目的：探討單純腦白質疏松癥(LA)以及LA合并腦梗死及其MRI影像學嚴重程度與年齡、性別、高血壓、糖尿病相關性初步分析。方法：根據郭氏等2003年制定的LA診斷標準納入168例腦白質疏松癥患者，分為A、B兩組：A組95例為單純腦白質疏松(LA)，B組73例為LA合并腦梗死(LA+CI)。兩組患者均行頭MRI檢查。根據Kinkel等的方法將T2WI顯示腦室周圍高信號范圍及程度分為5型.結果：年齡與腦白質疏松的嚴重程度呈線性相關性(Plt;0.05)，男性與女性間比較腦白質疏松的發生率無顯著差異(Pgt;0.05)，LA以及LA+CI患者，其高血壓及糖尿病伴發率較高，而且LA+CI組高于LA組(高血壓Plt;0.01，糖尿病Plt;0.01)，LA患者MRI表現以1型為主，LA+CI患者表現以2型為主，Plt;0.01)。結論：腦白質疏松癥的嚴重程度與年齡密切相關，LA的發生率在男女性別間無明顯差異。高血壓、糖尿病可能是LA的危險因素。LA+CI組與單純LA組相比，其高血壓、糖尿病伴發率更高且MRI表現程度更重。
摘要:目的:探索可靠的卒中患者床旁吞咽評估方法。方法：61例住院卒中患者均進行各種床旁吞咽評估篩查及電視透視檢查，以后者為金標準探討各方法的敏感度、特異度及陽性、陰性預測值。結果:六種獨立床旁吞咽評估方法與金標準相比較的敏感度在60%～87%之間，特異度在76%～89%之間，陽性預測值在50%～69%之間，陰性預測值在86%～95%之間；幾種評估方法作為平行試驗聯合應用時的敏感度在89%～98%之間，陰性預測值在94%～99%之間；幾種方法作為序列試驗應用時的特異度在97%～99%之間，陽性預測值在82%～90%之間。結論：根據不同方法的預測特點，可得到針對不同患者的、有效的床旁評估方法。床旁吞咽評估簡單、有效、便捷，是臨床工作中適宜的評估方法。
【摘要】 目的 分析合并免疫指標異常的視神經脊髓炎臨床特點。 方法 回顧性分析2009年5月-2010年11月收治的62例視神經脊髓炎患者中24例合并免疫指標異常患者的臨床資料。24例均為女性，發病年齡14~53歲。對其臨床表現、視覺誘發電位、影像學檢查結果、免疫檢查結果進行分析。 結果 所有患者均有脊髓和視神經同時或先后受累的表現。24例視覺誘發電位檢查23例異常。脊髓MRI顯示病變集中于頸段、上胸段脊髓。頸段和胸段脊髓同時受累17例，單純頸段脊髓受損6例，單純胸段脊髓受損1例。所有患者抗核抗體滴度均≥1∶100，合并抗SSA抗體陽性14例（55.5％），同時合并抗SSB抗體陽性11例（45.8％），合并抗Rib抗體陽性1例，合并抗SCL-70抗體陽性1例，合并抗dsDNA抗體1例。 結論 視神經脊髓炎合并免疫指標異常的患者以女性較為多見，易復發，青壯年患者發病率最高。脊髓MRI示病變集中于頸段、上胸段脊髓，表現為長節段脊髓損害。視神經脊髓炎患者合并結締組織病的病例較多。【Abstract】 Objective To analyze the clinical features of neuromyelitis optica (NMO) combined with abnormal immune parameters. Methods We retrospectively reviewed the clinical data of 24 patients with NMO and abnormal immune parameters among the 62 NMO patients who were admitted into our department between May 2009 and November 2010. All patients were female, aged from 14 to 53 years. We analyzed their clinical manifestations, visual evoked potentials, imaging results, and immunological examinations. Results All patients had simultaneous or successive spinal cord and optic nerve involvement. Twenty-three patients had abnormal visual evoked potential. MRI showed that the lesions focused on the cervical and upper thoracic spinal cord. Both cervical and thoracic spinal cord were involved in 17 cases; there were 6 cases of simple cervical spinal cord injury and 1 case of simple thoracic spinal cord damage. Antinuclear antibody titer of all the patients was ≥1∶100. Combined positive anti-SSA antibody occurred in 14 patients (55.5%); Concomitant positive anti-SSB antibodies occurred in 11 patients (45.8%); Combined positive anti-Rib antibodies occurred in 1 patient; Combined positive anti-SCL-70 antibody occurred in 1 patient; and combined positive anti-dsDNA antibodies occurred in 1 patient. Conclusions NMO combined with abnormal immune parameters mainly occurs in female patients, especially in young people. Recurrence rate is high. MRI shows that the lesions focus mainly on the cervical and upper thoracic spinal cord, manifesting the characteristic of long segment damage. And NMO is frequently combined with connective tissue disease.
