Objective:To compare the clinical and ultrasonic features of elderly-onset rheumatoid arthritis(EORA)and young-onset rheumatoid arthritis(YORA).Methods:A total of 104 patients diagnosed with rheumatoid arthritis were categorized into two groups based on their age of onset: the EORA group, consisting of 70 patients, and the YORA group, consisting of 34 patients.A comparative analysis was conducted on the clinical manifestations, laboratory findings, and ultrasonic images of patients in these two groups.Results:The male ratio in the EORA group was significantly higher than that in the YORA group(24.3% vs.8.8%, P=0.048).There were no statistical differences in the course of disease, DAS28, ESR, CRP, RF, and anti-CCP antibody positive rates between the two groups( P>0.05)when compared with the YORA group.The incidence of osteoarthritis and osteoporosis in the EORA group was significantly higher than that in the YORA group( P=0.018, P=0.011).Ultrasonic results revealed a significantly higher incidence of phalangeal bone erosion in the EORA group compared to the YORA group(14.9% vs.4.3%, P<0.01).Binary logistic regression analysis indicated that different age groups, disease duration, osteoarthritis, and osteoporosis did not have an effect on the ultrasonic changes of synovial hyperplasia, tendonitis, tenosynovitis, and bone erosion in RA patients. Conclusions:There is no significant difference in the clinical disease activity and disease progression between EORA group and YORA group.Additionally, the pattern of joint inflammation involvement is similar in both groups.Ultrasound examinations revealed a higher incidence of bone erosion in finger joints of EORA patients compared to YORA patients.

Objective To explore the value of 3D amide proton transfer weighted imaging(APTWI),diffusion weighted imaging(DWI)and the combination for differentiating benign and malignant bone and soft tissue tumors.Methods Non-contrast MRI,APTWI and DWI of pelvis or lower extremity were prospectively acquired in 96 patients with bone and soft tissue tumors.MTRasym and ADC maps were obtained based on APTWI and DWI calculation with an offset of 3.5 ppm,respectively,and the maximum asymmetric magnetization transfer rate(MTRasym)(MTRasymmax),the mean MTRasym(MTRasymmean)and the minimum MTRasym(MTRasymmin),as well as the maximum apparent diffusion coefficient(ADC)(ADCmax),the mean ADC(ADCmean)and the minimum ADC(ADCmin)values were measured.The above parameters were compared between benign and malignant tumors.Then receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of APTWI,DWI and the combination.Results Among 96 patients,there were 41 benign and 55 malignant pelvic or lower limb bone and soft tissue tumors.In benign tumors,MTRasym(3.5 ppm)values,including MTRasymmax.MTRasymmean and MTRasymmin were significantly higher,whereas ADC values including ADCmax,ADCmeanand ADCmin were significantly lower than those in malignant tumors(all P＜0.05).AUC of MTRasymmax and ADCmin for differentiating benign and malignant bone and soft tissue tumors was 0.791 and 0.873,respectively,being not statistically different(P=0.122),but both lower than that of their combination(AUC=0.944,P＜0.001,P=0.041).Conclusion APTWI combined with DWI had high efficacy for differentiating benign and malignant bone and soft tissue tumors.

Objective: To investigate the expression of uteroglobin-related protein 1(UGRP1) in thyroid cells induced by interleukin-1β(IL-1β) and its correlation with Fas/FasL mediated apoptosis. Methods: Control group, IL-1β group and IL-1β+anti-FasL antibody group were established, rat thyroid cells(FRTL-5 cells) were culturedin vitro. The expression levels of UGRP1 and Fas mRNA of each group were detected by real-time PCR and the apoptosis rate of each group was detected by flow cytometry. Results: Compared with control group, the mRNA expression levels of UGRP1 and Fas in IL-1β group and IL-1β+anti-FasL antibody group increased, and the difference was statistically significant(P<0.05). Compared with control group, the early apoptosis rate of thyroid cells in IL-1β group increased(7.49%±1.91%vs28.46%±3.17%), and the difference was statistically significant(P<0.001). Compared with IL-1β group, the early apoptosis rate of thyroid cells in IL-1β+anti-FasL antibody group decreased(28.46%±3.17%vs19.20%±1.75%), and the difference was statistically significant(P<0.05). Compared with IL-1β group, the expression levels of UGRP1 mRNA(2.22±0.31vs2.66±0.28) and Fas mRNA(2.75±0.18vs3.03±0.16) in IL-1β+anti-FasL antibody group were not significantly different(P>0.05). Conclusion IL-1β induces the high expression of UGRP1 and Fas and apoptosis of thyroid cells, the high expression of UGRP1 is not associated with Fas/FasL mediated apoptosis.

