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Ortiz-Perez S, Zamorano-Martín F, Maciag E, Enseñat J. An Unusual Case of an Intradiploic Arachnoid Cyst of the Orbit. Ophthalmic Plast Reconstr Surg 2024; 40:e168-e171. [PMID: 38771895 DOI: 10.1097/iop.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
This study reported a case of an arachnoid cyst of the sphenoid bone causing orbital signs and symptoms in a 58-year-old man with progressive proptosis and nonspecific discomfort in the OS. Orbital MRI showed a 3-cm homogeneous cyst within the left greater wing of the sphenoid bone. To the best of our knowledge, this is the first report of an intradiploic arachnoid cyst in the sphenoid bone with atypical radiological features, causing clinical symptoms, and managed through an eyelid approach, achieving a complete resolution with no complications.
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Affiliation(s)
- Santiago Ortiz-Perez
- Department of Ophthalmology, Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen de las Nieves
- Departamento de Cirugía y sus especialidades, Universidad de Granada
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada
| | - Francisco Zamorano-Martín
- Department of Ophthalmology, Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen de las Nieves
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada
| | - Ewa Maciag
- Departamento de Neuro-radiología, Healthtime Clinica, Jaén
| | - Joaquim Enseñat
- Departamento de neurocirurgia, Hospital Clinic, Instituto de neurociencia, Barcelona, Spain
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Sindewald RW, Brandel MG, Wali AR, Khalessi AA, Santiago-Dieppa DR. Simultaneous resolution of arachnoid cyst and chronic subdural hematoma after middle meningeal artery embolization: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24192. [PMID: 39074387 DOI: 10.3171/case24192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Arachnoid cysts are cerebrospinal fluid-filled spaces that are typically congenital and treated conservatively or with fenestration when symptomatic. Chronic subdural hematomas (cSDHs) can arise in the presence of arachnoid cysts due to fragile leptomeningeal vessels or veins within the cyst wall or cyst lumen, leading to bleeding and subsequent hematoma formation. Middle meningeal artery (MMA) embolization is regularly used for the treatment of cSDH as an alternative to craniotomy and evacuation. OBSERVATIONS Here, the authors present the first known report of the simultaneous resolution of an arachnoid cyst and cSDH following MMA embolization in an adult. A 24-year-old male presented to the emergency department with 1 month of worsening headaches. Imaging revealed the presence of a cSDH and ipsilateral arachnoid cyst. The cSDH was treated with MMA embolization using coils exclusively. Follow-up imaging 4 months after embolization demonstrated simultaneous resolution of both the hematoma and the arachnoid cyst. LESSONS MMA embolization has been used for the treatment of cSDH. In cases in which the hematoma is related to an arachnoid cyst, MMA embolization can also lead to the concurrent resolution of both pathologies. https://thejns.org/doi/10.3171/CASE24192.
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Affiliation(s)
- Ryan W Sindewald
- Departments of Neurosurgery, University of California, San Diego, California
| | - Michael G Brandel
- Departments of Neurosurgery, University of California, San Diego, California
| | - Arvin R Wali
- Departments of Neurosurgery, University of California, San Diego, California
| | | | - David R Santiago-Dieppa
- Departments of Neurosurgery, University of California, San Diego, California
- Departments of Materials Science and Engineering, University of California, San Diego, California
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Peraud A, Schuler-Ortoli M, Schaal M, Reister F, Ehrhardt H, Friebe-Hoffmann U. Staged neurosurgical approach for giant and progressive neonatal arachnoid cysts: a case series and review of the literature. Childs Nerv Syst 2024; 40:1997-2007. [PMID: 38602531 PMCID: PMC11180026 DOI: 10.1007/s00381-024-06385-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES Prenatally diagnosed complex arachnoid cysts are very rare. While the true prenatal incidence is still unknown, they account for approximately 1% of intracranial masses in newborns. They rarely exhibit rapid growth or cause obstructive hydrocephalus, but if they increase to such a dimension during pregnancy, the ideal management is not well established. We present our detailed perinatal experience, covering prenatal diagnosis, a compassionate delivery process, and neonatal stabilization. Finally, a thorough postnatal neurosurgical intervention was performed. Initially, our focus was on the gradual reduction of cyst size as a primary effort, followed by subsequent definitive surgical treatment. METHODS This case series shows the treatment course of three fetuses with antenatally diagnosed large arachnoid cysts. We present pre- and postnatal management and imaging, as well as the surgical treatment plan and the available clinical course during follow-up. RESULTS Two girls and one boy were included in the current review. All three cases presented with prenatally diagnosed complex arachnoid cysts that increased in size during pregnancy. The mean gestational age at delivery was 35 weeks (range 32 to 37 weeks), and all patients were delivered by a caesarian section. Increasing head circumference and compression of brain structures were indications for delivery, as they are associated with a high risk of excess intracranial pressures and CSF diapedesis, as well as traumatic delivery and maternal complications. All cysts were supratentorial in location; one expanded into the posterior fossa, and one was a multicompartment cyst. All children underwent an initial surgical procedure within the first days of life. To relieve cyst pressure and achieve a reduction in head circumference, an ultrasound-guided or endoscopic-assisted internal shunt with drainage of the cyst to the ventricles or subdural/subarachnoid space was inserted. Definite surgical therapy consisted of cyst marsupialization and/or cysto-peritoneal shunt implantation. All children survived without severe neurodevelopmental impairments. CONCLUSION With the cases presented, we demonstrate that the slow reduction of immense cyst size as an initial procedure until optimal requirements for final surgical treatment were achieved has proven to be optimal for neurological outcome. Special emphasis has to be taken on the delicate nature of premature newborn babies, and surgical steps have to be thoroughly considered within the interdisciplinary team.
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Affiliation(s)
- Aurelia Peraud
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Marie Schuler-Ortoli
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Matthias Schaal
- Department of Radiology, University Hospital Ulm, Ulm, Germany
| | - Frank Reister
- Section Obstetrics & Perinatology, Department of Obstetrics & Gynecology, University Hospital Ulm, Ulm, Germany
| | - Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Ulrike Friebe-Hoffmann
- Section Obstetrics & Perinatology, Department of Obstetrics & Gynecology, University Hospital Ulm, Ulm, Germany
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Krishnan V, Jaganathan S, Baker A, Jayappa S, Murphy J, Glasier C, Choudhary A, Albert G, Ramakrishnaiah R. Arachnoid cyst in the pediatric patient: What the radiologist needs to know. Neuroradiol J 2024:19714009241248746. [PMID: 38649153 DOI: 10.1177/19714009241248746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Arachnoid cysts are the most common incidentally discovered intracranial lesions on imaging and the most common cystic intracranial lesions. They may be developmental or secondary. A relative lack of recent literature and any comprehensive radiological review on arachnoid cysts has led to a general lack of awareness among radiologists of symptomatic or complicated arachnoid cysts. This is particularly concerning in pediatric patients. While arachnoid cysts are asymptomatic in most cases, they can cause clinical symptoms in a minority of cases, especially when they occur in unusual sites. These include intraventricular locations where they may cause hydrocephalus, the basal cisterns where they may compress cranial nerves, the cerebellopontine angle where they have to be differentiated from a number of cystic lesions, the cavum septum pellucidum or cavum velum interpositum, the choroid fissure where they can entrap the temporal horn and compress the hippocampus, the posterior fossa where they need to be differentiated from other posterior fossa cystic lesions, and within the spinal canal where there is a concern for cord or nerve root compression. Larger cysts are more prone to complications such as mass effect, hemorrhage, and rupture. Hemorrhage and rupture often present with acute symptoms. Ruptured cysts lose their characteristic imaging appearance and can mimic several ominous pathologies. It therefore becomes vital to accurately diagnose these cases as complications of pre-existing arachnoid cysts for appropriate management. A detailed review of all diagnostic imaging aspects of arachnoid cysts will help fill in the existing information void on this important entity.
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Affiliation(s)
- Venkatram Krishnan
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Sriram Jaganathan
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Andrew Baker
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Sateesh Jayappa
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Janice Murphy
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Charles Glasier
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Arabinda Choudhary
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Gregory Albert
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Raghu Ramakrishnaiah
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
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Talreja R, Fonseca LD, Chikkannaiah M, Kumar G. Intracranial Arachnoid Cyst in Children: Clinical Presentation and Risk Factors for Surgical Intervention. Pediatr Neurosurg 2024; 59:55-65. [PMID: 38228110 DOI: 10.1159/000536284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Intracranial arachnoid cysts (IAC) in children are a common incidental finding on imaging. Most IACs are asymptomatic and can be monitored; however, a small percentage may enlarge and require surgical intervention. This study aimed to identify clinical risk factors in patients with IAC who underwent surgery versus those who did not. METHODS We conducted a retrospective chart review from 2009 to 2021 at a free-standing children's hospital. A total of 230 patients diagnosed with an IAC aged 0-21 years of age were included in the study. Data on demographics, imaging, and neurological follow-up were analyzed. RESULTS Out of 230 patients, 45 (19.6%) underwent surgery. At time of IAC diagnosis, the surgical patients were younger (median age 1.1 years), and their median cyst volume was larger (41.7 cm3), compared to nonsurgical patients (median age 5.9 years, volume 11.8 cm3, respectively). Headache was the most common reason for initial imaging in nonsurgical patients (54/185, 29.2%) while prenatal ultrasound (11/45, 24.4%) and macrocephaly (11/45, 24.4%) were the most common reasons for surgical patients. The majority of both surgical and nonsurgical patients had the IAC incidentally found (41/45, 91.1% and 181/185, 97.8%, respectively). Surgery relieved symptoms in 38/45 (84.4%) patients. Cyst volume and age were predictors of increased odds of having surgery. DISCUSSION/CONCLUSION Patients who underwent surgery were younger and had larger cyst volumes at time of diagnosis. The majority of the IAC were found incidentally and remained stable over prolonged follow-up. The majority of the patients experienced relief of symptoms postsurgical intervention. There is a greater odds of having surgical treatment with decreased age and greater cyst volume at diagnosis, and therefore these patients should be monitored closely for development of symptoms indicating need for surgical intervention.
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Affiliation(s)
- Raghav Talreja
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | | | - Mahesh Chikkannaiah
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Neurology, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Gogi Kumar
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Neurology, Dayton Children's Hospital, Dayton, Ohio, USA
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Lee JH, Holste KG, Selzer BJ, Garton HJL, Muraszko KM, Maher CO. Sports Participation and Sports-Related Neurologic Injuries in Pediatric Patients With Arachnoid Cysts. Neurosurgery 2023; 93:979-985. [PMID: 37199501 DOI: 10.1227/neu.0000000000002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Currently, there is no consensus recommendation regarding the safety of sports participation for pediatric patients with arachnoid cysts (ACs). OBJECTIVE To prospectively survey patients with ACs to define the risk of sports-associated neurologic injury in untreated and treated patients. METHODS A prospectively administered survey was given to all patients diagnosed with an AC who presented to a single pediatric neurosurgery clinic between December 2010 and December 2021. Data were recorded on demographic information, imaging characteristics, treatment, sports participation, and presence of sports-related neurologic injury. The type and date of surgery for the AC were noted if surgery was performed. RESULTS Of the 303 patients with completed surveys, 189 patients participated in sports, and 94 patients had prospective data available. There was no significant difference in cyst location or Galassi score between patients who did and did not participate in contact vs noncontact sports and those who did and did not experience a concussion. A cumulative total of 2700.5 seasons of sports were played (2499.7 in untreated and 200.8 in treated patients). There were 44 sports-related concussions among 34 patients: 43 in untreated patients and 1 in a treated patient. For all participants, the concussion rate was 16.3 per 1000 seasons of all sports and 14.8 per 1000 seasons of contact sports. The concussion rate after AC treatment was 4.9 per 1000 seasons of all sports. Three patients experienced sports-related AC rupture or hemorrhage, none of which required surgery or resulted in lasting neurologic symptoms or deficits. CONCLUSION The rates of sports-related concussion and cyst rupture in patients with AC in both treated and untreated populations were low. We advocate for a generally permissive posture toward sports participation in this population.
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Affiliation(s)
- Johan H Lee
- School of Medicine, University of Michigan, Ann Arbor , Michigan , USA
| | - Katherine G Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Bela J Selzer
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Hugh J L Garton
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Cormac O Maher
- Department of Neurosurgery, Stanford University, Stanford , California , USA
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Leavitt LA, Nanda P, Stemmer-Rachamimov A, Dunn GP, Jones PS. Spontaneous rupture of an arachnoid cyst in an adult: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22420. [PMID: 38015025 PMCID: PMC10550604 DOI: 10.3171/case22420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/12/2022] [Indexed: 11/29/2023]
Abstract
BACKGROUND Arachnoid cysts are common intracranial mass lesions frequently discovered as incidental findings on radiographic imaging. It is routine practice to monitor these lesions as a large majority remain stable. Although traumatic cyst rupture is a known risk, it is rare for patients to present with spontaneous rupture. OBSERVATIONS The authors report the case of a 32-year-old patient who required emergent neurosurgical intervention for spontaneous rupture of a left hemispheric arachnoid cyst. LESSONS Patients with ruptured arachnoid cysts can present with vague, nonspecific symptoms that may delay diagnosis. If not diagnosed and treated promptly, arachnoid cyst rupture can progress to a neurosurgical emergency as the subdural collection may cause extensive mass effect and even cerebral herniation.
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Affiliation(s)
- Lydia A. Leavitt
- University of Illinois College of Medicine, Rockford, Illinois; and
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Peraud A, Ibel R. Controversies in the Treatment of Arachnoid Cysts with Special Emphasis on Temporal Arachnoid Cysts. Adv Tech Stand Neurosurg 2023; 46:175-192. [PMID: 37318575 DOI: 10.1007/978-3-031-28202-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intracranial arachnoid cysts (ACs) are benign lesions. The incidence in children is 2.6%. ACs are often diagnosed incidentally. Because of the broad use of CT and MR imaging, the frequency of AC diagnosis has increased. In addition, prenatal diagnosis of ACs is becoming more common. This places clinicians in a difficult situation with regard to the optimal treatment, since the presenting symptoms are often vague and operative management includes not negligible risks. It is generally accepted that conservative management is indicated in cases with small and asymptomatic cysts. In contrast, patients with definite signs of raised intracranial pressure should be treated. There are however clinical situations in whom the decision about the preferred treatment is difficult to make. Unspecific symptoms such as headaches and neurocognitive or attention deficits can be challenging to evaluate, whether they are related to the presence of the AC or not. The treatment techniques intent to establish a communication between the cyst and the normal cerebrospinal spaces or consist of a diversion of the cyst fluid by a shunt system. Which surgical method (open craniotomy for cyst fenestration, endoscopic fenestration, or shunting) is preferred differs between neurosurgical centers or the pediatric neurosurgeon in charge. Each treatment option has a unique profile of advantages and disadvantages which should be considered when discussing treatment with the patients or their caregivers.
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Affiliation(s)
- Aurelia Peraud
- Section Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Ulm, Ulm, Germany.
| | - Rebecca Ibel
- Section Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Ulm, Ulm, Germany
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Lu Y, Tian Y, Gan Y, Fu Y, Chen Q, Zou L, Zhao B, Yan Y, Liu S, Chen X, Li X. The Efficacy and Tolerability of Electroconvulsive Therapy in Psychiatric Patients with Arachnoid Cysts: A Retrospective Chart Study. Brain Sci 2022; 12:brainsci12101393. [PMID: 36291326 PMCID: PMC9599128 DOI: 10.3390/brainsci12101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective therapy for many psychiatric illnesses. However, intracranial occupying lesions are a relative contraindication to ECT. Arachnoid cysts are benign, congenital, and space-occupying lesions. Our study aimed to evaluate the efficacy and tolerability of ECT in psychiatric patients with arachnoid cysts. We retrospectively identified 62 psychiatric patients with arachnoid cysts; 43 of them underwent ECT and 19 did not. Their conditions were assessed by CGI-S and different scales depending on different diagnoses (PANSS for schizophrenia; HAMD for depression; YMRS for bipolar disorder). The side effect was assessed by TESS. Significant differences were shown in the reduced scores of the CGI-S between patients who underwent ECT and those who did not (p = 0.001), while, at the same time, there was no significant difference in their TESS score (p = 0.297). The current study found that ECT is an effective and tolerable therapy for psychiatric patients with arachnoid cysts.
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Affiliation(s)
- Ying Lu
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Tian
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Gan
- Department of Psychiatry, Chongqing Eleventh People’s, Chongqing 400038, China
| | - Yixiao Fu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bangshu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu Yan
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shudong Liu
- Department of Clinical Psychology II, Chongqing Mental Health Center, Chongqing 400030, China
| | - Xiaolu Chen
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400015, China
- Correspondence: (X.C.); (X.L.)
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Correspondence: (X.C.); (X.L.)
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