Objective To study the effects of repetitive transcranial magnetic stimulation (rTMS) combined with hyperbaric oxygen (HBO) therapy on the recovery of neurological functional after cerebral infarction,and to discuss its possible mechanism.Methods Forty-five patients with cerebral infarction were randomly divided into a control group,an rTMS group and an rTMS plus HBO group,each group with 15 patients.The patients in the two treatment groups received 1 Hz rTMS to inhibit the unaffected hemisphere and 3 Hz rTMS to stimulate the affected hemisphere.One of the treatment groups also received HBO therapy,14 daily sessions.The National Institutes of Health stroke scale (NIHSS) and the Barthel index (BI) were evaluated on the 1st,14th and 30th day of treatment.Results The neurological function scores of those in the rTMS group and the rTMS & HBO group improved significantly.On the 1st and 14th day,no significant difference in NIHSS or BI scores was observed among the three groups,but by the 30th day the average neurological functional score in the rTMS & HBO group had improved significantly compared with the control group.The rTMS plus HBO group showed significantly better improvement than the rTMS group in terms of BI scores,but no significant difference in average NIHSS and BI scores was observed between the rTMS group and the control group.Fifteen days after the treatments had finished,the follow up results showed the improvements of the patients in the rTMS plus HBO group were significantly better than those in the other groups.Conclusion For patients with cerebral infarction,rTMS combined with HBO therapy can improve neurological function more significantly than rTMS therapy alone.

Atherosclerotic plaque is an important cause of ischemic stroke. High-resolution vessel wall magnetic resonance imaging (VW-MRI) has been widely used in the study of intracranial atherosclerotic plaques, which is of great value for the display of plaque distribution. This article reviews the distribution of intracranial atherosclerotic plaques based on VW-MRI.

With the development of imaging technology, high-resolution magnetic resonance vascular wall imaging technology has been gradually applied to the risk assessment of intracranial aneurysms rupture. It has provided more comprehensive information for clinicians to assess the stability of intracranial aneurysms. This article summarizes the indicators used for assessing the risk of intracranial aneurysms rupture in recent years with high-resolution magnetic resonance vascular wall imaging.

Objective To compare the clinical effect of ifosfamide in combination with liposomal doxorubicin and dexamethasone (CDD) in the treatment of relapsed/refractory multiple myeloma (MM) with or without extramedullary plasmacytoma (EMP). Methods The clinical data of 71 relapsed/refractory MM patients treated with CDD regimen from January 2011 to December 2016 were retrospectively analyzed, including 48 patients with EMP(group A)and 23 patients without EMP (group B).One cycle of the CDD treatment was 21 d or 28 d and efficacy analysis was performed after every two cycles.Results The overall response rate in group A was 43.8%(21/48)and the complete remission and near complete remission rate was 8.3%(4/48);the overall response rate in group B was 65.2%(15/23)and the complete remission and near complete remission rate was 13.0% (3/23). There were no statistically significant differences between the two groups(χ2=1.203,0.659,P>0.05).The progression-free survival (PFS)time in group A was(8.6 ± 3.3)months, while the PFS time in group B was(7.9 ± 2.5)months and there was no significant difference between the two groups(t=1.009,P>0.05).There was no significant difference about incidence rate of adverse effects between the two groups(P>0.05).Conclusions CDD regimen can be used for the treatment of relapsed/refractory MM with or without EMP, the PFS and drug related adverse effects are similar, especially in patients with EMP.

