OBJECTIVES: To investigate the associations between Tau protein deposition and brain biochemical metabolites detected by proton magnetic resonance spectroscopy (¹H-MRS) in patients with advanced Alzheimer's disease (AD). METHODS: From April, 2022 to December, 2024, 64 Tau-positive AD patients and 29 healthy individuals underwent ¹⁸F-APN-1607 PET/MR and simultaneously acquired multi-voxel ¹H-MRS in the Department of Nuclear Medicine, Nanjing First Hospital. Visual analysis and voxel-based analysis of PET/MR data were performed to investigate the Tau protein deposition patterns in AD patients. Valid voxels within the ¹H-MRS field of view were selected, and their standardized uptake value ratio (SUVr) in PET and metabolite levels of N-acetylaspartate (NAA), choline (Cho), creatine (Cr), NAA/Cr, and Cho/Cr were recorded. The Tau-positive (Tau⁺) voxels and Tau-negative (Tau^-) voxels of the AD patients were compared for PET and ¹H-MRS parameters, and the correlations between the metabolites and Tau PET SUVr within Tau⁺ voxels were analyzed. RESULTS: Significant Tau protein deposition were observed in the AD patients, involving mainly the bilateral frontal lobes (30.07%), parietal lobes (29.96%), temporal lobes (21.07%), and occipital lobes (15.89%). A total of 1422 valid voxels in AD group (including 994 Tau⁺ and 428 Tau^- voxels) and 814 voxels in the control group were selected. The AD patients showed significantly decreased NAA level and increased SUVr compared with the control group (P<0.05). Subgroup analyses revealed that Tau⁺ voxels had higher SUVr and lower Cr and Cho/Cr than Tau^- voxels (P<0.05). Compared with the control group, Tau⁺ voxels exhibited higher SUVr and lower Cr (P<0.05), while Tau^- voxels showed lower NAA (P=0.004). No significant differences were found in Cho or NAA/Cr among the subgroups (P>0.05). Within Tau⁺ voxels, NAA, Cho, and Cr were negatively correlated with SUVr (P<0.001). CONCLUSIONS The patients with progressive AD have significant Tau protein deposition in the brain, which is correlated with alterations in metabolite levels. Decreased NAA is more prominent in early or pre-tau deposition stages, while Cr changes is more significant in the regions with Tau protein deposition, suggesting the potential of NAA and Cr as biomarkers for Tau protein deposition in AD for disease monitoring and treatment evaluation.
Humans ; Alzheimer Disease/diagnostic imaging* ; Aspartic Acid/metabolism* ; tau Proteins/metabolism* ; Creatine/metabolism* ; Brain/metabolism* ; Biomarkers/metabolism* ; Positron-Emission Tomography ; Male ; Female ; Proton Magnetic Resonance Spectroscopy ; Choline/metabolism* ; Aged ; Middle Aged

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers

The multidisciplinary diagnosis and treatment (MDT) mode plays a positive role in diagnosing and treating difficult and complicated diseases, improving service quality, and promoting the construction of an integrated medical system. In March 2023, Zhejiang Provincial People′s Hospital had launched the " 6 New" MDT management practice to further improve the hospital′s inpatient MDT service level, including new concepts, new architectures, new standards, new processes, new models, and new quality control. This practice had improved the quality and efficiency of MDT management and promoted interdisciplinary integration by strengthening top-level design, establishing MDT leadership and quality control teams, developing relevant standards and specifications, enhancing the level of information management throughout the entire process, implementing diversified MDT models, and implementing quality control measures. As of July 2024, the hospital had established 80 MDT teams covering 30 clinical departments, conduct 120 MDT discussions for hospitalized cases per month, and with the continuous promotion of inpatient MDT work, the number of MDT teams and cases continued to increase. This practice had achieved good results and could provide references for other public hospitals in China to improve the level of inpatient MDT services.

The multidisciplinary diagnosis and treatment (MDT) mode plays a positive role in diagnosing and treating difficult and complicated diseases, improving service quality, and promoting the construction of an integrated medical system. In March 2023, Zhejiang Provincial People′s Hospital had launched the " 6 New" MDT management practice to further improve the hospital′s inpatient MDT service level, including new concepts, new architectures, new standards, new processes, new models, and new quality control. This practice had improved the quality and efficiency of MDT management and promoted interdisciplinary integration by strengthening top-level design, establishing MDT leadership and quality control teams, developing relevant standards and specifications, enhancing the level of information management throughout the entire process, implementing diversified MDT models, and implementing quality control measures. As of July 2024, the hospital had established 80 MDT teams covering 30 clinical departments, conduct 120 MDT discussions for hospitalized cases per month, and with the continuous promotion of inpatient MDT work, the number of MDT teams and cases continued to increase. This practice had achieved good results and could provide references for other public hospitals in China to improve the level of inpatient MDT services.

