Volume 94  ·   Issue 03  ·  2014

In recent years, there are more and more papers on clinical and basic research using magnetic resonance (MR) technology. In view of some common problems, this paper puts forward some suggestions on how to choose topics and how to standardize the experimental design.

To analyze the magnetic resonance neural imaging distribution of lumbar plexus in patients with degenerative lumbar scoliosis and evaluate its value and the safety of extreme lateral interbody fusion (XLIF).

Three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) sequences of lumbar spine were scanned on 19 patients with degenerative lumbar scoliosis, including levoscoliosis (n=11) and dextroscoliosis (n=8). All images were sent to workstation for multiplanar volume reconstruction to analyze the distribution of lumbar plexus from L1-2 to L4-5 level. The axial image distance (AID) was measured between anterior edge of lumbar plexus and sagittal central perpendicular line (SCPL). SCPL was drawn perpendicularly to the sagittal plane of intervertebral disc and passed through its central point. It was actually the pathway of guide wire implanting procedure and the ongoing axis of work channel during XLIF. With respect to SCPL, the distance with a positive value indicated posterior neural tissue whereas a negative value anterior neural tissue. The differences of AID were compared between convex and concave sides and among different cases and levels.

From L1-2 to L4-5 level, the AID on the concave side in levoscoliosis or dextroscoliosis cases was (13.7±2.5) mm/(12.9±5.5) mm, (8.3±4.7) mm/(8.5±5.7) mm, (2.7±3.6) mm/(2.5±7.2) mm and (-4.2±3.8) mm/(-3.8±7.1) mm respectively. They were located significantly posteriorly to the relevant disc compared to those on the convex side at the same intervertebral space (P<0.05). The differences of AID at the same side, concave or convex side, was significant (P<0.05). No significant differences of lumbar plexus distribution existed between levoscoliosis and dextroscoliosis cases (P>0.05).

Lumbar plexus passes through psoas posteriorly to SCPL on both side at L1-2, L2-3 level and on the concave side at L3-4 level. And they shift anteriorly to SCPL on the convex side at L3-4 level and on both sides at L4-5 level. It indicates a ventral migration of lumbar plexus from L1-2 to L4-5 level. Preoperative magnetic resonance neural imaging is valuable for assessing the safety of XLIF approach. Operation from the concave may reduce the risk of injury to lumbar plexus.

To explore the diagnostic value of 3.0T MRI in neurogenic tumor of soft tissue in the extremities.

The MRI appearance of 17 neurogenic tumors with patholog ical confirmation was retrospectively analyzed. Various imaging characteristics of tumors were evaluated and different imaging findings were compared.The diagnosis value of each MRI features was evaluated with receiver-operating-characteristics (ROC) analysis.

In the benign tumors significant differences between neurilemmoma and neurofibromas were noted for the position (P=0.044). Heterogenicity on T₂-weighted fat suppression images was also significant in differentiating between neurilemmoma and neurofibromas ( P=0.020). The shape of tumors, maximum length of tumor short diameter, edem around masses, relationship with adjoining fascia had the best discriminatory ability. The ROC analysis yield the area under curve (AUC) of them was 0.967 (P=0.037), 0.923(P=0.048), 0.981(P=0.034), 0.981(P=0.034), respectively.

If the neurogenic tumors of soft tissue in the extremities had one or several features of these characteristics (irregular margin, big volume, edem around masses, aggressive behavior with adjoining fascia) on 3.0T MRI, they had more possibility to be malignant. T₂-weighted fat suppression series on 3.0TMRI was very important for discrimination of tumor histological characteristics.

To explore the influence of signal noise ratio (SNR) on analysis of clear cell renal cell carcinoma (CCRCC) using DWI with multi-b values.

The images of 17 cases with CCRCC were analyzed, including 17 masses and 9 pure cysts. The signal intensity of the cysts and masses was measured separately on DWI for each b value. The minimal SNR, as the threshold, was recorded when the signal curve manifest as the single exponential line. The SNR of the CCRCC was calculated on DWI for each b value, and compared with the threshold by independent Two-sample t Test.