Objective To investigate the value of diffusion kurtosis imaging (DKI) in diagnosing early diabetic nephropathy. Methods Twelve pigs were divided into the experimental group (7 pigs) and the control group (5 pigs), used the random number table method. The experimental group was fed with high?fat high?sugar diet,and then repeatedly injected small doses(50 mg/kg) of Streptozotocin (STZ) through the ear vein. Meanwhile,the control group was fed with normal diet and injected with the same dose of citric acid?sodium citrate buffer solution.After the type 2 diabetes was established successfully, T1WI, T2WI and DKI sequence imaging were performed every month for 2 pigs from the experimental group and the control group,respectively.Mean kurtosis(MK), axial kurtosis (K∥), radial kurtosis (K⊥), fractional anisotropy (FA) and mean diffusivity(MD) were measured on the pseudo?color map of the post?processing workstation. fasting blood glucose(GLU),insulin (INS),renal function, urine routines and random albumin creatinine ratio(RACR) were measured before MRI scan. Specimens from bilateral kidneys were taken for pathological examination after MRI scan. The paired t test was used to compare the parameter values of the cortex and medulla. Independent sample t test was used tocompare the parameter values of the experimental group and the control group. Results In the experimental group,the MK, FA values of medulla were 0.66±0.07 and 0.19± 0.04, the MK, FA values of cortex were 0.60±0.06 and 0.16±0.03.In the control group,the MK, FA values of medulla were 0.59±0.03 and 0.20±0.04, the MK, FA values of cortex were 0.53±0.03 and 0.17±0.04.The MK and FA values of medulla were increased compared with the cortex and the difference were statistically significant (P<0.01). The MK, K⊥ values of cortex and medulla were increased in the experimental group compared with the control group and the difference were statistically significant (P<0.05). There was no significant differences in the K∥, FA and MD values between two groups (both cortex and medulla, P>0.05). Conclusion DKI sequencehas certain value in the diagnosis of early diabetic nephropathy, and to some extent reveals the pathological change in early diabetic nephropathy.

Objective:To explore the value of enhancement rate of aneurysm wall by high-resolution magnetic resonance vessel wall imaging (HR-VWI) in assessing the risk of intracranial aneurysm rupture.Methods:Seventy patients with 80 intracranial aneurysms, admitted to our hospital from January 2016 to December 2019, were chosen in our study; morphological parameters (shape, neck width, height, diameter) of the intracranial aneurysms, and signal intensity and enhancement rate of aneurysm wall were collected from HR-VWI. These patients were divided into a high-risk rupture group (PHASES scores>3) and a low-risk rupture group (PHASES scores≤3) according to PHASES scores. Univariate analysis was used to compare the differences of clinical data (age, gender, blood pressure, blood lipids, and smoking history) and aneurysm imaging data between the two groups of patients. Multivariable Logistic regression was used to determine the independent influencing factors for aneurysm rupture, and receiver-operating characteristic (ROC) curve of enhancement rate of aneurysm wall in predicting aneurysm rupture was drew to determine the best diagnostic value.Results:Univariate analysis showed that the percentages of patients with hypertension, multiple aneurysms and irregular aneurysm morphology, aneurysm height, aneurysm diameter and aneurysm wall enhancement rate were significantly different between the high-risk rupture group and low-risk rupture group ( P<0.05). Multivariate Logistic regression analysis showed that aneurysm diameter ( OR=1.647, 95%CI: 1.177-2.306, P=0.004) and aneurysm wall enhancement rate ( OR=5.317, 95%CI: 1.527-18.512, P=0.009) were independent influencing factors for rupture of intracranial aneurysms. The area of ROC curve was 0.735, the optimal cut-off value was 0.583; the sensitivity of predicting rupture of intracranial aneurysms was 72.7% and the specificity was 70.2%. Conclusion:The aneurysm wall enhancement rate is significantly correlated with risk of aneurysm rupture; when the PHASES scores>3 and aneurysm wall enhancement rate>58.3%, clinical intervention should be vigilant.

Objective:To investigate the high resolution vessel wall imaging (HR-VWI) features of basilar artery (BA) in patients with acute isolated pontine infarction (AIPI) of different infarct types, and explore the pathogenesis of AIPI.Methods:A retrospective analysis of clinical and imaging data of 52 patients with AIPI admitted to our hospital from June 2016 to November 2019 was performed. According to the morphology and location distribution of pontine high-signal lesions in diffusion-weighted imaging (DWI), these patients were divided into paramedian pontine infarction (PPI) group and small deep pontine infarction (SDPI) group. The general clinical data, modified National Institute of Health stroke scale (mNIHSS) scores at admission and discharge, modified Rankin scale (mRS) scores, and incidence of basilar artery plaques and plaque characteristics of basal artery in HR-VWI of patients from the two groups were compared.Results:Among the 52 AIPI patients, there were 28 patients with PPI (54%) and 24 with SDPI (46%). The mNIHSS scores at admission and discharge in the PPI group were significantly higher than those in the SDPI group ( P<0.05). The incidence of basilar artery plaques in PPI group was significantly higher than that in SDPI group (92.9% vs. 62.5%, P<0.05). As compared with SDPI group, PPI group had a significantly higher incidence of right lateral wall plaques, a statistically lower incidence of ventral wall plaques, and a significantly higher incidence of centripetal plaques, and significantly increased maximum thickness of vessel wall ( P<0.05). Conclusion:The AIPI mechanism is generally related to the branch atheromatous disease of basilar artery; PPI patients have more severe clinical symptoms, more serious clogged perforation opening of the basilar artery plaque, more unstable basilar artery plaque than the SDPI group.

