Objective To study the MR images of patients with Alzheimer's disease (AD) for analysis of the volume changes ofbrainstem and deep brain nuclei,hoping to provide evidence for early clinical diagnosis.Methods Selected for this study were MRI images from the ADNI database from July 2006 to November 2010 of 31 AD patients (AD group),34 patients with mild cognitive impairment (MCI group),and 34 normal aged people (NC group).The follow-up MRI data of all the above subjects 2 years later were also collected.Software Freesufer was used to calculate and compare the volume changes ofbrainstem and deep brain nuclei in all the subjects.Results An identical trend was found concerning the MRI-based volumes of brainstem,hippocampus and deep brain nuclei (caudal nucleus and putamen) before and after follow-up between the 3 groups:AD group＜MCI group＜NC group,with statistically significant differences between groups (P＜0.05).Follow-ups revealed significant decreases in all the indicators in AD and MCI groups (P＜0.05),but no such differences in NC group (P＞0.05).Pearson relative analysis showed a positive correlation between the brainstem volume and the volume of deep brain nuclei (caudal nucleus and putamen) in AD patients (r=0.653,P=0.021;r=0.596,P=0.014).Conclusions As AD progresses,the brainstem and deep brain nuclei in AD patients continue to shrink in volume and there may be a positive correlation between them.Therefore,detection of the volume changes of the brainstem and deep brain nuclei contributes to the early diagnosis of AD.

Objective To investigate the morphological changes of the brainstem in patients with Alzheimer's disease (AD) and their relationship with hippocampal morphological changes.Methods Sixty AD patients (AD group) and sixty age-and gender-matched normal elderly (normal control group) were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database.The hippocampus and the brainstem of each subject were segmented and their normalized volumes were calculated.According to the hippocampal volume standard value (Z-score),AD patients were divided into two subgroups (hippocampal atrophy group (n=51) and hippocampal spared group (n=9)).A voxel-based morphology (VBM) study was also performed to investigate the morphological differences of the brainstem between the normal control group and the AD group,as well as between the AD subgroups.Results Compared with the normal control group,the brainstem volume in the AD group decreased significantly (16 741.31±1 739.11 vs 15 609.67±1 451.60,t=3.870,P=0.001).In AD subgroups,the volume of the brainstem in the hippocampal atrophy group was significantly smaller than that in the hippocampal spared group (16 556.30 ± 1 514.86 vs 15 442.62 ± 1 389.05,t=2.189,P=0.033).Pearson correlation analysis showed that Mini-Mental State Examination scores were positively correlated with the hippocampal and the brainstem volumes (r=0.590,P＜0.01;r=0.234,P＜0.05),and there was a positive correlation between the hippocampal and the brainstem volume changes in patients with AD (r=0.315,P=0.014).VBM results showed that both the bilateral midbrain and the bilateral pons in the AD group had significant atrophy compared with the normal control group (P＜0.05).In the AD subgroups,the bilateral midbrain and the left pons in the hippocampal atrophy group were significantly atrophied compared with the hippocampal spared group (P＜0.05).Conclusion The brainstem showed morphological changes in patients with AD,and the morphological changes of the brainstem in AD patients with different degrees of hippocampal atrophy were different,indicating the morphological changes of the hippocampus and the brainstem may have an interrelated relationship.

AIM: To investigate the effects of age, gender, duration of medication and combined medication on the steady-state blood concentration of tacrolimus in patients with autoimmune diseases, and to establish the reference range of steady-state blood concentration of tacrolimus in combination with liver and kidney function, so as to provide theoretical basis for clinical individual medication. METHODS: A total of 107 patients with autoimmune diseases treated with tacrolimus in the department of rheumatology and immunology of our hospital from August 2017 to June 2021 were included. Their gender, age, dose, drug combination, blood concentration, and liver and kidney function were statistically analyzed by SPSS 22.0 statistical software. RESULTS: In the treatment of autoimmune diseases with tacrolimus, there was statistical significance in the blood concentration of different genders (P<0.05), but there was no statistical significance in the blood concentration of different ages (P>0.05) and a statistically significant difference in the dosage of tacrolimus (P<0.05), the duration of medication did not affect the effective dose, target blood concentration, liver and kidney functions. There was a weak correlation between tacrolimus dose and blood concentration (r=0.115, P=0.047). When the blood concentration of tacrolimus ranged from 4.20 to 9.48 ng/mL, the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and urea increased significantly. When tacrolimus blood concentration ranged from 0.08 to 4.20 ng/mL, there was no significant difference in serum creatinine, AST, ALT, albumin, total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL). CONCLUSION: Tacrolimus is used for the treatment of autoimmune diseases, and the blood concentration varies greatly among individuals. To avoid the risk of potential damage to liver and kidney function. It is recommended that clinicians control the blood concentration at 0.08-4.20 ng/mL, and adjust the dose and optimize the dose according to the patient's gender, age, and clinical efficacy.