The signal decreased on DWI with increased b factors for both pure cysts and CCRCC. The threshold is 1.29±0.17, and the signal intensity of the cysts on DWI with multi-b values shown as a single exponential line when b≤800 s/mm². For the CCRCC, the SNR is similar to the threshold when b=1 000 s/mm² (t=0.40, P=0.69), and is lower when b=1 200 s/mm² (t=-2.38, P=0.03).

The SNR should be sufficient for quantitative analysis of DWI, and the maximal b value is 1000 s/mm² for CCRCC.

To evaluate functional connectivity in patients with unilateral sensorineural hearing loss(USNHL) using resting-state fMRI.

Functional connectivity MRI were employed in 29 patients with SNHL (15 left, 14 right) with averaged hearing level above 70 dB HL for the deaf ear, and matched 15 and 14 normal hearing subjects, respectively, were recruited. Functional connectivity mappings between the SNHL patients and normal hearing subjects were evaluated and the differences were contrasted.

The positive functional connectivity of auditory cortex with whole brain in USNHL patients is weaker than that in normal subjects both in volume and intensity. Using the affected side AⅠas a seed, left and right Laterality index(LI)of auditory cortex was 30.14, -31.25, respectively. Using the healthy side as a seed, the LI of auditory cortex was 0.1, 19.37, respectively. Compared to normal subjects, increased activation in bilateral precentral gyrus, left middle frontal gyrus, left superior frontal gyrus and posterior cingulate cortex/precuneus were found in left USNHL patients. Contrasted with normal subjects, no significant difference was found between the normal subjects and right SNHL patients, except the right caudate nucleus using left AⅠas a seed.

The reduced functional connectivity among the affected side and healthy side auditory cortex as well as associated auditory cortex may suggest a result of functional reorganization adaptive to the SNHL.

To study the detail functional anatomy of ocular motor nerves in the brainstem by high-resolution magnetic resonance imaging (MRI).

Sixty eight normal subjects with high resolution MRI were recruited in our study. The ocular motor nerves at the brainstem were performed using 3-dimensional, T₂-weighted Turbo-Spin-Echo sequence with high sampling efficiency sequence (3D T₂-SPACE), Parameters: TR=1000 ms, TE=134 ms, averages=2, thickness=0.8 mm, FOV=225 mm×225 mm, matrix=384×384, total scanning time is 4 min 2 s. Nerves in the brainstem were observed in oblique axial, oblique sagittal and coronal planes acquired with multi-planar reformation (MPR). The diameters of oculomotor nerves (CN3) and abducens (CN6) in the brainstem were measured in 68 normal subjects on MR images by 2 neuro-radiologists.

All of 136 CN3 and CN6 of the cisternal segment were well demonstrable in 68 normal subjects (100%). Trochlear nerves (CN4) were depicted 87%. The diameters of CN3 and CN6 in the cistern were 2.2 mm, 1.3 mm, had no linear correlation with age. There were no significant difference between the results of the 2 radiologist (F=2.557, 1.329, P=0.085, 0.271).

T₂-SPACE sequence combined with MPR could precisely show the ocular motor nerves, as well as the relationship with adjacent structures in the cistern. The exact data measurement can provide more accurate anatomical basis for some special forms of neuropathic strabismus.

To explore the effects of phytoestrogen (PE) on blood lipid and bone density in postmenopausal women.

A total of 75 menopausal women aged 50-70 years with estrogen reduction symptoms received an intake of soy protein containing 70 mg isoflavone daily in a year.Their changes of blood fat, density lumbar bone and sex hormone level were compared with control group without an intake.

The changes of blood triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) in two groups before and after a year showed no statistical significance.High-density lipoprotein (HDL) decreased in control group while it had no significant change in the study group.Bone densities in two groups showed a downward trend by an annual rate of 1%-4%, the changes in two groups showed no statistical significance.E2 increased slightly over basic value in the study group.But it had no statistical significance.The changes of follicle-stimulating hormone (FSH) in two groups were also similar.

The above soy protein preparation has no effect on hypothalamic-pituitary-ovarian axis and no stimulation on endometrium of uterus.But it may improve the profile of HDL.

To explore the treatment of multiple or recurrent intracranial tumors by hypodermatic placement of Ommaya reservoir and local chemotherapy with methotrexate.

Retrospective analyses were performed on the clinical data of 45 cases with multiple or recurrent intracranial tumors at Friendship Affiliated Hospital, Capital Medical University from January 2010 to September 2013. All 45 cases had a placement of Ommaya reservoir under skin. Shunt tubes were placed in ventricle (n=41), cystic tumor cavity (n=3) and tumor cavity (n=1). Methotrexate was injected postoperatively into Ommaya reservoir by transcutaneous paracentesis.

After local chemotherapy, head magnetic resonance imaging (MRI) re-examinations were performed. Tumors disappeared (n=32), shrunk significantly (n=10) and had no significant improvement of symptoms with spinal implantation metastasis (n=1). During chemotherapy, there were two mortalities due to septic shock and heart failure (n=1 each). Follow-ups were conducted for 32 cases and 7 of them died. One case had operation-related complications. After an adjustment of shunt tube, symptoms and signs improved. And after local chemotherapy, tumor disappeared on MRI.

The placement of Ommaya reservoir is mini-invasive and well-tolerated. And local chemotherapy with methotrexate by Ommaya reservoir is convenient and it may reduce systemic side effects, improve the efficacy of chemotherapy drugs, prolong survival time and enhance quality of life.

To observe the change of the retinal fiber layer thickness in patients at early stage of diabetes.

A case-control study. A total of 157 patients with diabetes, who were divided into four groups according to the degree of diabetic retinopathy in fudus photos, and 40 normal patients were examined by optical coherence tomography (OCT). The difference among the group was assessed by χ ² test, One-Way ANOVA test and LSD test.

The superior RNFL around optic nerve was not statistically thinner in NDR group than normal group (P=0.195). The superior RNFL around optic nerve was statistically thinner in miNPDR group, moNPDR group and sNPDR group (P=0.13, 0.02, 0.00). The thickness of fovea in both moNPDR group and sNPDR group were thicker than normal (P=0.003, 0.001). In fovea, the superior RNFL was thinner in all diabetic groups (P<0.01).

In early stage of diabetes, the RNFL both in optic nerve and fovea were thinner, which would precede the microvascular changes.

To evaluate the therapeutic efficacy of etanercept for active ankylosing spondylitis (AS) at different levels of high sensitivity C-reactive protein (hs-CRP).

Patients with active AS received a subcutaneous injection of etanercept (50 mg, once per week) for 12 weeks. According to the baseline hs-CRP, they were divided into group A (hs-CRP ≤ 3 mg/L), group B (3 < hs-CRP ≤ 11 mg/L), group C (11< hs-CRP ≤ 26 mg/L) and group D (hs-CRP >26 mg/L). The following clinical data were recorded: VAS (visual analogue score) of spinal pain, time of morning stiffness, patient global assessment (PGA), BASDAI, BASFI, ASDAS, indices of joint tenderness on baseline and week 12. And the percents of ASAS20, ASAS40, ASAS partial remission, BASDAI20, BASDAI50, ASDAS clinically important improvement and major improvement responders were assessed in all groups.

A total of 161 patients finished the study, including group A (n=18), group B (n=47), group C (n=49) and group D (n=47). Group B was similar with group A. Groups C and D were higher than group A in terms of ASDAS improvement score, percents of ASDAS clinically important improvement and major improvement responders.

Patients with moderately and significantly elevated hs-CRP may achieve ASDAS improvement more easily than those with normal and mildly elevated levels.

To explore the effects of NKp44+ NK cells from rheumatoid arthritis (RA) patients on the proliferation and monocyte chemotactic protein 1 production of fibroblast-like synoviocytes (FLS).

The proportions of natural killer (NK) p44 NK cells in peripheral blood (PB) of 50 RA patients and 50 healthy individuals were detected by flow cytometry. Synovial fluid (SF) samples from 30 RA patients were also detected. NKp44+ NK cells in RA SF were sorted by flow cytometry for 5 times. The supernatant level of interleukin (IL)-22 was measured by enzyme-linked immunosorbent assay (ELISA). The proliferation of FLS after an addition of culture supernatant of NKp44+ NK cells was detected by methyl thiazolyl tetrazolium (MTT) at 24, 48 and 72 h. Monocyte chemotactic protein (MCP)-1 production of RA FLS after an addition of rhIL-22 was detected by ELISA.

The proportion of NKp44+ NK cells in PB of RA patients was significantly higher than that of normal controls while the proportion of NKp44+ NK cells in SF of RA patients was higher than that in PB of matched RA patients (1.270% vs 0, 15.190% vs 2.425%, P<0.01). The supernatant level of IL-22 in NKp44+ NK cell culture was (1 603±332) ng/L. Rapid proliferation of RA FLS was observed at 24, 48, 72 h after an addition of culture supernatant(P<0.01). IL-22 antibody obviously inhibited the proliferation of RA FLS induced by NKp44+ NK cells. MCP-1 production of RA FLS was detected at 72 h after an addition of rhIL-22(P<0.01).

NKp44+ NK cells can promote the proliferation and MCP-1 production of RA FLS through the production of IL-22 so as to play an important role in the synovial proliferation and inflammation of RA.

To analyze the CT and MRI features of glomus tympanicum tumors accompanied with tympanitis and evaluate the diagnostic value of CT and MRI in order to improve the cognition for the disease.

The clinical materials and images of 8 patients with the symptoms of pulsatile tinnitus and hearing loss in whom glomus tympanicum tumors with tympanitis surgically and pathologically confirmed were retrospectively reviewed. The characteristics and diagnostic value of CT and MR imaging were summarized.

By CT examination the lesions in middle ear and mastoid were preoperatively diagnosed as tympanitis in five cases and only in three cases the glomus tympanicum tumors were suspected. In six patients underwent MR examination the lesions were all preoperatively diagnosed as glomus tympanicum tumors accompanied with tympanitis. HRCT scanning of the temporal bone in all patients showed the soft tissue lesions in the tympanic cavity and mastoid, and the cavitas tympanica were mostly (n=3) or completely (n=5) occupied by soft tissue lesions, but the auditory ossicles were all without destruction. Contrast-enhanced axial CT scanning performed in five cases showed less soft tissue mass on the cochlear promontory, and the size of mass was less than that observed in MR imaging. MR T₁-weighted imaging showed the presence of isointense lesions in middle ear and isointense (n=3) or hyperintense (n=3) lesions in mastoid. On T₂-weighted imaging the lesions with slight hyperintense were viewed in the middle ear and the lesions with hyperintense in mastoid. T₁-weighted gadolinium-enhanced MRI showed the masses in tympanum were markedly increased enhancement, but the lesions in mastoid without enhancement. MRI and CT imaging revealed the masses in six cases of eight extending to the eustachian tube.

When the glomus tympanicum tumor was accompanied with tympanitis the tumor could be misdiagnosed or missed only by CT examination. The patients with pulsatile tinnitus should be taken seriously. MRI with contrast-enhancement is superior to CT in the preoperative diagnosis and accurately evaluation for the glomus tympanicum tumors with tympanitis.

To evaluate the CT the characteristics of dehiscent sigmoid plate accompanied with pulsatile tinnitus (PT).

Dual phase contrast enhancement CT data of 15 PT patients were analyzed retrospectively.

