Juvenile myoclonic epilepsy (JME) diagnosed with seizure history,semiology and electroencephalography is a syndrome of idiopathic generalized epilepsy.MRS can quantitatively detect the concentration of neurometabolites noninvasively,and assess the metabolic changes in brain.Currently,studies of pathogenesis of JME are focused on the dysfunction of thalamo-cortical network and the neurometabolites and imbalance of Glutamate and γ-aminobutyric acid in the network are alterted.Epilepsy is associated with the imbalance of the ratio of excitatory and inhibitory amino acid,and seizures lead to neuronal lesions which result in altered concentration of neuron related metabolites.This article reviewed MRS studies of JME by combining material metabolism,neural structure and function.

Objective To evaluate the feasibility of the lateralization of unilateral medial temporal lobe epilepsy(mTLE)by using arterial-spin-labeling(ASL)based perfusion MR imaging and investigate the changes of perfusion in the regions related to mTLE network and the relationship between the perfusion and the clinical status.Methods Twenty-five patients with left-sided and 23 with right-sided mTLE were enroiled,and 30 healthy volunteers were recruited.The cerebral blood flow(CBF)of related region was measured based on pulsed-ASL sequence on Siemens 3 T scanner.The CBF of the mTLE group were compared with that in the controls by using ANOVA analysis.The asymmetric indices of CBF in the medial temporal lobe were calculated as the lesion side compared with the normal side in matched region in mTLE group.Results Compared with the volunteers,the patients with mTLE showed the decrease of CBF in the bilateral medial and lateral temporal,the frontal and parietal regions relating to the default-mode network and more serious in lesion side.The CBF values of the medial temporal lobe were negatively correlated with the epilepsy duration(r =-0.51,P ＜0.01).The asymmetric index of CBF as-0.01 has a 76.0％(19/25)sensitivity and a 78.3％(18/23)specificity to distinguish the lesion side.Conclusions The decrease of CBF in the temporal and extra-temporal region by ASL-based MRI suggests the functional abnormalities in the network involved by mTLE.The ASL technique is a useful tool for lateralizing the unilateral mTLE.

Objective:To investigate the clinical and imaging characteristics of isolated cortical vein thrombosis (ICVT) in order to improve the understanding of this rare disease.Methods:From December 2013 to September 2019, patients with ICVT admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were collected retrospectively. Their clinical manifestations, imaging examination, treatment and prognosis were analyzed.Results:A total of 6 patients with ICVT were enrolled in the study, including 3 males and 3 females, with an average age of 37 years. The main clinical manifestations were acute seizures (5/6, 83.3%), focal neurological deficits (3/6, 50.0%), and headache (3/6, 50.0%). In the imaging examination, the direct signs of ICVT were spot sign and cord sign, and the indirect signs were cerebral lobe hemorrhage, infarction, or edema.Conclusions:Seizures, focal neurological deficits and headaches are common manifestations of ICVT. Multimodality imaging examinations are helpful for early diagnosis of the disease.

Objective:To explore the clinical application of a new high dielectric constant (HDC) to improve image quality in 3.0 T fetal head MR scans.Methods:Forty pregnant women who underwent 3.0 T fetal head MR examinations at the Drum Tower Hospital of Nanjing University School of Medicine from May to July 2021 were prospectively included and divided into a test group and a control group according to the placement and non-placement of HDC pads. After the scans were completed, qualitative and quantitative analysis were performed on the image quality of the two groups acquired in each case. Qualitative analysis: A 5-point scale was used to score the images of both groups by two diagnosticians and their scores were recorded. Quantitative analysis: Firstly, the overall radiofrequency specific absorption ratio (SAR) values of the two sets of fetal cranial cross-sectional scans of each pregnant woman were recorded separately, and the average rate of change of the overall SAR values was calculated; secondly, four regions of interest (ROIs) were placed on the standard level of the cross-sectional section of each fetal cranium (including the level of the basal ganglia region of the dorsal thalamus), and the minimum and maximum of the four ROIs of each of the two data sets were calculated separately. The ratio of minimum to maximum signal intensity (RSI), signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated for each of the four ROIs in the two sets of data. Wilcoxon test was used to analyze the differences between the two groups of image quality score results; paired sample t-test or paired rank sum test was used to analyze the differences in SAR, RSI, SNR and CNR values between the two groups. Results:The fetal head image quality score was 4 (3, 4) in the test group and 3 (1, 4) in the control group, and the test group was significantly higher than the control group, with statistically significant difference ( Z=-3.62, P<0.01), and the images in the test group had a uniform signal compared with the control group, and none of them had significant artifacts. The results of quantitative analysis showed that the overall SAR value of the test group was significantly reduced, with a mean reduction rate of 32.1%, and the difference between the SAR values of the two groups was statistically significant ( Z=-2.78, P<0.01). The RSI, SNR and CNR in the frontal, temporal, thalamic and occipital lobes of the test group were all higher than those of the control group, and the differences were all statistically significant ( P<0.01). Conclusion:The HDC pads can significantly improve the image quality of 3.0 T fetal head imaging by reducing or eliminating the inhomogeneous artifacts in the RF field, which makes a good technical foundation for fetal head MR imaging.