OBJECTIVETo evaluate the efficiency of individually fabricated titanium mesh to correct enophthalmos following orbital fracture by using computer-assisted navigation system.

METHODSForty- nine patients with unilateral orbital fracture were divided into navigation group (25 cases) and non-navigation group (24 cases). All patients underwent orbital reconstruction to correct post-traumatic enophthalmos with individually fabricated titanium mesh. The bilateral global projection and the orbital volumn were measured preoperatively and postoperatively. The depth of titanium mesh was measured postoperatively.

RESULTSStatistical analysis demonstrated the global projection at the affected side increased by (3.35 ± 1.46) mm in navigation group and by (2.25 ± 1.14) mm in non- navigation group postoperatively, and there was a significant difference between the two groups (P < 0.05). The orbital volumn at the affected side decreased by (5.94 ± 2.20) ml in navigation group and by (4.21 ± 2.18) ml in non-navigation group, and there was a significant difference between the two groups (P < 0.05). The depth of titanium was (31.95±2.97) mm in navigation group and (29.27±2.72) mm in non-navigation group, and the values between the two groups differed significantly (P < 0.05).

CONCLUSIONSThe use of computer-assisted navigation for the orbital wall reconstruction with individually fabricated titanium mesh can protect the optic nerve reliably and achieve satisfactory results.

Enophthalmos ; etiology ; surgery ; Eye Injuries ; Humans ; Orbit ; Orbital Fractures ; complications ; Prostheses and Implants ; Reconstructive Surgical Procedures ; Surgery, Computer-Assisted ; Surgical Mesh ; Titanium

Objective    To summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation. Methods    Perioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period. Results    Among them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation. Conclusion    MICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.

Objective: To investigate the molecular epidemiological characteristics of Human Calicivirus (HuCV) infection among children less than 5 years in Kunming city, Yunnan province, it might be provide effective evident for prevention and control the diarrhea related with HuCV infection. Methods: Four sentinel hospitals were recruited in the study from Kunming city, Yunnan province, 850 diarrhea cases and 170 non-diarrhea subject were recruited in this study from 2014 to 2015. RT-PCR was performed to screen HuCV infection, and gene sequencing was used to ensure positive infection subtypes and genotypes. Results: The positive rate of HuCV was higher in children with diarrhea than in non-diarrhea children (11.5%, 98/85; 4.7%, 8/170, χ²=7.083, P=0.008), and the positive rate of Norovirus (NoV) GII was higher in non-diarrhea children were (11.1%, 94/85; 4.7%, 8/170, χ²=6.353, P=0.012). There was no significant difference in the positive rate of NoV GI (0.1%, 1/850; 0.0%, 0/170, P=0.833) and Sappovirus (0.4%, 3/850; 0.0%, 0/170, P=0.578) in diarrhea children and non-diarrhea children. GII.P4 (10%, n=102) was the most important genotype of NoV GII detected in diarrhea and non-diarrhea individuals. Despite no significant difference in Norovirus GII infection between different age groups (χ²=0.038, P=0.846) and sex(χ²=0.620, P=0.733), infection rate of NoV GII varied with season (χ²=9.867, P=0.020), having close relationship with diarrhea in autumn (15.6%), primarily caused by GII.4 and GII.12 genotype (χ²=8.881, P=0.031; χ²=7.917, P=0.039). Conclusions NoV GII diarrhea had higher epidemic rate, which was caused by multiple genotypes, GII.P4 was a dominant genotype, and was a major pathogenic agent of diarrhea in infants f in Kunming city.