Pathological images of gastric cancer serve as the gold standard for diagnosing this malignancy. However, the recurrence prediction task often encounters challenges such as insignificant morphological features of the lesions, insufficient fusion of multi-resolution features, and inability to leverage contextual information effectively. To address these issues, a three-stage recurrence prediction method based on pathological images of gastric cancer is proposed. In the first stage, the self-supervised learning framework SimCLR was adopted to train low-resolution patch images, aiming to diminish the interdependence among diverse tissue images and yield decoupled enhanced features. In the second stage, the obtained low-resolution enhanced features were fused with the corresponding high-resolution unenhanced features to achieve feature complementation across multiple resolutions. In the third stage, to address the position encoding difficulty caused by the large difference in the number of patch images, we performed position encoding based on multi-scale local neighborhoods and employed self-attention mechanism to obtain features with contextual information. The resulting contextual features were further combined with the local features extracted by the convolutional neural network. The evaluation results on clinically collected data showed that, compared with the best performance of traditional methods, the proposed network provided the best accuracy and area under curve (AUC), which were improved by 7.63% and 4.51%, respectively. These results have effectively validated the usefulness of this method in predicting gastric cancer recurrence.
Objective To investigate the effect of monocyte chemoattractant protein 1 (MCP-1) on the migration of the induced and differentiated mouse bone marrow mesenchymal stem cells (BMSCs) for raising the efficacy of intravenous transplantation of BMSCs. Methods The BMSCs were cultured with the method of differential adhesion and density gradient centrifugation of C57/BL10 mice, and were identified by alkal ine phosphatase Gomori modified staining after osteogenic inducing. At the 3rd passage, the BMSCs were induced to the myoblasts with 5-azacytidine (5-Aza). The chemotaxis of MCP-1 in the induced and differentiated BMSCs in vitro at concentrations of 25, 50, 100, 200, and 400 ng/mL was observed through the migration test, by counting the number of the migrated cells. The expression of the chemokine receptor 2 (CKR-2) in the induced and differentiated BMSCs was detected with the flow cytometry. Results The cells could be cultured with the methods of differential adhesion and density gradient centrifugation and still had higher prol iferative and differentiative potency; the induced cells at the 3rd passage could differenciate to the osteoblasts, confirming that the cells were BMSCs; the myogenic induced BMSCs possesed the sarcotubule structure. The number of the migrating BMSCs at MCP-1 concentrations of 25-400 ng/ mL were respectively 35.066 7 ± 6.584 2, 43.200 0 ± 6.460 8, 44.466 7 ± 4.823 5, 45.600 0 ± 8.650 3, and 50.733 3 ± 7.582 5; showing significant difference when compared with control group (28.333 3 ± 8.917 6, P lt; 0.05), and presenting significant difference among 25, 50, 400 ng/mL groups compared with each other (P lt; 0.05). The expression of CKR-2 in the mouse BMSCs (48.0%) was significantly higher (P lt; 0.001) than those of blank control (0.6%) and negative control (17.0%). Conclusion The results indicate that the MCP-1 can induce the migration of mouse BMSCs by MCP-1/CKR-2 pathway.
Objective We aimed to evaluate the current status of the construction and practice of the stroke center in West China Hospital of Sichuan University and develope a future strategy to promote the standardized developement of inpatients care and evidence practice. Methods The current status of the Stroke Center in West China Hospital of Sichuan University was assessed. The procedure of diagnosis and treatment was inspected in detail, including triage, thrombolytic therapy, antithrombotic medication and anticoagulant, primary and secondary prevention, filter of risk factors, rehabilitation and education for patients. After that, new plans were made on the basis of the assessment and experiences acquired from practices in the Stroke Center in West China Hospital. Results The primary Stroke Center had been constructed in West China Hospital. The practice in West China Hospital showed that the Stroke Center significantly reduced the mortality and shortened the length of hospital stay of the patients with stroke. Conclusion It is proved that construction and implementation of the Stroke Center in West China Hospital are feasible.
ObjectiveTo explore the clinical features of myasthenia gravis (MG) harboring both acetylcholine receptor antibody (AChRAb) and muscle-specific tyrosine kinase antibody (MuSKAb) positivity.MethodsWe searched PubMed, Web of Science, Embase and China National Knowledge Infrastructure databases (from inception to November 2016), to collect the case reports of MG with both AChRAb and MuSKAb positivity. Along with one case discovered in Department of Neurology, West China Hospital, the clinical data of the cases were retrospectively analyzed.ResultsA total of 13 double-seropositive MG patients were enrolled in this study, demonstrating a marked female predominance (including 1 male and 12 females) and a younger age at onset [(31.07±24.77) years]. During the disease course, 10 of the included patients presented severe bulbar involvement, dyspnea and neck weakness, with myasthenic crisis in 6 individuals. Among the 11 patients with detailed records, abnormal thymus glands comprised 4 thymus hyperplasia and one thymoma. While the response to oral pyridostigmine was unsatisfactory in 11 double-seropositive MG patients, ranging from mild benefit to overt intolerance; the patients treated with plasma exchange (3/3), rituximab (1/1) or corticosteroid (7/12) improved dramatically, with other immumosuppressants and intravenous immunoglobulin partially responsive. Moreover, 5 patients undergoing thymectomy improved markedly or partially.ConclusionsCompared with MG patients with MuSKAb positivity merely, the condition of the double-seropositive MG patients seem to be more severe and further inclined to myasthenic crisis. The incidence of abnormal thymus, such as thymus hyperplasia, is higher. Thymectomy may be an effective treatment for such patients.