Volume 95  ·  Issue 39  ·  2015

Albumin is the most important protein for maintaining colloid osmotic pressure in plasma^[1]。 As a carrier for transporting a variety of endogenous and exogenous components, albumin also has anti-oxidant, anti-inflammatory and buffering acid-base balance disorders properties^[2,3]。 The choice between crystalline solution (e.g. saline) or plasma albumin for fluid resuscitation in critically ill patients has long been debated^[4,5,6]。 It is believed that supplementing albumin to the normal range for patients with hypoalbuminemia is the correct treatment, just as they need to eat to satisfy their hunger when they are hungry. But there are also opposing views that dispute this.

To investigate the dynamic changes of extra vascular lung water index(EVLWI) and pulmonary vascular permeability index (PVPI) on the prognosis of acute respiratory distress syndrome (ARDS), and predict the risk factors affecting prognosis of ARDS.

70 patients meeting ARDS Berlin definition, who were admitted to the ICU from July 2012 to July 2014, were analyzed with a prospective method. The patients were divided into a survival group and a death group according to their survival situation in 28 days.EVLWI (EVLWI₁–EVLWI₄), PVPI(PVPI₁–PVPI₄), ΔEVLWI (subtracting EVLWI day4 from day1), and ΔPVPI (subtracting PVPI day4 from day1) of the two groups of patients from the 1st day to the 4th day were monitored by the pulse indicator continuous cardiac output (PiCCO). Parameters including the acute physiology and chronic health evaluation (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, EVLWI, PVPI, ΔEVLWI, ΔPVPI, oxygenation index(OI), CVP, the number of organ dysfunction were compared between the two groups.Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors associated with prognosis.Receiver operating characteristic curve (ROC curve) was drawn to evaluate the prediction performance of those risk factors in the prognosis of ARDS.

Comparison of EVLWI and PVPI between the survival group and the death group of ARDS patients at different time points: EVLWI and PVPI showed no statistical difference from the 1st day to the 2th day after admission, but those two parameters in the death group were higher than those in the survival group from the 3rd day to the 4th day after admission (P<0.01). The comparison of the dynamic changes of EVLWI and PVPI within the two groups: the EVLWI and PVPI in the survival group declined gradually from 1st day to 4th day after treatment, but that changing trend in the death group showed no statistical difference.ΔEVLWI and ΔPVPI changes in the survival group were higher than in the death group (P<0.01). They were independent risk factors of patients 28–day prognosis (P<0.05). ROC curve and 28–day survival curve showed that the area under ROC curve of ΔPVPI predicting prognosis of patients with ARDS was 0.812, when the optimal cut off value was 1.2, and the median survival period in ΔPVPI>1.2 group was longer than that in the ΔPVPI≤1.2 group.

The continuous dynamic observation of EVLWI and PVPI changes is better than that of a single detection.ΔEVLWI and ΔPVPI are independent risk factors and can be used as an auxiliary indicator for the prognosis of patients with ARDS.

To assess the effect of mehanical ventilation (MV) guided by transpulmonary pressure (Ptp) on respiratory mechanics and gas exchange in severe acute pancreatitis patient with intraabdominal hypertension.

Twelve severe acute pancreatitis patient with intraabdominal hypertension and acute respiratory distress syndrome(ARDS) underwent mechanical ventilation were involved from Jan to Dec 2013.PEEP levels were set to achieve a Ptp of 0 to 10 cm of water at end expiration.We also limited tidal volume to keep Ptp at less than 25 cm of water at end inspiration.Respiratory mechanics and gas-exchange were measured.

Plat pressure (Pplat) increased and the compliance of chest wall (C_cw) decreased when intraabdominal pressure (IAP) increased.Pplat correlated with IAP positively(r²=0.741 9, P<0.05) and C_cw correlated with IAP negtively (r²=0.722 2, P<0.05), respectively.There were not corrletions between IAP and end-expiratory Ptp (Ptp-e) and end-inspiratory Ptp (Ptp-i)(P>0.05). Compared with baseline, after guiding MV with Ptp, the Level of PEEP (14.6±4.2) cmH₂O vs (8.3±2.0) cmH₂O, and Ptp-e (1.5±0.5) cmH₂O vs (–2.3±1.4) cmH₂O increased (P<0.05) and Ptp-i did not increase significantly (P>0.05). Ptp-e correlated with PEEP (r²=0.549, P<0.05) and end-expiratory esophageal pressure (Pes-e) (r²=0.260, P<0.05). Ptp-i correlated with Pplat (r²=0.523, P<0.05) and end-inspiratory esophageal pressure (Pes-i)(r²=0.231, P<0.05), but did not correlate with Tidal volume(VT)(r²=0.052 4, P>0.05). Compared with baseline, lung compliance(C_L)(48.1±10.3) cmH₂O vs (25.7±6.4) cmH₂O and oxygenation index (PaO₂/FiO₂) (235±48) mmHg vs(160±35) mmHg improved obviously (P<0.05), dead space fraction (V_D/V_T) (0.48±0.07) vs (0.59±0.06) decreased (P<0.05), but C_cw and respiratory compliance(Cr) didn't improve (P>0.05).

Transpulmonary pressure-directed mechanical ventilation in ARDS secondary to severe acute pancreatitis patient with intraabdominal hypertension could not only recruit the collapsed alveoli, improve lung compliance, increase oxygenation index and decrease dead space ventilation but also monitor lung stress to avoid alveoli overinflation, which might be lung protective.

To evaluate the accuracy of APACHEⅡ score derived from critical clinic information system compared with artificial method.

The APACHEⅡscore derived from critical clinical information system(simple called system score) from August 1^st to September 1^st 2013 were collected.Each of the results including overall score subtitle were compared with the corresponding score calculated through artificial method.

there is big difference between the two methods both between overall score and subtitle score.overall score (193.4) vs.(127.6) (P=0.001); age: (161.4) vs.(159.6) (P=0.862); Temperature: (169.6) vs.(151.4) (P=0.027); MAP: (190.8) vs.(130.2) (P=0.001); HR: (181.8) vs.(139.3) (P=0.001); RR: (191.4) vs.(129.6) (P=0.001); PaO₂: (152.5) vs.(168.5) (P=0.001); pH: (174.0) vs.(147.0) vs. (P=0.001); Na⁺ : (161.5) vs.(159.6) (P=0.576); K⁺ : (163.4) vs.(157.6) (P=0.457); CR: (177.2) vs (143.8) (P=0.001); HCT: (166.2) vs.(154.8) (P=0.199); WBC: (167.8) vs.(153.2) (P=0.054); Items of GCS and Organ Failure were not being compared.

The APACHEⅡscore obtained from critical clinic information system is more accurate and more objective.

To observe the effect of hydrogen sulfide on Bsep and Mdr2 in acute liver failure induced by thioacetamide.

Twenty-four male SD rats were randomly divided into thioacetamide (TAA) induced model group (n=6), control group (n=6), TAA+ sodium hydrosulfide group (n=6), and TAA+ propargylglycine group (n=6). TAA was given to enterocoelia at the dose of 600 mg/kg for the model group, sodium hydrosulfide group and propargylglycine group rats.Sodium hydrosulfide with the dose of 0.15 mmol/kg and propargylglycine of 30 mg/kg was injected into enterocoelia one hour before the TAA used.All rats were sacrificed and serum specimen was collected to test hydrogen sulfide and hepatic function.The method of Western blot and Immunohistochemistry were used to measure the expression of Bsep and Mdr2 in the liver.

The Liver function of TAA group rats was severely injured [ALT(524.0±32.0) vs (28.3±8.4) U/L] .It was worsen by application of sodium hydrosulfide [ALT(861.9±55.1) U/L] while recovered [ALT(59.5±10.2) U/L]] by propargylglycine.The level of bilirubin and bile acid was significantly higher in the TAA group rats than in the normal control group, and the application of sodium hydrosulfide caused bile acids increased further besides of bilirubin.On the contrary, the levels of bile acids and bilirubin were significantly decreased with PPG application.The level of hydrogen sulfide in the serum of the TAA group rats was higher than normal group rats'.That was elevated by sodium hydrosulfide and decreased by propargylglycine.Severely edema, necrosis and inflammatory cell infiltration were observed in TAA group rats, which worse by sodium hydrosulfide and released by propargylglycine.The expression of Bsep and Mdr2 down regulated in TAA and deteriorated by sodium hydrosulfide application and relieved by propargylglycine application.