Objective:To explore the expression and importance of Piezo1, E-cadherin, and Vimentin in nasal polyps patients. Methods:Thirty-five patients undergoing endoscopic sinus surgery under general anesthesia were streamed into 20 cases of nasal polyps（NP group） and 15 cases of simple septoplasty without any sinus disease（Control group）. Immunofluorescence staining and Western Blot were applied to detect the protein level of Piezo1, E-cadherin, and Vimentin in NP tissues and nasal polyp-derived primary human nasal epithelial cells（pHNECs）. Also, BEAS-2B cell lines were treated with human TGF-β1 protein to establish epithelial mesenchymal transition（EMT） model in vitro and quantitative real-time polymerase chain reaction were used to calculate Piezo1 and above biomarkers in the model. Results:Compared with control group, Piezo1 and Vimentin showed higher level while E-cadherin was lower in NP tissues and pHNECs.In EMT model in vitro, Piezo1 and Vimentin were demonstrated higher expression with decreased level of E-cadherin. Conclusion:The tendency of Piezo1 is consistent with the mesenchymal-related biomarker Vimentin, going against with epithelial-related biomarker E-cadherin, implying its involvement with EMT process in nasal polyps.
Humans ; Biomarkers/metabolism* ; Cadherins/metabolism* ; Chronic Disease ; Epithelial-Mesenchymal Transition ; Nasal Polyps/metabolism* ; Rhinosinusitis ; Sinusitis ; Transforming Growth Factor beta1/metabolism* ; Vimentin/metabolism*

Objective To investigate the safety,efficacy and feasibility of endovascular recanalization in non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,and analyze the factors affecting its success.Methods Fifty-four patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,underwent endovascular recanalization in our hospital from January 2013 to December 2017,were enrolled.Modified Rankin scale (mRS) and National institutes of health stroke scale (NIHSS) scores were compared before and after treatment;the prognosis results were analyzed after 2 years of follow-up.Independent factors influencing the prognoses were identified by Logistic regression analysis.Results Recanalization was achieved in 52 patients and failure was noted in two patients.The mRS scores and NIHSS scores before treatment (2.25±0.13,18.43±1.36) were significantly higher than those after treatment (1.44±0.05,11.81±0.71,P＜0.05).After 2 years of follow-up,good prognosis was noted in 42 patients,poor prognosis in 8 patients,and loss of follow-up in 2 patients.Multivariate Logistic analysis showed that history of hypertension and history of diabetes were independent risk factors for the prognoses of patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery after endovascular reeanalization (OR=1.429,95CI:1.146-1.783,P=0.005;OR=2.597,95CI:2.364-2.854,P=0.005).Conclusion The curative effect of interventional therapy for non-acute occlusion of symptomatic internal carotid artery is reliable,and histories of hypertension and diabetes can affect the prognoses of patients.

Objective To investigate the effect of hypertension on white matter microstructure and its correlation with cognitive function using automated fiber-tract quantification.Methods Consecutive subjects visited Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between January 2017 and July 2018 were collected.They were divided into hypertension without cognitive impairment (HTN-nonCI) group (n =44),hypertension with cognitive impairment (HTN-CI) group (n =50),and control group (n =25).The imaging data and neuropsychological scale test results of the subjects were collected.The automated fiber-tract quantification was used to obtain the diffusion parameters of 100 nodes on 20 fiber tracts in the whole brain.The differential segments of each fiber tract diffusion parameter between the control group and HTN-nonCI group,and the HTN-nonCI group and HTN-CI group were compared.Correlation analysis was performed in white matter fiber tracts with significant differences and each cognitive domain between the HTN-nonCI group and the HTN-CI group.Results The fractional anisotropy (FA) of white matter fiber tracts in 3 groups showed a decreasing trend,and the mean diffusion diffusivity (MD) showed an increasing trend.The comparison between the control group and the HTN-nonCI group showed that there were significant differences in the FA values of the midpoint of left thalamic radiation tract partial to brainstem,the genus of corpus callosum near brainstem,and frontal part and and proximal ventricle of splenium of corpus callosum (all P＜0.05);there were significant differences in the MD values of the middle part of left thalamic radiation tract and near the brainstem,the right thalamic radiation tract near the brainstem,the top of left corticospinal tract and near brainstem,the middle hippocampus of right cingulate tract,the middle part of genu of corpus callosum,the splenium of the corpus callosum near the lateral ventricle,the left uncinate tract near the forehead (all P ＜ 0.05).A comparison between the HTN-nonCI group and the HTN-CI group showed that there was significant difference in the FA value between the distributed segments of cingulate gyrus of left cingulate tract and the left inferior fronto-occipital tract near the occipital lobe,in which cingnlate gyrus of left cingulate tract was significantly correlated with the Montreal Cognitive Assessment Scale score (standardized3 =0.268,P =0.029);there were significant differences in the right thalamic radiation tract near the brainstem,the forehead and proximal ventricle of splenium of the corpus callosum,and the scattered distribution segments of the right inferior longitudinal fasciculus,in which the right inferior longitudinal fasciculus was significantly correlated with memory (standardizedβ=-0.243,P=0.047) and executive function (standardizedβ=-0.284,P=0.021).Conclusions Microstructural integrity of white matter was generally destroyed in patients with hypertension,but some segments were more susceptible to hypertension.The integrity of cingnlate gyrus of cingulate tract was significantly correlated with the overall cognitive function.The integrity of inferior iongitudinal fasciculus was significantly correlated with the executive function and memory.

Objective To explore the association between white matter hyperintensities volume and cognitive function in patients with hypertension.Methods Eighty-two patients with hypertension enrolled from the Department of Neurology of Nanjing Drum Tower Hospital from January 2017 to December 2017 were recruited in this study sequentially,who aged between 50 and 80 years.All subjects used automatic white matter quantitative technique to get their personal whole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume.Neuropsychological scales were used to evaluate their global cognitive function,memory function,fluency,executive function and processing speed.The association between white matter hyperintensities volume and cognitive function via linear regression analysis was assessed.To explore whether the association between white matter hyperintensities volume and cognitive function be affected by the duration of hypertension,stratification analyses were conducted using the median of the duration of hypertension as separation.Results After adjusting for age,sex,education,lacunar infarctions and global cortical atrophy grade,the Trail Marking Test (2-1) score which reflects executive function was found to be related to whole white matter hyperintensities volume (standardized beta-value=0.268,P=0.019),periventricular white matter hyperintensities volume (standardized beta-value=0.243,P=0.037) and deep white matter hyperintensities volume (standardized beta-value=0.243,P=0.021).Victorial Snoop Test-2 score which reflects processing speed was found to be related to periventricular white matter hyperintensities volume (standardized beta-value=0.270,P=0.023).After additional adjusting for the duration of hypertension,the Trail Marking Test (2-1) score was still found to be related to whole white matter hyperintensities volume (standardized beta-value=0.277,P=0.016),periventricular white matter hyperintensities volume (standardized beta-value=0.251,P=0.032) and deep white matter hyperintensities volume (standardized beta-value=0.248,P=0.019).The Victorial Stroop Test-2 score was found to be related to whole white matter hyperintensities volume (standardized beta-value=0.237,P=0.041) and periventricular white matter hyperintensities volume (standardized beta-value=0.290,P=0.013).Conclusion Whole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume are related to executive function,periventricular white matter hyperintensities volume is also related to processing speed in patients with hypertension,and the association between white matter hyperintensities volume and cognitive domain is not influenced by the duration of hypertension.

Objective To investigate the correlation between white matter lesions (WMLs) score and volume and cerebral microbleeds (CMBs) in patients with cerebral small vessel disease (CSVD).Methods Patients with non-acute lacunar infarction from the CSVD Follow-up Cohort Study in the Affiliated Drum Tower Hospital of Nanjing University from January 2017 to December 2017 were enrolled.The relevant clinical data were collected and 3.0 T cranial MRI examinations were performed,including T1-weighted imaging,T2-weighted imaging,fluid attenuated inversion recovery (FLAIR) sequence,susceptibility-weighted imaging,and diffusion-weighted imaging.W2MHS software was used to quantify the volume of WMLs.Fazekas method was used to score periventricular and deep WMLs separately.The number of CMBs was counted visually.Multivariate logistic regression analysis was used to determine the independent influencing factors of CMBs.Multivariate linear regression equation (stepwise method) was used to analyze the independent influencing factors of the number of CMBs.Medcalc 18.6 was used to deseribe receiver operating characteristic (ROC) curve.The predictive value of WMLs Fazekas scores and volumes for CMBs was evaluated.Results A total of 82 patients were enrolled,including 31 (37.8％) in CMBs group and 51 (62.2％) in non-CMBs group.The comparison between the two groups showed that smoking,use of antiplatelet agents,history of transient ischemic attack (TIA) or lacunar infarction,larger WMLs volume,higher levels of triacylglycerol,and lower levels of high-density lipoprotein cholesterol might be the risk factors for CMBs.Multivariate logistic regression analysis showed that higher Fazekas score (odds ratio 1.908,95％ confidence interval 1.210-3.009;P=0.005) and larger WMLs volume (odds ratio 4.620,95％ confidence interval 1.279-16.683;P =0.019) were the independent risk factors for CMBs.Multiple linear regression analysis showed that Fazekas score (r =0.379,P =0.001) and WMLs volume (r =0.260,P =0.023) were independently and positively correlated with the number of CMBs.The ROC curve analysis showed that the area under the curve of Fazekas scores predicting CMBs was 0.768 (95％ confidence interval 0.654-0.881).The optimal cut-off value was 3,the sensitivity was 61.29％,and the specificity was 90.20％.The area under the curve of WMLs volume predicting CMBs was 0.783 (95％ confidence interval 0.677-0.867).The optimal cut-off value was the volume of WMLs reaching 2 137.96 mm3.The sensitivity was 73.33％,and the specificity was 84.00％.Conclusion WMLs and CMBs had significant correlation in patients with CSVD.The WMLs Fazekas score and volume quantification are expected to serve as the alternative indicators for the urgent assessment of CMBs.

Intravenous thrombolysis within the time window is an effective treatment for patients with acute ischemic stroke,but the serious consequences of intracranial hemorrhage after thrombolysis can not be ignored.Although there are still some controversies about whether cerebral microbleeds will increase the risk of intracranial hemorrhage after thrombolytic treatment,attention should be paid to cerebral microbleeds when thrombolytic therapy is performed.