Objective To analyze the clinical and MRI manifestations of neurosyphilis in order to improve the recognition and di‐agnosis of the disease .Methods The MRI and clinical data of 11 patients with neurosyphilis confirmed in clinic were collected .The patients were categorized into different phenotypic types according to the clinical manifestations ,and the MRI manifestations were al‐so analyzed .Results 5 patients with parenchymal types showed cerebral atrophy .3 patients with meningovascular types showed cer‐ebral infarction .1 patient with encephalitis showed brain signal changes and meningeal enhancement .1 patient without symptom showed signal changes in brain parenchyma and mild enhancement .1 patient of myelopathic type showed signal changes of thoracic spinal cord without enhancement .Conclusion There is an overlap of the MRI findings of neurosyphilis in different clinical pheno‐types ,exhibiting no specifity .Neurosyphilis can be diagnosed when the young patient is manifested as cerebral atrophy ,infarction , MR signal intensity abnormality of cerebral parenchyma and spinal cord ,as well as meningeal enhancement .

Objective To evaluate the efficacy and safety of the transobturator tension-free vaginal tape (TVT-O) surgery, a minimally invasive surgery for treating patients with the stress urinary incontinence (SUI). Methods 28 cases with female stress uri-nary incontinence treated by TVT-O procedure from April 2006 to June 2008 were retrospectively analyzed. The follow-up time is from 4 to 24 months. Results The mean operation time was 23 min (rang 10～30 min) and the mean intraoperative bleeding was 24 ml (range 15～40 ml). An indwelling catheter had been used for 3 d because of urinary retention in 3 cases. 24 patients(85.7%)reached complete control after the surgery,effective control in 4 patients(14.35%). Conclusions TVT-O surgery is an effective, safe, minimally invasive management to treat the stress urinary incontinence.

Objective To evaluate diagnostic value of the novel virtual touch tissue imaging quantification (VTIQ) technique of acoustic radiation force impulse (ARFI) shear wave elastography in the differential diagnosis between benign and malignant thyroid lesions. Methods From June to July 2014, the imaging data of 82 thyroid lesions in 75 patients proven by fine needle aspiration cytology (FNAC) biopsy on conventional ultrasound and VTIQ were retrospectively analyzed. The thyroid nodules were examined by conventional ultrasound firstly and then the lesions were classified by thyroid imaging report and data system (TI-RADS). The maximum, minimum, median and average of shear wave velocity (SWV) values were obtained from multiple SWV measurement under the VTIQ speed mode. The region of interest (ROI) was determined according to the VTIQ quality mode after the patients holding the breath. According to the FNAC cytology results, ROC curve were plotted to determine the most accurate SWV value and the cut-off value for differential diagnosis. Results According to the FNAC results, grading≥5 level was set as the positive results and FNAC<5 level as the negative results. There were 28 positive nodules and 54 negative nodules in 82 thyroid nodules. The positive rates of TI-RADS classification were consistent with the theoretical results. The SWVmax, SWVmin, SWVmedian, and SWVmean on VTIQ of negative and positive thyroid nodules were (3.2±0.6), (2.2±0.4), (2.7±0.4), (2.6±0.4) m/s, and (4.6±1.7), (3.1±0.8), (3.5±1.0), (3.6±1.1) m/s. There were significant differences between positive and negative thyroid nodules in SWVmax, SWVmin, SWVmedian, and SWVmean on VTIQ (t=3.53, 3.68, 3.32, 3.81, all P<0.01). Based on the area under curve of ROC, the SWVmean value in the nodule was the best value in comparison with other SWV values. The cut-off value of VTIQ mean was 2.9 m/s. According to ROC curve analysis, the sensitivity, specificity and Youden index for VTIQ were 70.6%, 88.5%, 0.59, respectively. Conclusion The study proved that VTIQ elastography technique plays an important role in differential diagnosis of thyroid nodules and the VTIQ SWVmean is the best parameter for differential diagnosis.

Objective To explore the imaging indexes of early diagnosis of vascular cognitive impairment (VCI).Methods Totally 30 rats were collected and divided into model group (n=20) and control group (n=10).Modified 4-VO method was used to establish the VCI rat models.Morris water maze test was used to detect learning and memory abilities of rats.T2W and DTI scanning were performed in all rats 2 weeks,1 month,3 months and 5 months after operation,respectively.ROI was used to analyze the change of hippocampal volume and FA value.Voxel-based analysis (VBA) was used to analyze the change of FA value in all brain on DTI images.Then the rats were sacrificed,HE staining and Nissl staining of brain tissue slices were performed to observe the morphological changes.Results Compared with control group,the learning and memory ability of rats in model group decreased significantly.Compared with the control group,the hippocampal volume and FA value in model group decreased significantly at 3 months and 5 months after operation,respectively (all P＜0.05).FA in many brain areas reduced 1,3,5 months after operation in model group (all P＜0.05),and the decrease regions expanded with time going.Pyramidal cells in the hippocampal showed degeneration and nuclear condensation,and cytoplasmic Nissl bodies demonstrated reduction and disappearance gradually.Conclusion Changes of rat hippocampal volume and microscopic white matter may be helpful to early diagnosis of VCI.Decrease of FA value can be used as an indicator for early diagnosis and severity evaluation of VCI.

Objective:To investigate the incidence and risk factors of coma in patients with hypoglycemia (≤3.9 mmol/L).Methods:A retrospective study was conducted. Patients aged 20 years and older with blood glucose levels ≤3.9 mmol/L, and measured by emergency physicians from January 2020 to December 2022 were collected. Baseline patient data, clinical values collected on-site, and treatment outcomes were analyzed. The Glasgow Coma Scale (GCS) was used to determine if patients were comatose, with GCS ≤8 classified as the coma group and GCS >8 as the non-coma group. Further analysis was conducted on the resuscitated coma group to identify factors affecting patient recovery. Patients were divided into eight age groups, seven time periods within 24 h, and six blood glucose level groups to calculate the incidence of coma. A multivariate logistic regression model was constructed to analyze independent risk factors for coma in hypoglycemic patients.Results:A total of 754 patients with blood glucose levels ≤3.9 mmol/L were collected, with 425 cases of coma and 329 non-coma cases, resulting in a coma probability of 56.37% (95% CI: 52.82%-59.91%). Patients in the coma group were older ( P<0.001) and had a higher prevalence of diabetes compared to the non-coma group (82.12% vs. 67.78%, P<0.001). The age of all patients was (73.05±15.20) years, with the 61-90 years age groups being the most prone to hypoglycemia and coma. In terms of time distribution, the high-incidence periods for hypoglycemia and coma were 0-6 o’clock, 6-9 o’clock, and 14-18 o’clock. The primary causes of hypoglycemia included reduced energy intake after insulin injection (12.07%), improper use of insulin (6.37%), and reduced energy intake (6.23%), with 71.09% of cases having unknown causes. Additionally, 18.44% of patients used insulin before the onset of hypoglycemia, with a higher proportion in the coma group compared to the non-coma group (22.12% vs. 13.68%, P=0.003). The initial blood glucose level of all patients was (2.13±0.85) mmol/L, with lower levels observed in the coma group compared to the non-coma group ( P<0.001). The probabilities of coma occurrence corresponding to blood glucose levels were: 1.1-1.5 mmol/L (72.97%), 1.6-2.0 mmol/L (68.90%), 2.1-2.5 mmol/L (54.10%), 2.6-3.0 mmol/L (38.20%), 3.1-3.5 mmol/L (37.50%), and 3.6-3.9 mmol/L (19.40%). Multivariate logistic regression analysis indicated that age ( OR=1.021, 95% CI: 1.010-1.033, P<0.001), insulin use before onset ( OR=1.948, 95% CI: 1.142-3.323, P=0.014), and blood glucose concentration ( OR=0.426, 95% CI: 0.347-0.522, P<0.001) were independent predictors of coma in hypoglycemic patients. The investigation revealed that after intravenous injection of 50% glucose solution, 215 of 425 coma patients regained consciousness (50.58%), and the recovery time was (18.43±9.09) min. Patients in the recovery group were younger and had lower initial blood glucose levels compared to the non-recovery group (both P<0.05), while recovery group re-measured blood glucose levels were higher than those in the non-recovery group ( P=0.002). Conclusions:The probability of coma in hypoglycemic patients was high, with insulin use being a common trigger. Proper use of insulin is essential to prevent hypoglycemia and coma.

Objective To analyse the influencing factors diagnosed by the virtual touch tissue quantification (VTQ) technology on the hardness of papillary thyroid carcinoma (PTC).Methods From May 2011 to March 2014,a total of 266 PTCs in 266 patients confirmed by pathology were enrolled in Shanghai Tenth People's Hospital.The shear wave velocity (SWV) values of PTCs were measured by VTQ.PTCs were divided into 2 groups including SWV ≥ 2.87 rn/s and SWV ＜ 2.87 rn/s.The x2 test was used to compare the basic clinical data,ultrasound features and immunohistochemical results between 2 groups.The influencing factors of SWV values of PTCs were analyzed by forward stepwise Logistic regression analysis.Results Of the 266 PTCs,183 were SWV ≥ 2.87 m/s and 83 were SWV ＜ 2.87 m/s.The x2 test showed that the ultrasound features of PTCs such as single or multiple,with or without central lymph node metastasis,location,size,shape,with or without posterior acoustic attenuation,with or without calcification,with or without capsule invasion,whether close to the trachea between the 2 groups were significant different (x2=4.233,4.740,9.910,4.988,4.416,4.737,7.154,8.559,all P ＜ 0.05 or 0.01).Logistic regression analysis demonstrated that nodules were single or multiple,location,with or without posterior acoustic attenuation,with or without calcification,whether close to the trachea were influencing factors of SWV value of PTCs.The regression equation was defined as Y=-2.507 + 0.670X1 (nodules were single or multiple) + 0.800X3 (location of nodules) + 0.851X6 (with or without posterior acoustic attenuation) + 0.628X7 (with or without calcification) + 1.106X9 (whether close to the trachea).Conclusions Multiple nodules,central lymph node metastasis,located isthmus,nodules size ＞ 10 mm,irregular shape,posterior acoustic attenuation,calcification,capsule invasion,close to the trachea were correlated with the diagnosis of PTC by VTQ technology.The more characteristics of nodules appeared,such as multiple nodules,located isthmus,posterior acoustic attenuation,calcification,close to the trachea,the harder PTCs were.

AIM: To examine the effects of three commonly used general anesthetics on the proliferation and activation of glial cells in neonatal rats. METHODS: Neonatal rats were exposed to either isoflurane, sevoflurane or desflurane for 2 h on postnatal day 2 (P2). The animals were euthanatihed and the brain were harvested on P7 and P14, respectively. The immunohistochemical localihation of glial markers (vimentin, GFAP, Iba1) were examined. RESULTS: Activation of astrocyte in granular layer and molecular layer of dentate gyrus of hippocampus was significantly enhanced on P7 and P14 after desflurane exposure, while that in isoflurane group the change was only significantly different on P14. The activation of microglia in the granular layer of dentate gyrus but not in the pyramidal cell layer of CA1 region was significantly enhanced in the desflurane group on P7 and P14, while the isoflurane group only showed significant difference on P14. CONCLUSION: Short time exposure of different inhalation anesthetics has different effects on the activation of glial cells in different subregions of hippocampus in neonatal rats on postnatal day 2, and sevoflurane may have the least effect on it.