Dehiscent sigmoid plate was located on the same side of PT in all patients. Thirteen defects had been showed in both CT images and surgery. Among of them, eight defects located on the descending segment, 3 on the superior curve, and the other 2 defects involved the superior curve and descending segment of sigmoid sinus simultaneously. The maximum anteroposterior and vertical diameters of defect measured in CT images were significant larger than that measured during surgery. There were still 5 defects showed in CT images, which did not been found during surgery. Among 9 patients with unilateral dominant brain venous systems, all the dehiscent sigmoid plates were seen on the dominant side. The other 2 patients showed co-dominant brain venous systems, whose the dehiscent sigmoid plates were on the left side. In addition, extensive pneumatized temporal bone filled with air was found in all patients.

Dehiscent sigmoid plate co mmonly located on the anterior, lateral, or anterolateral wall of the superior curve or descending segment of the sigmoid plate, which usually coexist with the strong unilateral dominant brain venous system and extensive temporal bone pneumatization.

To explore the association between outdoor activity and myopia among 681 primary students from Beijing.

School-based, cross-sectional investigation. Eye examination includes the visual acuity test, auto-refractor, slit lamp, ocular biometry and non-mydriatic fundus camera. Questionnaire includes regular items, near work, outdoor activity and social-economic status.

The mean time spent outdoors was 1.6±0.8 hours daily. Time spent on outdoor sports and outdoor leisure were 0.7±0.1 hours daily, 1.0±0.8 hours daily, respectively. Mean time of outdoor activity in urban was 1.1±0.4 hours daily, compared with 2.2±0.8 hours daily in rural (P=0.000). In grade-1, total time spent outdoors is significantly different between myopia and non-myopia (1.4±0.6 vs 1.8±0.8 hours daily, P=0.000), similar to outdoor leisure (0.8±0.6 vs 1.1±0.9 hours daily, P=0.000). The same trend was also found in grade-4.

The mean time spent outdoors was 1.6±0.8 hours daily. Myopia spent a lower outdoor activity compared with non-myopia. More outdoor activity, e. g., in schools, may potentially be helpful to reduce the high prevalence of myopia in the young generation.

To analyze the correlation between ST segment elevation, Q wave and peak biomarkers with left ventricular dysfunction in patients with acute anterior ST elevation myocardial infarction(STEMI).

A total of 138 consecutive inpatients with acute anterior STEMI, left anterior descending branch as the convict vessle, from January 2009 to January 2012 in our hospital were enrolled in this study. They were divided into reperfusion(n=92) and non-reperfusion group(n=46). Clinical data, electrocardiogram, peak biomarkers, type B natriuretic peptide(BNP) were collected by physicans and the patients were followed up three months.

The sum of the ST segments elevation, Q waves and Q wave leads in anterior STEMI were positive correlation with the Killip grades, myocardium biomarkers, BNP and left ventricle end diastolic diameters(LVEDD) [γ, 0.52-0.75,P<0.01], while negative correlation with left ventricle ejection fraction(LVEF) [γ, -0.63--0.95,P<0.01]. The sum of R wave altitude was negative correlation with myocardium biomarkers, BNP and LVEDD in three months after the onset of STEMI [γ, -0.48--0.79,P<0.01], while positive correlation with LVEF [γ, 0.73-0.82,P<0.01]. BNP, one of the best markers of left heart dysfunction, was found to be strongly negative correlation with LVEF in acute stage and three months after the onset of STEMI [γ , -0.92, -0.80,P<0.01].

There are close correlations between electrocardiogram, myocardial biomarkers and left ventricular dysfunction in acute anterior ST segment elevation myocardial infarction, which may be strong predictors for the short-term prognosis.

To explore the effects of Telmisartan on IKCa1 potassium channel after T-lymphocyte activation and proliferation in peripheral blood of hypertensive patients in Xinjiang Kazakh.

Peripheral blood T cells in vitro culture were isolated from 30 Xinjiang Kazakh outpatients without antihypertensive drug therapy. They were randomly selected from our hypertension clinic from August 2012 to December 2012. The proliferated T lymphocytes were divided into control, telmisartan and TRAM-34 groups. After culturing for 0, 24, 48 h after corresponding treatments, the patch-clamp technique was employed to record the electrophysiological changes of IKCa1 potassium channel of T lymphocytes.

Under different treatment conditions, the IKCa1 potassium channel showed different electrophysiological changes. Pairwise comparison was made among the groups on the same time. For the telmisartan group, IKCa1 potassium channel peak current, peak current density of intervention 24 h and 48 h were significantly reduced compared with the control group (24 h: (835±117)vs(1 471±255) pA, (213±61) vs (388±129) pA/pF; 48 h: (631±142) vs (1 555±383) pA, (155±54) vs (388±114) pA/pF, all P<0.01). And the blocking rates of 0 h, 24 h and 48 h of telmisartan on IKCa1 potassium channel were 6.8%, 45.1% and 60.1% respectively.

Telmisartan can block the IKCa1 potassium channel of T lymphocytes in peripheral blood of hypertensive patients in Xinjiang Kazakh. It suggests that telmisartan may play an anti-inflammatory effect by blocking the IKCa1 potassium channels of T lymphocyte activation.

In traditional open surgery or endoscopic surgery, the surgeon directly senses the texture of tissue or tumor with the touch of the hand or indirectly senses the texture of tissue or tumor through the instrument, whether the ligation line is tight, etc. This tactile perception information is transmitted to the hand, which is called force feedback. Force feedback is crucial in surgery. However, in recent years, this tactile force feedback that we have become accustomed to has completely disappeared in robot-assisted surgery. How to make up for this deficiency, we can only visually observe the deformation of tissue after stress to judge the softness and hardness of tissue texture, and observe the tension of suture to determine whether the knot is tight. After a period of training and adaptation, the surgeon can skillfully determine this information through visual perception and brain judgment, which we call visual force feedback. We have studied and applied visual force feedback such as tightness of clamp tissue, weight of pulling organs and force of pushing and stripping blood vessels under the robot, among which knotting operation is the most representative. How to use visual force feedback to skillfully complete the knotting operation under the robot? When tying the first knot, pay attention to whether the tissue or blood vessels are appropriately tightened, whether the knot is tight, and whether the tension of the thread is appropriate. After tying the second knot, pay attention to the tightness of the knot and the tension of the thread, so as to avoid the tightness of the knot and the suture breaking. The sign to determine that the knot is tight is that, in the case of a monofilament thread, there is no gap between the two single knots; If it is a braided thread, the thread strand cannot be clearly seen at the thread knot, and the thread at the thread tip is obviously thinner. After a period of operation, knotting will become more skilled and handy. After about half a year to one year, the application of this visual force feedback can reach its highest level, that is, it feels that there is really strong feedback on the hand, and when the wire is tight, there will be a feeling that the wire can't be pulled. In fact, this kind of visual feedback also exists in life. For example, when we take the conveyor belt at the airport or the escalator in the shopping mall, we don't get used to it at first, and we will trip or even fall down. After we are proficient, we will walk freely. However, when the conveyor belt or escalator does not move, you will instead feel uncomfortable or feel tripped when you walk up. Therefore, there is reason to believe that a full understanding of visual force feedback and continuous practice will help to master robot-assisted surgery faster and easier.

To explore the molecular mechanisms of C/EBPα for regulating the osteogenesis of C3H10T1/2 cells.

We constructed an in vitro osteogenic differentiation model and investigated the mRNA and protein expression profile of PPARγ2 during C3H10T1/2 osteogenesis by reverse transcription-polymerase chain reaction(RT-PCR)and Western blot. Next we constructed an adenovirus vector loading siRNA against PPARγ2 and employed a specific antagonist of PPARγ, G3335, to examine the effect of PPARγ on activating the expression of C/EBPα. Then we performed ChIP to test PPARγ2 binding on -1 286 bp/-1 065 bp region of C/EBPα promoter and explore the role of PPARγ in the dependence of histone hypoacetylation on DNA methylation in -1 286 bp/-1 065 bp region of C/EBPα promoter.

During the osteogenic differentiation, PPARγ mRNA and protein expression initially increased and then decreased in double-phase reactions. siRNA and G3335 induced down-regulation of PPARγ activity inhibited C/EBPα in C3H10T1/2 cells up-regulation of osteogenic differentiation. ChIP results show that DNA methylation could weaken the binding section PPARγ2 to -1 286 bp/-1 065 bp capabilities.

This study provides a deeper insight into the molecular mechanisms underlying the osteogenesis of MSCs regulated by C/EBPα in synergy with PPARγ. PPARγcontributes to C/EBPαexpression through binding on -1 286 bp/-1 065 bp region of its promoter during the osteogenesis of C3H10T1/2 cells. And DNA hypermethylation in-1 286 bp/-1 065 bp region during the terminal stage of osteogenesis prevents PPARγ from binding on it so that PPARγ-associated repression of HDAC1 is relieved to down-regulate the acetylation status of -1 286 bp/-1 065 bp region. Meanwhile DNA methylation and histone acetylation are linked by PPARγ for regulating the differentiation of MSCs.

To explore the changes of renal hemodynamic in dogs with endotoxemic shock (ES) and their potential roles in acute kidney injury (AKI).

Canine endotoxic shock model was induced by an infusion of lipopolysaccharide of Escherichia coli through pulmonary artery catheter (PAC). Systemic hemodynamics and left renal blood flow (RBF) was monitored by PAC, pulse index continuous cardiac output (PiCCO) and ultrasonic blood flow meter. Blood and urine specimens were harvested timely for blood gas analysis, renal function tests and biochemical detection.

Hemodynamics: CO and RBF fluctuated widely but without any significance (P>0.05). The values of mean arterial pressure (MAP), systemic vascular resistance (SVR), renal vascular resistance (RVR) and 2-hour urine volume significantly decreased (allP<0.05) while extravascular lung water (EVLW) increased markedly (P<0.05). Renal function: There was a drop in CCr, urine osmotic pressure and an elevation in SCr and NAG. RBF was correlated positively with CO(R²=0.630, P=0.001). However, it had no correlation with MAP (R²=0.009, P=0.758). CCr was correlated positively with MAP(R²=0.415, P=0.003). However, it had no correlation with RBF or CO (P>0.05 ). The auto-regulation curve of GFR had a shift to the right.

RBF is positively correlated with cardiac output in endotoxin shock. Renal pressure perfusion may decrease obviously without any noticeable change of renal flow perfusion. The shift of renal autoregulation under pressure perfusion occurs at the early stage of septic shock.

To explore whether chemokine CXCL16 is up-regulated after myocardial infarction and promotes the phagocytic activity of macrophage in vitro.

Forty wild-type mice were randomly separated into 2 groups (n=20 each). Group A had the ligation of left anterior descending coronary artery while group B underwent a sham operation. Electrocardiogram was used to assess whether the operation was successful or not. Three days after surgery, 10 animals of each group were sacrificed and the serum level of CXCL16 was detected by enzyme-linked immunosorbent assay (ELISA). Twenty-eight days after surgery, cardiac function of the remaining mice was measured by small animal ultrasound. Then the animals were sacrificed. Hematoxylin and eosin (HE) staining and immunohistochemical staining of cardiac paraffin section were used to observe the inflammation and detect the expression of CXCL16 in cardiac tissue after myocardial infarction. To explore the function of CXCL16 in vitro, primary murine monocytes were separated from bone marrow, cultured to differentiate into macrophages and transfected with adenovirus vectors over-expressing CXCL16 or control adenovirus vectors. After stimulation by debris of cardiac cells, the phagocytic uptake by macrophages was evaluated by flow cytometry.

