In this study, we report on a patient who suffered from injury of the superior longitudinal fasciculus following ventriculoperitoneal (VP) shunt operation, which was demonstrated with diffusion tensor tractography (DTT).

An 82-year-old female patient was diagnosed as suffering from normal pressure hydrocephalus (NPH) and underwent VP shunt operation approached through the right posterior parietal area in the brain 3 years ago(Figure 1A). Brain MRI at 3 years after the shunt operation showed that the VP shunt passed through the right inferior parietal lobule and adjacent subcortical white matter (Figure 1B). Her cognition was so poor that the Mini-Mental State Exam score was not even checked. Therefore, her neglect could not be evaluated using a formal evaluation tool such as the line bisection test, however, she did not show symptoms of neglect clinically. The study was approved by the Institutional Review Board of Yeungnam University Hospital (IRB No. YUMC-2015-07-064).

李峤汝还真没想到，母亲竟然说出这样的话。梁叔有工资，一个月接近两千。就他们俩，吃不愁穿不愁的，还能有什么苦？李峤汝自认为自己做女儿还算称职，平时经常塞给母亲一些零花钱，过年过节也会给他们买衣服买礼物。她自己离婚后，就更能理解母亲当年带她的不易。当然，她也不吃亏，乐乐的生活费都是母亲和梁叔负担，连学费都没让李峤汝出过。听说梁叔也曾有过两个孩子，发大水给冲没了。梁叔把父爱毫无保留地给了乐乐，比乐乐爸还疼她。

Diffusion tensor imaging (DTI) data were acquired 2 weeks after VP shunt operation using a 6-channel head coil on a 1.5 T Philips Gyroscan Intera (Philips,Ltd, Best, The Netherlands) with single-shot echo-planar imaging. For each of the 32 non-collinear diffusion sensitizing gradients, 70 contiguous slices were acquired parallel to the anterior commissure-posterior commissure line. Sixty contiguous slices (acquisition matrix = 96 × 96; reconstruction matrix = 192 × 192 matrix; fi eld of view = 240 × 240 mm2; repetition time= 10,398 ms; echo time = 72 ms, b = 1000 s/mm2, number of excitations = 1, slice gap = 0 mm and thickness =2.5 mm) were acquired for each of the 32 noncollinear diffusion-sensitizing gradients. Fiber tracking was performed using the fi ber assignment continuous tracking algorithm implemented within the DTI task card soft-ware (Philips Extended MR Work Space 2.6.3). Each DTI replication was intra-registered to the baseline “b0”images to correct for residual eddy-current image distortions and head motion effect, using a diffusion registration package (Philips Medical Systems). For reconstruction of the superior longitudinal fasciculus (SLF),the seed region of interest was placed on the triangular shape just lateral to the corticospinal tract near the anterior horn of the lateral ventricle and the target region of interest was placed on the triangular shape near the posterior horn of the lateral ventricle (Bernal and Altman,2010). Termination criteria were fractional anisotropy(FA) ＜ 0.15 and an angle change ＞ 2°. The lower portion of the right SLF was not reconstructed compared with the left SLF (Figure 1C). In addition, the value of fi ber number (FN) of the SLF showed difference between the right and left hemispheres except for the values of fractional anisotropy and mean diffusivity (MD) the right SLF— FA: 0.37, MD: 0.91, FN: 4015 and left — FA: 0.38,MD: 0.88, FN: 4950).

Figure 1 Brain MR imaging and diffusion tensor tractography for a 82-year-old female patient with normal pressure hydrocephalus following ventrioculoperitoneal (VP) shunt.

(A, B) Brain MR images taken before the VP shunt operation (A) and 3 years after VP shunt (green dotted line) operation show that the VP shunt passes through the right upper portion of the anterior thalamus(B). (C) Diffusion tensor tractography. The lower portion of the right superior longitudinal fasciculus (yellow arrows) is not reconstructed compared with the left superior longitudinal fasciculus. L: Left: R: right.

VP shunt operation is a common neurosurgical procedure for management of NPH. In this study, using DTT, injury of the right SLF following VP shunt operation was demonstrated in a patient with NPH. Because the VP shunt passed through the lower portion of the remaining SLF, it appeared that the injury of the lower portion of the right SLF resulted from the VP shunt.However, the symptom of neglect, which is the most representative symptom of the right SLF injury, was not observed in this patient, although the patient’s neglect could not be precisely estimated due to poor cognition(Shinoura et al., 2009; Lunven et al., 2015). Since introduction of DTT, several studies have reported that passage of a VP shunt caused injury of adjacent neural tracts (Gold et al., 2008; Kwon and Jang, 2012; Jang and Yeo, 2013; Jang and Seo, 2015, 2016). These neural tracts comprised the corticospinal tract, limbic system,cingulum, corticoreticulospinal tract, and thalamocingulate tract among the Papez circuit (Gold et al., 2008;Kwon and Jang, 2012; Jang and Yeo, 2013; Jang and Seo,2015, 2016). Thus, to the best of our knowledge, this is the fi rst case report to demonstrate an injury of the SLF following VP shunt operation. However, limitations of DTT should be considered: it can produce both false negative and false positive results due to crossing fi ber,partial volume effect, or instrument-induced artifact(Parker and Alexander, 2005).

Sung Ho Jang, Han Do Lee＊

In conclusion, injury of the SLF was demonstrated following VP shunting in a patient with NPH, using DTT. It appears that DTT could be a useful imaging tool in detection of underlying injury of neural tracts after VP shunting. In-depth studies including a large number of subjects and development of safe neurosurgical procedures to save the neural tracts should be encouraged (Jang and Kwon, 2014; Jang et al., 2015; Kwon and Jang, 2015).

Accepted: 2017-05-10

Institutional review board statement:: The study was approved by the Institutional Review Board of Yeungnam University Hospital (approval No. YUMC-2015-07-064). The study followed the principles of the Declaration of Helsinki.

以深圳速度投入深圳工作。7月3日凌晨三点，我们来自于北京印刷学院的6名学生带上行李奔往机场赶飞机，有人甚至是刚下火车就上飞机。从北京飞往深圳，落地后没有片刻休息，我们立即投入到工作之中，虽然状态很懵，但确定的是自己不能闲下来。

Financial support: This work was supported by the Medical Research Center Program (2015R1A5A2009124) through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning. The funder had no involvement in the study design;data collection, analysis, and interpretation; paper writing; or decision to submit the paper for publication.

orcid: 0000-0002-1668-2187 (Han Do Lee)

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea

doi: 10.4103/1673-5374.235093

跳绳运动开展起来比较方便，在空旷的地方就可以开展，并且跳绳的费用还比较低，更适合学生运动。跳绳运动属于有氧运动范畴，有效的运动时间后便于学生心率恢复，同跳绳相比，跑步运动的恢复时间较长，不利于后面课程的学习。此外，跳绳运动还比较简单易学，大多数学生都可以学会，可以让每一个学生都参与进来。跳绳运动还富有多样性和创新性，我们可以指导学生自主探究，发现更有趣的运动方法，丰富跳绳运动内容。跳绳运动对器材的要求也很低，只要有空地和跳绳便可以开展，所以无论是农村学校还是城市学校，开展起来都比较方便。

Author contributions: SHJ was responsible for conception and design of this study and development and writing of the paper. HDL participated in conception and design of this study, was responsible for acquisition and analysis of data, and authorized the paper. Both of these two authors approved the fi nal version of this paper.

Con fl icts of interest: None declared.

＊Correspondence to: Han Do Lee, M.S., lhd890221@hanmail.net.

对灌浆速率（GRmean）而言，整体表现为外缘籽粒的灌浆速率高于中部籽粒和内部籽粒，并有籽粒平均灌浆速率（外缘、中部、内部籽粒的平均值）随着密度的增加而降低，随着深松深度减小呈下降趋势；其中以深松S45处理、密度D1下的灌浆平均灌浆速率最大为0.446，浅旋耕处理RT、密度D3下的最低为0.267。

矿区位于广西山字型构造前弧西翼内侧，主构造线方向为NNW向，北段受南岭EW向构造体系的影响，构造形迹的方向略有改变，北东部有NNE向新华夏系构造反映。

Data sharing statement: Datasets analyzed during the current study are available from the corresponding author on reasonable request.

Copyright transfer agreement: The Copyright License Agreement has been signed by all authors before publication.

Plagiarism check: Checked twice by iThenticate.

虽然近年来不少学者也逐渐转向多模态视频分析，但多数学者仍旧关注静态文本的多模态。总体上说来，研究还较少，尚处于起步阶段。

Peer review: Externally peer reviewed.

Open access statement: This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non-Commercial-ShareAlike 4.0 License, which allows others to remix, tweak,and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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