Objective·To assess the number and distribution of cerebral microbleeds(CMBs)in patients with end-stage renal disease(ESRD)using susceptibility-weighted imaging(SWI),and to explore the relationship between SWI-detected imaging features and cognitive impairment.Methods·Hospitalized ESRD patients who had received dialysis treatment for more than one year at Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine,between January 2023 and March 2024 were included.All patients underwent conventional MRI sequences and SWI scanning.The number and regional distribution of CMBs were recorded.Cognitive function was assessed using the Montreal Cognitive Assessment(MoCA).Patients with MoCA scores≥26 were classified into the ESRD without cognitive impairment group,and those with scores<26 were placed in the ESRD with cognitive impairment group.The presence and number of CMBs were analyzed in relation to cognitive impairment.The distribution of CMBs in various brain regions was examined,and correlations between the number of CMBs in specific regions and the severity of cognitive impairment were evaluated.Results·A total of 38 patients were enrolled,including 16 in the ESRD with cognitive impairment group and 22 in the non-impaired group.CMBs were more frequently observed in the cognitively impaired group(14 cases,87.50%)compared to the non-impaired group(12 cases,54.55%),with a statistically significant difference(P=0.033).The impaired group had more CMBs(106 in total),primarily located in bilateral cortical and subcortical regions(59.43%)and the basal ganglia(19.81%).In contrast,the non-impaired group had fewer CMBs(47 in total),mainly located in the bilateral basal ganglia(46.80%)and cortical and subcortical regions(40.43%),with all regional distribution differences being statistically significant(both P<0.05).Among those with cognitive impairment,the number of CMBs in the cortical and subcortical areas was significantly negatively correlated with cognitive function(r=-0.718,P=0.030).Conclusion·The number and distribution of CMBs detected by SWI in ESRD patients are associated with both the presence and severity of cognitive impairment.SWI can be used to identify CMBs formation and localization in ESRD patients,thereby aiding in the assessment of cognitive dysfunction.

Objective·To assess the number and distribution of cerebral microbleeds(CMBs)in patients with end-stage renal disease(ESRD)using susceptibility-weighted imaging(SWI),and to explore the relationship between SWI-detected imaging features and cognitive impairment.Methods·Hospitalized ESRD patients who had received dialysis treatment for more than one year at Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine,between January 2023 and March 2024 were included.All patients underwent conventional MRI sequences and SWI scanning.The number and regional distribution of CMBs were recorded.Cognitive function was assessed using the Montreal Cognitive Assessment(MoCA).Patients with MoCA scores≥26 were classified into the ESRD without cognitive impairment group,and those with scores<26 were placed in the ESRD with cognitive impairment group.The presence and number of CMBs were analyzed in relation to cognitive impairment.The distribution of CMBs in various brain regions was examined,and correlations between the number of CMBs in specific regions and the severity of cognitive impairment were evaluated.Results·A total of 38 patients were enrolled,including 16 in the ESRD with cognitive impairment group and 22 in the non-impaired group.CMBs were more frequently observed in the cognitively impaired group(14 cases,87.50%)compared to the non-impaired group(12 cases,54.55%),with a statistically significant difference(P=0.033).The impaired group had more CMBs(106 in total),primarily located in bilateral cortical and subcortical regions(59.43%)and the basal ganglia(19.81%).In contrast,the non-impaired group had fewer CMBs(47 in total),mainly located in the bilateral basal ganglia(46.80%)and cortical and subcortical regions(40.43%),with all regional distribution differences being statistically significant(both P<0.05).Among those with cognitive impairment,the number of CMBs in the cortical and subcortical areas was significantly negatively correlated with cognitive function(r=-0.718,P=0.030).Conclusion·The number and distribution of CMBs detected by SWI in ESRD patients are associated with both the presence and severity of cognitive impairment.SWI can be used to identify CMBs formation and localization in ESRD patients,thereby aiding in the assessment of cognitive dysfunction.

Objective To explore the biliary tract microbiota changes before and after drainage treatment in patients with malignant biliary obstruction(MBO),and to study the effects of biliary obstruction and drainage intervention on the bile microbiota from a microecological point of view.Methods From January 2020 to December 2022,DSA-guided percutaneous transhepatic catheter drainage(PTCD)was carried out in 32 patients with MBO.A 22G drainage needle was inserted into the bile duct,and about 15-20mL of bile was extracted after it was confirmed that the needle was located within the intrahepatic bile duct,then,an external drainage tube,or an internal drainage tube together with an external drainage tube,was implanted into the bile duct along the guide wire.Seven days after PTCD,bile was extracted through a drainage tube.Bile sampling for germiculture and gene sequencing was conducted twice.The general data of patients,including whether acute cholangitis occurred and its severity,whether antibiotics was used for treatment,etc.,were collected.Results Of the 32 patients,cholangiocarcinoma was seen in 15,pancreatic cancer in 10,hepatocellular carcinoma in 3,and hilar lymph node metastasis from gastrointestinal malignant tumor in 4.Before PTCD,in the bile microbiota the burkholderia,acinetobacter,pseudomonas and staphylococcus were the bacteria with a high relative abundance,and the diversity and evenness of other microbial species seen in the normal biliary tract were reduced.Conclusion There is a stable microbiota within the normal biliary system,and in malignant obstructive biliary tract the microbiota has similar composition.After biliary drainage,the abundance of intestinal flora in bile is increased,and the species richness and diversity of the original biliary tract microbial community are decreased,which may explain the clinical phenomenon that patients are more prone to biliary tract infection after biliary drainage.(J Intervent Radiol,2024,33:516-522)