【Objective】 To investigate the effect of leukocyte-depleted suspended red blood cells (lds-RBCs) storaged for different time on blood transfusion effect of patients with hematologic diseases and malignant tumors, as well as to evaluate the storage quality of lds-RBCs in blood stations. 【Methods】 Seven hospitals (4 tertiary-A hospitals and 3 secondary-A hospitals), applying for blood from our blood center, were selected. Blood transfusion cases (medical record) and related data (indicators) of patients with blood diseases and malignant tumors in those hospitals from December 2018 to May 2019 were collected, including disease diagnosis (type) before transfusion, demographic characteristics, date of solo transfusion of lds-RBCs, units of lds-RBCs [(1~2)U/bag, 1 U=200 mL whole blood], different storage duration (1~5 weeks) (bar code), and hemoglobin (Hb) 48 h before and after transfusion. The efficacy of lds-RBCs (storaged for different time) transfusion in patients with hematologic diseases and malignant tumors was evaluated by statistical analysis. 【Results】 A total of 3 557 patients with hematologic diseases and malignant tumors were enrolled in this study. No significant changes were noticed in transfusion efficacy by blood transfusion unit, gender and previous transfusion history (P > 0.05). The effective rate of lds-RBCs in patients with blood diseases and malignant tumors, stratified by storage duration, i. e. storaged for >1~2 weeks, >2~3 weeks, >3~4 weeks and more than >4~5 weeks, was 78.77% vs 77.68% vs 75.06% vs 70.37%, and 79.32% vs 76.73% vs 72.79% vs 67.65%, respectively(P<0.05), with lds-RBCs of 4-5 storage weeks presenting the lowest transfusion efficacy in both groups of patients. 【Conclusion】 The storage time of most lds-RBCs supplied by our center is moren than 3 weeks, and the transfusion effect of lds-RBCs stored for 5 weeks needs further observation. In order to ensure and improve the efficacy of blood transfusion, evidence-based medicine and information management are needed to help the clinical gasp the advantageous time of blood products and shorten the storage-to-transfusion time of red blood cells.

Objective:To clarify the application value of direct cortical electrical stimulation (DES) in locating vestibular functional cortices and the distribution of vestibular functional cortices.Methods:Implantation of stereo-electroencephalography (SEEG) electrodes was performed in 17 drug-resistant epilepsy patients in our hospital from January 2016 to December 2019. The clinical data of these patients were retrospectively analyzed. DES was performed on these patients and stimulation sites eliciting vestibular symptoms were selected to evaluate accurately anatomic locations of stimulation sites eliciting vestibular symptoms in standard Montreal Neurological Institute (MNI) space, and acquired accurate vestibular functional maps in groups.Results:There were 33 stimulation sites eliciting vestibular symptoms, including 9 sites (28%) located in the supramarginal gyrus, 6 sites (18%) located in the precuneus, 6 sites (18%) located in the posterior insular cortex, 1 site (3%) located in the anterior insular cortex, 4 sites (12%) located in the superior temporal gyrus, 2 sites (6%) located in the middle temporal gyrus, 4 sites (12%) located in the precentral gyrus, and 1 site located in cingulate cortex (3%). Stimulation sites eliciting vestibular symptoms induced by lowest intensity located in the insular cortex (average intensity was 2.43 mA), and the average intensity of 6 stimulation sites located in the posterior insular cortex was 2.17 mA.Conclusion:The functional cortex associated with vestibular symptoms defined by DES sites including the insular cortex, superior temporal gyrus, middle temporal gyrus, superior marginal gyrus, precuneus, precentral gyrus, and cingulate cortex.