The model of myocardial infarction was successfully established. ELISA showed that the serum level of CXCL16 was elevated 3 days after myocardial infarction [(1 079±176) vs (611±37) pg/ml, P=0.032]. HE and immunohistochemical staining demonstrated that the infiltration of macrophages increased during an early stage of myocardial infarction and decreased at the late stage. The CXCL16 level was up-regulated 3 days after myocardial infarction and returned to normal level at Day 28. Furthermore, macrophages transfected with adenovirus over-expressing CXCL16 showed stronger phagocytic activity compared with control (17.11%±0.87% vs 7.91%±0.71%, P<0.01).

CXCL16 is up-regulated after myocardial infarction in mice. And an in vitro over-expression of CXCL16 promotes the macrophage phagocytosis of cardiac debris.

osteoporosis (OP) is a disease of the skeletal system characterized by decreased bone strength leading to increased fracture risk^[1]。 According to the estimated data in 2006, the number of OP patients in China over 50 years old is as high as 69.44 million, and about 210 million patients have low bone mass^[2]。 The male-to-female ratio of crude incidence of hip fractures was approximately 1:1.2 and the age-standardized incidence was approximately 1:1.6 for people over 50 years of age^[3]。 In Sweden, the prevalence of OP was higher in males than in females, approximately 34.7%^[4]。 In China, the mortality rate of elderly hip fracture within one year is 20%, and the disability rate is as high as 50%^[2]。 The high incidence and mortality of hip fractures in the male population and their impact on quality of life highly suggest that OP is also an elderly male disease and must receive the same attention and standardized treatment as female patients.

high frequency oscillations (HFOs) are high frequency signals in EEG recordings, which are closely related to normal or abnormal brain function, and have received much attention in recent years. In this paper, the classification, mechanism and clinical application of HFOs in epilepsy are reviewed, aiming to improve the understanding of HFOs and promote its research.

The incidence of twin transfusion syndrome (TTTS) in monochorionic twin pregnancies ranges from 10% to 15%, and the untreated fetal and neonatal mortality rate is as high as 80% to 100%. At present, the commonly used treatment methods for TTTS include amniotic fluid reduction, diaphragmatic perforation, selective placental communicating vessel laser electrocoagulation (SLPCV) and selective fetal reduction^[1]。 SLPCV is currently recognized as the treatment of choice.

The patient was an 85-year-old female who experienced dull pain in the lower abdomen with vaginal bleeding for half a day without obvious trigger in the past 2 months. The patient found a 15 cm diameter anechoic area on the right side of the uterus in B-ultrasound examination in the local hospital, so he went to the Second Affiliated Hospital of Suzhou University and was admitted to the hospital with a "pelvic mass". Gynecological examination: A mass with a diameter of 15 cm can be palpable above the uterus, with medium texture and poor mobility. MRI examination revealed a multilocular cystic space-occupying lesion in the right ovary, 10 cm ×11 cm ×15 cm in size. Multiple fine compartments were found in the lesion, and the thickness of the compartments was uneven. No irregular thickening and isosignal wall nodules were found. The contents of the sac were T₁WI showed low signal, T₂WI-SPAIR showed high signal, and the signal intensity of cystic fluid in each chamber was different. A nodular abnormal signal focus was seen in the anterior and upper part of the lesion, showing T₁WI slightly lower signal (Figure 1), T₂WI-SPAIR was significantly low-signal, 4.5 cm ×4.2 cm ×3.8 cm in size (Figure 2), a capsule is visible around the lesion with clear boundaries. The cyst wall and septum of the lesion were moderately enhanced by enhanced scan, but the cyst fluid was not enhanced. Most of the anterior and upper nodules of the lesion were not enhanced obviously, and only a few flocculate enhancements were seen inside (Figure 3)。 The surrounding structures such as the uterus and bladder change under pressure. MRI diagnosis of ovarian mucinous cystadenoma is possible, but Brenner's tumor is not excluded. Pathological examination revealed one cyst, 13 cm in diameter, with multilocular section, and mucoid fluid flowing from the cyst. The pathological picture shows the morphology of Brenner's tumor. Pathological diagnosis: right ovarian mucinous cystadenoma and Brenner's tumor (occasionally pathological mitosis) (Figure 4)。