The functional connectivity of the default mode network is important in understanding the neuro-pathophysiological abnormalities in patients with non-arteritic anterior ischaemic optic neuropathy. Independent component analysis can effectively determine within and between network connectivity of different brain components. Therefore, in order to explore the association between the default mode network and other brain regions, we utilized independent component analysis to investigate the alteration of functional connectivity of the default mode network. Thirty-one patients with non-arteritic anterior ischaemic optic neuropathy and 31 healthy controls, matched for age, sex and years of education, were recruited. For patients and healthy controls, functional connectivity within and between the default mode network and other brain regions were evaluated by independent component analysis. Compared with healthy controls, patients with non-arteritic anterior ischaemic optic neuropathy showed reduced functional connectivity within the default mode network in the right cerebellar tonsil and left cerebellum posterior lobe and increased functional connectivity in the left inferior temporal and right middle frontal gyri. Furthermore, patients with non-arteritic anterior ischaemic optic neuropathy showed reduced functional connectivity between the default mode network and other brain regions in the left cerebellar tonsil and increased functional connectivity in the right putamen, left thalamus, right middle temporal and left middle frontal gyri. In conclusion, negative correlations between several clinical parameters and functional connectivity of the default mode network were observed. The study contributes to understanding the mechanism of functional reorganization in non-arteritic anterior ischaemic optic neuropathy.

BackgroundChronic nonbacterial osteomyelitis (CNO) is an auto-inflammatory bone disease that usually develops in childhood. Spinal involvement is a common manifestation of CNO, but it is rare for CNO to lead to rapid progression of scoliosis deformity. Here we present a 9-year-old girl with acute scoliosis with CNO and scoliosis progressed rapidly in 2 months.Case PresentationA 9-year-old girl presented bilateral shoulder inequality with pain in the left hypochondrium for 2 months. Standing spinal x-rays showed right convex scoliosis with a 25° Cobb angle. Chest magnetic resonance imaging (MRI) showed that the T8 vertebra was flattened and local bone was destroyed with bone marrow edema. The bone biopsy showed evidence of fibrosis and chronic inflammatory changes with no specific diagnosis. One month later, her scoliosis and bone destruction deteriorated obviously. Thoracic vertebra MRI showed that the T8 vertebra had a compression fracture. 99mTc-MDP whole-body bone scintigraphy showed intense uptake at T8/9 and the right sacroiliac joint. She was diagnosed with CNO accompanied by rapidly progressive scoliosis. The scoliosis was successfully treated with adalimumab and zoledronic acid, which showed significant improvement after 6 months of follow-up.ConclusionZoledronic acid and adalimumab successfully treated CNO with rapidly progressive scoliosis, but could not prevent vertebral compression.

目的:探讨肺癌患者外周血Septin9基因甲基化状态与临床病理特征的关系,及其对人肺癌A549细胞生物学行为的影响.方法:选取104例肺癌患者为研究对象,96例健康人员为对照,采用甲基化特异聚合酶链式反应(PCR)法检测两组外周血中Septin9基因甲基化情况,并计算Septin9基因甲基化阳性率,分析Septin9基因甲基化阳性率与肺癌临床病理特征的关系.采用5、10、20 μmol·L-1 5-aza-dC处理人肺癌细胞系A549,以正常培养的A549细胞作为对照组,采用实时荧光定量PCR和蛋白质印迹(Western blot)检测细胞中Septin9 mRNA和蛋白表达,通过MTT法检测细胞的增殖活性,流式细胞仪检测细胞的凋亡情况,Transwell实验检测细胞的迁移与侵袭能力.结果:与对照组相比,肺癌患者外周血中Septin9基因甲基化阳性率显著升高.Septin9基因甲基化阳性与肺癌患者的TNM分期、分化程度、淋巴结转移有关,Septin9基因甲基化阳性与肺癌患者的性别和年龄无关.经5-aza-dC处理后,A549细胞中Septin9 mRNA和蛋白表达水平均显著上调,且呈浓度依赖性;5-aza-dC能显著抑制A549细胞增殖,呈浓度与时间依赖性;在5-aza-dC处理后,A549细胞的凋亡率呈浓度依赖性地显著增加;同时,5-aza-dC显著抑制了 A549细胞的迁移与侵袭,且均呈浓度依赖性.结论:肺癌外周血Septin9基因甲基化阳性率增加,该指标与肺癌肿瘤分期、分化程度和淋巴结转移有关,5-aza-dC处理能通过恢复A549细胞中Septin9表达来抑制肺癌细胞增殖、迁移与侵袭,并诱导细胞凋亡.

目的 探讨T淋巴细胞亚群基线水平在培美曲塞联合顺铂一线化疗方案治疗肺腺癌生存预测中的价值.方法 选取医院呼吸科2015年1月至2019年12月接受培美曲塞联合顺铂一线化疗方案治疗的肺腺癌患者147例,按不同化疗疗效分为完全缓解(CR)+部分缓解(PR)组(61例)、疾病稳定(SD)组(56例)和疾病进展(PD)组(30例).采用LSD-t检验或χ2检验分析肺腺癌患者外周血T淋巴细胞亚群基线水平与临床病理特征的关系,进一步比较不同化疗疗效患者的T淋巴细胞亚群基线水平,采用Cox回归分析评价CD8+T细胞比例和CD4+/CD8+基线水平对肺腺癌患者化疗后2年总生存率(OS)的影响,采用Kaplan-Meier生存分析分别比较CD8+≥32.0％和CD8+<32.0％,CD4+/CD8+>1.3和CD4+/CD8+≤1.3两组肺腺癌患者化疗后6个月、1年、2年的OS.结果 CD8+T细胞比例和CD4/CD8+与肺腺癌患者淋巴结转移、TNM/T分期和远处转移密切相关(P<0.05).CR+PR组的CD8+T细胞比例基线水平为(36.5±8.1)％,显著高于SD组的(31.2±6.9)％及PD组的(29.5±7.4)％(P<0.05);CR+PR组的CD4+/CD8+基线水平为1.1±0.3,显著低于SD组的1.5±0.4及PD组的1.6±0.4(P<0.05).多因素Cox回归分析显示,CD8+T细胞比例和CD4+/CD8+基线水平均为影响肺腺癌患者化疗后2年OS[HR=1.56,95％CI(1.15,3.98,P=0.028;HR=1.67,95％CI(1.35,4.24),P=0.039]的独立预测因素.Kaplan-Meier生存分析结果显示,CD8+≥32.0％和CD4+/CD8+≤1.3的患者化疗后6个月、1年、2年OS均显著高于CD8+<32.0％ 和CD4+/CD8+>1.3的患者(100.00％ 比91.44％、89.53％ 比65.43％、72.32％ 比45.61％,100.00％ 比93.63％、92.53％比60.92％、78.61％比44.53％,P<0.05).结论 外周血CD8+T细胞比例基线水平较高、CD4+/CD8+基线水平较低,提示患者化疗后生存时间较长,预后较好.

目的 观察外周血自然杀伤细胞(NK)、CD8+T淋巴细胞在早期卵巢癌(OC)患者中的水平,并分析二者预测早期OC患者腹腔镜术后淋巴结转移的价值.方法 回顾性分析2016年3月至2018年3月该院收治完成腹腔镜手术后3年内发生淋巴结转移的40例早期OC患者病历资料,设为转移组;另收集同期该院收治完成手术后3年内未发生淋巴结转移的40例早期O C患者资料,设为未转移组;均获得3年随访结果,随访时间截至2021年3月,查阅资料,记录患者基线资料及实验室指标,重点比较入院时外周血N K细胞、CD8+T淋巴细胞水平,并分析二者预测早期OC患者术后淋巴结转移的价值.结果 转移组患者入院时血清糖类抗原125(CA125)、人附睾蛋白-4(HE4)、外周血CD8+T淋巴细胞水平高于未转移组,外周血NK细胞水平低于未转移组(P<0.05);回归分析发现,入院时HE4、CD8+T淋巴细胞高水平、NK细胞低水平均可能与患者术后淋巴结转移有关(P<0.05);绘制受试者工作特征曲线,入院时NK细胞、CD8+T淋巴细胞单独及联合预测早期OC患者术后淋巴结转移风险的曲线下面积均>0.80,有一定预测价值;相关性检验,外周血NK细胞、CD8+T淋巴细胞水平之间呈负相关(r=-0.446,P<0.001).结论 外周血NK细胞低水平、CD8+T淋巴细胞高水平对预测早期OC患者腹腔镜术后淋巴结转移风险具有一定价值.

Objective:To investigate the clinical value of peripheral monocyte and neutrophil count in predicting the response of patients with metastatic non-small cell lung cancer (mNSCLC) to immunosuppressive checkpoint inhibitors (ICI).Methods:The clinical data of 34 adult mNSCLC patients who received nafulizumab or pabolizumab in Danzhou People's Hospital of Hainan Province from January 2017 to March 2019 were retrospectively analyzed. The correlation of the demographic characteristics, clinical data, hematological examination results in the first two weeks before the treatment and two weeks after ICI treatment with prognosis was recorded and observed.Results:The baseline mean monocyte count [(0.52±0.09)×10 9/L vs. (0.60±0.12)×10 9/L] and neutrophil count [(4.27±0.87)×10 9/L vs.(5.39±1.02)×10 9/L] of patients with ICI reaction were lower than those of patients without ICI reaction, and the differences were statistically different ( t = -2.572, -2.727, all P < 0.05). However, there was a negative correlation between the monocyte count of the patients who responded to ICI and the reaction time ( r = -0.507, P < 0.05). The median reaction time in patients with monocyte count >0.70×10 9/L was shorter than that in patients with monocyte count ≤0.70×10 9/L (8 weeks vs. 12 weeks, χ2=4.162, P = 0.041). There was no correlation between monocyte count and time of reaction duration, progression of free survival (PFS) and overall survival (OS) ( r = -0.214, 0.182, 0.232, all P > 0.05). The decrease rate of neutrophil count in response group was higher than that in non-response group (22% vs. 2%, P < 0.05). After the first administration, cutoff value of neutrophil count was 4.2×10 9/L; the response rate of patients with neutrophil count ≤ 4.2×10 9/L was higher than that of patients with neutrophil count > 4.2×10 9/L [86.7% (13/15) vs. 36.8% (7/19), χ2=6.657, P < 0.05]. Conclusion:Peripheral blood monocyte and neutrophil count can predict the response to ICI therapy in patients with mNSCLC.

Purpose: To investigate the possible changes in functional connectivity (FC) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) using resting-state functional MRI (fMRI).Methods: Thirty-one NAION patients and 31 healthy controls were recruited and underwent resting-state fMRI scans. Regions of interest (ROIs) were defined as bilateral Brodmann’s area 17 (BA17). FC analysis was performed between the ROIs and the rest of the brain regions, and the between group comparisons of FC were performed. We conducted correlation analysis between the FC changes and the clinical variables in NAION patients.Results: Compared with healthy controls, patients with NAION showed significantly decreased FC between the left BA17 and the right inferior frontal gyrus, left caudate nucleus. As for the right BA17, patients exhibited significantly increased FC with the left olfactory gyrus and decreased FC with the right superior frontal gyrus (SFG), right insula. Moreover, FC values between the right insula and the right BA17 were positively correlated with the right side of mean sensitivity in the central visual field (r = 0.52, P < 0.01) and negatively correlated with the right side of mean defect in the central visual field (r = −0.55, P < 0.01).Conclusion: Our study indicated that patients with NAION showed significantly abnormal functional reorganization between the primary visual cortex and several other brain regions not directly related to visual function, which supports that NAION may not only be an ophthalmic disease but also a neuro-ophthalmological disease.

2020年1月27日北京中医药大学组建国家中医医疗队赴武汉参与一线抗疫工作.为协助医疗队更好地救治重型患者,提高疗效,北京中医药大学组织了远程专家视频会诊,邀请北京中医药大学医学专家组的部分专家与医疗队员通过网络会议形式讨论病情,指导辨证用药.以2020年2月14日远程专家会诊的2则新型冠状病毒肺炎重型患者为例,介绍会诊专家对具体病例难点和用药思路的分析,体现远程会诊模式在新型冠状病毒肺炎诊疗中的作用,推动中医药在救治新型冠状病毒肺炎患者中的广泛应用.

Objective To explore altered regional neuronal activity in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and its correlation with clinical performances using the regional homogeneity (ReHo) method, which is based on resting-state functional magnetic resonance imaging (fMRI). Method Thirty-one patients with NAION (20 males, 11 females) and 31 age- and sex-matched normal controls (NCs) (20 males, 11 females) were enrolled in the study. All patients underwent ophthalmic examination, including eyesight, intraocular pressure measurement, optimal coherence tomography (OCT), visual field analysis, and fMRI scans. After ReHo was calculated, we investigated group differences in results between the patients and NCs. We analyzed the relationship between ReHo values for different brain regions in patients with NAION and intraocular pressure, visual field analysis, and OCT. A receiver operating characteristic (ROC) curve was used to assess the diagnostic ability of the ReHo method. Results Compared with NCs, patients with NAION exhibited higher ReHo values in the left middle frontal gyrus, left middle cingulate gyrus, left superior temporal gyrus, and left inferior parietal lobule. Additionally, they exhibited lower ReHo values in the right lingual gyrus, left putamen/lentiform nucleus, and left superior parietal lobule. ReHo values in the left superior parietal lobule were negatively correlated with right retinal nerve fiber layer values (r = −0.462, P = 0.01). The area under the ROC curve for each brain region indicated that the ReHo method is a credible means of diagnosing patient with NAION. Conclusion NAION was primarily associated with dysfunction in the default mode network, which may reflect its underlying neural mechanisms.

目的:总结武汉地区52例普通型和重型新型冠状病毒肺炎(COVID-19)患者的临床特征,以提高对该病的认识.方法:收集COVID-19普通型25例和重型27例患者的临床资料,对比分析2组患者的临床症状及实验室检查结果,将2组具有差异的指标绘制受试者工作特征(ROC)曲线,找出最佳截断值.结果:重型组年龄大于普通型组.主要临床表现有发热、乏力、食欲差、咳嗽、咳痰、喘息气短、腹泻等,其中重型组患者乏力、食欲差表现较普通型更为明显.实验室检查发现27％的患者出现淋巴细胞计数减少,其中重型组淋巴细胞减少例数较普通型患者更多,重型组患者中性粒细胞/淋巴细胞比值(NLR)高于普通型;重型组患者血C反应蛋白(CRP)水平高于普通型;52例患者中,天门冬氨酸转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)升高患者分别占25.0％、13.5％、13.5％、48.1％,其中重型组患者AST、CK-MB及LDH值高于普通型;ROC曲线结果显示NLR、CRP、AST、LDH预测COVID-19重型患者的曲线下面积均＞0.7,有一定的预测价值.结论:预估COVID-19患者病情时,需结合病史、临床症状、实验室检查等综合评估,NLR、CRP、AST、LDH对COVID-19重型患者有一定的预测价值.

目的:探索分泌PD-1 scFv的CAR-T细胞对胃癌的抗瘤功效。方法:选择EGFR作为CAR-T细胞的靶标,构建二代EGFR-CAR-T细胞（EGFR BB-z）和分泌PD-1 scFv的四代EGFR-CAR-T细胞（EGFR BB-z/E30）,通过体外激活以及靶细胞长期刺激检测其抗肿瘤活性,通过胃癌移植瘤小鼠模型检测其肿瘤抑制能力。结果:胃癌组织及细胞均高表达EGFR（均P＜0.01）。通过慢病毒感染的方式成功获得EGFR BB-z和EGFR BB-z/E30细胞。体外实验表明,与EGFR BB-z相比,EGFR BB-z/E30具有更长效的增殖能力及更强的肿瘤杀伤活性（均P＜0.01）。体内实验显示了EGFR BB-z/E30在胃癌细胞皮下移植瘤模型和胃癌人源性肿瘤异种移植瘤（patient-derived tumor xenograft,PDX）模型中具有明显的肿瘤抑制能力（均P＜0.01）,并可显著增加肿瘤部位T细胞的浸润（P＜0.01）,减少EGFR BB-z/E30细胞表面PD-1的表达（P＜0.01）和高分泌IFN-γ的水平（P＜0.05）。结论:分泌PD-1 scFv的EGFR-CAR-T细胞EGFR BB-z/E30可对胃癌进展产生显著的抑制作用,为胃癌治疗提供一种潜在新策略。

To the Editor: Non-arteritic anterior ischemic optic neuropathy (NAION), characterized by a sudden onset of unilateral painless visual loss and a swollen optic disc, is the most common form of acute optic neuropathy in patients over 50 years of age.[1] The pathogenesis of NAION remains unclear, but most histopathological studies support the concept of vasculopathic occlusion in the region of the short posterior ciliary arteries.[2] Functional magnetic resonance imaging (fMRI) is one of the most widely used non-invasive techniques for measuring brain function over time in vivo. To the best of our knowledge, only one study has investigated the effects of stimulating the affected eye in the extra-visual areas in NAION in humans.[3] However, this previous study only examined task-state fMRI, and lacked a measure of resting-state fMRI (rs-fMRI). Thus, it remains unclear whether regional spontaneous brain changes are limited to the visual system. Thirty-one patients with NAION (20 males, 11 females, aged from 35 to 79 years, mean age 52.74 ± 11.29 years) and 31 normal controls (NCs) (20 males, 11 females, aged from 33 to 66 years, mean age 50.97 ± 8.20 years) matched in age and gender were enrolled in the study treated at Dongfang Hospital, Beijing University of Chinese Medicine between June 2015 and November 2017. Sixteen of the 31 patients exhibited unilateral NAION (eight in the left eye and eight in the right eye) with 15 patients exhibiting bilateral NAION (in both eyes, either sequentially or simultaneously). All NAION patients met the following criteria: (1) presenting with sudden, painless and monocular visual loss or successively bilateral visual loss; (2) receiving standardized treatment and evaluation in our hospital; (3) no history of hypertension, coronary artery disease, drug addiction, or sleep disorder; and (4) no contraindication from MRI scans, such as claustrophobia or irremovable metal in the body. All patients and NCs underwent eyesight testing, intraocular pressure measurement, optical coherence tomography (OCT) to measure retinal nerve fiber layer (RNFL) thickness, and visual field analysis. All patients and NCs underwent MRI (1.5 Tesla, Philips Intera Achieva system, Royal Philips, Amsterdam, the Netherlands) while wearing a black blinder and sponge earplugs before hospital treatment. High-resolution structural images were obtained using a three-dimensional brain volume technique. Resting-state fMRI was obtained using an echo planar imaging pulse sequence with each scan: matrix 64 × 64, field of view 20 cm × 20 cm, slice thickness 3.6 mm, space between the slices 0.72 mm, number of excitations 1, repetition time/echo time 3000/30, flip angle 90°, 35 slices, dynamic scan 100 times, total scan time of 5.06 min. Subjects were asked to remain motionless with their eyes open, and not to think of anything specific during the scan, particularly during functional scans. Resting state fMRI data were obtained using Data Processing Assistant for Resting-State fMRI (DPARSF) software (http://www.rfmri.org/DPARSF_V2_3), which is based on Statistical Parametric Mapping (SPM8), and the Resting-State fMRI Data Analysis Toolkit (REST) (http://www.rfmri.org/DPARSF_V2_3). Sequential pre-processing included removing the first 10 volumes for adapting to the scan environment and signal instability, slice timing and head motion correction. Any subjects with head motion >1.5 mm maximum displacement or rotation motion >1.5° in the x, y, or z-axis was excluded. Using these criteria, four patients were excluded. The remaining fMRI series was then spatially normalized for the purpose of ensuring dataset comparability at the group level and coregistered to standard stereotactic Montreal Neurological Institute (MNI) space (resampling voxel size, 3 mm × 3 mm × 3 mm). After pre-processing, fMRI images were smoothed with a Gaussian kernel of 4 mm × 4 mm × 4 mm full-width at half maximum. To remove the effects of low-frequency drift, physiological high-frequency respiration, and cardiac noise, temporal bandpass filtering (0.01–0.08 Hz) and linear trend removal were performed on all pre-processed data. Individual amplitude of low-frequency fluctuation (ALFF) maps were generated for each data series. REST was used for statistical analysis. Two-sample t tests were used for comparisons between patients and normal controls, with gender, age, and duration of disease as covariates of no interest. We corrected the significance level of multiple comparisons using a false discovery rate (FDR)-corrected threshold of P < 0.05 for analysis of differences between NAION patients and NCs. The results were presented using Xjview toolbox (http:www.alivelearn.net/xjview) and REST software. Finally, Pearson correlation analyses were performed using SPSS 17.0 software (SPSS, Inc., Chicago, IL, USA) to explore the correlation between abnormal ALFF values and clinical parameters. Compared with NCs, NAION patients showed lower ALFF values in the right insula, right inferior frontal gyrus and bilateral middle frontal gyrus, and higher ALFF values in the right precuneus [Supplementary Table 1, https://links.lww.com/CM9/A18 and Figure 1A]. In NAION patients, the ALFF values in the right middle frontal gyrus were positively correlated with right RNFL values (r = 0.42, P = 0.02) [Figure 1B].Figure 1: (A) Altered ALFF in NAION patients in comparison with normal controls. Compared with NCs, the ALFF in patients with NAION were lower in the right insula, right inferior frontal gyrus, bilateral middle frontal gyrus and higher ALFF value in the right precuneus. (B) Correlations between the RNFL in the right eye and ALFF values in right middle frontal gyrus (n = 31; r = 0.42, P = 0.02). ALFF: Amplitude of low-frequency fluctuation; NAION: Non-arteritic anterior ischemic optic neuropathy; NCs: Normal controls; r: Pearson correlation coefficient; RMFG: Right middle frontal gyrus; RNFL: Retinal nerve fiber layer.The default mode network (DMN) is comprised of medial prefrontal cortex (ventral medial prefrontal cortex and anterior cingulate cortex), medial parietal cortex (posterior cingulate), precuneus, lateral temporal parietal cortex (superior gyrus, angular gyrus, and superior temporal sulcus), parahippocampal gyrus and hippocampal formation.[4] The DMN plays a key role in many brain functional networks, and DMN activity is negatively correlated with many brain functions, such as vision, hearing, and somatesthesia. In addition, the DMN is believed to be closely associated with a range of phenomena, such as anxiety, cognition, memory, and depression. The DMN in the brain is active, with high metabolic rates during the resting-state condition. In patients with glaucoma, Liu and Tian[5] reported abnormal activity in the right medial frontal gyrus. Furthermore, patients with optic neuritis were found to have lower ALFF values in the medial frontal gyrus, bilateral medial frontal gyrus/anterior cingulate.[6] Based on these findings, it has been proposed that optic neuritis may lead to DMN damage. In the present study, we found that, compared with NCs, patients with NAION had lower ALFF values in the right insula, right inferior frontal gyrus, and bilateral middle frontal gyrus, but higher ALFF values in the right precuneus. As an important feature of rs-fMRI, ALFF provides more information to aid the understanding the NAION-related functional reorganization. Rather than examining each individual area, the brain is examined as a whole entity, recognizing that damage in one region may lead to dysfunction in other brain regions. Therefore, the decreased ALFF values in the present study indicate that NAION may lead to DMN dysfunction, whereas increased ALFF values in the right precuneus may reflect compensation to maintain the stability of the internal network. A previous study reported that the inferior frontal gyrus plays an important role in audiovisual communication.[7] In another study, patients with advanced primary open-angle glaucoma were found to exhibit decreased blood-oxygen-level dependent (BOLD) values in inferior frontal gyrus.[8] In the present study, we found that patients with NAION exhibited lower ALFF values in right inferior frontal gyrus, which may reflect functional damage in these regions. Furthermore, the precuneus plays a pivotal role in the DMN. Recent fMRI studies in healthy subjects have suggested a central role for the precuneus in a wide spectrum of highly integrated tasks, including visuospatial imagery, spatial awareness, and consciousness.[9] A previous study reported significant increases in precuneus activation in a patient with advanced primary open-angle glaucoma.[8] In addition, strong interactions between the precuneus/posterior cingulate region and the left inferior parietal lobe with DMN have been reported.[10] Consistent with these findings, in the present study, we found that activity in the right precuneus was significantly increased in NAION patients compared with NCs, indicating alterations of the DMN in NAION patients. Therefore, increased ALFF values in the precuneus, as part of the DMN, may also reflect a type of spatial vision enhancement in NAION patients, which in turn enhances the processing capability of visual space. In addition, the middle prefrontal cortex also is a subsystem of the DMN, which is involved in the self-relevant mental simulation. In the present study, we observed some areas exhibiting lower ALFF values in bilateral middle frontal gyrus in NAION patients compared with NCs. Furthermore, ALFF values in the right middle frontal gyrus exhibited a positive correlation with right RNFL values. This finding suggests that NAION may involve substantial damage to the middle frontal gyrus. Thus, homolateral RNFL in the middle frontal gyrus may provide a useful index, providing insight into the neural mechanisms underlying NAION. In conclusion, the current study revealed that patients with NAION exhibited abnormalities in spontaneous brain activity, including a positive correlation with homolateral RNFL. These findings indicated that NAION may affect the hub position of the brain functional network-DMN. The current results provide potentially important information for improving our understanding of the inherent neural mechanisms underlying NAION. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Funding The work was supported by grants from the Basic Scientific Research Program from Beijing University of Chinese Medicine (No. 2015-JYB-JSMS107) and the Capital Characteristic Clinical Project (No. Z171100001017206). Conflicts of interest None.

目的 比较术前螺旋CT与磁共振成像(MRI)两种检查方法对于前哨淋巴结诊断直肠癌患者T分期、N分期的准确性.方法 采用随机数字表法将我院收治的180例直肠癌患者分为两组,每组包含90例受试者,两组术前分别采用螺旋CT、MRI两种方式进行检查,并将检查结果与术后病理学检查结果进行比较.结果 术前采用螺旋CT与术后病理学检查两种方法的T分期、N分期的一致性均为中等,其中术前螺旋CT对患者T分期、N分期的总准确度分别为74.4％(67/90)、64.4％(58/90).术前采用MRI检查与术后病理学检查两种方法的T分期一致性为满意,MRI检查对患者T分期的总准确度为75.6％s(68/90),MRI用于诊断前哨淋巴结转移的灵敏度与特异性分别为88.0％(44/50)、67.5％(27/40),阳性预测值、阴性预测值分别为76.4％(42/55)、82.9％(29/35),Youden指数为0.549;术前采用MRI检查与术后病理学检查两种方法的N分期一致性为中等,MRI检查对患者进行N分期的总准确度为62.2％(56/90),MRI用于诊断前哨淋巴结转移的灵敏度与特异性分别为84.4％(27/32)、62.1％(36/58),阳性预测值、阴性预测值分别为55.1％(27/49)、87.8％(36/41).结论 基于前哨淋巴结的状况,采用MRI对直肠癌患者进行T分期效果较好,但螺旋CT与MRI对直肠癌术前N分期的准确性无明显差异且均不理想.

人们通常对不了解的东西更害怕,X射线就是这样.坐火车坐地铁,碰到安检机成为一件寻常的事.安检设备,尤其是通道型安检机,必须使用X射线,这对我们的身体健康有影响吗?其实,与其害怕,不如先理解它.

目的 探讨沉默烯酰辅酶A水合酶短链1(ECHS1)表达对结肠癌HT-29细胞自噬的影响及可能作用机制.方法 将ECHS1 shRNA质粒及阴性质粒转染入HT-29细胞为shECHS1组和NC组,另设空白对照组,实时荧光定量PCR(QPCR)检测各组ECHS1表达.采用MTT法和流式细胞术检测3组细胞增殖和凋亡的情况.Western blotting法检测微管相关蛋白1轻链3(LC3-Ⅱ)和Beclin 1以及相关信号通路蛋白:转化生长因子活化激酶1(TAK1)、腺氨酸活化蛋白激酶α1(AMPKα1)、过氧化物酶体增殖物激活受体γ(PPARγ)的水平.采用免疫荧光技术观察细胞自噬情况.结果 shECHS1组HT-29细胞ECHS1表达量为0.23±0.05,明显低于空白对照组的0.78±0.09和NC组的0.76±0.09,差异有统计学意义(P＜0.05).shECHS1组48、72、96 h吸光值分别为0.62±0.10、0.75±0.11、0.81±0.08,均明显低于空白对照组和NC组,差异有统计学意义(P＜0.05).shECHS1组48 h细胞凋亡率为(59.86±3.10)％,高于空白对照组的(27.48±2.25)％和NC组的(27.62±2.59)％,差异有统计学意义(P＜0.05).shECHS1组细胞Beclin 1、LC3-Ⅱ、TAK1、AMPKα1、PPARγ蛋白表达分别为0.76±0.12、0.49±0.07、0.93±0.15、0.57±0.08、0.46±0.09,高于空白对照组和NC组(P＜0.05).加入AMPK特异性抑制剂SZ4003作用48 h后,shECHS1组细胞Bec1in 1、LC3-Ⅱ蛋白的表达量分别为0.50±0.10、0.35±0.06,较处理前明显降低(P＜0.05).结论 沉默ECHS1表达可显著抑制结肠癌HT-29细胞的增殖活性,并促进其凋亡,其具体机制可能与激活TAK1-AMPK信号通路诱发结肠癌细胞HT-29自噬有关.

目的 研究仿真排粪造影影像学征象与中医证型的相关性.方法 纳入80例慢性功能性便秘患者,中医辨证分为肝郁气滞证、肺脾气虚证、脾肾阳虚证、肝肾阴虚证.仿真排粪造影检查,于PACS系统上测量数据及影像征象,应用对应分析对征象与证型进行分析.结果 通过对中医证型和造影征象对应图的解读,不同象限区分了不同中医证型及其相关的排粪造影表现.特异性分析发现,脾肺气虚及脾肾阳虚证型之间相关性较强,而肝肾阴虚及肝郁气滞的辨证分型差异性较大.会阴下降及黏膜内套叠对应辨证分型的差异性不大.耻骨直肠肌综合征更具特异性.肝郁气滞与耻直肌痉挛相关性强;肝肾阴虚与黏膜内脱垂、直肠前突相关性强.脾肺气虚与脾肾阳虚更倾向于出现会阴下降、黏膜内套叠、骶直分离、小肠疝及乙状结肠疝.结论 排粪造影征象与中医证型之间存在一定相关性,可以为临床用药辨证论治提供依据,为中医辨证的客观化及可视化发展提供支持.

随着人们生活水平的提高,各地人员交流交往日益增多,通过安检成为我们日常生活的一部分.如果在城市,每天甚至要通过安检多次.安检设备,尤其是通道型安检机都必须使用的 X线对我们的身体健康有影响吗?人们通常对不可见的东西更害怕, X线就是这样的.那么,搞明白不就是了;与其害怕它,不如先理解它.下图就是多视角通道型安检机的工作示意图.

Objective: To observe the efficacy of Bushenyanggong decoction combined with Femonston on endometrial thickness, estrogen level and pregnancy rate in patients with infertility caused by thin endometrium. Methods: A total of 120 patients with infertility caused by thin endometrium in our hospital were selected and randomly divided into the observation group and the control group, 60 cases in each group. Patients in the control group were treated with Femonston while they in the observation group were treated with Femonston combined with Bushenyanggong decoction. Estradiol (E2) level, blood flow resistance index (RI), endometrial thickness, endometrial shape and pregnancy rate were compared between two groups. Results: (1) After the treatment, the endometrial thickness in the observation group was significantly increased and was higher than that in the control group, while RI was lower than that in the control group (P ＜0. 05). (2) After the treatment, the rate of type A endometrium in the observation group was higher than that in the control group (61. 67％ vs 31. 67％) (P ＜0. 05). (3) After the treatment, E2 level in the observation group was higher than that in the control group (P ＜0. 05). (4) The pregnancy rate in the observation group was higher than that in the control group (53. 33％ vs 31. 67％) (P ＜0. 05). Conclusion: On the basis of routine western medicine, Bushenyanggong decoction for the treatment of women with infertility caused by thin endometrium can increase the endometrial thickness, improve the E2 level and the pregnancy rate.

目的 探讨多层螺旋CT低剂量扫描在CT引导下氩氦刀治疗肺癌时减少辐射剂量的可行性.方法 采用数字表法随机选取52例行氩氦刀手术的肺癌患者,分低剂量组(A组)和常规剂量组(B组);A组(22例)扫描方案为120 kV、自动管电流调节技术(automatic tube current modulation,ATCM)(15 ～60 mA),B组(30例)扫描方案为120 kV、ATCM(50～600 mA);比较两组图像质量(肺纹理、纵隔结构、肿瘤形态、冰球形态)、辐射剂量指数(CT dose index volume,CTDIvol)、肿瘤CT值、图像噪声SD值.结果 辐射剂量指数CTDIvol组间差异具有统计学意义(P＜0.01),A组较B组的辐射剂量指数下降80.90％;氩氦刀治疗前后两组肿瘤的CT值、图像噪声SD值差异均无统计学意义(P＞0.05).两组间肺纹理图像评分比较,差异有统计学意义(P=0.020),B组评分优于A组;其余两组间的各项图像质量评分差异无统计学意义(P＞0.05).结论 CT引导下氩氦刀治疗肺癌时应用低剂量扫描不影响术中穿刺定位的准确性、安全性及术中术后对冷冻效果的评估,且能够有效降低患者辐射剂量.