Hydrogen sulfide exacerbated the Bsep and Mdr2 loss in the liver failure and contributed to high serum concentration of bile acids.

To observe the effects of rosiglitazone (ROSI) on endotoxin–induced acute liver injury in rats.

All the animals were randomly assigned to one of four following groups (n=24 per group). Rats in the Sepsis–Dimethyl sulfoxide (DMSO) group(n=24), rats were treated with 10%DMSO(1 ml/kg) 30 mins before they were challenged with cecal ligation and puncture(CLP) (n=24). In the sepsis–rosiglitazone (ROSI) group was identical to the sepsis–DMSO group but received ROSI (10 mg/kg intravenously) (n=24). In the sham–DMSO group, rats were treated with 10% DMSO(1 ml/kg) 30 mins before the administration of saline (n=24). The sham–ROSI group was identical to the sham–ROSI group except that ROSI (10 mg/kg intravenously) was administered instead of DMSO (n=24). Sepsis was induced in rats by dissecting the cecum and placing the discontinued organ back into the abdomen CLP.And all the Rats were decapitated at 0, 6, 12, 24 h after the model completed.Serum glutamic oxaloacetic transaminase(GOT), glutamic pyruvic transaminase (GPT), interleukin 12(IL–12) were determined to assess activity and liver pathologic change of rats in different groups.Data were analyzed with SPSS 19.0 software.Student'st–test was used to compare densitometry data.

SPSS 19.0 statistical software analysis by the outcome of the application ELASA method for determining zero hours between every group, there was non–difference.The sepsis–ROSI group and the sepsis–DMSO group 12 hours and 24 hours the presence of plasma GOT concentration changes statistically significant difference(t₁₂=3.97, P₁₂=0.01; t₂₄=3.10, P₂₄<0.001), (t₁₂=0.55, P₁₂<0.001;t₂₄=4.32, P₂₄<0.001). The Sepsis–ROSI group and the sepsis–DMSO group 6 hours, 12 hours and 24 hours the presence of plasma GPT concentration changes statistically significant difference(t₆=3.17, P₆=0.021; t₁₂=2.81, P₁₂=0.018; t₂₄=5.06, P₂₄<0.001), (t₆=2.67, P₆=0.001; t₁₂=3.36, P₁₂=0.002; t₂₄=2.83, P₂₄<0.001). The sepsis–ROSI group and the sepsis–DMSO group 6 hours, 12 hours and 24 hours the presence of plasma IL–12 concentration changes statistically significant difference(t₆=3.17, P₆=0.021; t₁₂=2.81, P₁₂=0.018; t₂₄=5.06, P₂₄<0.001), (t₆=2.67, P₆=0.001; t₁₂=3.36, P₁₂=0.002; t₂₄=2.83, P₂₄<0.001). Sepsis GOT, GPT, IL–12 began to increase in 6 hours, 24 hours of high–value, no clear peak trend, the sepsis–ROSI group compared with the sham–ROSI group had lower concentrations of GOT, GPT and IL–12 to some extent.Description rosiglitazone inhibit inflammatory cytokines in rats with sepsis role of IL–12, there is a certain role to reduce the inflammatory response in sepsis.

Treatment with Thiazolidinedione, markedly inhibited the expression of IL–12, attenuated pulmonary inflammation and liver injury caused by sepsis in rat.

To explore the characteristics of emotional regulation in children with attention–deficit/hyperactivity disorder (ADHD).

Two hundred and eighty–two children who were diagnosed as ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–Ⅳ) were recruited from the child psychiatric clinic of Peking University Sixth Hospital/Institute of Mental Health from August 2012 to April 2014.And 260 normal children from the local primary schools were selected as the healthy control group.The emotional factors or items of Conners' Parent Rating Scale, Behavior Rating Inventory of Executive Function (BRIEF), Achenbach's Child Behavior Checklist (CBCL) and Rutter Children Behavior Questionnaire were used to assess the characteristics of emotional regulation multi–dimensionally.