OBJECTIVETo determine the levels of urinary soluble intercellular adhesion molecule-1 (sICAM-1) and vascular cellular adhesion molecule-1 (VCAM-1) in patients with lupus nephritis (LN), and explore their correlation with renal disease activity.

METHODSUrine samples were collected from 92 renal biopsy-proven LN patients and 20 healthy controls. Renal disease activity was determined according to the ISN/RPS 2003 Revised Classification of Lupus Nephritis. The urine levels of sICAM-1 and VCAM-1 were detected by enzyme-linked immunosorbent assay, and the expressions of intrarenal ICAM-1 and VCAM-1 were evaluated by immunohistochemisty staining.

RESULTSUrinary sICAM-1 and VCAM-1 levels were elevated in LN patients compared with the controls. Significantly higher levels of urinary sICAM-1 and VCAM-1 were found in patients with active LN, who had also significantly increased intrarenal expressions of ICAM-1 and VCAM-1 compared with patients in remission. A strong positive correlation was noted between intrarenal expression and urine levels of ICAM-1 and VCAM-1. The receiver-operating characteristic (ROC) curve of urine sICAM-1 showed tan area under ROC curve of 0.874 for all participants in the test. A cutoff of 1095.00 pg/mg creatinine yielded a good sensitivity (0.945) and specificity (0.789). The ROC curve of urine VCAM-1 showed an area under ROC of 0.882 for all the participants, and a cutoff of 898.11 pg/mg creatinine yielded a good sensitivity (0.982) and specificity (0.667).

CONCLUSIONUrine sICAM-1 and VCAM-1 levels are positively correlated with their intrarenal expressions and reflect the activity of the nephritis, and therefore they may serve as potential biomarkers for early diagnosis of active LN.

Biomarkers ; urine ; Case-Control Studies ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Intercellular Adhesion Molecule-1 ; urine ; Kidney ; metabolism ; Lupus Nephritis ; diagnosis ; urine ; ROC Curve ; Sensitivity and Specificity ; Vascular Cell Adhesion Molecule-1 ; urine

The geometric morphology of intracranial arteries has unique characteristics and laws. Congenital variation is also often seen in clinical work. Both have certain clinical significance in the occurrence and development of cerebrovascular diseases, as well as in anatomy and function. This article summarizes some of the findings on the morphology and variation of intracranial arteries in cerebrovascular disease research in recent years, and reviews the imaging techniques of intracranial arteries as well as the clinical significance of geometric morphology and congenital variation.

Objective　To investigate the characteristics of high resolution vessel wall imaging (HR-VWI) imaging of unstable plaques in acute pontine infarction.Methods　Data from thirty-nine patients with symptomatic acute pontine infarction and 45 patients with asymptomatic pontine infarction in the Peopl’s Hospital of Baoan District,Shenzhen from June 2016 to November 2019 was retrospectively analyzed.The distribution of BA plaques and plaque involvement were counted on HR-VWI Quadrant.Plaque surface continuity,plaque length,vascular volume (Vouter),vascular wall volume (V wall),lumen diameter in the narrowest layer of the lumen (LD MLN),maximum diameter of the outer lumen (OD MLN ),vascular area (OA MLN),vascular wall area (WA MLN),the thickest thickness (WTmax),the plaque load (PB),and lumen stenosis rate were measured.Measurement indicators were compared between the two groups.Results　The plaque distribution,plaque discontinuity,WTmax,WA MLN,PB,and BA lumen stenosis rates between the two groups were statistically different (P<0.05).Conclusions　BA plaques with symptomatic pontine infarction are more likely to be distributed on the side wall,the surface is more discontinuous,thicker plaque thickness,larger blood vessel area and plaque load,higher luminal stenosis rate,suggesting that it has instability Plaque characteristics.