Objective:To investigate clinical features, imaging characteristics, etiology, and potential mechanisms of medullary "comma-shaped" infarctions.Methods:Patients with common-shaped infarction treated at Weihai Central Hospital Affiliated to Qingdao University from January 2020 to September 2023 were retrospectively collected, and their clinical manifestations, imaging findings, treatment, and outcome were analyzed and summarized.Results:A total of 9 patients with medullary common-shaped infarction were enrolled, including 3 males, aged 67.22±14.66 years (ranging from 39 to 83 years). Main clinical symptoms and signs included the decreased pain and temperature sensation on the contralateral limb (66.67%, 6/9), coughing or choking while drinking liquids/dysphagia (66.67%, 6/9), ipsilateral pharyngopalatine muscle paralysis (66.67%, 6/9), and dizziness (66.67%, 6/9). Seven patients (77.78%, 7/9) had severe stenosis or occlusion at the ipsilateral vertebral artery, one (11.11%, 1/9) had occlusion at the left middle cerebral artery, and one (11.11%, 1/9) did not have large vessel stenosis. At 90 days after onset, the follow-up showed that the modified Rankin Scale scores were all <2.Conclusions:Medullary comma-shaped infarctions are rare in clinical practice, its main manifestations include the decreased pain and temperature sensation on the contralateral limb, coughing or choking while drinking liquids/dysphagia, ipsilateral pharyngopalatine muscle paralysis, dizziness, etc. The pathogenesis is mainly hypoperfusion caused by vertebral artery stenosis.

Objective:To investigate the distribution characteristics of conjugate eye deviation on MRI in patients with posterior circulation ischemic stroke (PCIS) presenting as isolated acute vestibular syndrome (AVS), and its relationship with infarct lesions.Methods:Patients with PCIS presenting as isolated AVS admitted to Weihai Central Hospital Affiliated to Qingdao University from January 2022 to June 2024 were included retrospectively. The infarct distribution and eye deviation were detected by MRI within 3 days of admission. If the gaze deviation of both eyes horizontally towards the same side is observed, it was defined as radiological conjugate eye deviation (RCED); if one eye was deviated while the other eye was not; it was defined as radiological non-conjugate eye deviation (RDED). Multivariate logistic regression analysis was to determine the independent influencing factors of RCED. Results:A total of 82 patients with PCIS presenting with isolated AVS were included. Among them, there were 61 males (74.4%), mean aged 66.20±12.50 (range, 31-91) years. Seventy-two patients (87.8%) had cerebellar infarction, 9 (11.0%) had medullary infarction, 2 (2.4%) had caudal pontine infarction, 1 had both cerebellar and medullary infarction. MRI revealed RCED in 42 cases (51.2%), RDED in 22 cases (26.8%), and no deviation in 18 cases (22.0%). Of the 42 patients with RCED, 32 had cerebellar infarction, accounting for 44.4% of all patients with cerebellar infarction; there were 2 patients with caudal pontine infarction and 9 with medullary infarction. All 22 patients with RDED had cerebellar infarction. Univariate analysis showed that there was significant difference between the RCED group and the non-RCED group in age and the proportion of patients with lesions involving the cerebellar hemisphere and medullary infarction (all P<0.05). Multivariate logistic regression analysis showed that the lesion involvement in the cerebellar hemisphere was an independent influencing factor for RCED (odds ratio 0.169, 95% confidence interval 0.033-0.876; P=0.034). Conclusions:Cerebellar infarction is the most common in patients with PCIS presenting as isolated AVS. Both patients with medullary infarction and pontine infarction present with RCED, while the incidence of RCED in patients with cerebellar infarction is 44.4%. RDED is only seen in patients with cerebellar infarction. Compared with RCED, RDED is more common in patients with infarction involving the cerebellar hemisphere.

Objective To compare the diagnostic significance of pleural SLPI,IFN-γ and ADA for differenti-ating TPE from pleural effusions with the other etiologies. Methods Pleural effusion samples were obtained from 93 patients who were divided into the following groups: tuberculous pleural effusion,malignant pleural effusion, bacterial pleural effusion and transudative pleural effusion. The pleural effusion and/or serum levels of SLPI , IFN-γand ADA were determined. Results 1.The concentrations of SLPI, IFN-γand ADA in tuberculous pleural effusion was higher than that in malignant group, bacterial group and transudative group. 2. The diagnostic value of SLPI, IFN-γor ADA for the diagnosis of tuberculous PE is high respectively. The combinations of SLPI, IFN-γand/or ADA gained the more valuable diagnostic performance. Conclusion Pleural SLPI, IFN-γand ADA may be helpful for the differential diagnosis of tuberculous pleural effusion and the other pleural effusion. The combinations of SLPI or/and IFN-γor/and ADA further increased diagnostic value.