Volume 94  ·   Issue 43  ·  2014

With the rapid improvement of China's economic strength, medical and health undertakings have developed rapidly, and all kinds of high-precision medical imaging equipment have been rapidly popularized. At present, in China's large medical institutions, the new CT models have been updated in synchronization with the world's advanced level; The localization of CT equipment has promoted the popularization of CT in small and medium-sized medical institutions. In clinical medical work, CT scan is widely used in the detection, characterization and evaluation of therapeutic efficacy of diseases, and plays an important role in the construction of health undertakings in China. However, the widespread use of CT is accompanied by a serious public health problem: that is, the number of CT examinations is climbing rapidly, resulting in a large increase in the dose of CT radiation to the exposed population. Although the radiation dose level per CT examination is low (much lower than the fatal biological effect dose that leads to cell death), more and more people at home and abroad are beginning to pay attention to the random effect that low radiation dose may lead to cancer development. At present, there is no direct evidence that CT scan is one of the direct causative factors of cancer. The results of long-term follow-up surveys of radiation-exposed survivors of Hiroshima and Nagasaki atomic bombings and 400,000 nuclear industry practitioners in 15 countries show that X-ray radiation exposure is one of the high-risk causative factors of tumors. Therefore, it is necessary to take effective measures to reduce the radiation dose of CT scan^{[1,2,3,4,5,6,7,8,9]}。

The patient was a 27-year-old female. Lower back pain for 2 months, aggravated with radiating pain in the left lower limb for 1 month. Physical examination: Obvious tenderness and percussion pain in the left spinous process and paravertebral, and slight tension in the paravertebral muscles. Skin pain on the anterior and posterior side of the left thigh was significantly reduced. Imaging examination: CT plain scan showed the soft tissue density shadow in the spinal canal of L2~3 intervertebral discs, and nodular calcification was found inside (FIG. 1A)。 MRI plain scan showed an oval short T running up and down in the spinal canal at the level of L2/3 intervertebral disc₁Long T₂Signal, T₂WI lipid pressure showed high signal, the size was 16.1 mm ×12.2 mm ×21.0 mm, with clear boundary and spotty long T₁Short T₂Signals. Nodular short T was seen in the upper part of the lesion₁Short T₂Signal shadow, clear boundary, T₂Pressure lipid showed low signal (FIG. 1B，Figure 1C，Figure 1D)。 The enhanced MRI scan showed obvious uniform enhancement in the main body of the lesion, and the nodular signal shadow in the upper part of the lesion showed annular enhancement (Figure 1E)。 Imaging diagnosis: teratoma is likely. During the operation, the mass in the dural sac was explored, which was hard, gray-black in color, and the capsule was intact. A hard white mass was seen in the upper part, which was mobile, 12.2 mm ×16.1 mm ×21.0 mm in size, and slightly adhered to the nerve root. The results of pathological examination of the tumor showed that the cyst wall-like tissue was gray-white and gray-red, with a size of 20 mm ×10 mm ×10 mm and a cyst wall thickness of 1.0 cm. Pathological diagnosis: cystic mature teratoma (in lumbar spinal canal) (Figure 1F)。

