[The application of 3D reconstruction in investigating the frontal sinus drainage pathway based on computer tomography data]

Objective:The aim of this study is to explore the value of 3D reconstruction technology based on computer tomography data in understanding the frontal sinus drainage pathway. Method:Three-dimensional reconstruction of DICOM data from 100 cases of sinus CT was performed by using Mimics 19.0 software. The 3D models were used to study types, the relative locations of frontal sinus and recess cells as well as the influence of the frontal sinus drainage pathway. Result:The 3D model of frontal sinus, frontal recess cells and frontal sinus drainage pathway were reconstructed successfully. Among them, the incidence of nasal cavity was 95.5% (191/200), nasal cavity was 31.5% (63/200), nasal cavity on the frontal air room was 24.5% (49/200) supra bulla cells were 54% (108/200), supra bulla frontal cells were 14.5% (29/200), supraorbital ethmoid cells were 20.5% (41/200), and the rate of frontal septal cells were 4% (8/200). It visually demonstrated the relationship between the frontal recess and the frontal sinus drainage channel. Conclusion:The 3D reconstruction technology based on computer tomography data not only helps us to understand the anatomy of the frontal sinus, the relative position of the frontal crypt and the effect on the frontal sinus drainage channel, but also provides a new method for preoperative planning and intraoperative guidance to endoscopic frontal sinus surgery.

[Correlation between ultrasonographic optic nerve sheath diameter and intracranial pressure]

Objective: To evaluate the association of the ultrasonographic optic nerve sheath diameter (ONSD) and intracranial pressure (ICP), and the feasibility of ultrasonographic ONSD in predicting high ICP. Methods: A prospective study. The outpatients who planned to measure ICP by lumbar puncture in Department of Neurology, Xuanwu Hospital, Capital Medical University were selected from January 2011 to May 2012. All the retrobulbar ONSD measurement with B-scan ultrasound was performed just before lumbar puncture. When high ICP was defined as ICP more than 200 mmH₂O(1 mmH₂O=0.009 8 kPa), the participants were divided into the high ICP group and the normal ICP group. The Pearson correlation coefficient analysis was used to analyze the correlation between ICP and postbulbar ONSD measurements. The difference in ONSD was compared between the high ICP and normal ICP groups with the t test. The receiver operating characteristic (ROC) curve was used to calculate the cutoff value of mean ONSD and evaluate the sensitivity and specificity of the method. Results: A total of 130 participants were involved in this study. There were 71 males and 59 females, aged (38±14) years.The mean ICP was (209.84±79.99) mmH₂O. The mean ONSD was (5.68±0.78) mm in the right eyes, (5.78±0.78) mm in the left eyes, and (5.73±0.71) mm in both eyes. The ICP had a significant correlation with ONSD in the right eyes (r=0.54, P<0.001), ONSD in the left eyes (r=0.56, P<0.001) and ONSD in both eyes (r=0.60, P<0.001), but no correlation with age (r=-0.14, P=0.114) and gender (r=0.20, P=0.817). The ONSD in the high ICP group (n=65) was (6.11±0.66) mm, (6.22±0.56) mm and (6.17±0.50) mm in the right eyes, left eyes, and both eyes, respectively. Compared with the ONSD in the normal ICP group (n=65), which was (5.26±0.64) mm in the right eyes, (5.34±0.72) mm in the left eyes and (5.30±0.62) mm in both eyes, there was a significantly enlarged ONSD in the high ICP group (t=-7.507, -7.778, -8.779, all P<0.001). The ROC analysis showed the ONSD of 5.6 mm was the best cutoff value with a sensitivity of 86% and a specificity of 71% for identifying high ICP. Conclusions: There is a significantly positive correlation between ICP and postbulbar ONSD measured by ultrasound. This non-invasive method may be an alternative approach to predicting the ICP value of patients whose ICP measurement via lumbar puncture is at high risk. However, it can not replace the direct ICP measurement with the invasive method. (Chin J Ophthalmol, 2018, 54: 683-687).

[Profiles of cognitive and language impairment of logopenic and non-fluent variant of primary progressive aphasia]

OBJECTIVE

To decipher the cognitive and linguistic feature of logopenic variant primary progressive aphasia (lv-PPA) and nonfluent variant primary progressive aphasia (nfv-PPA) and to explore the extent to which cognitive and language impairment contribute to the dysfunction of activity of daily living(ADL).

METHODS

Seven lv-PPA and five nfv-PPA were enrolled in memory clinic of Xuanwu Hospital, Capital Medical University from January 2015 to January 2016 accordig to the international consensus criteria for PPA and its three subtypes. 20 age-matched normal controls (NC) were included. Both the patients and the NC completed a battery of neuropsychological test, lingusitic test and brain magnetic resonance imaging. All the patients conducted (11)C Pittsburgh compound B (PiB) PET imaging.

RESULT

Lv-PPA patients were characterized by deficits in lexical retrieval and long sentenses repetition, while nfv-PPA were with motor speech apraxia and phonetic distortion. Compared with nfv-PPA, lv-PPA patient displayed more severe cognitive deficit with younger onset of age (56±5 vs 61±5, P<0.05) , rapid decline of MMSE score within 1.5 years and pariental cortex dysfunctions such as ideomotor praxis, Gerstmann syndrome and contructional apraxia. Correlation analysis indicated that there was more significant association between pariental cortex dysfunction and ADL/mini-mental state examination(MMSE) than that of language deficit(r=-0.868, r=-0.922; r=0.312, r=-0.257). All seven lv-PPA were PiB-PET positive and five nfv-PPA were negative.

CONCLUSION

This study enriched the chinical and linguistic characterization of lv-PPA and nfv-PPA, which has implication for diagnosis, disease management and treatment for clinicians.

Hypervalinemia and hyperleucine-isoleucinemia caused by mutations in the branched-chain-amino-acid aminotransferase gene

Valine, leucine, and isoleucine are essential branched chain amino acids (BCAAs). When BCAA metabolism is genetically impaired in human, serum levels of BCAA and/or their metabolites rise considerably, causing severe neurological dysfunction. The first step in BCAA catabolism is catalyzed by branched chain aminotransferase (BCAT). Hypervalinemia and hyperleucine-isoleucinemia caused by BCAT gene mutation in human have not been reported previously. A 25-year-old man presented with headache complaints and mild memory impairment for about six years. Brain MRI showed symmetric white matter abnormal signals. Metabolic studies revealed remarkably elevated plasma valine and leucine concentrations. Maple syrup urine disease (MSUD) diagnosis was not supported since all genes for the branched-chain α-keto acid dehydrogenase complex (BCKD) gene were normal. Interestingly, two heterogeneous BCAT2 gene mutations were found in the patient, including c.509G > A (p.Arg170Gln) and c.790G > A (p.Glu264Lys). In addition, c.509G > A (p.Arg170Gln) and c.790G > A (p.Glu264Lys) were found in his father and mother, respectively, suggesting an autosomal recessive disorder. BCAT2 functional studies demonstrated that the two BCAT2 gene mutations resulted in decreased BCAT2 enzyme activity. After treatment with vitamin B6, the levels of BCAA, especially valine were remarkably decreased and brain MRI lesions were improved. These findings suggest a new type of branched chain amino acid metabolism disorder. This rare case provides great insight into the further understanding of BCAA metabolism and its defect in human. BCAT2 gene mutations can cause hypervalinemia and hyperleucine-isoleucinemia, which are associated with brain white matter lesions.

Isolated cortical vein thrombosis: a widely variable clinicoradiological spectrum

BACKGROUND/AIMS

The aim of this study is to highlight the variable clincoradiological spectrum of isolated cortical vein thrombosis (ICoVT), which seems to remain a challenge to clinicians.

CASES REPORTS

We reported 3 patients with this diagnosis. One presented with only an epileptic seizure, one with worsening headache, seizures, mental disorder, speech disturbance and right-sided weakness, and the other with seizures and fluctuating paralysis in her left-sided limbs. Brain images were manifested with a strand-like abnormal signal, a large hemorrhagic infarction and a continuously enlarged space-occupying massive edema, respectively.

