Objective To compare the effect on intraoperative cerebral metabolism between the propofol combined with remifentanil infusion in total intravenous anesthesia and the desflurane combined with remifentanil intravenous inhalation anesthesia in patients in neurosurgery.Methods Thirty-four patients were randomly divided into the propofol combined with remifentanil group (group A,n=16) and the desflurane combined with remifentanil group (group B,n =18).The B-ultrasound under the guide of retrograde catheterization through right internal jugular vein and artery was prepared after the patients entered the operation room.Atropine,propofol,fentanyl,rocuronium were used in the induction of anesthesia.The mechanical ventilation was applied after conventional trachea cannula.Once patients were anesthetized steadily,jugular bulb venous oxygen saturation (SjvO2),jugular bulb venous oxygen partial pressure (PjvO2),Jugular Bulb venous hemoglogin (Hbv),jugular bulb venous lactate (Ljv),jugular bulb venous gluxose (Gv),arterial oxygen saturation (SaO2),arterial oxygen pressure (PaO2),arterin (Hba),arterial blood lactate (La),arterial blood gluxose (Ga),arterial blood oxygen content (CaO2),jugular bulb venous oxygen content (CjvO2),arteriovenous oxygen difference (AVDO2),cerebral extraction of oxygen (CEO2),cerebral lactate production rate (CLP) and cerebral glucose uptake rate (CGU) at different time [before anesthesia induction (T1),1 hours after the start of the operation (T2),2 hours after the start of the operation (T3),half an hour after the operation]were collected.Results (1) The value of SjvO2,PjvO2,CjvO2 and CaO2 in group B was significantly higher than that in group A (P＜0.001);The value of AVDO2 and CEO2 in group B was lower than that in group A (P＜0.05);(2) The value of Gv and Ga in group B was higher than that in group A (P＜0.05);There were no significant differences about CGU in two groups (P＞0.05);(3) The value of CLP in group B was lower than that in group A (P＜0.05);there were no significant differences about Ljv and La in two groups (P＞0.05);(4) Compared with the value at moment of T1 between group A and group B,the value ofPaO2,SaO2,PjvO2 and SjvO2 were increased with time (P＜0.05),the value of CaO2,CjvO2,AVDO2 and CEO2 showed a downward trend (P ＜0.05).Conclusion (1) Both total intravenous anesthesia and intravenous inhalation anesthesia can reduce the cerebral oxygen metabolism;(2) For the cerebral protection of neurosurgery operation,it seems that the effect of intravenous inhalation anesthesia is more stronger than total intravenous anesthesia.

Objective To study the activated status of insula during the performance of word generation task, and to explore the function of different part of insula with functional MRI (fMRI). Methods Twenty-eight subjects were recruited in this study (male 15, female 13), all of them underwent block-designed fMRI with word generation tasks and resting-state scan. SPM 5 and REST 1.3 were used to process the data. Bilateral anterior insula and posterior insula were selected as seeds to calculate the connectivity coefficiency with other voxels, and differences between the anterior and the posterior insula were compared. Results Bilateral anterior insula was significantly activated, while bilateral posterior insula was significantly deactivated. The functional connectivity areas with left anterior insula included right anterior insula, right posterior insula, supplementary motor area (SMA), left superior temporal gyrus, left middle frontal gyrus, left superior frontal gyrus, left inferior parietal lobe, middle cingulate gyrus, right striatum and right inferior frontal gyrus. The functional connectivity areas with left posterior insula included right posterior insula, left anterior insula, right superior temporal gyrus, middle cingulate gyrus, right precentral gyrus and right striatum. The functional connectivity areas with right anterior insula included SMA, left inferior frontal gyrus, right inferior parietal lobe, left inferior parietal lobe, left superior temporal gyrus, right precentral gyrus, right striatum, middle cingulate gyrus, left middle frontal gyrus, left striatum, right middle frontal gyrus, right inferior frontal gyrus and left transverse temporal gyrus. The functional connectivity areas with right posterior insula included right precentral gyrus, left superior temporal gyrus, left anterior insula, left posterior insula, right supramarginal gyrus and middle cingulate gyrus. Conclusion Anterior insula and posterior insula are functionally connected with different areas, and concerned with the language function in different manners. Left lateral anterior insula may play an important role in the language function.

