Objective To observe the value of MR vessel wall imaging(VMI)for predicting instability status of intracranial aneurysm(IA).Methods MR angiography(MRA)and vascular wall imaging(VWI)data of 506 patients with single IA were retrospectively analyzed.Asymptomatic IA was included in stable status group(n=349),while those with enlargement during follow-up or threatened rupture symptoms were taken as instable status group(n=157).The patients were divided into training set(n=354)and validation set(n=152)at a ratio of 7:3.The least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression were performed to screen risk factors associated with IA instability based on clinical data,MRA and VWI manifestations.Then model 1 was constructed based the above indexes,while model 2 was established based only on MRA manifestations of IA.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting IA instability.Results LASSO and multivariate logistic regression showed that female patient,age＜50 years with history of cerebral infarction and IA wall enhancement on MRA were all independent predictors of IA instability status.The AUC of model 1 for predicting instability status of IA was 0.733 and 0.742 in training set and validation set,respectively,both higher than that of model 2(0.593 and 0.609,both P＜0.05).Conclusion MR VWI was helpful for predicting IA instability status.

Objective To observe the value of MR vessel wall imaging(VMI)for predicting instability status of intracranial aneurysm(IA).Methods MR angiography(MRA)and vascular wall imaging(VWI)data of 506 patients with single IA were retrospectively analyzed.Asymptomatic IA was included in stable status group(n=349),while those with enlargement during follow-up or threatened rupture symptoms were taken as instable status group(n=157).The patients were divided into training set(n=354)and validation set(n=152)at a ratio of 7:3.The least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression were performed to screen risk factors associated with IA instability based on clinical data,MRA and VWI manifestations.Then model 1 was constructed based the above indexes,while model 2 was established based only on MRA manifestations of IA.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting IA instability.Results LASSO and multivariate logistic regression showed that female patient,age＜50 years with history of cerebral infarction and IA wall enhancement on MRA were all independent predictors of IA instability status.The AUC of model 1 for predicting instability status of IA was 0.733 and 0.742 in training set and validation set,respectively,both higher than that of model 2(0.593 and 0.609,both P＜0.05).Conclusion MR VWI was helpful for predicting IA instability status.

Objective:To explore the practical value of general anesthesia with non-intubated spontaneous breathing in uniportal thoracoscopic surgery in elderly patients.Methods:Clinical data of 86 elderly patients undergone uniportal thoracoscopy surgery during hospitalization at our hospital between March 2020 and December 2021 were retrospectively reviewed and analyzed.Based on the anesthesia intubation method, they were divided into a non-intubated spontaneous breathing video-assisted thoracic surgery group(NI-VATS group)and a one-lung ventilation video-assisted thoracic surgery group(OLV-VATS group), with 43 cases in each group.Data were compared on the inflammatory indexes, preparation time for anesthesia, time to awakening after anesthesia, intraoperative lung collapse score, mediastinal flutter score, time to postoperative feeding, digestive tract complications, sore throat, postoperative pulmonary atelectasis, and hospitalization time.Results:Compared with the OLV-VATS group, the NI-VATS group had a shorter anesthesia preparation time [(19.8±2.6)min vs.(32.3±4.5)min, t=-15.77, P<0.001]and a shorter time to awakening [(6.8±2.1)min vs.(11.9±2.9)min, t=-9.485, P<0.001], slightly poorer operating field during surgery, an unfavorable lung collapse score [(2.5±0.7) vs.(1.8±0.7) t=4.704, P<0.001], worse mediastinal flutter [(2.1±0.6) vs.(1.3±0.5), t=6.514, P<0.001]. Lower procalcitonin(PCT)[(0.189±0.130)μg/L vs.(0.264±0.123)μg/L, t=-2.744, P=0.007), a shorter time to postoperative feeding [(3.4±1.0)h vs.(5.5±1.0)h, t=-9.55, P<0.001], and lower rates of digestive tract reactions(4.7% vs.20.9%, χ2=5.108, P=0.024)and throat pain(4.7% vs.23.3%, χ2=6.198, P=0.013), and a shorter length of hospital stay [(3.8±0.3)d vs.(4.9±0.8)d, t=-7.266, P<0.001]. Conclusions:For the elderly patients undergoing uniportal thoracoscopic surgery, non-intubated spontaneous breathing may somewhat obstruct the operating field, but it can shorten the time of anesthesia and the time to awakening, does not increase complications from anesthesia and surgery, favors rapid postoperative recovery for patients and therefore should be promoted.