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 value of ADC histogram in the differential diagnosis of angiomatous meningioma (AM) and hemangiopericytoma (HPC)and to screen out the best diagnostic parameter.Methods The MRI data of 21 cases with AM and 22 cases with HPC confirmed by surgical pathology were analyzed retrospectively.The ROI were drawn on the maximum cross section of the tumor on ADC maps,and the ADC histogram analysis was performed using the software named Mazda.Then the histogram parameters were statistically analyzed to find out the statistically significant parameters between the two groups,and the ROC curve was drawn to evaluate their diagnostic efficacy.Results ADCvariance ,ADC1th and ADC10th had statistical significances between the two groups (P＝0.030,0.002 and 0.02 1 ). ADC1th had the best diagnostic efficacy among them,with the optimal cut-off value of 0.086×10－3 mm2/s,the AUC was 0.814(P＝0.003),and the sensitivity and specificity were 86.70%and 64.70%,respectively.ADCvariance took the second place,for the AUC was 0.725 (P＝0.030),and the sensitivity and specificity were 7 6.50%and 80.00%,respectively.Conclusion The ADC histogram is of great value in the differential diagnosis of AM and HPC,and the ADC1th is the most effective parameter.

Objective To analyze the clinical,radiological features and risk factors of diplopia in patients with acute lacunar infarction (ALI).Methods Retrospectively retrieved patients of ALI (lesion diameter was less than 1.5 cm in DWI sequence)diagnosed by MR and clinical.We further summarized 13 ALI patients with diplopia and randomly selected 13 ALI patients without diplopia as the control group. SPSS22.0 statistical software was used for statistical analysis.The general clinical data such as sex and age was compared by Ch-i square test and t-test.The risk factors were primarily analyzed by one-way ANOVA and then the risk factors with statistical significance were brought into the logistic regression model for multivariate analysis.Results The incidence of diplopia in ALI patients was about 2.7%(13/489). The infarct sites were all located in the brain stem of the oculomotor-related brain nucleus and the dorsolateral medulla oblongata.Hypertension and hematocrit were negatively correlated with diplopia after infarction (P＜0.05 ).Conclusion The incidence of diplopia is low in ALI patients.The medial longitudinal tract of the dorsolateral medulla is an important area causing diplopia.Hypertension and hematocrit are non-risk factors for diplopia after ALI.

Objective: To explore whether the proprioceptive sensory cueing delivered by electrical stimulator to common peroneal nerve can improve the freezing of gait of parkinsonian patients. Methods: Thirty patients with Parkinson′s disease experiencing freezing of gait (FOG) admitted to the First Affiliated Hospital of Anhui Medical University from January to December 2018 were included in the trial. Proprioceptive sensory cueing was provided by alternating electrical stimuli to bilateral common peroneal nerves delivered through the wearable electrical stimulator automatically triggered by walking. The modified 12 meters Timed Walking Test, six items of the modified Parkinson Activity Scale (PSA-6), and FOG score were used to test the gait function respectively when the stimulator was turned on and off. Results: Compared to the off status, time duration for two 360° turns (T360), initiating (T1) and the turning (T2) was reduced with statistical significance when the stimulator was turned on in the three trial situations which were walking with no extra task (17.49 (13.55, 23.48) s vs 14.73 (10.31, 21.71) s, 2.16 (1.78, 2.68) s vs 1.70 (1.38, 2.29) s, 6.37 (4.10, 7.45) s vs 4.77 (3.40, 6.85) s; Z=-3.219, -4.206, -2.910, P<0.05), walking with cognitive task (21.35 (16.30, 30.72) s vs 18.36 (13.83, 27.98) s, 2.80 (2.05, 3.75) s vs 2.04 (1.64, 3.00) s, 6.58 (5.23, 8.96) s vs 5.75 (4.59, 7.76) s; Z=-3.486, -4.206, -3.363, P<0.05) and walking with motor task (25.34 (17.79, 30.30) s vs 22.24 (14.11, 29.33) s, 2.46 (2.19, 3.18) s vs 2.35 (1.66, 2.59) s, 7.77 (4.75, 9.93) s vs 6.45 (3.81, 7.66) s; Z=-3.468, -3.983, -3.570, P<0.05). In all the three exercise modes, the maintaining time (T3) was not significantly different. With the stimulator turned on, the total walking time (Tt) was not significantly different when the patients walked without extra task and with cognitive task but obviously improved with motor task (29.26 (20.11, 33.21) s vs 27.66 (17.70, 32.73) s, Z=-2.644, P=0.008). Compared to the off status, patients showed higher PAS-6 scores (18.99±2.55 vs 16.82±2.92, t=-6.617, P=0.000) and lower FOG scores (14.10±5.02 vs 10.61±5.05, t=6.151, P=0.000) with statistical significance when the stimulator was turned on. Conclusion The wearable electrical stimulator can alleviate FOG in patients with Parkinson′s disease by improving rotation, gait initiation and turning and may be used as a new rehabilitative therapy for patients with FOG.

Objective To explore whether the proprioceptive sensory cueing delivered by electrical stimulator to common peroneal nerve can improve the freezing of gait of parkinsonian patients. Methods Thirty patients with Parkinson′s disease experiencing freezing of gait (FOG) admitted to the First Affiliated Hospital of Anhui Medical University from January to December 2018 were included in the trial. Proprioceptive sensory cueing was provided by alternating electrical stimuli to bilateral common peroneal nerves delivered through the wearable electrical stimulator automatically triggered by walking. The modified 12 meters Timed Walking Test, six items of the modified Parkinson Activity Scale (PSA?6), and FOG score were used to test the gait function respectively when the stimulator was turned on and off. Results Compared to the off status, time duration for two 360°turns (T360), initiating (T1) and the turning (T2) was reduced with statistical significance when the stimulator was turned on in the three trial situations which were walking with no extra task (17.49 (13.55, 23.48) s vs 14.73 (10.31, 21.71) s, 2.16 (1.78, 2.68) s vs 1.70 (1.38, 2.29) s, 6.37 (4.10, 7.45) s vs 4.77 (3.40, 6.85) s; Z=-3.219,-4.206,-2.910, P<0.05), walking with cognitive task (21.35 (16.30, 30.72) s vs 18.36 (13.83, 27.98) s, 2.80 (2.05, 3.75) s vs 2.04 (1.64, 3.00) s, 6.58 (5.23, 8.96) s vs 5.75 (4.59, 7.76) s; Z=-3.486,-4.206,-3.363, P<0.05) and walking with motor task (25.34 (17.79, 30.30) s vs 22.24 (14.11, 29.33) s, 2.46 (2.19, 3.18) s vs 2.35 (1.66, 2.59) s, 7.77 (4.75, 9.93) s vs 6.45 (3.81, 7.66) s; Z=-3.468,-3.983,-3.570, P<0.05). In all the three exercise modes, the maintaining time (T3) was not significantly different. With the stimulator turned on, the total walking time (Tt) was not significantly different when the patients walked without extra task and with cognitive task but obviously improved with motor task (29.26 (20.11, 33.21) s vs 27.66 (17.70, 32.73) s, Z=-2.644, P=0.008). Compared to the off status, patients showed higher PAS?6 scores (18.99±2.55 vs 16.82±2.92, t=-6.617, P=0.000) and lower FOG scores (14.10 ± 5.02 vs 10.61 ± 5.05, t=6.151, P=0.000) with statistical significance when the stimulator was turned on. Conclusion The wearable electrical stimulator can alleviate FOG in patients with Parkinson′s disease by improving rotation, gait initiation and turning and may be used as a new rehabilitative therapy for patients with FOG.