Members of the working group:Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong People's Hospital (Liang Changhong); Department of Radiology, Huashan Hospital, Fudan University (Feng Xiaoyuan); Department of Radiology, Shengjing Hospital affiliated to China Medical University (Guo Qiyong, Liu Zhaoyu); Department of Radiology, First Affiliated Hospital of China Medical University (Xu Ke, Ren Ke, Dai Xu); Department of Radiology, Beijing Hospital (Zhou Cheng); Editorial Department of Chinese Journal of Radiology (Gao Hong); Department of Radiology, West China Hospital, Sichuan University (Chen Weixia); Department of Radiology, Nanfang Hospital, Southern Medical University (Xu Yikai); Department of Radiology, Hainan Provincial People's Hospital (Chen Feng); Department of Radiology, Panyu Central Hospital, Guangzhou (Chen Hanwei); Department of Radiology, Zhongda Hospital, Southeast University (Deng Gang); Department of Radiology, Second Hospital of Hebei Medical University (Li Caiying); Department of Radiology, First Hospital of Dalian Medical University (Liu Ailian); Department of Interventional Oncology, PLA General Hospital (Liu Fengyong); Department of Radiology, Hubei Cancer Hospital (Liu Yulin); Department of Radiology, Third Hospital of Sun Yat-sen University (Meng Xiaochun); Department of Radiology, Peking University Cancer Hospital and Beijing Institute of Cancer Prevention and Treatment (Sun Yingshi); Department of Radiology, Second Hospital of Xinjiang Medical University (Wang Hong); Department of Radiology, Tongji Hospital, Tongji University, Shanghai (Wang Peijun); Department of Radiology, Guizhou Provincial People's Hospital (Wang Rongpin); Department of Radiology, Shandong Institute of Medical Imaging (Xu Zhuodong); Department of Radiology, Peking Union Medical College Hospital (Xue Huadan); Department of Radiology, Union Hospital affiliated to Fujian Medical University (Xue Yunjing); Department of Radiology, First Hospital of Xi'an Jiaotong University (Jian Yang); Department of Radiology, Third Hospital of Central South University (Ye Bin); Department of Radiology, Second Hospital of Zhejiang University (Yu Risheng); Department of Interventional Therapy, Second Hospital of Shanxi Medical University (Yu Shiping); Department of Radiology, Beijing Chaoyang Hospital (Zhai Renyou); Department of Radiology, First Affiliated Hospital of Shanxi Medical University (Zhang Ruiping); Department of Radiology, Hospital of Inner Mongolia Autonomous Region (Zhang Xiaoqin); Department of Radiology, Daping Hospital, Third Military Medical University (Zhang Weiguo); Department of Radiology, First Hospital of Zhengzhou University (Zhang Yong); Department of Radiology, First Hospital of Kunming Medical College (Zhao Wei); Department of Radiology, Xiangya Second Hospital, Central South University (Zhou Shunke); People's Liberation Army First ○ Department of Radiology, Fifth Hospital [Zhu Youzhi]

To explore the application of optimal monochromatic images according to computed tomography (CT) values of conventional CT scans with high concentration contrast agent and the feasibility in guiding abdominal arteries imaging with low concentration contrast.

From March 2013 to February 2014, 160 patients of suspected celiac disease with a body mass index (BMI) of >25 kg/m ² underwent spectral CT scan. And they were randomly divided into two groups. In group A (n=61), 270 mgI/ml low concentrations of contrast agents and spectral CT imaging; in group B (n=99), 350 mgI/ml high concentrations of contrast agents and 120 kVp scan. For CT values of the first measurement of abdominal aorta B group of patients, the average CT value was calculated .The optimal monochromatic images of group A according to CT values of group B were reconstructed and 70 keV images (group C) also reconstructed. The CT values of hepatic, splenic, right renal and superior mesenteric arteries were measured and contrast to noise ratios (CNRs) calculated. CT values and CNR were compared through t test on independent samples. P>0.05 indicated no significant difference.

Mean CT value of abdominal aorta was (422±65) HU in group B. And optimal keV was (67±5) keV in group A. CT values of abdominal aorta and its branches showed no statistical significance; the CNRs of abdominal aorta and its branches showed statistical significance. The scoring consistency between two observers was excellent and the score (4.1±0.9 vs 4.2±0.7) showed no significant difference (P>0.05).

GSI abdominal scans with low concentration contrast may obtain better image qualities compared toconventional CTA of high concentration. And (67±5)keV is recommended.

To explore the computed tomographic (CT) imaging features of abdominal compartment syndrome (ACS) complicated by severe acute pancreatitis (SAP) to improve the diagnosis of disease.

Thirty-six cases of ACS and 61 cases of non-ACS (NACS) complicated by SAP were studied retrospectively. And the meaningful CT features were studied.

Among them, the ACS vascular complications of abdominal cavity and gastrointestinal bleeding were found significantly more in ACS than in NACS (P<0.05). The ACS intestinal obstruction occurred significantly more often in ACS than in NACS (P<0.05). The ACS inferior vena cava pressure, diaphragm elevation, round belly sign and marked seroperitoneum occurred significantly more often in ACS than in NACS (P<0.05). The score of ACS with Balthazar was higher than that of NACS (P<0.05). For CT signs associated with ACS, four or more associated with ACS CT characteristics, the diagnostic sensitivity was 96.5%. And the specificity, positive predictive value and negative predictive value were 100%, 100% and 87.5% respectively. And the surgical survival rate was significantly higher than the non-surgical survival (P<0.05).