Shenling Baizhusan is a traditional Chinese medicine compound prescription formulated on the basis of Si Junzitang （Ginseng Radix et Rhizoma， Atractylodis Macrocephalae Rhizoma， Poria， Glycyrrhizae Radix et Rhizoma）. It has excellent functions of replenishing Qi， invigorating spleen， draining dampness， and checking diarrhea， and is one of the classical prescriptions of ''reinforcing earth to generate metal''. This prescription is primarily used in clinical practice to treat malnutrition in children， chronic diarrhea， gastrointestinal dysfunction， and other disorders. In addition， it has a good effect on gastrointestinal adverse reactions associated with radiotherapy and chemotherapy. With the booming of molecular biology， researchers have revealed the role of Shenling Baizhusan in the treatment of diseases， especially the mechanism of regulating different signaling pathways. We retrieved 26 relevant papers （4 written in English and 22 in Chinese） published in recent 5 years from 6 databases including China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， Cochrance Library， and Excerpta Medica Database （Embase）. On the basis of these papers， we summarized the mechanisms of Shenling Baizhusan in disease treatment. In the animal model of inflammatory bowel disease， Shenling Baizhusan can protect gastrointestinal mucosa by regulating the activation of nuclear factor kappa-B （NF-κB）， mitogen-activated protein kinase （MAPK）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， and myosin light chain kinase-myosin light chain （MLCK-MLC） signaling pathways. In the animal model of non-alcoholic fatty liver disease， Shenling Baizhusan regulates the activation of phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway and Kelch-like ECH-associating protein 1/NF-E₂-related factor 2/advanced glycation end-products （KEAP1/NRF2/AREs） signaling pathway， thus alleviating the lipid metabolism disorder induced by high-fat diet and reducing liver lipid accumulation and inflammatory response. In the animal model of lung cancer with bone metastasis， Shenling Baizhusan regulates the activation of PI3K/Akt/mTOR signaling pathway， thus playing an analgesic role. By summarizing the mechanisms of Shenling Baizhusan in treatment of different disease models from signaling pathways， we aim to provide clues for the in-depth study of this prescription.

Objective:To investigate the correlation between aneurysm wall enhancement (AWE) shown on high-resolution magnetic resonance imaging (HR-MRI) and the risk of intracranial aneurysm rupture risk.Methods:Patients with unruptured intracranial aneurysm admitted to the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2019 were enrolled retrospectively. Three-dimensional digital subtraction angiography was used to measure the morphological parameters of aneurysms. HR-MRI was used to evaluate the enhancement mode. Univariate analysis and multivariate logistic regression analysis were used to determine the independent influencing factors of AWE. The 5-year rupture risk of intracranial aneurysms was assessed based on the PHASES score. Spearman rank correlation analysis was used to determine the correlation between the enhancement mode and the risk of aneurysm rupture. Results:A total of 261 patients and 333 unruptured intracranial saccular aneurysms were included. There were significant differences in the proportion of multiple aneurysms, the size and location of aneurysms between the enhanced group and the non-enhanced group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors such as age and gender, multiple aneurysms (odds ratio [ OR] 0.446, 95% confidence interval [ CI] 0.251-0.791; P=0.006), aneurysm size ( OR 1.327, 95% CI 1.218-1.445; P<0.001) and location (anterior cerebral artery/posterior communication artery/posterior circulation: OR 2.058, 95% CI 1.217-3.482; P=0.007) were significantly independently related to AWE. Based on the PHASES score, the 5-year predicted rupture risk of the enhanced group was significantly higher than that of the non-enhanced group (5.2%±6.2% vs. 1.5%±2.0%; P<0.001). Spearman rank correlation analysis showed that there was a significant positive correlation between the extent of aneurysm enhancement and the risk of aneurysm rupture ( r=0.435, P<0.001). Conclusions:AWE shown on HR-MRI is associated with multiple aneurysms, aneurysm size, and location. Application of AWE might predict the risk of rupture of intracranial aneurysms.