CONCLUSIONS

Neurologic features and brain imaging of ICoVT are highly variable, which might be partly responsible for the underestimation of ICoVT. Clinical diagnosis should probably be evoked more often.

Research on inhibitive behaviors of electrolysis on the growth of Microcystis aeruginosa

Electrochemical method using a novel Ti/RuO2 anode was employed to inhibit a typical cyanobacteria, Microcystis aeruginosa (M. aeruginosa) under different electrolytic conditions. It is demonstrated that Ti/RuO2 anode was more efficient than traditional graphite anode in M. aeruginosa inhibition. The experimental results showed that the higher current density or longer electrolytic time could effectively improve the inhibition of M. aeruginosa. In addition, sodium chloride was a more effective electrolyte than sodium sulfate to enhance inhibition. The maximum inhibiting rate dose to 100% could be obtained at a current density of 12 mA cm(-2) when sodium chloride was used as a supporting electrolyte. Furthermore, UV-Visible spectra demonstrated that the structures of phycocyanins and chlorophyll a (Chl a) in M. aeruginosa could be changed or destroyed during electrolysis. Moreover, EPR spectra showed the generation of the free radicals through electrolysis, which might be one of the reasons responsible for the inhibition of algal growth.

Methods to improve electrochemical treatment effect of dye wastewater

Several methods, including changing electrolyte concentration, temperature, stirring, and voltage were studied to improve the degradation effect of electrochemical treatment in dye wastewater. In addition, nanophase TiO2 catalyst and Co-Bi-PbO2/Ti anode have been prepared to expedite color removal. Enhancement of temperature leads to proportional increase of color removal. As for voltage, at low levels its increase could greatly improves color removal. After voltage reaches about 3.0 V, its improvement effect declines quickly. The influence of electrolyte concentration and aerating on color removal are similar to that of voltage. So it favored to degrade organic pollutants using high salt concentration, high voltages and large electric current to improve treatment effect. However, the efficiency of energy supplied during electrolysis decreases. A nonlinear model is established to evaluate the influence of electrolyte concentration and voltage on color removal. The model agrees with the experiment data very well. It is suggested by the simulation result of this model that electrolysis degradation should better be carried out at about 3.0 V, in 0.01 M Na2SO4 concentration for high energy efficiency. Additionally, either catalyst or Co-Bi-PbO2/Ti anode brings about 0.15 times more color removal without increasing electric current. Together, they could bring forth some 0.22 times higher color removal.

Cerebrospinal fluid tau, Aβ1–42 and inflammatory cytokines in patients with Alzheimer's disease and vascular dementia

In this study we aimed to evaluate the possibility of using cerebrospinal fluid (CSF) tau, Abeta(1-42) and inflammatory cytokines for diagnosis of Alzheimer's disease (AD) and vascular dementia (VD). We measured levels of total tau (T-tau), phospho-tau (P-tau), Abeta(1-42), IL-6, and TNFalpha in CSF in groups of AD, VD, and controls using enzyme-linked immunosorbent assay (ELISA). T-tau level was found significantly higher in groups of AD (t = 3.015, P < 0.01) and VD (t = 2.872, P < 0.01) than in controls. IL-6 level as also higher in AD (t = 2.883, P < 0.01) and VD (t = 3.032, P < 0.01) than in controls. Both T-tau and IL-6 were not significantly different between AD and VD (P > 0.05). The group of AD had remarkably higher P-tau (t = 4.261 and 3.883, respectively, P < 0.01) and lower Abeta(1-42) (t = 3.883 and 4.129, respectively, P < 0.01), as compared with those in VD and controls. TNFalpha level in AD was significantly higher than that in controls (t = 2.745, P < 0.01), but lower than in VD (t = 3.032, P < 0.01). Our data suggested that increment of T-tau and IL-6 levels in CSF was useful for screening AD and VD in certain population, while descending Abeta(1-42) and ascending TNFalpha in CSF are preferable to diagnose AD. In addition, a higher level of CSF P-tau might support AD diagnosis.