2022年 · 第102卷第23期

Cerebrospinal fluid (CSF) is a colorless and transparent fluid in the central nervous system, which plays a protective and supportive role in the central nervous system. It is mainly produced by the choroid plexus tissue of the middle ventricle of the human cerebral hemisphere, and a small part is produced in the third and fourth ventricles. It is absorbed by arachnoid granulosa cells near the sagittal sinus at the apex of the brain, and thus flows back into the venous blood. The daily secretion of cerebrospinal fluid is relatively constant, ranging from 400 to 500 ml. When CSF absorption is impaired, it will lead to an increase in the total amount of CSF in the central nervous system, which is clinically called hydrocephalus. At present, the main surgical treatment for hydrocephalus is ventriculoperitoneal shunt (V-P shunt) and third ventriculostomy. In most cases, the choice of treatment is ventriculoperitoneal shunt. The main complications of this procedure include intracranial infection, excessive shunt, subdural hematoma, induced epilepsy and tube blockage. It is widely accepted in the industry that early detection of such complications can lead to a better prognosis for patients. The purpose of this study was to evaluate and compare the effects of CSF MRI flow imaging scans, CSF component analysis, and X-ray films in the detection of postoperative complications in hospitalized children with V-P shunt. The study conducted a retrospective analysis of hospitalized cases of school-age children in a 10-year period from 2006 to 2016 at Rasul Akram Hospital in Tehran. The recorded data covered age, sex, postoperative complications, MRI flow imaging scans and routine and biochemical indexes of cerebrospinal fluid. A total of 95 children were included, 56 males (58.9%) and 39 females (41.1%), and the mean age of onset of postoperative complications was (2.8 ± 2.2) years. Postoperative tubular obstruction (60%) was the most common complication, followed by intracranial infection (25.3%). MRI CSF flow imaging could detect 36.5% of postoperative complications. The specificity and sensitivity of MRI CSF flow imaging for finding postoperative tubular obstruction were 87% and 50%, respectively. On the other hand, MRI CSF flow imaging is also valuable in detecting postoperative intracranial infection, with its specificity and sensitivity reaching 60% and 20%, respectively. When children had postoperative intracranial infection, the results of routine and biochemical examination of cerebrospinal fluid in all samples were comprehensively analyzed. 92% of children had decreased glucose level, 87.5% had increased protein and cell count, and 62.5% had positive cultures of cerebrospinal fluid pathogens. The sensitivity, specificity, positive predictive value and negative predictive value of CSF components were 92%, 82%, 63% and 97%, respectively. Combining the symptoms and signs of the child with the diagnosis helps to obtain a higher accuracy.

Long-term cardiac complications following COVID-2019 infection are poorly understood. This study was mainly to follow up the changes in left and right ventricular function after acute COVID-2019 infection based on echocardiographic parameters. The study mainly selected patients with acute COVID-19 infection registered with the World Echocardiography-COVID Federation, and all enrolled patients completed transthoracic echocardiography and were followed up. A total of 198 patients were enrolled with a mean follow-up day of 129 d, of which 153 patients had both analysable initial images (at the time of acute COVID-2019 infection) and follow-up images, including echocardiographic parameters of the left and right ventricles. Differences in echocardiographic parameters were compared at the time of acute COVID-2019 infection and at follow-up, respectively. Throughout the study cohort, echocardiographic parameters of left and right ventricles at follow-up did not differ significantly from those at acute COVID-2019 infection (bothP>0.05）。 Patients with hyperdynamic left ventricular ejection fraction (>70%) at acute COVID-2019 infection were reduced at follow-up (74.3% ± 3.1% vs. 64.4% ± 8.1%,P<0.001), while left ventricular ejection fraction decreased (<50%) were elevated at follow-up (42.5%±5.9% vs 49.3%±13.4%,P=0.02), there was no significant change in patients with normal left ventricular ejection fraction. Left ventricular longitudinal strain normal (<-18%) were reduced at follow-up (-21.6%±2.6% vs-20.3%±4.0%,P=0.006), whereas patients with impaired left ventricular longitudinal strain improved at follow-up (-14.5%±2.9% vs-16.7%±5.2%,P<0.001）。 Patients with abnormal right ventricular global longitudinal strain (>-20%) and abnormal right ventricular basal transverse diameter (>4.5 cm) improved at follow-up (bothP<0.05）。