Septic Cavernous Sinus Thrombosis: An Unusual and Fatal Disease

BackgroundSeptic cavernous sinus thrombosis (CST) is a rare and fatal disease. Clinical presentations in the early stage are nonspecific, and the sensitivity of cranial axial computed tomography (CT) with thick section is low. This study analyzed the clinical manifestation and neuroimaging findings in patients with septic CST in a medical center in Taiwan.MethodsThis retrospective case series included nine patients with septic CST who had typical symptoms and clinical course, evidence of infection, and imaging studies which demonstrated cavernous sinus lesion, and who were treated between 1995 and 2003 at National Taiwan University Hospital.ResultsSeven (77.8 %) patients were more than 50 years old. Five (55.6%) had diabetes, and three (33.3%) had hematologic diseases. All cases were associated with paranasal sinusitis. The most frequent initial symptom was headache (66.7%), followed by ophthalmic complaints (diplopia or ophthalmoplegia, 55.6%; blurred vision or blindness, 55.6%), and ptosis (44.4%). Initial cranial images failed to identify CTS in all patients. Subsequent magnetic resonance imaging (MRI) or coronal contrast-enhanced CT (CECT) with thin section confirmed the diagnosis. Fungi were the most common pathogens (55.6%). The inhospital case-fatality rate was high (44.4%).ConclusionDue to the high case-fatality rate and low yield rate of blood cultures, fungal CST should be suspected in an immunocompromised patient with ophthalmic complaints that progress from one eye to the other. Coronal thin-section CECT may be a useful alternative to MRI as a diagnostic modality for this condition

Association between cystatin C and the interaction of pulmonary tuberculosis with chronic diseases

Purpose: To determine the association between Cystatin C (Cys C) levels and the interaction of pulmonary tuberculosis (PTB) with chronic diseases (CD).Methods: Participants (n = 356) were selected randomly from The First Affiliated Hospital of Wannan Medical College, China, and divided into 4 groups: normal control group (n = 80), PTB group (n = 98), chronic disease group (n = 146), and PTB combined with chronic disease group (PTB+CD, n = 31). The investigation included information on demographics and analysis of blood samples for Cys C, liver function, renal function, blood glucose and other biochemical indices.Results: The highest level of Cys C was obtained in PTB + CD group. Before and after adjusting eGFR, there was no association between Cys C and PTB or/and chronic disease. However abnormal levels of Cys C were significantly higher in PTB+CD group after adjusting eGFR (OR = 4.014, p = 0.0125).Conclusion: Higher levels of Cys C may be associated with chronic diseases co existing with PTB.Keywords: Cystatin C, Pulmonary tuberculosis, Chronic diseases, Inflammatio

Poly[[diaqua­[μ4-4,4′-carbonyl­bis(benzene-1,2-dicarboxyl­ato)]bis­(dipyrido[3,2-a:2′,3′-c]phenazine)dicadmium(II)] monohydrate]

In the title compound, {[Cd2(C17H6O9)(C18H10N4)2(H2O)2]·H2O}n, the CdII atom is seven-coordinated by five O atoms from two different 4,4′-carbonyl­bis(benzene-1,2-dicarboxyl­ate) (BPTC) anions and one water mol­ecule, and by two N atoms from one chelating dipyrido[3,2-a:2′,3′-c]phenazine (L) ligand in a distorted penta­gonal-bipyramidal geometry. The BPTC anions link the CdII atoms, forming a one-dimensional chain structure. The L ligands are attached on both sides of the chain. A twofold rotation axis passes through the complex molecule. The crystal structure involves O—H⋯O hydrogen bonds

Characterization of One-Dimensional Luttinger Liquids in Terms of Fractional Exclusion Statistics

We develop a bosonization approach to study the low temperature properties of one-dimensional gas of particles obeying fractional exclusion statistics (FES). It is shown that such ideal gas reproduces the low-energy excitations and asymptotic exponents of a one-component Luttinger liquid (with no internal degrees of freedom). The bosonized effective theory at low energy (or temperature) is identified to a $c=1$ conformal field theory (CFT) with compactified radius determined by the statistics parameter $\lambda$. Moreover, this CFT can be put into a form of the harmonic fluid description for Luttinger liquids, with the Haldane controlling parameter identified with the statistics parameter (of quasi-particle excitations). Thus we propose to use the latter to characterize the fixed points of 1-d Luttinger liquids. Such a characterization is further shown to be valid for generalized ideal gas of particles with mutual statistics in momentum space and for non-ideal gas with Luttinger-type interactions: In either case, the low temperature behavior is controlled by an effective statistics varying in a fixed-point line.Comment: 16 pages, a reference adde

Disrupted Spontaneous Neural Activity in Patients With Thyroid-Associated Ophthalmopathy: A Resting-State fMRI Study Using Amplitude of Low-Frequency Fluctuation