Objective:To investigate the clinical and imaging characteristics of deep cerebral vein thrombosis (DCVT).Methods:From December 2006 to December 2019, patients with DCVT admitted to Nanjing Drum Tower Hospital were enrolled retrospectively. The clinical manifestations, imaging examinations, treatment and prognosis of the patients were analyzed.Results:A total of 11 patients with DCVT were enrolled in the study, including 4 females and 7 males. Their average age of onset was 41.6 years. Their most common clinical manifestations were acute or subacute onset headache (11/11, 100%), disturbance of consciousness (5/11, 45.5%), and seizures (4/11, 36.4%). All 11 patients involved straight sinus, 9 involved the great cerebral vein, 5 involved the internal cerebral vein, and 1 involved the basilar vein. All patients were complicated with other venous sinus thrombosis, and 3 were complicated with superficial cortical venous thrombosis. Early CT plain scan (within 1 week of onset) of 8 patients (72.3%) showed high-density point sign of great cerebral vein or cord sign of straight sinus. Head MRI showed that 90.9% (10/11) of patients had brain parenchymal damage, thalamic involvement (5/11, 45.5%) was the most common, followed by deep white matter (4/11, 36.4%). One patient received urokinase interventional thrombolysis and died on the 6 th day of onset. The remaining 10 patients improved after receiving anticoagulant therapy. Follow up of 4 months to 13 years showed that 4 patients left with mild to moderate disability (the modified Rankin scale score 1-3), and 6 returned to normal. Conclusions:Headache, disturbance of consciousness and seizures are common clinical manifestations of DCVT. Imaging examination shows that the possibility of DCVT should be warned when the thalamus or deep white matter is involved. It is necessary to pay attention to the high-density thrombus spot sign and cord sign on early CT plain scan. DCVT patients with cortical venous thrombosis progressed rapidly in the acute phase, and the outcomes were poor.

Objective: To explore the mediating effect and gender difference of mobile phone use in the association between different types of childhood abuse experiences and sleep quality of medical students, so as to provide reference for promoting sleep quality of medical students. Methods: A longitudinal study design method was used to select freshmen and sophomores in two medical colleges in Anhui Province from November to December 2019, follow up data were collected from May to June 2020, and a total of 6 879 students were included in this study. Spearman correlation was used to analyze the association between baseline childhood abuse experiences, baseline mobile phone use and follow up sleep quality. Bootstrap program and Process software were applied to test the mediating effect of mobile phone use in the relationship between childhood abuse and sleep quality. Results: Childhood abuse experiences were positively correlated with mobile phone use and sleep quality score ( r = 0.27 , 0.24, P <0.01), and mobile phone use was positively correlated with sleep quality score ( r =0.31, P <0.01). In the total sample, after adjusting for confounding factors, mobile phone use played a partial mediating role in childhood abuse experiences (including emotional abuse, physical abuse, sexual abuse) and sleep quality, and the mediating effect was 18.08% (18.12%, 17.15%, 24.09%). The mediating effect of mobile phone use on the relationship between childhood emotional abuse, sexual abuse, childhood abuse and sleep quality in girls(18.32%, 28.05%, 18.24%) was higher than in boys(17.81%, 18.94%, 17.63%). Conclusion Mobile phone use has a mediating effect on the relationship between childhood abuse and sleep quality, controlling mobile phone overuse may contribute to improving the sleep quality for those who have experienced childhood abuse.