06%,98.65%,97.30%and 79.78%,respectively.The obvious enhancement was more common in benign thyroid nodules (χ2＝33.45,P＝0.000)and it can be regarded as a specific sign of adenoma and adenomatoid nodule(χ2＝74.7 5 ,P＝0.000 ).Conclusion The multi-phase contrast enhanced MR has important clinical application value in the diagnosis and differential diagnosis of thyroid nodules.The outflow ring sign can be regarded as a specific sign of papillary thyroid carcinoma,and the obvious enhancement was an important feature of benign nodules,especially of adenoma and adenomatoid nodules.

Objective To investigate the relation between TMB and the efficiency of PD-1/PD-L1 inhibitors treatment for non-small-cell lung cancer. Methods Studies were searched from PubMed, Embase, Cochrane Library database, Chinese Biomedical Literature Database and Wanfang Database up to March 25, 2020. RevMan 5.3 software and STATA15.0 were used for analysis. Results Twelve literatures were involved, including 1209 patients. TMB significantly improved PFS (HR=0.54, 95%CI: 0.42-0.70, P < 0.001) but reduced the ORR (OR=4.41, 95%CI: 2.54-7.63, P < 0.001) of NSCLC patients treated with PD-1/PD-L1 inhibitors. The subgroup analyses showed that the predictive value of TMB was significant in non-small cell lung cancer treated by PD-1/PD-L1 inhibitors combined with anti-CTLA-4 therapy or chemotherapy. No significant publication bias was observed by the Begg's test and Egger's test. Conclusion High tumor mutation burden may predict the improved PFS of non-small cell lung cancer by PD-1/PD-L1 inhibitors treatment, but its predictive value for OS, ORR and long-term survival need more exploration.

Objective:To analyze the clinicopathological features of intraabdominal bronchogenic cyst.Methods:The clinical data of 8 patients with intraabdominal bronchogenic cyst admitted in 3 Grade-A tertiary hospitals in Yunnan province between 2014 and 2023 were retrospectively analyzed. The clinical and pathological features, diagnosis, treatment and prognosis of intraabdominal bronchogenic cyst were reviewed.Results:There were 1 male and 7 females with an mean age of 45±12 years (21-65 years). Two patients presented with abdominal pain and 5 asymptomatic patients were found during physical examination. The cysts were located in retroperitoneum in 4 cases, located between the pancreas tail, spleen and the posterior wall of the stomach in 2 cases, located in the posterior wall of the stomach in 1 case, and located close to left adrenal gland in 1 case. Two patients had elevated tumor markers, while tumor markers in the remaining 6 cases were normal. Seven cases underwent laparoscopic complete cyst resection and 1 case had open surgical resection. The wall of most cysts were lined with respiratory epithelium and composed of goblet cells or pseudostratified ciliated columnar epithelium. The wall of cysts was composed of fibrous connective tissue or smooth muscle bundles, and the cavity contained serous mucous glands. Two cases showed cartilage tissue and one showed the infiltration of large number of inflammatory cells. The mean follow-up time was 31±32 months (range 5-107 months), and no recurrence or metastasis was found during the follow-up.Conclusions:Abdominal bronchogenic cyst is often found in adulthood, and most cases are symptomatic and found during physical examination. The diagnosis mainly depends on pathological examination, and tumor markers are not specific for its diagnosis. Surgery is the best way for treatment.

OBJECTIVE: To explore the correlation between diabetic nephropathy (DN) and cognitive impairment through examining the cognitive function and the metabolism of the cerebrum in Type 2 diabetes mellitus patients at different stages of renal function.
 METHODS: Eighty six patients with Type 2 diabetes mellitus (T2DM) were enrolled for this study. According to the urinary albumin excretion rate (UAER), the patients were divided into a T2DM without DN group (DM group, n=33), an early DN group (DN-III group, n=26) and a clinical stage group (DN-IV group, n=27). Thirty healthy adults were selected as a control group (NC group). Biochemical indexes and UAER were measured, and glomerular filtration rate (GFR) was detected by single-photon emission computed tomography (SPECT). The cognitive function was measured by Montreal Cognitive Assessment (MoCA, Beijing version) and mini-mental state examination (MMSE). The peak areas of N-acetylasparte (NAA), creatine (Cr), choline-containing compounds (Cho) were detected by proton magnetic resonance spectroscopy (1H-MRS).
 RESULTS: 1) There was no statistical difference in MMSE scores between the DM group and the control group. The scores of MoCA in the DN-III group or in the DN-IV group were significant less than that in the NC group (F=3.66, P<0.05); 2) There was significant difference in left N-acetylaspartate (LNAA), left choline (LCho) among the diabetes groups. Compared with the DM group, the level of LNAA was decreased significantly (t=3.826, P<0.05) while the LCho was increased significantly (t=4.373, P<0.05) in the DN groups, with statistic difference between the 2 groups (t=3.693, P<0.05); 3) The MoCA scores of T2DM patients were negatively correlated with UAER (r=-0.285, P<0.05), while positively correlated with GFR (r=0.379, P<0.05); 4) Logistic regression analysis indicated that UAER and GFR were the major risky factors for diabetic cognitive impairment.
 CONCLUSION Diabetic cognitive impairment is closely correlated with the nephropathy in patients with Type 2 diabetes. With the decline in glomerular filtration function, the cognitive disorder tends to be aggravated. The hippocampal brain metabolism may have some changes in left side of Cho/Cr in patients with diabetic nephropathy.
Adult ; Aspartic Acid ; analogs & derivatives ; metabolism ; Case-Control Studies ; Cerebrum ; metabolism ; Choline ; metabolism ; Cognition ; Cognition Disorders ; epidemiology ; Creatine ; metabolism ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Nephropathies ; epidemiology ; Glomerular Filtration Rate ; Humans ; Neuropsychological Tests