Objective: To evaluate the value of computed tomography (CT) multi-planner reconstruction (MPR)in the treatment of lung cancer with percutaneous argon-helium cryoablation.Method:A total of 66 patients with stage T2 or T3 non-small cell lung can-cer who had complete follow-up data were treated with percutaneous argon-helium cryoablation with conventional axial CT(conven-tional group)or MPR guidance(MPR group)between January 2013 and 2016.There were 31 patients in the conventional group and 35 in the MPR group.The total number of punctures,the total time of operation,and the incidence of complications,tumor residual rates,and local control rates were compared between the two groups.Results:When the number of needles was the same,the aver-age number of punctures and puncture errors in the two groups were significantly lower in the MPR group than in the conventional group(P<0.05).Comparing the average operation time,there was no statistical difference between the MPR group and the conven-tional scan group(P>0.05).The incidence of postoperative complications was significantly lower in the MPR group than in the conven-tional scan group.Among them,the incidence of puncture combined hemorrhage was 1.52% vs.13.64%,and pneumothorax second-ary to puncture was 3.03% vs.19.70%(P<0.05).During the follow-up period to 12 months after surgery,the therapeutic benefit indica-tors such as local residual rate and total effective rate in the MPR group were also significantly better than those in the conventional group,which were 1.52% vs.10.61 and 51.52% vs.36.36%(P<0.05),respectively.Conclusions:Using MPR technology to guide percuta-neous argon-helium cryoablation treatment for lung cancer confers a small puncture error,low incidence of complications,and signifi-cant treatment benefits.This method is worthy of clinical promotion.

ObjectiveTo investigate the effect of combination with repetitive transcranial magnetic stimulation (rTMS) and median nerve electrical stimulation (MNS) on patients with prolonged disorders of consciousness (pDOC) in different age. MethodsFrom January, 2021 to May, 2023, 93 patients with pDOC in the First Affiliated Hospital of Nanchang University were divided into young group (≤ 45 years old), middle-aged group (46 to 60 years old) and elderly group (> 60 years old). All the groups were treated with rTMS and MNS for four weeks. The Coma Recovery Scale-Revised (CRS-R), Glasgow Coma Scale (GCS), and Full Outline of Unresponsiveness Scale (FOUR) were used to evaluate the efficiency of awakening after treatment and the awakening ratios were compared among three groups weekly. Four weeks after treatment, regional cerebral blood flow (rCBF) was measured with CT perfusion imaging. The score of Glasgow Outcome Scale Extended (GOS-E) was compared six months after treatment. ResultsFrom three weeks after treatment, the scores of CRS-R, GCS and FOUR increased in all groups (P < 0.05). After weekly treatment, there was no significant difference in the composition ratio of consciousness level and the awakening ratio among three groups (χ² < 11.057, P > 0.05). After four weeks of treatment, rCBF improved in three groups (|t| > 2.495, P < 0.05), however, there was no difference among three groups (F < 1.887, P > 0.05). There was no difference in the score of GOS-E at six months after treatment (F = 3.083, P = 0.055). ConclusionrTMS combined with MNS is effective on pDOC patients in different ages, and elderly patients could also benefit from it.

Alzheimer's disease (AD) is associated with the impairment of white matter (WM) tracts. The current study aimed to verify the utility of WM as the neuroimaging marker of AD with multisite diffusion tensor imaging datasets [321 patients with AD, 265 patients with mild cognitive impairment (MCI), 279 normal controls (NC)], a unified pipeline, and independent site cross-validation. Automated fiber quantification was used to extract diffusion profiles along tracts. Random-effects meta-analyses showed a reproducible degeneration pattern in which fractional anisotropy significantly decreased in the AD and MCI groups compared with NC. Machine learning models using tract-based features showed good generalizability among independent site cross-validation. The diffusion metrics of the altered regions and the AD probability predicted by the models were highly correlated with cognitive ability in the AD and MCI groups. We highlighted the reproducibility and generalizability of the degeneration pattern of WM tracts in AD.
Humans ; White Matter/diagnostic imaging* ; Diffusion Tensor Imaging/methods* ; Alzheimer Disease/complications* ; Reproducibility of Results ; Cognition ; Cognitive Dysfunction/complications* ; Brain/diagnostic imaging*