Objective To investigate the significance of blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) and ambulatory urodynamics monitoring (AUM) to find the cause of primary monosymptomatic nocturnal enuresis (PMNE) in children.Methods Thirty-seven children with PMNE (20 males and 17 females) were selected,with a mean age of (11.3 ±4.1) years old.A clinical management tool,3-day urination record,daytime BOLD-fMRI scan,conventional urodynamics (CUD) and AUM were performed respectively.Thirty-seven gender-age matched children(19 males,18 females) who would receive surgery treatment because of upper urinary tract disease and were confirmed to have no lower urinary tract dysfunction by CUD were enrolled as controls,with a mean age of (11.1 ± 2.9) years old,and 13 cases underwent BOLD-fMRI scanning.Results It was found that the ALFF value of the left middle frontal gyrus of PMNE was decreased and the ReHo value of the left superior occipital gyrus was increased compared with the control group by the resting BOLD-fMRI.The maximum voiding volume of PNME children was (303.11 ± 87.48) mL,the total urine volume at night was (568.65 ± 208.48) mL,and the nighttime bladder volume was (217.43 ± 81.53) mL.The incidence of maximum voiding volume reduction,nocturnal polyuria and decreased nocturnal bladder volume were 24.32％ and 56.76％,and 64.86％,respectively.However,AUM results showed that maximum detrusor pressure in the PMNE group was (39.22 ± 7.78) cmH2O (1 cmH2O =0.098 kPa),which was statistically significantly higher than that in CUD (32.22 ±9.00) cmH2O,and the difference was statistically significant (P ＜0.05).In PMNE group,29 cases (78.37％) had detrusor overactivity (DO),which was significantly higher than that in CUD group [16 cases (43.24％)],and the difference was statistically significant(t =-3.047,P =0.004).CUD and AUM were all detected in children with DO,the frequency of DO detected by AUM was significantly higher than that detected by CUD[(2.00 ±0.55 times/h) vs.(1.38 ±0.50) times/h,P ＜0.05],and the maximum amplitude of detrusor pressure when DO occurring was significantly higher in AUM than in CUD [(19.56 ± 6.01) cmH2O vs.(14.38 ± 3.07) cmH2O],and the differences were statistically significant (all P ＜ 0.05);however,there was no significant difference in bladder compliance detected by AUM or CUD (P ＞ 0.05).Conclusions The abnormal functions of the left middle frontal gyrus and left superior occipital gyrus,nighttime DO and the decrease of bladder capacity at night are considered to be key causes of enuresis in children with PMNE.AUM and resting state BOLD-fMRI evaluations are helpful in differentiating the pathogenesis of PMNE.

Objective To observe the feasibility of PC-cine MRI for estimating the cerebrospinal fluid circulation of fistula after endoscopic third ventriculostomy (ETV)in obstructive hydrocephalus.Methods 25 cases with obstructive hydrocephalus were scanned with routine MR protocol and PC-cine sequence before and after ETV.Qualitative and quantitative evaluation of the cerebro-spinal fluid flow through the fistula were performed and the results were compared with 25 cases of healthy volunteers.Results One week after operation,the cerebrospinal fluid flow through the fistula showed obviously positive in 23 patients,while negative in the other 2 patients,and the waveform was similar to that in the normal midbrain aqueduct.The outflow and inflow peak velocity of the cerebrospinal fluid through the fistula were lower than that in normal midbrain aqueduct(P<0.05),while the quantity of outflow,inflow and netflow were much higher(P<0.05).6 patients showed ventricular narrowing one week after operation and 17 cases maintained the same finding.During follow-up of half year,the ventricular size still showed no obvious narrowing in 14 patients.Ventricular expanding was observed in 2 post-operative patients.Conclusion PC-cine MRI can provide intuitive and reliable evidences in evaluation of ETV for obstructive hydrocephalus.

Objective To explore the value of three-dimensional constructive inference in steady state sequence (3D-CISS se-quence)in case of midbrain aqueduct obstruction.Methods 46 cases with midbrain aqueduct obstruction were scanned with FLASH T1 WI、TSE T2 WI and 3D-CISS sequence at 3.0T superconductive MR scanner.The original images of the 3D-CISS sequence were reconstructed.The images of three sequences showing midbrain aqueduct obstruction were observed and analyzed.Results The de-tection rate of the midbrain aqueduct obstruction was 13% 、71.7% and 100% in FLASH T1 WI、TSE T2 WI and 3D-CISS sequence, respectively.The difference between the three sequences were significant (P <0.01 67).Conclusion 3D-CISS sequence shows mid-brain aqueduct obstruction more accurately.

Bacteriophage is a bacterium dependent virus. It has unique advantages in the treatment of bacterial infection, especially infection caused by drug-resistant bacteria. Its metabolic kinetics and route of administration are the current research focus. Bacteriophage lytic enzyme, as a new therapeutic method, has more advantages than active bacteriophage. This review is focused on the recent progress in bacteriophage research, including the mechanism of bacteria lysis, the route of administration, the application of genetic engineering, etc.
Bacterial Infections ; therapy ; Bacteriophages ; Humans