After controlling for the effects of age, sex and intelligence quotient (IQ), in Conner scale, the emotional lability (EL) scores of ADHD group were significantly higher than that of healthy control group [(4.3±2.6) vs (1.4± 1.5), P<0.001]. In BRIEF scale, the emotional control (ECTRL) scores of ADHD group were significantly higher than that of control group [(16.1±4.4) vs (12.0±2.5),P<0.001]. In CBCL scale, the deficient emotional self–regulation (DESR) scores of ADHD group were significantly higher than that of control group [(26.8±11.0) vs (6.6±6.8),P<0.001]. In Rutter questionnaire, the emotional symptoms (ES) scores of ADHD group were significantly higher than that of control group [(2.7±2.0) vs (1.7±1.5),P<0.001]. Based on the receiver operating characteristics (ROC) curve, the area under the curve (AUC) of EL was 0.84 with 95% Confidence Intervals (CI) 0.81–0.87.The AUC of ECTRL was 0.81 with 95%CI 0.77–0.84. The AUC of DESR was 0.95 with 95%CI 0.93–0.97.The AUC of ES was 0.66 with 95%CI 0.61–0.70.

The study multi–dimensionally indicated that children with ADHD displayed significant deficient emotional regulation.

This study aimed to investigate the resting-state functional connectivity of the hypothalamus and its relationships with gonadal steroid hormones and depression symptoms in perimenopausal women.

Total 66 perimenopausal women voluntarily participated in this study from October 2012 to June 2013.Zung Self-rating Depression Scale (ZSDS) was used to assess depression symptoms.Plasma gonadal steroid hormones including estradiol, testosterone, and progesterone were determined by the chemiluminescence immunoassay.A 3.0 Tesla magnetic resonance imaging (MRI) scanner was utilized to acquire resting-state functional MRI data.The z-value functional connectivity map of each participant was calculated voxel-wisely based on the seed region of the hypothalamus.One sample t test of Statistical Parametric Mapping (SPM) were used to determine the brain areas with statistically significant functional connectivity to the hypothalamus, then multiple regression of SPM was used to calculate the correlated areas with 3 gonadal steroid hormones, respectively.Finally, Pearson correlation was performed to analyze bivariate correlations between mean z-values and ZSDS scores.

Significant functional connectivity to the hypothalamus were found in brain areas as follows: the lateral inferior frontal gyrus, medial prefrontal cortex, dorsal lateral prefrontal cortex, orbitofrontal cortex, subgenual cortex, anterior cingulate cortex, posterior cingulate cortex, cuneus and precuneus, hippocampus and parahippocampal gyrus, and angular gyrus (False Discovery Rate q<0.05). Among these areas, the plasma testosterone level was positively related to the functional connectivity strength of the right angular gyrus, and negatively related to the strengths of the right subgenual cortex and bilateral medial superior frontal gyrus to the hypothalamus (P_AlphaSim<0.05). Especially, meanz-value in the subgenual cortex was positively related to the ZSDS index score (r=0.279, P=0.023), and factor scores of the core depression symptoms (r=0.278, P=0.024) and somatic symptoms (r=0.357, P=0.003).

In perimenopausal women, the hypothalamus has resting-state functional connectivity with widespread areas involved in the brain depression-related network and default mode network, and the plasma androgen level may modulate the functional connectivity strengths of the hypothalamus and decrease the susceptibility of perimenopausal women to depression.

To compare the interictal spontaneous brain activity between migraine without aura(MwoA) patients, Migraine with visual aura(MA) patients and healthy control subjects in order to provide further insights into the complex migraine pathophysiology.

Twenty–three eligible MwoA patients, twelve MA patients who were treated in the neurology clinics in the Second Hospital of Hebei Medical University from March to October 2014 and twenty–five gender–, age– and education– matched healthy volunteers participated in this study.After demographic and clinical characteristics were acquired, a 3.0–T MRI system was used to obtain rfMRI.ReHo method was applied to analyze the synchronization of the BOLD signal in the same time series among neighboring voxels of the brain.

Compared with healthy controls, MwoA patients showed significant decreases in ReHo values in the right thalamus, right putamen, right prefrontal lobe and right hippocampus (P<0.05); while MA patients showed significant decreases in ReHo values in the right thalamus, right putamen, right cerebellum and brainstem, whereas a significant increase in ReHo values in the right occipital lobe (P<0.05). Furthermore, compared with MA patients, increased ReHo values in the right cerebellum and brainstem were shown in the MwoA group (P<0.05).

The results suggest that the resting–state abnormalities of these regions may be associated with functional impairments in pain processing in migraine.Specifically, the results of brain regions may reflect both the similarities and differences of pathophysiological mechanisms relative to the major subtypes of migraine.

To evaluate the efficiency of diffusion-weighted MRI in differentiating between benign and malignant polypoid gallbladder lesions.

The study population consisted of 10 benign (5 polyps, 3 adenomyomatosis and 2 adenomas) and 13 malignant (all adenocarcinomas) polypoid gallbladder lesions treated in hospital from November 2007 to May 2014.DWI was evaluated by two observers.Qualitatively, the signal intensity of the lesions on DWI was visually evaluated and categorized as iso, high, or very high signal.Quantitatively, the ADC values of the lesions were measured from ADC maps. Statistical analysis was performed using a two-tailed Fisher's exact test and the Mann-Whitney test, respectively.The cut-off values were determined by receiver operating characteristic analysis.

Qualitative analysis revealed a statistical difference (P=0.036). In the 10 benign lesions, three were categorized as iso, 5 as high, and 2 as very high signal.Four of the 13 malignant lesions were categorized as high, and the remaining 9 were categorized as very high signal.The mean ADC value of the malignant lesions [(1.13±0.28)×10^–3mm²/s] was significantly lower than that of benign lesions [(2.22±0.42)×10^–3mm²/s, P<0.01]. The cut-off value between cancer and the benign lesions was 1.5×10^–3mm²/s, the sensitivity, specificity, and accuracy were 92%, 100% and 96%, respectively.

Diffusion-weighted MRI may be useful in differentiating between benign and malignant polypoid gallbladder lesions.

To investigate the endovascular management strategy of mechanical thrombectomy using Solitaire AB stent for acute middle cerebral artery occlusion with atrial fibrillation and assess the safety and efficacy.

From June 2012 to Dec 2013, 40 patients of acute middle cerebral artery occlusion with atrial fibrillation admitted to our institutes were treated by Solitaire AB stent.Clinical status was evaluated by the score of National Institute of Health Stroke Scale (NIHSS) before and 72 hours after treatment, immediate scale of thrombolysis in cerebral infarction (TICI) after thrombectomy, the 90 d score of Modified Rankin Scale (mRS). The patients were classified into good result group (mRS≤2) and bad result group (mRS﹥2) according to the mRS score.

Out of 40 cases, there were 28 cases caused by cardiogenic embolism.Recanalization was successful (TICI score 2b or 3) in 37 out of 40 (92.5%).90 d follow–up mRS was 0–2 in 19 of 40 patients (47.5%).3–5 in 21 patients (52.5%).5 patients died (12.5%). Symptomatic hemorrhagic transform developed in 6 patients (15%). No complications related to the Solitaire AB thrombectomy occurred.Mean time from symptom onset to recanalization (312±52 min vs 370±68 min, P<0.05) and initial NIHSS score (17.0±0.4 vs 18.6±0.4,P<0.05) were of significant difference between good result group and bad result group.

These results confirm that mechanical thrombectomy using solitaire AB stent for acute middle cerebral artery occlusion with atrial fibrillation is safe and effective.

Modify the pterional approach for intracranial aneurysms clipping with minimally invasive concept to reduce the risk of iatrogenic surgical trauma.

A 4.0 cm skin incision was made along the temporal hairline and centered on the pterion, temporal muscle was incised along the sylvian fissure.A bone flap with 2.0 to 2.5 cm in diameter was milled after a bone hole was drilled just on the sphenoid ridge, which was drilled off as needed then.Aneurysms were exposed after dissection of sylvian fissure and cistern, as well as cerebrospinal fluid releasing.A total of 123 cases with 140 intracranial aneurysms were treated surgically via the pterional keyhole approach, including 6 large aneurysms, 4 giant aneurysms, and 17 cases with multiple aneurysms (34 aneurysms). Of 3 cases with bilateral aneurysms, 2 were treated via bilateral approach as well as 1 via unilateral approach.Contralateral approach was used in 1 case with ophthalmic artery aneurysm, which pointed medial.Concomitant intracranial tumors were removed simultaneously in 2 cases, and one of them was diagnosed with middle cerebral artery aneurysm and tuberculum sellae meningioma, the other one with posterior communicating artery aneurysm and middle cranial fossa menigioma.

Of the 140 aneurysms, 139 aneurysms were clipped and 1 was trapped.Postoperative image showed 4 cases had residual of aneurysm neck. 3 cases had incomplete dysfunction of oculomotor nerve and 1 had mild hemiplegia after surgery and recovered eventually.4 cases presented with aggravated disturbance of consciousness, of whom 3 cases were caused by ischemia and 1 by brain edema.Unusual ipsilateral hemiplegia occurred in 1 case in Hunt&Hess grade Ⅳ, which caused by contralateral vasospasm.Postoperative courses in other cases were uneventful.

As a minimally invasive and effective approach, the pterional keyhole approach is applicable to intracranial aneurysms clipping for patients without any necessary for decompressive craniectomy.Surgical related complications and operative duration can be reduced significantly.

To analyze the outcome in patients who underwent transsphenoidal surgery (TSS) with Cushing's disease (CD) with no visible adenoma on magnetic resonance imaging (MRI).

Between 2012 and 2014, 118 patients with CD underwent TSS at PUMCH.We retrospectively analyzed data in 43 patients without visible adenomas on MRI and compared them with 75 patients with MRI–visible microadenomas.

Of 75 patients with MRI–visible microadenomas, postoperative remission was achieved in 64 patients (85.3%), and no recurrence or persistent of CD was observed during 2–year follow–up, and pituitary adenoma confirmed by pathology examination in 71 cases.Of 43 patients with negative MRI, postoperative remission was achieved in 32 patients (74.4%), and pituitary adenoma confirmed by pathology examination in 38 cases.No statistic difference was found between MRI–negative group and MRI–visible group after χ ² test (P value >0.05). BIPSS was performed in 32 cases, and 27 cases were positive.Pituitary adenoma was confirmed in 28 cases.

There is no difference in remission rate of CD in MRI–visible and MRI–negative group.BIPSS should be performed in normal MRI cases. We recommend transsphenoidal surgery as the first–line treatment for CD.Selective adenomectomy was recommended when an adenoma was found during surgery, and partial or hemihypophysectomy when no adenoma was found.

To investigate the relevant factors affecting the prognosis of traumatic optic neuropathy (TON).

A total of 685 cases (719 eyes) of TON from June 2007 to June 2012 were analyzed retrospectively.A total of 9 independent variables (X) including sex, side of TON, duration of coma, vision after trauma, fracture of optic nerve canal, fracture of big ridge of sphenoid bone, hematoma in sphenoid sinus and surgical treatment, and the dependent variable (Y) of visual prognosis were analyzed using the unconditioned Logistic regression analysis to find the risk factors for the visual prognosis of TON.

A total of 325 eyes (45.2%) recovered out of 719 eyes.Four variables showed a significant relation with the visual recovery: duration of coma>0.5 h (X₃, P<0.01), remnant vision after trauma (X₄, P<0.01) and sphenoid ridge fractures (X₇, P<0.01), and surgical treatment (X₉, P<0.01). These factors above were also proved to be significant in Logistic regression.

The duration of coma>0.5 h, no light perception after trauma, sphenoid ridge fractures are risk factors of visual recovery, while surgical treatment is the protective factor for the visual recovery after TON.

To evaluate the clinical value of dual-energy CT(DECT) in the detection of green-coloured voxels in toenails in patients with gout using DECT.