PurposeThe purpose of the study was to investigate the brain functional alteration in patients with thyroid-associated ophthalmopathy (TAO) by evaluating the spontaneous neural activity changes using resting-state functional magnetic resonance imaging (rs-fMRI) with the amplitude of low-frequency fluctuation (ALFF) method.Materials and MethodsThe rs-fMRI data of 30 TAO patients (15 active and 15 inactive) and 15 healthy controls (HCs) were included for analyses. The ALFF values were calculated and compared among groups. Correlations between ALFF values and clinical metrics were assessed.ResultsCompared with HCs, active TAOs showed significantly decreased ALFF values in the left middle occipital gyrus, superior occipital gyrus, and cuneus. Compared with inactive TAOs, active TAOs showed significantly increased ALFF values in the bilateral precuneus. Additionally, inactive TAOs showed significantly decreased ALFF values in the left middle occipital gyrus, superior occipital gyrus, cuneus, and bilateral precuneus than HCs. The ALFF value in the right precuneus of TAOs was positively correlated with clinical activity score (r = 0.583, P < 0.001) and Mini-Mental State Examination (MMSE) score (r = 0.377, P = 0.040), and negatively correlated with disease duration (r = −0.382, P = 0.037). Moreover, the ALFF value in the left middle occipital gyrus of TAOs was positively correlated with visual acuity (r = 0.441, P = 0.015).ConclusionTAO patients had altered spontaneous brain activities in the left occipital lobe and bilateral precuneus. The neuropsychological aspect of the disease should be noticed during clinical diagnosis and treatment

Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients

Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients.BackgroundIt remains uncertain whether the hemodynamic parameters are important determinants of left ventricular mass (LVM) in normotensive chronic hemodialysis (NTHD) patients, as has been found in their hypertensive counterparts.MethodsForty NTHD patients (mean age, 53.7 ± 14.4 years; male/female, 18/22) without the requirement of antihypertensive drugs for at least six months were studied. Controls were 41 hypertensive hemodialysis patients (HTHD) and 46 normotensive subjects with normal renal function (NTNR). The influence of anthropometrics, cardiovascular structure and function, and volume status on LVM (by two-dimensional echocardiography) was analyzed by steps of multiple linear regression.ResultsAs compared with the NTNR and NTHD group, the HTHD group had obvious pressure and volume/flow overload, and greater LV wall thickness, chamber size and mass. In contrast, NTHD subjects had similar blood pressure, large artery function, LV chamber size and stroke volume as the NTNR subjects. However, the NTHD patients still had greater wall thickness and LVM, along with greater cardiac output, lower total peripheral resistance and lower end-systolic meridional stress to volume ratio (ESSV) than the NTNR group. LVM in the NTHD group was significantly positively related to averaged systolic blood pressure (SBPavg), body surface area, extracellular fluid (ECF), carotid intima-media thickness (IMT), aortic pulse wave velocity (PWV), and negatively related to ESSV and Kt/V. The independent significant noncardiac structural determinants of LVM in NTHD subjects were ESSV, SBPavg, PWV and SV (model r2 = 0.617, P < 0.001).ConclusionsThe NTHD patients, without significant pressure and volume overload, still had increased LVM that was partially explained by the persistent flow overload and subclinical LV dysfunction

Increased brain iron in patients with thyroid-associated ophthalmopathy: a whole-brain analysis

BackgroundTo investigate the whole-brain iron deposition alternations in patients with thyroid-associated ophthalmopathy (TAO) using quantitative susceptibility mapping (QSM).MethodsForty-eight patients with TAO and 33 healthy controls (HCs) were enrolled. All participants underwent brain magnetic resonance imaging scans and clinical scale assessments. QSM values were calculated and compared between TAO and HCs groups using a voxel-based analysis. A support vector machine (SVM) analysis was performed to evaluate the performance of QSM values in differentiating patients with TAO from HCs.ResultsCompared with HCs, patients with TAO showed significantly increased QSM values in the bilateral caudate nucleus (CN), left thalamus (TH), left cuneus, left precuneus, right insula and right middle frontal gyrus. In TAO group, QSM values in left TH were positively correlated with Hamilton Depression Rating Scale (HDRS) scores (r = 0.414, p = 0.005). The QSM values in right CN were negatively correlated with Montreal Cognitive Assessment (MoCA) scores (r = -0.342, p = 0.021). Besides that, a nearly negative correlation was found between QSM values in left CN and MoCA scores (r = -0.286, p = 0.057). The SVM model showed a good performance in distinguishing patients with TAO from the HCs (area under the curve, 0.958; average accuracy, 90.1%).ConclusionPatients with TAO had significantly increased iron deposition in brain regions corresponding to known visual, emotional and cognitive deficits. QSM values could serve as potential neuroimaging markers of TAO

Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma

PURPOSEIntrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma.METHODSPatients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared.RESULTSA total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002).CONCLUSIONPerfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma