Volume 90  ·   Issue 21  ·  2010

The principle of brain functional activity can be understood and studied from two aspects: one is functional segmentation, that is, finding specific brain regions corresponding to each brain function, the main means is functional localization study, and task-stimulated functional magnetic resonance imaging (fMRI) has been widely used [1]; The second is functional integration, which believes that brain functional activities are accomplished by the synergistic action of multiple brain regions, and the main means is to study the connection between brain regions through brain connection analysis technology. The resting state fMRI technology that has appeared in recent ten years is more inclined to study the brain functional integration network.

Pulmonary hypertension is a hot topic in medical research in recent years. With the deepening of research on its pathogenesis, pathology, pathophysiology and therapeutics, the classification and nomenclature of pulmonary hypertension are constantly updated.

Objective To detect magnetically labeled single cells in vitro by using 7.0T MRI system and to optimize the parameters used for labeled cell imaging. Methods The endothelial cells ECV-304 were incubated with self-synthesized Fe2O3-PLL Prussian blue stain was employed for identifying intracellular irons. Agarose phantoms of dispersed labeled cells were made with an cell concentration of 2 × 10/ml. 3D-FLASH sequence was employed for the detection of single cells and the cell concentration calculated by counting the number of dark points in MR images; The investigators compared the effects of gradient echo sequence (2D-FLASH) and spin echo sequence (MSME) upon the imaging of magnetically labeled single cells; Also the effects of different echo times (Es) and resolutions of magnetic nanoparticle relaxation upon the imaging of cells were analyzed. Results The endothelial cells ECV-304 were labeled successfully and the labeling efficiency reached almost 100%. Prussian blue staining of Fe2O3-PLL labeled cells revealed the cytoplasmic presence of iron. Single cells were detected as isolated dark points and the cell concentration corresponded with the actual data. The 2D-FLASH sequence had a much stronger T2 * effect than MSME sequence in single cell detection. The T2 * effect increased with the prolongation of TE. The signal loss fell significantly as the resolution decreased. And it reached almost zero when the voxel size reached 200 μm3. Conclusions 7.0T MR system is able to detect magnetically labeled single cells. The optimization of imaging sequences enhances the sensitivity of magnetically labeled single cells. Thus it provides a better method for ire vivo detection of single cells.

Objective To probe the relationship of clinical and pathological features of hepatocellular carcinoma ( HCC) with the blood oxygen level by the technique of noninvasive magnetic resonance multi-echo R2 * . Methods Multi-echo R2 * sequence was carried out pre-operatively in a total of 46 patients with pathologically proved HCC. The T2 * and R2 * values of HCC, liver, spleen and paraspinous muscle on T2 * and R2 * maps and the ratios of HCC to liver ( H/L), spleen ( H/S) and muscle ( H/M) were calculated. Different groups were defined according to such clinical parameters as the serum AFP level, lesion dimension, Edmondson's grade, ascites, capsula, liver cirrhosis, intrahepatic daughter foci or tumor-emboli in portal vein respectively. The differences in T2 * and R2 * values and the ratios between different groups were analyzed. Results In contrast with T2 * value, the R2 * value of HCC was less than that of liver or spleen (P < 0.05). Difference in R2 * ratio of H/M (0. 81 ± 0. 26 vs 1. 23 ± 0. 39) was found between positive and negative groups of AFP (P = 0. 047, t = 2. 248 ). And so was the same difference (0. 83 ±0. 24 vs 1. 23 ±0. 43) between the lesions with or without capsula (P =0. 046, t = 2. 257). The R2 * ratio of H/S in hepatic cirrhosis group (1. 01 ±0. 58) was higher than that in non- cirrhosis one ( 0. 53 ± 0. 17) (P = 0. 035, t = 2. 247) whereas the T2 * ratio of H/S was reversed (1.42 ± 0. 92 vs 2. 64 ± 1. 15) (P =0. 036, 1=2. 230). The differences in T2 * ratio of H/M in the group with or without intrahepatic daughter foci (1. 18 ± 0. 47 vs 2. 24 ± 1. 71 ) ( P = 0. 048, t = 2. 115 ) , and in T2 * value in the group with or without tumor-emboli in portal vein (27. 24 ± 11. 90 ms vs 46. 70 ±38. 40 ms) (P =0.049, t =2.046) were shown to be significant However, no differences in MR parameters between other groups were observed (P>0. 05). Conclusion The blood oxygen level parameters, R2 * and T2 * values and the ratios are related to some clinical and pathological features of HCC. And the blood oxygen level is affected by multiple factors.

Objective To explore the central mechanism of acupuncture in protecting gastric mucous membrane by a composite analysis of gastric mucous membrane related indices in peripheral blood and functional MRI (fMRI) signal changes after electric-acupuncturing Zusanli (ST36) acupoint. Methods Sixteen healthy adult volunteers were divided into true acupoint group ( A ) and sham acupoint group ( B). Zusanli acupoint was used for Group A. Peripheral blood was drawn 5 min before and 5, 15, 25, 30 min after needle-removal for the detection of gastric mucous membrane related indices. fMRI was performed during acupuncture and the acquired fMRI data were analyzed by SPM2 (P <0. 001). Results The levels of calcitonin gene related peptide (CGRP) and prostaglandin E2 ( PGE2 ) increased while those of endothelin (ET) and gastrin (GAS) decreased significantly after acupuncture in Group A (P<0. 01). And there was no significant change in Group B (P > 0. 05). Acupuncturing Zusanli activated the bilateral middle frontal gyrus, caudate, left precentral and postcentral gyri, hypothalamus, anterior cingulate cortex, right hippocampus, insula and cerebellar hemisphere. But acupunturing the sham acupoint only activated the paracentral lobule and cerebellar hemisphere. Conclusion Acupuncturing Zusanli acupoint activates certain cortex areas and multiple systems to stimulate the release of neurotransmitters and regulate the peripheral humoral factors to achieve the protection of gastric mucous membrane.

Objective To study the linguistic-functional cortex and identify the effect of age and sex on normal language processing by ER-fMRI and to observe whether a left or right predominance for linguistic- functional cortex exits or not. Methods A total of SO healthy Chinese volunteers with right-hand dominance were divided into 4 groups according to gender and age; Group A, young male ( ≤50 yr) ; Group B, young female( ≤50 yr); Group C, old male ( >50 yr); Group D, old female ( >50 yr). Each group finished 2 tasks of reading Chinese words loudly and silently. Results There were no statistical differences of activated voxel and intensity changes in linguistically functional cortex between healthy male and female individuals of different decades. The activated areas include bilateral frontal lobe, temporal lobe, parietal lobe, occipital lobe and bilateral cerebellar hemisphere. And there were no statistical difference of activated voxel and intensity changes in bilateral activated areas. Although the activated areas were not quite the same between two tasks and more activation elicited by overt-reading, but there was no statistical difference of activated voxel and intensity changes in the same activated areas. Conclusion There is no age and gender difference in linguistic-function regions of healthy individual whose native language is Chinese. It is bilateral- equilibrium and no linguistic hemisphere's predominance exits. This characteristic is different from the left- hemisphere dominance of western languages. Although there is no statistical difference of activated voxel and intensity change between overt-reading and covert-reading, the activated areas of covert-reading are so unreliable that the way of covert-reading to study the linguistic-function regions of human brain is improper to some extent.

Objective To study the neural mechanism of visual cortical deficits between anisometropic and strabismic amblyopia comparatively by BOLD-fMRI retinotopic mapping. Methods Ten anisometropic amblyopes, 10 strabismic amblypes and 9 normal subjects underwent fMRI with retinotopic mapping and luminous spots stimuli (spatial frequency: 6 cpd, contrast; 0.5). 1. 5T MRI system was used to obtain functional images of visual cortex. Responses in primary and secondary visual cortex were compared among the dominant (normal subject group) , anisometropic and strabismic amblyopic eyes by one-way ANOVA, successively analyzed by paired-samples t test between amblyopic eyes and fellow fixing eyes (anisometropic and strabismic amblyopia group respectively) . Their fMRI deficits of amblyopes were analyzed regressively in two amblyopia groups respectively. Results The result of one-way ANOVA showed significantly a lower activation (average T value) in V1, V2, V3, Vp and V7 visual areas (P < 0. 05,P values 0. 018, 0. 007, 0. 002, 0. 000, 0.025 respectively) between anisometropic amblyopia and normal group. This was in accordance with the result of paired-samples t test between amblyopic eyes and fellow fixing eyes in anisometropic amblyopia group (P < 0. 05 , P values 0.035, 0. 007, 0. 020, 0. 009, 0. 023 respectively). Statistical difference was found in V1, V2 and Vp areas between strabismic amblyopia and normal group (P < 0.05, P values 0.010, 0.007 & 0.003 respectively). The paired-samples t test in strabismic amblyopia group showed statistical difference only in V2, Vp areas ( P < 0. 05 , P values 0. 026 and 0. 009 respectively. ). So the two results were discordant. Between the two amblyopic groups, there was no statistical difference (P > 0. 05) except in V7 area (P < 0. 05, P value = 0. 048). There was no causal relation between the primary visual cortical deficits and the secondary cortex in amblyopia ( P > 0. 05 ). Conclusion Anisometropic amblyopia and strabismic amblyopia both have functional deficits in the primary and secondary visual cortex. The neural mechanism of secondary visual cortical deficits may be more complex than decreased cortex activation induced by the deficit of primary cortex. In the primary cortex, strabismic amblyopia and anisometropic amblyopia have neuronal deficits and/or abnormal interaction. In addition, strabismic amblyopia may also have suppressive influences of the fixing eyes upon the amblyopic eyes. Anisometropic amblyopia has the neural undersampling at a high spatial frequency in the secondary visual cortex as compared to amblyopic amblyopia.

Objective To analyze the correlative factors of traumatic embolism in superficial cerebral vein and explore their corresponding treatments. Methods A total of 74 cases were divided into 3 groups according to their injury mechanisms. Group A: traumatic brain injury in superficial cerebral vein with cerebral contusion, acute intracerebral hematoma and subdural hematoma in the same place; Croup B; traumatic brain injury in superficial cerebral vein with acute intracerebral hematoma, subdural hematoma and skull fracture in the same place; Group C: traumatic brain injury in superficial cerebral vein with acute subdural hematoma and skull fracture in the same place, without cerebral contusion or acute intracerebral hematoma. They were divided into different groups according to gender, age, pre-operative GCS and cerebral hemia. Results Among 74 cases, 28, 39 and 7 cases belonged to groups A, B and C respectively. There was significant difference among injured veins in three groups (P <0. 01). Cerebral infarction was found in 37 cases in groups A and B while only 2 cases in group C. Cerebral infarction had no correlation with sex, age, pre-operative GCS and cerebral hernia. Conclusion Injuries in superficial cerebral vein are mainly caused by skull fracture, contre-coup injury and shearing force. Cerebral infarction often exists if there is cerebral contusion. It is necessary to protect injured primary superficial cerebral veins and ambient venous network, remove intracranial hematoma and large bone flap to reduce intracranial hypertension and dilute blood post-operatively to prevent venous embolism.

Objective To analyze the different risk factors for reversible posterior leukoencephalopathy syndrome ( RPLS) in systemic lupus erythematosus (SLE). Methods The clinical and imaging characteristics of 2 cases were described in details. The literature reports for 33 cases of SLE and RPLS were reviewed systematically. The etiologies of SLE and RPLS were analyzed for all 35 cases. Results Thirty-five cases of SLE patients were complicated with RPLS, 32 cases suffered hypertension, 3 cases had no hypertension, 1 case was explicitly related with rituximab and 1 case was related with cyclosporine therapy. Conclusion SLE complicated by RPLS has different causes, such as hypertension, SLE involving central nervous system and drug neurotoxicity.

Objective To study the outcome in the arthroscopic treatment of acute greater tuberosity fractures. Methods Twelve cases with acute great tuberosity fractures received reduction with arthroscopic treatment from August 2006 to December 2007. There were 7 males and 5 females. Eight cases were on left side and 4 on right side. The patients were operated at a mean age of 38 years old (range; 27-45). The fractured fragments in displacements were greater than 5 mm. X-ray film and Constant score were used to evaluate the post-operative outcome. Results Three hollowed threaded screws with a washer were used to fix the big fractured fragments. The post-operative follow-up was a mean of 18 months (range: 14-33). The fracture fixations were excellent and bone union occurred. The patients received a mean Constant score of 92 (86-100) at the last follow-up. Conclusion Arthroscopic treatment of acute greater tuberosity fractures is quite Efficacious.

Objective To explore the feasibility and efficacy of modified minimally invasive percutaneous pedicle screws osteosynthesis for the treatment of thoracolumbar vertebral compression fracture. Methods Twenty cases of thoracolumbar fracture without neural impairment were enrolled. None needed laminotomy decompression. With the aid of C-arm image intensifier, the GSS Ⅱ pedicle screws were inserted through four small longitudinal incisions and modified surgical instruments. Perioperative parameters and postoperative imaging indices were compared with those undergoing conventional open pedicle screws osteosynthesis in other 20 cases. Results There was no significant difference in operative time between minimal invasive group and conventional group (P > 0. 05); but the length of incisions, length of hospital stay, the volume of operative hemorrhage and post-operative drainage in minimal invasive group were significantly shorter than those in conventional group (P<0. 05) ; in each group, the comparisons of Cobb's angle, anterior vertebral height and disc height between pre and post-operation were all significantly different ( P > 0. 05 ) ; The incidence rate of chronic lower back pain in minimal invasive group was obviously lower than conventional group during the follow-up visit. Conclusion The percutaneous internal pedicle screw fixation using modified instruments has the advantages of simple manipulation, less trauma and hemorrhage, quicker recovery, less pain, shorter hospital stay and a lower incidence rate of chronic lower back pain.

Objective To investigate the prevalence and the epidemiological factors of female mixed urinary incontinence (MUI) in China. Methods In February to July 2006, 19 024 subjects aged over 20 years old in 6 Chinese regions including Northwest, Southwest, Northern China, Eastern China, Northeast and South China were selected. Questionnaires were used to investigate the general characters and the lower urinary tract symptoms in these subjects. Results The overall prevalence of mixed urinary incontinence was 9. 4% among these women and it increased with advancing age. In multiple logistic models, age, vaginal delivery, constipation, pelvic organ prolapse, chronic pelvic pain, respiratory system disease, menstrual disorder, urinary system disease, alcohol consumption, pelvic surgery, obesity as well as high educational level were independent risk factors for mixed urinary incontinence. Conclusion The prevalence of MUI increases with advancing age. Vaginal delivery, constipation and pelvic organ prolapse are risk factors for mixed urinary incontinence in China while high educational level is a protective factor.

Objective To investigate the effect of neoadjuvant chemotherapy on patient controlled intravenous analgesia ( PICA) postoperatively in ovarian cancer patients. Methods Sixty three patients with ovarian cancer (ASA I -Ⅲ grade) were selected. They were divided into 2 groups according to with or without neoadjuvant chemotherapy: neoadjuvant chemotherapy group (N) 33 cases, direct operation group (D) 30 cases. Both of them were completed with tumor cell reduction-extinction operation under total intravenous general anesthesia. Patients' chemotherapy-induced peripheral neuropathy(CIPN) was assessed by the total neuropathy score exclusively clinically-based (TNSc) preoperatively, the assessment of analgesic effect and side-effect was performed postoperatively. Results No statistically significant difference between the two groups (P > 0. 05) on ages, body mass index, ASA grades and Kamofsky scores. Patients in group N were significantly lower than that of group D( P < 0. 05) on the VAS scores at 2、4、8 h postoperatively, the pressure times and effective times of Bolus and the total consumption amount of analgesic drug in the whole process of analgesia treatment. But the scores on nausea and vomiting of group N were significantly highter than that of group D( P < 0. 05). There were no significant differences on Bruggrmann comfort scale at 2, 4, 8, 12 h postoperatively, dizziness scores, pruritus scores and Ramsay Sedation scores between this two groups (P >0.05). There was negative linear correlation between the total consumption amount of analgesic drug in the whole process of analgesia treatment and TNSc scores (r = -0. 881, P = 0. 048) , and there was positive linear correlation between nausea scores and TNSc scores (r = 0. 920, P = 0. 027). Conclusion Patients with neoadjuvant chemotherapy have peripheral neuropathy at different degree before operation. The more serious of peripheral neuropathy, the less demand of PCIA analgesic drug postoperatively and with more side effects occur, such as nausea.

Objective To estimate the burden of disability and health services use by people with knee pain, with or without radiographic evidence of osteoarthritis (OA) , in rural northern China. Methods A population-based cross-sectional survey was conducted among 1030 residents of Wuchuan County, Inner Mongolia, aged 50 years old and over. The participants completed an interviewer-based questionnaire and obtained bilateral weight-bearing posterior-anterior semi-flexed knee radiographs. Results Of 1027 participants with knee radiographs, 513 (50%) participants reported knee pain in most days of at least a month over the past 12 months. Of those with knee pain, 109 (21%) had radiographic OA ( Kellgren Lawrence grade ≥ 2) in symptomatic knees. Adjusting for age, gender, BMI, education and back pain, the presence of knee pain was associated with a significantly greater difficulty in walking, climbing 10 steps, stooping, performing cleaning chores and preparing meals. Among 513 subjects with knee pain, the presence of radiographic disease was significantly associated with the presence of unbearable pain (36% vs 59% ), restricted activity (39% vs 64% ), use of NSAIDs (78% vs 88% ) and consulting a doctor over the last 12 months (33% vs 59% ). Conclusion Knee pain is associated with significant physical disability in rural China. The prevalent use of NSAIDs for knee pain and a low use of knee surgery should be of particular concerns. These findings will be useful to guide the distribution of future health care resources and preventive strategies.

Objective To assess the efficacy of transcutaneous electrical acupoint stimulation (TEAS) in preventing the relapse of detoxified heroin users in a period of 12 months. Methods A total of 164 rehabilitating heroin users in Shanghai area were recruited after compulsory detoxification treatment for a period ranging from 3 months to 3 years. The TEAS was executed by the device named Hans acupoint nerve stimulator (HANS). The patients were treated with HANS for at least 3 months. All the subjects were then followed up for one year and relapse was monitored by monthly heroin/morphine urinalysis. Results Of 164 rehabilitating former heroin addicts, 53 remained drug-free at the end of 12 months observation period as judged by negative urinalysis while 35 become relapsed as documented by positive urine tests. The rest 76 dropped off due to various reasons and were all counted into the category of "relapsed". Thus, our data indicated 32. 3% rehabilitating heroin users could stay sober for at least one year, which is significantly higher than the existing reports that less than 5% detoxified abusers would stay drug free for one year with no further intervention. No obvious correlation was found between the susceptibility of relapse and the duration of compulsory detoxification. Conclusion Compared to the existing literatures, our results indicate that HANS could produce a marked decrease of the relapse rate of rehabilitating heroin users after compulsory detoxification.

Objective To study the significance and expression of FKHR and AKT after subarachnoid hemorrhage (SAH) in rat brain cortex. Methods Twenty-four rats were randomly divided into three groups; sham, SAH and SAH plus nimodipine (n =8 each). A reliable SAH model was established by double injections of blood into cistern magna in Wistar rats. The neurological scores were measured by Loeffler and the expressions of FKHR, P-FKHR, AKT and P-FKHR detected by Western blot. Results Compared with sham group, the neurological score of SAH group obviously decreased (P < 0.05), the expression of FKHR became elevated in rat cortex (P < 0.01), the expression of AKT had no change and the expressions of P-AKT and P-FKHR obviously decreased (all P <0. 01). But the neurological score markedly increased (P <0. 01) and the expressions of P-AKT and P-FKHR became elevated (all P <0. 01) after administration of nimodipine. Conclusion Both P-AKT and P-FKHR are involved in the process of brain cortex damage induced by SAH. The protective effects of nimodipine on brain injury induced by SAH may be related to the elevated expressions of P-AKT and P-FKHR in brain cortex.

Objective To study the efficacy of polyporus composite phosphate calcium and rhBMP- 2 compounds with laparoscopical lumbar interbody fusion in sheeps. Methods Fourteen uniform-weight adult sheeps were randomly divided into three groups for L4-5 interbody fusion with titanium mesh. Autogenous bone and titanium mesh was applied with open anterior technique in group 1 (n = 4). In group 2, 4 sheeps were operated with laparoscope technique for L4-5 interbody fusion with composite phosphate calcium (CPC) and titanium mesh. In group 3, 6 sheeps underwent laparoscopical L4-5 interbody fusion with titanium mesh as well as polyporus composite phosphate calcium and rhBMP-2 compounds. At Weeks 6 and 12 post-operation, the sheeps were sacrificed for imaging, biomechanic and morphological examinations. Results Although there was no statistical difference between open and laparoscopical interbody fusion group when comparing the remaining disc and endplate decorticated, bone fusion occurred in 3 groups after 3 months. A much larger amount of bony callus was observed earlier in laparoscopical L4-5 interbody fusion group with titanium mesh as well as polyporus composite phosphate calcium and rhBMP-2 compounds than two other groups. Conclusion Polyporus composite phosphate calcium and rhBMP-2 compounds are suitable prosthetic materials for clinical trials. When these materials are utilized with a laparoscopical technique, satisfactory interbody fusion may be achieved.

Corpus luteum cyst can occur during pregnancy or non-pregnancy, and ovarian corpus luteum cyst rupture is a common acute abdominal disease in gynecology, because it is often accompanied by different degrees of intraabdominal hemorrhage, and some cases are co-existence of tubal pregnancy and corpus luteum cyst, or rupture of corpus luteum during intrauterine pregnancy, so it is easy to be misdiagnosed and needs careful identification.

An 83-year-old male was admitted to hospital because of myelofibrosis diagnosed for 11 years, dizziness and fatigue for 6 months. The patient was found to have splenomegaly himself in 1995, and was diagnosed as primary myelofibrosis in another hospital. Regular blood monitoring showed that white blood cells (WBC) (3.0~4.0) ×109/L, hemoglobin (Hb) 80~100 g/L, platelet (PLT) (200~400) ×109/L.