Objective:To investigate the application of magnetic resonance imaging (MRI) in clinical staging and classification of adult Japanese encephalitis.Methods:The clinical data and craniocerebral MRI findings of 35 adult patients with Japanese encephalitis admitted in General Hospital of Ningxia Medical University from August to September 2018 were analyzed retrospectively. The MRI imaging characteristics were compared among patients with different stages and types, the apparent diffusion coefficient (ADC value) of thalamic lesions in patients of different stages was analyzed. SPSS 23.0 software was used to analyze the data.Results:Six moderate cases all had lesions involving the thalamus, and the number of intracranial lesions was <2. In 11 severe cases, 8 had lesions involving thalamus and 5 had lesions involving hippocampus; the number of intracranial lesions was <2 in 3 cases, the number of intracranial lesions was 2-4 in 3 cases, and the number of intracranial lesions was >4 in 5 cases. In 18 cases critical cases, the lesions involved thalamic in 14 cases, hippocampus in 14 cases, cerebral cortex in 14 cases, cerebral feet in 9 cases, basal ganglia area in 6 cases, and brain stem in 2 cases, respectively; 2 cases had the intracranial lesions <2, 6 cases had intracranial lesions 2-4, 10 cases had intracranial lesions >4. In 11 preliminary stage patients, 9 cases had DWI high signal and 2 had FLAIR slightly high signal; in 19 extreme stage patients, 16 cases had DWI high signal, 11 cases had FLAIR slightly high signal, 3 cases had T1WI high signal and 6 cases had T2WI high signal. In 5 recovery stage patients, 1 case had DWI slightly high signal, 5 cases had FLAIR high signal, and 1 case had T2WI high signal. The ADC values of thalamic lesions in recovery and extreme patients were higher than those in the preliminary stage ( q=3.931 and 4.012, P<0.05). The ADC value of thalamic lesions in the recovery period was higher than that in the extreme period ( q=3.372, P<0.05). Conclusions:The number of lesions and the range of involvement are associated with disease severity in adult Japanese encephalitis. The DWI sequence is easy to detect at early stage, and the FLAIR sequence shows a long time span of lesions; and the DWI and FLAIR sequences are of great significance for the early clinical staging and classification of adult encephalitis patients. At the same time, the ADC value shows a trend of disease progresses, which can be used as a supplement for the clinical staging in adult encephalitis patients.

Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.

OBJECTIVETo investigate changes over time in the shape and signal intensity of high intensity zone (HIZ) in the lumbar intervertebral discs on magnetic resonance images in patients with low back pain.

METHODSThe imaging data were collected from 27 patients with low back pain, who underwent lumbar magnetic resonance (MR) imaging examinations that identified HIZ lesions and received follow-up MR examinations at least 1.5 years later over the period from January 2009 to January 2017. The initial and follow-up MR T2WI images of the patients were read by two experienced radiologists to categorize the changes in the shape of the HIZ lesions into enlarged, unchanged, shrunk, and disappeared. The volume and signal/cerebrospinal fluid signal intensity (T2/CSF) ratio of the HIZ were measured on sagittal MR images using ImageJ software.

RESULTSOf the 43 HIZ lesions found in the initial examinations, 22 (51.2%) remained unchanged in the follow-up examinations, 10 (21.3%) were enlarged, 9 (20.9%) shrank, and 2 (23.3%) disappeared. The follow-up examinations revealed 4 new HIZ lesions in the intervertebral discs. The volumes of these lesions did not vary significantly in the follow-up examinations (=0.653), but the T2/CSF ratio was significantly higher in the follow-up than in the initial examinations (=0.043).

CONCLUSIONSAfter observation for an average of 3 years and 3 months, most of the HIZ lesions in the lumbar intervertebral discs of the patients with low back pain remained stable in shape, but their signal intensity on MR images increased.

Objective To investigate the difference of Alzheimer-associated neuronal thread protein ( AD7c-NTP) level and related factors among different symptom types of schizophrenia. Methods The con-centrations of AD7c-NTP in urine of 30 patients with positive symptoms,46 patients with negative symptoms and 24 controls were detected by enzyme linked immunosorbent assay( ELISA) . Positive and negative symp-tom scale ( PANSS) was used to assess schizophrenia patients. The correlation analysis was conducted be-tween the urine AD7c-NTP and demographic factors. Results The level of AD7c-NTP in urine of patients with negative symptoms((0. 88±0. 93) ng /ml)was higher than that in the patients with positive symptoms ((0. 50±0. 22)ng/ml,P<0. 05). The level of AD7c-NTP of in urine female patients((1. 16±1. 12)ng/ml) was higher than that in the male patients((0. 57± 0. 49)ng/ml,P<0. 01). AD7c-NTP levels in patients with a course of disease of more than 100 months((0. 96±0. 96)ng/ml) were higher than those in patients with a course of disease of less than 100 months((0. 60±0. 59)ng/ml,P<0. 05). The level of AD7c-NTP in pa-tients over 35 years old((0. 94±0. 96)ng/ml) were higher than that in patients under 35 years old((0. 62±0. 62)ng/ml,P<0. 05). The level of AD7c-NTP in patients with MMSE score of 0-22 points((0. 92±0. 80) ng/ml) were higher than that in patients with score of 23-29 points((0. 62±0. 74)ng/ml,P<0. 05). Before admission(at least 2 months),the level of AD7c-NTP in patients without persisting in taking drugs((0. 99± 0.95)ng/ml) was higher than that in patients with persisting in taking drugs((0. 62±0. 65)ng/ml,P<0. 05). The level of AD7c-NTP in schizophrenic patients was positively correlated with age and course of dis-ease( r=0. 29,0. 26,P<0. 05) ,and negatively correlated with smoking history and mini-mental state exami-nation( MMSE) ( r=-0. 13,-2. 41,P<0. 05) . Conclusion There is a difference in AD7c-NTP levels be-tween patients with positive and negative symptoms of schizophrenia. Gender,age,course of disease and anti-psychotics are important factors that affect AD7c-NTP levels in patients with schizophrenia.

Objectives To explore the genetic diagnosis of fructose 1,6 diphosphatase deficiency and analysis of mutation sites of its pathogenic genes. Methods The clinical data and the related results of gene panel screening in one child with fructose 1, 6 diphosphatase (FBPase) deficiency were retrospectively reviewed. Results The 2-year-old girl suffered repeated infection, nausea, vomiting, mental illness, and drowsiness, accompanied by intermittent convulsions. Blood biochemical tests sμggested hypoglycemia and acidosis.The FBP1 gene had a missense mutation,c.355G>A,p.Asp119Asn(isozygoty).Both her parents carried the locus variation (heterozygous). Conclusions Fructose 1, 6 diphosphatase deficiency should be considered when child with hypoglycemia after repeated infection, acidosis, and ketosis.

OBJECTIVETo observe the impact of electroacupuncture (EA) on the quality of life in the patients of female mixed urinary incontinence (MUI) and evaluate its clinical efficacy.

METHODSEA was adopted in 25 cases of MUI at Zhongliao (BL 33) and Huiyang (BL 35), needle retaining for 30 min each time. The treatment was given once every two days, three treatments a week, totally for 12 weeks of treatment. The incontinence quality of life questionnaire (I-QOL), the incontinence impact questionnaire-7 (IIQ-7), the urogenital distress inventory short form (UDI-SF) and the visual analogue scale (VAS) were adopted in the comparison before and after treatment. The efficacy was evaluated.

RESULTSThe curative rate was 52.0% (13/25) and the total effective rate was 96.0% (24/25) in 25 cases. In comparison before and after treatment, in I-QOL, the score of limiting behaviors was increased up to (30.32 ± 3.39) from (11.52 ± 2.45), the score of psychosocial impacts was up to (36.48 ± 2.90) from (13.52 ± 2.25) and the score of social isolation was up to (21.52 ± 1.61) from (9.84 ± 2.23). The score of IIQ-7 was decreased, down to (2.48 ± 1.36) from (11.96 ± 3.45), the score of UDI-SF was down to (2.92 ± 0.95) from (8.84 ± 2.58) and VAS score was down to (1.40 ± 0.91) from (6.96 ± 1.65). The differences were all significant statistically in comparison (all P < 0.05).

CONCLUSIONEA improves effectively the quality of life in MUI patients and the clinical efficacy is apparent.

Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Middle Aged ; Quality of Life ; Treatment Outcome ; Urinary Incontinence ; physiopathology ; therapy ; Urination

Objective To explore the action of nurses etiquette scene assessment to clinical nurses carrying out the etiquette rules consciously .Methods An inspection team was established to assess the scene of nurses etiquette;scoring criteria , evaluation methods and evaluation of the program were set up for the assessment .At first weeks of every month , from September to November in 2015 , when the patients′nursing satisfaction was surveyed , nurses etiquette service status in hospital was tested using scoring criteria of nurses etiquette scene assessment privately which was assigned as the control group .As the observed group, during the period of the first weeks of December , 2015 to February, 2016, While nursing satisfaction questionnaires were implemented , all ward nurses etiquette was tested openly .All nurses of two groups received routine training and theory of etiquette training before coming to the wards .Results Scores of control group were lower than the observed group , and the total scores , the scores of nurse dressing code and communication behavior norms were different between the two groups (P <0.05).The nursing service satisfaction of control group was lower than the observed group (P<0.05).Conclusions Scene assessment of nurse etiquette can help nurses improve compliance with the norms of etiquette consciously and the patients′satisfaction of nursing service .

Objective To compare the value of assessment with DWI and contrast-enhanced MRI (CE-MRI) in activity of sacroiliitis of patients with ankylosing spondylitis(AS).Methods Ninety-six patients conforming to modified New York criteria were prospectively collectedas the AS group, and twenty-one healthy volunteers were enrolled into the control group. According to the Bath AS disease activity index (BASDAI), erythrocyte sedimentation rate and C-reaction protein, AS patients were divided into the active AS group (n=60) and the chronic AS group (n=36) . All subjects were performed with conventional MRI, DWI and CE-MRI of bilateral sacroiliac joints. The MRI manifestations were reviewed and the ADC values and signal intensity enhancement rate (ΔSI) were measured.ANOVA was performed for the comparison ofΔSI and ADC values among active AS group, chronic AS group and control group with BASDAI and lab test results as the gold standards. ROC was analyzed with ΔSI and ADC values for activity of AS and paired
samples t test was obtained to comparethe areas under the ROC ofΔSI and ADC values.Results Among 96 cases of AS patients, MRI of sacroiliac jointsshowed that 62 cases had subchondral bone edema (57 cases of active group, 5 cases of chronic group), that 11 cases had bone surface erosion(4 cases of active group, 7 cases of chronic group), that 15 cases had bone sclerosis(6 cases of active group, 9 cases of chronic group) and that 58 cases had fat deposition on the sacroiliac joints (27 cases of active group, 31 cases of chronic group). The ΔSI values of the active group, the chronic group and control group were respectively (2.51 ± 1.69)%,(1.19 ± 0.67)%and(0.75 ± 0.21)%, and the ADCvalues were(1.33 ± 0.33)× 10-3,(1.00 ± 0.43)× 10-3 and(0.38±0.13)×10-3mm2/s. There were significant differences forΔSI and ADC values among three groups (F=18.375, 16.366. P<0.01), and statistical significance ofΔSI and ADC values were found between every two groups of three(P< 0.05).The area under the ROC between ΔSI and ADC to determine activity of AS patients were respectively 0.814 and 0.730, which had nostatistical significance(t=1.632, P=0.103). The sensitivity and specificity to determine activity of AS patients byΔSI=1.44%were 81.67%and 80.00%.The sensitivity and specificity to determine activity of AS patients by ADC=1.15 × 10-3/mm2 were 76.67% and 71.43%.Conclusion DWI and CE-MRI performed equally in detecting activity of AS patients.

OBJECTIVETo assess the correlation between vertebral body deformity and degeneration of the adjacent intervertebral discs in patients with old thoracolumbar compression fractures.

METHODSSeventy-one patients who had been conservatively treated after single segment thoracolumbar compression fractures between April, 2011 and May, 2014 were enrolled in this study. Both radiographic and magnetic resonance (MR) images of the thoracolumbar segment were obtained. The involved vertebral body deformity was rated on radiography according to the Genant criterion, and the degeneration of the adjacent cephalic and caudal discs was assessed on MR images using the Oner and Pfirrmann classification schemes, respectively. The relationship between vertebral body deformity and adjacent disc changes was assessed using correlation analysis, and the changes in the adjacent cranial and caudal discs was compared.

RESULTSThe Genant classification of the involved vertebral bodies was moderately correlated with Oner morphological scores (r=0.48, P<0.01), but not with the Pfirrmann signal scores of the adjacent cephalic discs or with the Genant or Pfirrmann scores of the adjacent caudal discs (P>0.05). The Oner classification of the adjacent cephalic discs was higher than that of the adjacent caudal discs (P<0.01), but their Pfirrmann classification did not differ significantly.

CONCLUSIONThe deformity of vertebral body affects the adjacent cephalic discs proportionally but not the adjacent caudal discs.

Fractures, Compression ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Spine ; pathology

OBJECTIVETo compare the image quality of isotropic 3-dimensional fast spin echo (3D-FSE), 3D fast field echo (3D-FFE), and 2D fast spin echo (2D-FSE) sequences in magnetic resonance imaging (MRI) of the anatomical structure of the ankle joint.

METHODSThe ankle joints of 10 healthy volunteers were examined with isotropic 3D-FSE, 3D-FFE and 2D-FSE sequences using a 1.5T MR scanner and 3D reconstruction. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the tissues were measured. Two radiologists evaluated the image quality of the 3 sequences using a 5-point Likert scale in a double-blinded manner.

RESULTSThe 3D-FSE sequences resulted in the highest SNRs for all the tissues and the highest CNRs for differentiation between cartilage and marrow, between muscle and tendon, and between tendon and fluid. In the estimation of image quality for cartilages, 3D-FFE had the highest score followed by 3D-FSE, and the latter had the highest score among the 3 sequences in displaying the tendon.

CONCLUSION3D-FSE sequence has a high performance in displaying the anatomical structures of complex joints especially for cartilage, ligament, and tendon tissues.

Ankle Joint ; anatomy & histology ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging