The aim of this study is to assess the effectiveness of conventional and two additional functional markers derived from standard cardiac magnetic resonance (CMR) images in detecting the occurrence of late gadolinium enhancement (LGE) in patients with secondary cardiac amyloidosis (CA) related to multiple myeloma (MM). This study retrospectively included 32 patients with preserved ejection fraction (EF) who had MM-CA diagnosed consecutively. Conventional left ventricular (LV) function markers and two additional functional markers, namely myocardial contraction fraction (MCF) and LV long-axis strain (LAS), were obtained using commercial cardiac post-processing software. Logistic regression analyses and receiver operating characteristic (ROC) analysis were performed to evaluate the predictive performances. (1) There were no notable distinctions in clinical features between the LGE+ and LGE- groups, with the exception of a reduced systolic blood pressure in the former (105.60 ± 18.85 mmHg vs. 124.50 ± 20.95 mmHg, P = 0.022). (2) Patients with MM-CA presented with intractable heart failure with preserved ejection fraction (HFpEF). The LVEF in the LGE+ group exhibited a greater reduction (54.27%, IQR 51.59-58.39%) in comparison to the LGE- group (P < 0.05). And MM-CA patients with LGE+ had significantly higher LVMI (90.15 ± 23.69 g/m2), lower MCF (47.39%, IQR 34.28-54.90%), and the LV LAS were more severely damaged (- 9.94 ± 3.42%) than patients with LGE- (all P values < 0.05). (3) The study found that MCF exhibited a significant independent association with LGE, as indicated by an odds ratio of 0.89 (P < 0.05). The cut-off value for MCF was determined to be 64.25% with a 95% confidence interval ranging from 0.758 to 0.983. The sensitivity and specificity of this association were calculated to be 95% and 83%, respectively. MCF is a simple reproducible predict marker of LGE in MM-CA patients. It is a potentially CMR-based method that promise to reduce scan times and costs, and boost the accessibility of CMR.

新型冠状病毒肺炎(COVID-19)属于中医学中"疫病"的范畴,传染性较强,对社会影响较大.本文从附子的临证使用特点及渊源,包括配伍及剂型,并从其使用注意事项及验案方面进行分析,阐释附子以其温阳、回阳之效,在重症COVID-19患者治疗中的作用.

腹部血管压迫综合征在临床中并不常见,表现为邻近解剖结构对血管的外源性压迫[如正中弓状韧带综合征(median arcuate ligament syndrome,MALS)、"胡桃夹"综合征(nutcracker syndrome,NCS)、髂总静脉压迫综合征(May-Thurner syndrome,MTS)]或血管压迫邻近中空脏器[如肠系膜上动脉综合征(superior mesenteric artery syndrome,SMAS)、肾盂输尿管连接处梗阻(ureteropelvic junction ob-struction,UPJO)、下腔静脉后输尿管].

中医十层脉是熊鸣峰教授根据传统的脉学理论提出的一种脉诊思维方法,该脉诊思维方法不仅是诊断方法,还囊括中西医诊断学、中西医治疗学等方面的内容.中医十层脉主要将脉诊细分为十层进行分析,具体包括肺脉、大肠脉、心脉、小肠脉、脾脉、胃脉、肝脉、胆脉、肾脉、膀胱脉.熊教授经过30余年临床观察及经验的总结,得出中医十层脉的相关理论体系.通过中医十层脉理论体系的指导,熊教授提出了辨脉论治的诊治思路,同时通过三焦阴阳舌诊法来辨别患者的舌象,以舌象特点确定患者的寒热病性,根据脉诊、舌诊相关信息进一步确立最适宜的治疗方案.临证中,熊教授发现通过辨脉论治的思路来诊治不孕不育症具有良好的临床疗效.笔者经过整理熊教授多年的临床病案,总结发现辨脉论治不孕不育症的经验,主要内容如下:治疗女性不孕症可通过调整与其相关的经脉,主要是月经脉、子宫脉、输卵管脉;治疗男性不育症,则主要通过调整其肝脉、精子脉、前列腺脉,以达助孕目的.调整好相关经脉后,促进患者成功受孕,在发现怀孕后,则提醒患者通过保胎方来健脾补肾安胎,达到保胎目的.可见,熊教授通过中医十层脉诊治不孕不育症,根据脉诊、舌诊信息调整肝、脾、肾,临床疗效显著,值得推广应用.

目的 探讨CT和MRI对合并出血的肾脏占位性病变的诊断及鉴别诊断价值,提高诊断的准确率.方法 回顾性分析经病理或随访证实的75例合并出血的肾脏占位性病变患者的临床及影像资料,其中,血管平滑肌脂肪瘤31例,囊肿26例,肾癌18例.所有患者行CT或MRI平扫和增强扫描,分析比较病灶的影像学征象,包括病灶的发生位置及类型、大小、形态、瘤肾界面、病灶内成分、强化程度及肿瘤内血管等.结果 3类病变在病灶类型、大小、形态、瘤肾界面的边界及形态方面存在统计学差异.血管平滑肌脂肪瘤较后两者出血更易破向肾包膜外且平均直径更大.血管平滑肌脂肪瘤与囊肿合并出血形态规则、边界清楚、瘤肾界面以喇叭口或杯口状为主.肾癌合并出血则表现为形态不规则或分叶形,边界不清,瘤肾界面以不规则或分叶状为主.囊肿合并出血以其内无实性成分及无强化的特点与其余2类比较差异有统计学意义.结论 CT平扫和增强检查可以准确地检出合并出血的肾脏占位性病变,明确病灶的影像学特点,提高原发灶的诊断准确率.MRI对病灶界面、成分等影像学表现作出重要补充.两者联合应用对鉴别不同性质合并出血的肾脏占位性病变有重要的临床应用价值.

目的 探讨成年男性重度阻塞性睡眠呼吸暂停(OSA)患者大脑灰质体积的变化及其与认知功能的关系.资料与方法 采集经多导睡眠监测确诊的36例OSA患者及40例健康对照者(对照组)的3D-T1薄层全脑容积结构图像.基于VBM-DARTEL方法 对图像进行后处理分析.比较两组全脑体素水平灰质体积的差异,并分析其与总睡眠时间、动脉血氧饱和度、蒙特利尔认知量表(MoCA)评分的相关性.结果 与对照组比较,OSA组左侧丘脑、左侧角回、左侧中扣带回、右侧海马旁回、双侧小脑后叶及双侧梭状回等灰质体积明显减低,右侧小脑后叶灰质体积增加(P<0.05).偏相关分析发现,OSA患者左侧丘脑减低的灰质体积与总睡眠时间及MoCA评分呈正相关(r=0.482、0.477,P=0.05);减低的右侧海马旁回体积、右侧梭状回体积与N2％呈正相关(r=0.479,P=0.05),右侧小脑后叶减低的灰质体积与最低动脉血氧饱和度呈正相关(r=0.351,P=0.045).结论 男性OSA患者存在多个脑区灰质体积萎缩,部分脑区灰质萎缩与认知、多导睡眠监测有关.

Chronic obstructive pulmonary disease (COPD) affects a large population and is closely associated with cognitive impairment. However, the mechanisms of cognitive impairment in COPD patients have not been unraveled. This study investigated the change in patterns of intrinsic functional hubs using a degree centrality (DC) analysis. The connectivity between these abnormal hubs with the remaining brain was also investigated using functional connectivity (FC). Nineteen stable patients with COPD and 20 normal controls(NC) underwent functional magnetic resonance imaging (MRI) examinations and clinical and neuropsychologic assessments. We measured the voxel-wise DC across the whole brain gray matter and the seed-based FC between these abnormal hubs in the remaining brain matter; the group difference was calculated. A partial correlation analysis was performed to assess the relationship between the abnormal DC and clinical variables in COPD patients. Compared to NC, the patients with COPD exhibited significantly decreased DC in the right lingual gyrus (LG), bilateral supplementary motor area (SMA), and right paracentral lobule (PCL). A further seed-based FC analysis found that COPD patients demonstrated significantly decreased FC between these abnormal hubs in several brain areas, including the left cerebellum anterior lobe, left lingual gyrus, left fusiform gyrus, right insula, right inferior frontal gyrus, limbic lobe, cingulate gyrus, left putamen, lentiform nucleus, right precuneus, and right paracentral lobule. A partial correlation analysis showed that the decreased DC in the right PCL was positively correlated with the FEV1 and FEV1/FVC, and the decreased DC in the SMA was positively correlated with naming and pH in COPD patients. This study demonstrates that there are intrinsic functional hubs and connectivity alterations that may reflect the aberrant information communication in the brain of COPD patients. These findings may help provide new insight for understanding the mechanisms of COPD-related cognitive impairment from whole brain functional connections.

目的 分析肺隐球菌病(PC)的CT表现,提高对PC的CT诊断水平.方法 回顾性分析2 9 例经病理或病原学检测证实为PC患者的临床及CT资料.结果 2 9 例中 1 0 例有基础疾病,1 8 例有咳嗽、咳痰,1 6 例胸痛或胸闷,7 例体检或其他原因发现.CT分型:①孤立结节、肿块型 6 例;②多发结节、肿块型 5 例;③单发或多发实变型 9 例;④实变与结节、肿块混合型 8 例;⑤弥漫混合型 1 例.2 3 例分布于肺外周带,6 例随机分布;8 例见"晕征",9 例见空洞,1 7 例见"充气支气管征".2 6 例增强扫描均表现为延迟性强化,2 3 例均匀强化,3 例不均匀强化;其中 1 9 例CT平扫+增强扫描,4 例轻度强化,1 0 例中度强化,5 例明显强化;1 9 例动脉期见"CT血管造影征".结论 CT出现"充气支气管征"、"血管造影征"、"晕征"对诊断 PC有一定价值;增强扫描多表现中度均匀延迟性强化.

Abnormal local spontaneous brain activity during the resting state has been observed in chronic obstructive pulmonary disease (COPD). However, it is still largely unclear whether the abnormalities are related to specific frequency bands. Our purpose was to explore intrinsic neural activity changes in different frequency bands by using the amplitude of low-frequency fluctuation (ALFF) method in stable COPD patients. Nineteen stable COPD patients and twenty gender-, age- and education-matched normal controls (NCs) underwent functional magnetic resonance imaging scans, cognitive function tests and lung function tests. Two different frequency bands (slow-4: 0.027–0.073 Hz; slow-5: 0.01–0.027 Hz) were calculated and analyzed for frequency-dependent intrinsic neural activity by using the ALFF method. A two-way analysis of variance test was used to compare the main effects of the groups and the frequency bands in the ALFF method. Further post-hoc t-tests were used to compare the differences between COPD patients and NCs in terms of the different frequency bands. A Pearson’s correlation analysis was performed to explore the relationship between the altered ALFF brain areas in the different frequency bands and the clinical evaluations in the COPD patients. There were main effects of the groups including significantly higher ALFF values in the right superior temporal gyrus (STG), the bilateral cerebellum posterior lobe (CPL), the right lingual gyrus (LG) and the right brainstem, and as well as significantly decreased ALFF values in the right inferior parietal lobule (IPL) and the angular. The main effect of frequency was demonstrated in the CPL, the STG, the prefrontal cortex and the middle cingulate gyrus. Furthermore, COPD patients exhibited more widespread alterations in intrinsic brain activity in the slow-5 band than in the slow-4 band. Moreover, the abnormal intrinsic brain activity in the slow-4 and slow-5 bands were associated with PaCO2 in COPD patients. These current results indicated that COPD patients showed abnormal intrinsic brain activity in two different frequency bands, and abnormal intrinsic neuronal activity in different brain regions could be better detected by slow-5 band. These observations may provide a neoteric view into understanding the local neural psychopathology in stable COPD patients.

Introduction aim: Abnormal brain structure and function in COPD has been reported on MRI. However, the deficit in local synchronization of spontaneous activity in patients with stable COPD remains unknown. The main aim of the present study was to explore spontaneous brain activity in patients with COPD compared with normal controls using the regional homogeneity (ReHo) method based on resting-state functional MRI. Methods: Nineteen patients with stable COPD and 20 well-matched (including age, sex, and number of years of education) normal controls who were recruited for the present study underwent resting-state functional MRI examinations and a series of neuropsychological and clinical assessments. The ReHo method was used to assess the strength of local brain signal synchrony. The mean ReHo values in brain areas with abnormal ReHo were evaluated with a receiver operating characteristic curve. The relationships between the brain regions with altered ReHo values and the clinical and neuropsychological parameters in COPD patients were assessed using Pearson’s correlation. Results: Patients with COPD showed significantly lower ReHo values in the left occipital lobe and the right lingual, bilateral precuneus, and right precentral gyrus. The result of receiver operating characteristic curve analysis showed that the altered average ReHo values have high efficacy for distinguishing function. The mean lower ReHo values in the precuneus gyrus showed a significant positive correlation with FEV 1 %, FEV 1 /FVC, and orientation function but a significant negative correlation with arterial partial pressure of carbon dioxide. Conclusion: The COPD patients demonstrated abnormal synchrony of regional spontaneous activity, and the regions with abnormal activity were all correlated with visual processing pathways, which might provide us with a new perspective to further understand the underlying pathophysiology of cognitive impairment in patients with COPD. COPD patients.

目的 研究阻塞性睡眠呼吸暂停(OSA)患者前、后默认网络功能连接情况,探讨OSA患者认知功能损害的潜在神经生理机制.方法 采集43例OSA患者(OSA组)及43名健康男性(HC组)的静息态磁共振脑功能成像(rs-fMRI)和临床量表评估数据.选用基于种子点的功能连接方法,分别以内侧前额叶(mPFC)和后扣带回(PCC)为种子点计算其与全脑的功能连接值,组间的功能连接差异比较采用双样本t检验.结果 与HC组相比,OSA组mPFC与左侧小脑后叶功能连接减低,而与左侧顶下小叶、双侧额中回、左侧额下回功能连接增高;OSA组PCC与双侧中央后回、右侧中央前回功能连接减低,而与右侧小脑后叶功能连接增高.结论 OSA患者前、后默认网络功能连接存在显著差异,这可能为进一步理解OSA认知功能的损害提供了新的视角.

目的 基于静息态功能磁共振(rs-fMRI)技术采用图论分析方法研究阻塞性睡眠呼吸暂停(OSA)患者功能脑网络的拓扑属性改变.方法 搜集未经治疗的男性重度OSA患者及正常睡眠组(GS组)各45例并采集被试的多导睡眠监测、临床量表评分及rs-fMRI数据.采用AAL模板构建功能脑网络,通过图论方法比较功能脑网络的整体和局部网络拓扑属性,并分析拓扑属性与临床变量之间的关系.结果 OSA及GS组均存在高效的“小世界”网络属性.然而OSA患者小世界指数(σ),标准化聚类系数(γ),整体效率(Eglob)值显著减低,最短路径长度(Lp),标准化最短路径长度(λ)值显著增高,且部分默认网络(DMN)、突显网络(SN)和中央执行网络(CEN)脑区节点中心性受损.OSA患者整体网络属性与爱泼沃斯嗜睡量表(ESS)评分、蒙特利尔认知量表(MoCA)评分和血氧饱和度显著相关.结论 虽然OSA患者功能脑网络具有“小世界”属性,但其功能整合和功能分离受损,且部分DMN、SN和CEN脑区的节点中心性存在异常破坏.OSA患者功能脑网络的拓扑属性异常可能是认知功能障碍的潜在生物学标志.

Rationale: Primary hepatic myelolipoma is a rare benign neoplasm comprising mature adipose tissue and marrow components in various proportions. Chemical shift imaging (CSI) can distinguish the lipid within the tumor clearly; however, there have been no reports on the CSI of hepatic myelolipoma. Patient concern: A 20-year-old woman visited our hospital after discovering a space-occupying lesion in the liver with a history of more than 1 year. She felt distension pain and discomfort under the xiphoid process, accompanied by nausea, vomiting, and occasional chest oppression. Diagnosis: The tumor showed a well-defined mass with a pseudocapsule and a heterogeneous appearance on both T1- and T2-weighted magnetic resonance (MR) images. CSI analysis showed a signal decline within the tumor. Based on the histopathology, the tumor was diagnosed as hepatic myelolipoma. Interventions and Outcomes: The patient underwent a right hepatectomy, and the postoperative vital signs were stable. Two weeks later, the patient was discharged safely. Lessons: Although hepatic myelolipoma is extremely rare, this condition should be considered in differential diagnosis when CSI shows that hepatic lesions contain fatty.

Background: The amygdala is one of the core areas of the emotional circuits. Previous neuroimaging studies have revealed that patients with obstructive sleep apnea (OSA) have aberrant structure and function in several brain areas (including the amygdala). However, the resting-state functional connectivity (rs-FC) of amgydala subregions remains uncertain. Objective: To determine whether aberrant rs-FC exists between the amygdala subregions and other brain areas and whether such abnormalities are related to emotional disorders and cognitive impairment in OSA. Methods: The resting-state functional magnetic resonance imaging (rs-fMRI) data of 40 male severe OSA patients and 40 matched healthy controls (HCs) were collected. The rs-FC between the amygdala subregions and other brain areas was compared between the two groups. The correlations between aberrant rs-FC and clinical variables and neuropsychological assessments were evaluated. Results: Compared with the HCs, the OSA patients showed significantly increased rs-FC between the left dorsal amygdala (DA) and the anterior lobe of the cerebellum, among the left ventrolateral amygdala (VA), the left inferior frontal gyrus (IFG) and the left superior temporal gyrus (STG), and between the right VA and the left IFG. However, significantly decreased rs-FC was observed between the right DA and the right prefrontal cortex (PFC) in OSA patients. No regional differences in rs-FC were found between the OSA patients and HCs in the bilateral medial amygdala (MA). Conclusion: In this study, male severe OSA patients showed complex rs-FC patterns in the amygdala subregions, which may be the result of OSA-related selective damage to the amygdala, and abnormal rs-FC between the amygdala subregions and brain regions associated with emotional, cognitive and executive functions may partly explain the affective deficits and cognitive impairment observed in male severe OSA patients.

Objective Obstructive sleep apnea (OSA) is accompanied by widespread abnormal spontaneous regional activity related to cognitive deficits. However, little is known about the topological properties of the functional brain connectome of patients with OSA. This study aimed to use the graph theory approaches to investigate the topological properties and functional connectivity (FC) of the functional connectome in patients with OSA, based on resting-state functional magnetic resonance imaging (rs-fMRI). Methods Forty-five male patients with newly diagnosed untreated severe OSA and 45 male good sleepers (GSs) underwent a polysomnography (PSG), clinical evaluations, and rs-fMRI scans. The automated anatomical labeling (AAL) atlas was used to construct the functional brain connectome. The topological organization and FC of brain functional networks in patients with OSA were characterized using graph theory methods and investigated the relationship between functional network topology and clinical variables. Results Both the patients with OSA and the GSs exhibited high-efficiency “small-world” network attributes. However, the patients with OSA exhibited decreased σ, γ, Eglob; increased Lp, λ; and abnormal nodal centralities in several default-mode network (DMN), salience network (SN), and central executive network (CEN) regions. However, the patients with OSA exhibited abnormal functional connections between the DMN, SN, and CEN. The disrupted FC was significantly positive correlations with the global network metrics γ and σ. The global network metrics were significantly correlated with the Epworth Sleepiness Scale (ESS) score, Montreal Cognitive Assessment (MoCA) score, and oxygen desaturation index. Conclusion The findings suggest that the functional connectome of patients with OSA exhibited disrupted functional integration and segregation, and functional disconnections of the DMN, SN, and CEN. The aberrant topological attributes may be associated with disrupted FC and cognitive functions. These topological abnormalities and disconnections might be potential biomarkers of cognitive impairments in patients with OSA.

Impaired spontaneous regional activity and altered topology of the brain network have been observed in obstructive sleep apnea (OSA). However, the mechanisms of disrupted functional connectivity (FC) and topological reorganization of the default mode network (DMN) in patients with OSA remain largely unknown. We explored whether the FC is altered within the DMN and examined topological changes occur in the DMN in patients with OSA using a graph theory analysis of resting- state functional magnetic resonance imaging data and evaluated the relationship between neuroimaging measures and clinical variables. Resting-state data were obtained from 46 male patients with untreated severe OSA and 46 male good sleepers (GSs). We specifically selected 20 DMN subregions to construct the DMN architecture. The disrupted FC and topological properties of the DMN in patients with OSA were characterized using graph theory. The OSA group showed significantly decreased FC of the anterior-posterior DMN and within the posterior DMN, and also showed increased FC within the DMN. The DMN exhibited small-world topology in both OSA and GS groups. Compared to GSs, patients with OSA showed a decreased clustering coefficient (C-p) and local efficiency, and decreased nodal centralities in the left posterior cingulate cortex and dorsal medial prefrontal cortex, and increased nodal centralities in the ventral medial prefrontal cortex and the right parahippocampal cortex. Finally, the abnormal DMN FC was significantly related to C-p, path length, global efficiency, and Montreal cognitive assessment score. OSA showed disrupted FC within the DMN, which may have contributed to the observed topological reorganization. These findings may provide further evidence of cognitive deficits in patients with OSA.

Objective: The majority of previous neuroimaging studies have reported both structural and functional changes in COPD, whereas the intrinsic low-frequency oscillations changes and the relationship between the abnormal brain regions and the clinical performances remain unknown. The present study was conducted with the aim of evaluating the intrinsic brain activity in COPD patients using the amplitude of low-frequency fluctuation (ALFF) method. Methods: All participants, including 19 stable patients with COPD and 20 normal controls (NCs) matched in age, sex, and education, underwent resting-state functional MRI scans and performed cognitive function tests and respiratory functions tests. The local spontaneous brain activity was examined using the voxel-wise ALFF. Pearson’s correlation analysis was used to investigate the relationships between the brain regions with altered ALFF signal values and the clinical features in COPD patients. Results: Compared with the NCs, COPD patients showed significantly lower cognitive function scores. Also, lower ALFF areas in the cluster of the posterior cingulate cortex (PCC) and precuneus, as well as a higher ALFF area in the brainstem were also found in COPD patients. The mean ALFF values in the PCC, precuneus, and brainstem showed high sensitivity and specificity in operating characteristic curves analysis, which might have the ability to distinguish COPD from NCs. Meanwhile, the mean signal values of the lower ALFF cluster displayed significant positive correlations with FEV 1 /FVC proportion and significant negative correlation with PaCO 2 ; the higher ALFF cluster showed significant positive correlation with FEV 1 proportion in COPD. Conclusion: According to the results of the present study, the COPD patients showed abnormal intrinsic brain activities in the precuneus, PCC, and brainstem, which might provide useful information to better understand the underlying pathophysiology of cognitive impairment.

肺黏膜相关淋巴组织(mucosa-associated lymphoid tissue, MALT)淋巴瘤是一种原发于淋巴结外边缘区的惰性 B细胞型非霍奇金淋巴瘤,而原发于肺内相对罕见,术前易误诊为肺癌、实变型肺炎等病变.本文回顾性分析 13 例经病理证实的肺MALT淋巴瘤的CT征象及误诊原因,以提高对该病的认识及影像诊断水平,指导临床治疗.

目的 采用基于图论的分析方法研究阻塞性睡眠呼吸暂停(OSA)患者默认网络(DMN)的“小世界”网络拓扑属性改变.方法 搜集首次确诊的重度OSA患者及年龄、受教育程度相似的正常睡眠组(GS组)各46例进行静息态功能磁共振成像(rs-fMRI)数据采集,选取20个特定的DMN感兴趣区(ROI)构建二值化网络,获取并比较DMN整体及局部属性参数,分析网络参数与临床变量的相关性.结果 OSA及GS组DMN均存在“小世界”属性.与GS组相比,OSA患者DMN在0.05≤稀疏度(Sp)≤0.12和0.15≤Sp≤0.50范围内聚类系数(Cp),Eloc显著减低,OSA组DMN的特征性最短路径长度(Lp),Eglob值无明显变化.与GS组相比,OSA患者左侧后扣带回的节点度、节点介数、节点效率均显著减低,而右侧海马旁回节点度、节点介数、节点效率均显著增高;背内侧前额叶皮层的节点介数显著减低,而腹内侧前额叶皮层节点介数显著增高.结论 OSA患者DMN具有“小世界”属性,但其整体网络属性和局部属性均存在改变,且血氧饱和度减低可能导致OSA患者DMN拓扑属性重塑,而OSA患者DMN的网络属性异常可进一步解释OSA患者认知功能障碍.