A comprehensive analysis CT features of ACS is important for early diagnosis and guiding treatment.

To evaluate the clinical application comparison of Surt-start imaging and dynamic volume scanning acquired from 320-detector row computed tomography (CT) for the diagnosis of hepatic artery complications after liver transplantation.

Retrospective analysis was conducted for 20 patients undergoing 320-slice CT scanning. Aquilion One scanner after liver transplantation was performed from April 2009 to September 2011. Dynamic volume scanning group employed dynamic volume scanning pattern while Surt-start group used helical scanning pattern. The contrast medium (Ultravist, 370 mgI/ml iopromide) was infused at 6 ml/s with a total dose of 50 ml in dynamic volume scanning group versus 1.5 ml/kg in Surt-start group. Two groups were compared with regards to hepatic artery enhancing peak time, the best arterial phase time, maximum peak enhancement of artery, maximum absolute peak enhancement of artery and branches of hepatic artery.

The hepatic artery enhancing peak time and the best arterial phase time was (21.5±2.5) s and (22.4±3.3) s in dynamic volume scanning group versus (19.5±1.8) s in Surt-start group. And there was significant inter-group difference(P=0.001, P=0.000). The maximum peak enhancement of artery or the maximum absolute peak enhancement of artery and branches of hepatic artery had no inter-group difference. Two groups showed no difference in displaying hepatic artery anastomosis and variations. Dynamic volume scanning group was better than Surt-start group in displaying hepatic artery microscopic lesions.

320-detector CT dynamic volume scanning has the advantage of low-dose contrast medium. Capable of acquiring overall accurate imaging process of hepatic artery, it is effective for follow-ups ofhepatic artery complications after liver transplantation.

To retrospectively evaluate the depiction of bronchial and nonbronchial systemic arteries with dual-source computed tomography (DSCT) versus conventional angiography in patients with hemoptysis.

DSCT and conventional angiography of thorax were performed in 66 patients with hemoptysis. There were 46 males and 20 females with a mean age of 45 (22-72) years. Findings on DSCT, including CT scans, maximal intensity projections and three-dimensional volume-rendered images were used to evaluate the visibility and traceability of bronchial and/or nonbronchial systemic arteries. CT scans were evaluated by two radiologists in consensus. The CT findings were compared with those of conventional angiography.

A total of 171 (87 right, 84 left) bronchial arteries and 18 nonbronchial systemic arteries were visible on DSCT. The right bronchial arteries arose from intercostal-bronchial trunk thoracic aorta (n=46), common trunk of both bronchial arteries (CBT) (n=32) and thoracic aorta (n=9) whereas left bronchial arteries arose from thoracic aorta (n=50), CBT (n=32) and left subclavian artery (n=2). Compared with angiography, the accuracy of DSCT in the diagnosis of hemoptysis responsible vessels (i.e. dilatation BA) was approximately 88.7% (133/150). DSCT correctly diagnosed 18 nonbronchial systemic arteries, but missed 7; DSCT correctly diagnosed 5 bronchial-pulmonary vascular fistulas, but missed 15.

Excellent for evaluating hemoptysis, DSCT may identify the origin and ostial position of bronchial arteries, detect non-bronchial systemic arteries and act as a roadmap for percutaneous transcatheterembolisation.

To evaluate the clinical outcomes of Biofelx dynamic stabilization system in the treatment of lumbar degenerative disease (LDD).

A total of 29 patients (16 males, 13 females) received the treatment of Bioflex between June 2011 and April 2013 were recruited. There were with lumbar spinal stenosis (n=15), lumbar disc herniation (n=10) and lumbar spondylolisthesis (n=4). And they underwent one-segment (n=14), two-segment (n=10), three-segment (n=3) and four-segment (n=2) implantations. Mean age was 52.3 (38-62) years. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical outcomes. And lumbar radiography was used to observe disc height (DH) and range of motion (ROM) in fixed segment and cranial adjacent segment before and after operation.

The mean follow-up period was 22.6±2.1 (8-32) months. The mean ODI score decreased from 39.96±2.58 preoperatively to 11.26±1.76 at 3 months postoperatively (P<0.05) and 3.97±1.30 at the last follow-up (P<0.05). The mean VAS score for low back pain dropped from 7.34±0.80 preoperatively to 2.63±1.01 at 3 months postoperatively (P<0.05) and 0.91±0.32 at the last follow-up (P<0.05). The mean VAS score for leg pain deceased from 8.63±0.95 preoperatively to 2.13±0.62 at 3 months postoperatively and 0.58±0.65 at the last follow-up (P<0.05). The implanted segment preserved some ROM at the last follow-up. Compared to preoperative, no statistically significance existed in postoperative DH and ROM (P>0.05).

The clinical outcomes of Bioflex system are excellent in the treatment of LDD. As an effective therapy for non-fusion of LDD, it may preserve some ROM of fixed segment and prevent increased rangeof motion in adjacent segment.

To explore the treatment outcomes of elderly femoral intertrochanteric fractures with long Gamma nail.

A total of 86 elderly femoral intertrochanteric fractures were treated with long Gamma nail. There were 30 males and 56 females with an average age of (65-93) 78.5 years. According to the AO classification, there were type 31A1 (n=19), 31A2 (n=61) and 31A3 (n=6). Hip function was evaluated according to the Harris score.

Among them, 59 patients received a mean follow-up period of 18.5 (12-28) months. The mean operative duration was 63 (41-85) min and mean time of bone union 10.6 (8-14) weeks. The time of partial weight-bearing was 3-10 days and that of full weight bearing 10 (6-14) weeks. The Harris score was used to evaluate the postoperative hip function at 6-12 months. The treatment outcomes were excellent (n=17), good (n=26), fair (n=7) and poor (n=6). And the ratio of excellent and good was 89.6%. No wound infection, hip pain or nail breakage occurred.

Use of long Gamma nail may avoid the postoperative occurrence of femoral refracture and reduce othercomplications. And partial weight-loading walk is safe.

To determine the performance of HR-HPV E6/E7 massager RNA (mRNA) test for detecting high-grade cervical intraepithelial neoplasia in cervical cancer screening and compare the clinical performance of HR-HPV E6/E7 mRNA test with HC-2 and Cervista HPV DNA tests for cross-sectional positivity in women with and without cervical neoplasia.

A total of 172 women underwent cytology, HR-HPV DNA test, HR-HPV E6/7 mRNA test, colposcopy and biopsy. We compared the clinical performance of HR-HPV E6/E7 mRNA test with Hybrid Capture 2 DNA test (HC-2) and Cervista HR-HPV DNA test on the cervical brush specimens during colposcopy and routine screening. The samples were histologically confirmed high-grade cervical intraepithelial neoplasia (CIN Ⅱ) or worse (CIN Ⅱ+ ) as an endpoint.

HR-HPV E6/E7 mRNA positive rate was 37.9% in NILM, 67.9% in ASCUS and LSIL, 88.5% in ASC-H+ . HR-HPV E6/E7 mRNA positive rate was 38.6% in CIN Ⅰ, 77.4% in CIN Ⅱ-3 and 92.5% in SCC. HR-HPV E6/E7 mRNA test showed a higher specificity than HC-2 and Cervista HPV DNA tests for high-grade lesions (61.4%, 54.3%, 55.7%, respectively, P<0.05) and also a higher positive predictive value (75.9%, 74.8%, 74.6% respectively). Among three tests, HR-HPV E6/E7 mRNA had the largest area of ROC curve and the best diagnostic value.

HR-HPV E6/E7 mRNA test has a performance more specific for detecting CIN Ⅱ+ with the same sensitivity as HC-2 and Cervista HPV DNA tests. And it may serve as a more specific test for predicting the risk of progression and offer a viable tool for triage during cervical cancerscreening.

To conduct an epidemiological survey on the relevant risk factors of ectopic pregnancy (EP) and provide scientific rationales for prevention and reducing its incidence.

During June 2010 to December 2011 at three local hospitals, a total of 800 patients with a diagnosis of EP responded to a questionnaire survey for understanding the risk factors of EP. And another 700 cases of normal early pregnancy women were selected as control group. Both multi and uni-factorial regression analyses were performed for the acquired clinical data. And the high-risk factors of EP were screened.

Among them, the age distribution was ≤ 25 years (n=175, 25.5%), 26-30 years (n=302, 37.8%) and 31-35 years (n=213, 26.6%). No contraceptive measure was adopted for 259 women (32.4%). The risk factors related to EP included oral emergency contraceptives, intrauterine device (IUD), pelvic inflammatory disease, infertility history, previous EP, smoking and age, etc. Based upon multivariate Logistic regression analysis of screening results, the decreasing odds rations were infertility, EP history, smoking history, emergency contraceptive use, history of EP, IUD, pelvic inflammatory disease and age.

The risks of EP are affected by many factors, including infertility, EP history, smoking history,emergency contraceptive use, history of EP, IUD, pelvic inflammatory disease and age.

To explore the expression and role of Caveolin-1 in the angiogenesis of cerebral arteriovenous malformation (AVM).

A total of 55 fresh AVM samples at Affiliated Hospital, Inner Mongolia Medical University and Beijing Tiantan Hospital from August 2013 to May 2014 were collected to test the expressions of Caveolin-1, vascular endothelial growth factor (VEGF), vascular endothelial growth factor-receptor 2 (VEGF-R2) and endothelial nitric oxide synthase (eNOS) by immunohistochemistry and Western blot. And the relationship between the expressions of Caveolin-1 and VEGF, VEGF-R2 and eNOS was analysed.

The expression rates of Caveolin-1, VEGF, VEGF-R2 and eNOS in human AVM were 100%, 87.27%, 76.36% and 85.45%. And the values were significantly higher than those in normal superficial temporal artery. Western blot showed that the expressions of Caveolin-1, VEGF, VEGF-R2 and eNOS in hemorrahge AVM were higher than those in non-hemorrahge counterpart (P<0.05). The expressions of Caveolin-1, VEGF, VEGF-R2 and eNOS were consistent.

Caveolin-1 plays a positive regulatory role in the angiogenesis of AVM through the PI3K/Akt signaling pathway. In cerebral AVM, Caveolin-1 plays an important role in occurrence, progression, hemorrahgeand degradation of brain AVM.

To explore the diagnostic and therapeutic values of stereotactic guidance of intraoperative high-field magnetic resonance imaging (iMRI) for multiple intracranial lesions.

We retrospectively assessed 18 patients with multiple intracranial lesions undergoing stereotactic guidance of high-field iMRI between June 2011 and May 2013. The procedures included biopsy of stereotactic guidance (n=6), stereotactic aspiration and drainage for brain abscess (n=4), stereotactic aspiration and intracavitary irradiation with ³²P for mixed solid and cystic craniopharyngiomas (n=3) and stereotactic hematoma evacuation (n=5).

For 6 cases with high-field iMRI stereotactic guidance, the target lesions were precisely predetermined and pathological specimens confirmed by clinical follow-up results. For 12 cases with multiple cystic lesions and multiple intracranial hematoma, aspiration of hematoma and liquids was satisfactory. And the course of clinical treatment was significantly shortened. And there was a lower incidence of postoperative complications.

iMRI may guide precisely stereotactic surgery. And it has important clinical significance forconfirming the diagnosis of multiple intracranial lesions and shortening their treatment courses.

To explore the correlations between polyethylene wear direction and implanted parameters of prosthesis in total hip arthroplasty (THA) by computer-assisted measurement techniques.

Retrospective analyses were performed for 58 uncemented THAs from April 1997 to March 2006. The sagittal displacement of femoral head to axis of acetabulum opening plane was examined to determine the direction and degree of linear polyethylene wear. Radiographs were assessed for femoral offset, acetabular abduction, acetabular anteversion and conventional polyethylene wear. The linear polyethylene wear directions were compared between different parameter groups.

The average linear wear rate was 0.17±0.08 mm/year and the angle between linear wear direction and axis of acetabulum 34.2°(±29.3°). Linear wear direction and acetabular abduction were positively relevant(r=0.480, P=0.000). Linear wear direction was negatively correlated with postoperative Harris scores(r=-0.314, P=0.016). Compared with the acetabular abduction of < 45°, the acetabular abduction of 45° or larger was associated with greater decentralization of acetabulum opening plane ( P=0.001). As an independent variable, there were no statistically significant difference in linear wear direction between different acetabular anteversions. And femoral offset had no significant association with linear wear direction(P>0.05).

Reasonable acetabular abduction and femoral offset may decrease linear wear rates, maintain hipstability and improve long-term putcomes.

To explore the incidence of self-reported neck or shoulder pain (NSP) and lower back pain (LBP) among Chinese adolescents in Shanghai and identify the influencing factors for the incidences of NSP and LBP.

A total of 3 600 students were selected from 30 high schools randomly chosen from 237 regular full-time high schools registered in Shanghai. From each school, 40 students were selected from each of the tenth, eleventh and twelfth grades for a total of 120 students per school. The questionnaire involved questions pertaining to demographic profiles, learning environment and exercise habits of each student. And it also contained questions regarding the amount of weight carried by each student while commuting to and from school, and it was also used to collect specific information related to the occurrence of NSP and LBP. Logistic regression was performed to analyze the potential risk factors for NSP and LBP.

Among 3 600 questionnaires, a total of 2 842 valid ones were returned. The results revealed that the incidence of NSP and LBP in the Chinese adolescent population was 41.1% and 32.8% respectively. Both NSP and LBP were more common in girls than in boys, and 6.3% students reported at least one NSP- or LBP-induced absence from school. A relatively large portion of Chinese adolescents reported experiencing problems such as sedentary behavior (26.7% of the students continued to sit for more than 3 hours after school), a lack of exercise (29.3% exercised less than once each week and 38.2% of students reported that their exercise duration was less than half an hour each time) and overweight backpacks (53.0% complained that their backpack was too heavy). Multivariate logistic regression analysis revealed that gender, grade, physical activity and learning environment were all significantly correlated with the occurrences of NSP and LBP.

The incidences of NSP and LBP are relatively high among adolescents in Shanghai. And several factors, including sedentary behavior, personal exercise habits and backpack weight, influence the occurrencesof NSP and LBP in adolesents.

To explore the effects of oral vitamin D supplementation on anthropometric parameters and insulin resistance (IR) in type 2 diabetes mellitus (T2DM).

A total of 164 subjects with T2DM, aged 30-75 years, were randomly divided into two groups of intervention and control. The intervention group received a daily dose of 0.50 μg calcitriol while the control group maintained the original treatment regimen. At the beginning and end of 12-week supplementation trial, the demographic and anthropometric data were recorded and the serum levels of glucose, insulin, HbA1C and 25(OH)D measured. IR was assessed by the homeostasis model approximation index.

There was no significant inter-group difference at baseline. Compared with the baseline level, body mass index(BMI)((-0.7±1.7) vs (-0.4±1.4) kg/m²)(P<0.05), waist circumference (WC) ((-1.3±1.3) vs (-0.2±1.1) cm)(P<0.05), fasting plasma glucose (FPG) ((-1.2±2.3) vs (-0.6±2.8) mmol/L), fasting plasma insulin (FPI) ((-1.6±2.2)vs(-0.32±1.49)μU/ml)(P<0.05), HbA1C ((-0.1±0.6) vs (-0.03±0.94))(P<0.05), HOMA-IR ((-0.91±2.63)% vs(-0.15±1.78)%)(P<0.05) and 25(OH)D ((20±17) vs(1.0±3.3)ng/ml)(P<0.05)decreased obviously in the intervention group at the end of study. After stratifying by different baseline serum levels of 25(OH)D, HOMA-IR significantly decreased after supplementation in < 20 ng/ml group ((6±3) vs(5±3))(P<0.05), 20-30 ng/ml group ((6±3) vs (5±3))(P<0.05)and >30 ng/ml group ((5±3)vs (4±3))(P<0.05). And BMI ((26±6) vs (26±4) kg/m²)(P<0.05), WC ((84±11) vs (82±12) cm) (P<0.05), FPG ((8±4) vs (6±4)mmol/L)(P<0.05), FPI ((17±4) vs (16±4)μU/ml)(P<0.05)and HbA1C((7.4±0.9)% vs(7.0±1.2)%)(P<0.05)decreased statistically significant only in 15-20 ng/ml group. Multivariate regression analysis showed that HOMA-IR was a significant independent risk factor for 25 (OH) D (OR=13, 95%CI=4-39, P<0.05).

There are significant improvements in BMI, WC, FPG, FPI, HbA1C and HOMA-IR after supplementation.Thus vitamin D supplementation may reduce insulin resistance in T2DM.

To explore the clinical features and prognosis of dermatomyositis patients with interstitial lung disease (ILD) as an initial manifestation.

Medical records of 184 dermatomyositis inpatients complicated with ILD, admitted into Peking Union Medical College Hospital from January 1999 to January 2013, were retrospectively analyzed. The clinical features, biochemical parameters, positive rates of autoantibodies, radiology, pulmonary function tests, pathology, treatments and prognosis were compared between two subgroups of ILD-initial and non-ILD-initial dermatomyositis.

The incidence of ILD of dermatomyositis inpatients was 17%. The average age was 48±12 years and the gender ratio of male-to-female was 63∶121. Eighty eight (47.8%) dermatomyositis patients had ILD as an initial manifestation, including (n=42, 22.8%) of ILD concomitant dermatomyositis (within 1 month) and (n=46, 25.0%) of ILD before dermatomyositis with an average ahead time of (11±3) months. Patients of ILD-initial dermatomyositis had a higher incidence of dyspnea on exertion, cough and lung crackles, but there were lower incidences of heliotrope rash, chest V area rash, shawl sign and joint involvement than non-ILD-initial dermatomyositis (P<0.05). The positive rate of anti-Jo-1 antibodies of ILD-initial dermatomyositis group was 13.6%. The main performances of ILD-initial dermatomyositis on pulmonary function tests were diffusing and restrictive ventilation impairment. And there was a lower diffusing rate of carbon monoxide than non-ILD-initial dermatomyositis group (P<0.01). Organic and non-specific interstitial pneumonias were the major clinical pathology types of ILD-initial dermatomyositis. The mortality rate of ILD-initial dermatomyositis patients was 19.3% and there was no significant difference from non-ILD-initial dermatomyositis (P>0.05). The main course of ILD-initial dermatomyositis was respiratory failure due to progressive ILD (n=13, 76.5%).

ILD as an initial manifestation is a common complication and a major mortality cause of dermatomyositis inpatients. And the frequent clinical pathology types are organic and non-specific interstitial pneumonias. Symptoms of skin and muscle, creatine kinase and anti-synthetase antibodiesshould be closely monitored.

To explore the effects of tumor suppressor p14ARF on chemosensitivity of human osteosarcoma U2OS cells to cisplatin and elucidate its molecular mechanism.

U2OS cells expressing no p14ARF and U2OS-ARF cells expressing p14ARF stably through stable transfection were treated with cisplatin. Cell viability and IC₅₀ were assayed with methyl thiazolyl tetrazolium (MTT). Apoptosis was examined by fluorescence-activated cell sorting and Hoechst33258 staining. The expressions of p53, Bax, p21, Mdm2 and Fas were detected by Western blot. And colorimetry was used to determine the activities of caspase-3, caspase-8 and caspase-9.

The viability was 84.8%±4.4%, 86.9%±5.0% and 66.7%±4.6% respectively in U2OS, U2OS-vec and U2OS-ARF cells. The values of IC₅₀ were (15.8±0.9) μmol/L, (16.3±0.6) and (8.9±0.8) μmol/L respectively in U2OS, U2OS-vec and U2OS-ARF cells. The levels of viability and IC ₅₀ obviously decreased in U2OS-ARF cells in response to cisplatin (P<0.05). There were higher apoptotic rate and more obvious apoptotic morphological changes in U2OS-ARF cells than U2OS and U2OS-vec cells. The basal levels of p53, Mdm2 and p21 in U2OS-ARF cells were slightly higher than those in U2OS-vec cells. Cisplatin up-regulated p53, Mdm2 and p21 in both cell lines. However, the up-regulation was more pronounced in U2OS-ARF cells. Cisplatin did not change the levels of Bax and Fas in U2OS-vec cells. Bax protein was up-regulated in U2OS-ARF cells while the level of Fas remained constant. p14ARF also enhanced the activities of caspase-9 and caspase-3 in response to cisplatin.

p14ARF enhances the chemosensitivity to cisplatin in human osteosarcoma U2OS cells through p53apoptotic pathway. And intrinsic mitochondrial apoptosis is involved.

The patient, a 23-year-old female, began to develop palpitations and chest discomfort without obvious triggers 3 years ago, but improved after a few minutes. She had no dizziness, no fear of cold and fever, and did not see a doctor at first. After that, palpitations recurred without obvious inducement, loss of consciousness, fall, and incontinence. After about 3 minutes, he woke up without limb twitching, closed teeth, and no foaming at the mouth. He went to the local hospital for treatment and got better after symptomatic treatment. After that, there were still repeated palpitations with loss of consciousness, and many dynamic electrocardiograms (DCG) showed "sinus rhythm, frequent multi-source ventricular premature, and short ventricular tachycardia".

leukoaraiosis (LA) is an imaging diagnostic term proposed by Canadian neurologist Hachinski et al. in 1987. It refers to spotty or patchy changes in periventricular or subcortical white matter. At present, most scholars believe that LA is closely related to ischemic injury and belongs to a type of cerebral small vessel disease. With the popularization of imaging examination, the detection rate of cerebral small vessel disease has increased significantly, which is closely related to stroke, cognitive impairment and aging^[1]Therefore, it has attracted much attention. Fundus artery belongs to a small branch of cerebral artery, and retinal arteriosclerosis seen by ophthalmoscopy can directly reflect the arterial vascular disease of the brain and even the whole body to a certain extent. Clinical trials have confirmed that fundus arteriopathy is associated with cerebral small vessel disease, suggesting that fundus arteriosclerosis and LA may have common risk factors and the same pathogenesis. Therefore, by studying the correlation between fundus arteriosclerosis and cerebral small vessel disease, it is speculated whether fundus arteriosclerosis can be used as an index for early assessment of LA.

Osteopenia/osteoporosis is one of the most common complications in patients with chronic liver disease^[1,2,3]。 In China, chronic liver disease is mainly caused by chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infection. The factors that cause osteopenia/osteoporosis in this population include the influence of the disease itself and the common risk factors of the general population. Osteopenia/osteoporosis will increase the risk of fracture, seriously affect the quality of life and even long-term prognosis of patients^[4]。 Clarifying the risk factors of disease, carrying out targeted screening, early diagnosis and early treatment are reasonable strategies to prevent fractures. At present, there are few studies on osteopenia/osteoporosis in patients with viral hepatitis in China. This article intends to introduce the relevant progress in order to attract attention.

A 46-year-old woman with a pelvic mass found on physical examination for 14 d. The patient usually has regular menstruation, without abdominal pain, abdominal distension and other discomfort. Gynecological examination: a huge mass can be accessed in the right adnexal area, with medium quality and average mobility. After admission, ultrasound showed a hypoechoic mass in the right pelvic cavity with irregular shape and uneven internal echo. Color Doppler imaging (CDFI) showed abundant internal blood supply, considering right broad ligament leiomyoma. MRI showed irregular mass and intestinal loop-like abnormal signals in the right pelvic cavity, with a size of 10.8 cm ×7.0 cm ×11.0 cm.₁isosignal on WI, and at T₂There was a mixed slightly high signal on WI lipid pressure, with multiple tortuous, thickened and empty blood vessel shadows, high signal on diffusion weighted imaging (DWI), and progressive enhancement on GD – DTPA enhanced scan, considering broad ligament leiomyoma (FIG. 1A，FIG. 1B，Figure 1C)。 One week later, total hysterectomy and double adnexal were performed. During the operation, multiple tumor protrusions were found in the right broad ligament and right pelvic vessels, the largest of which was about 8.0 cm in diameter. Postoperative pathology: leiomyoma of right broad ligament, intravascular leiomyomatosis around uterus (Figure 1D)。