A total of 53 patients with gout could be included in the study composed of 45 men and 8 women, and 33 individuals without gout were regarded as control group.There were no significant differences in gender and age between two groups.DECT were performed for the both feet, DE (80 kV and 140 kV) datasets were reconstructed via gout-recognition software, the pseudo-color images group as the postprocessed group.Imagings were reviewed independently by two senior radiologists.Chi-square test was used for statistical analysis with the SPSS 17.0 software.

In the gout group, DECT scans revealed a total of 266 areas of green-coloured voxels in 53 patients (relevance ratio 50.2%(266/530)); in the control group, 27 areas of green-coloured voxels were detected in 33 patients(relevance ratio 8.2%(27/330)), the differences had statistical significance (P<0.01). In the gout group, the green-coloured voxels were detected only in the nail groove in 8 patients which compared with 2 the control group, the differences had statistical significance (P<0.01).

DECT gout recognition technology can detect green-coloured voxels of monosodium urate in the toenails, with a great potential in clinical diagnosis.

To explore the effect of LINGO-1 silencing on movement function of experimental autoimmune encephalomyelitis (EAE) mice.

EAE was established by induction of MOG35-55 in female C57/BL6 mice.Then female EAE mice (n=105) were completely randomly divided into 5 groups: group A (n=21): 5 μl 5×10 ⁹ Tu/ml lentiviral vectors encoding LINGO-1shRNA (LV/LINGO-1-shRNA) by intracerebroventricular (ICV) injection, group B (n=21): 5 μl 5×10 ⁸Tu/ml LV/LINGO-1-shRNA by ICV injection, group C (n=21): 5 μl 5×10 ⁷ Tu/ml LV/LINGO-1-shRNA by ICV injection, group D (n=21): 5 μl LVCON053 by ICV injection and group E ( n=21): untreated.The movement function was scored and the expression of LINGO-1 protein was detected by Western blot on day 1, 3, 7, 14, 21, 30 after ICV among different groups.Luxol fast blue staining was performed to know about conditions of myelin sheath on day 30.

The expression of LINGO-1 in EAE mouse was obviously downregulated ever since day 7 after LV/LINGO-1-shRNA implantation.Group B and C achieved the most reduction of LINGO-1 expression(1.99±0.13, 2.08±0.10, P<0.05,P<0.01). Simultaneously, the movement functional score of group A, B and C was lowered at different levels from day 7 (3.11±0.13, 2.42±0.13, 2.96±0.10 vs 3.56±0.15, 3.87±0.12,P<0.01,P<0.01,P<0.05), with the most marked decrease in group B. The densities of myelin sheaths in group A and B were higher than untreated group on day 30(0.72±0.09, 0.83±0.11 vs 0.56±0.10,P<0.05,P<0.01).

LV/LINGO-1shRNA by ICV injection is an effective method to silence LINGO-1 expression.LINGO-1 silencing could ameliorate motor function and promote formation of myelin sheaths.But the effects do not enhance with the increase of LV/LINGO-1-shRNA dose.

To explore whether susceptibility weighted imaging (SWI) could diagnose the early changes of renal IRI in vivo by modeling the renal ischemia-reperfusion (IRI) of rabbit.

Thrity four New Zealand white rabbits were chosen, the vesseles of the left kidney of rabbits were ligated for 60 minutes, then the renal ischemia-reperfusion model was established.Respectively, the rabbits before ligation, 0.5, 24 and 48 h after the ligation, were examined with MR , then the signal of the cortex and medulla was analyzed in SWI and T₂WI, the imaging features were compared with histopathology.

The inner medullary of renal showed high signal, low signal in the outer medulla and mildly high in the cortex before ligation in T₂WI sequence, which showed the typical three-band signal distribution, while the outer medulla showed wildly hypo-signal in SWI, the remnants showed high signal; kidney swelled significantly 0.5 hour after ligation, the stripe of cortex became thin, however, the inner medulla and outer medulla widened.The hypo-signal of the outer medulla faded, while the signal of inner medullary and cortical slightly elevated.The signal intensity of outer medulla lowered more obviously in SWI, the margin of the cortex and medulla became more clearly 24 and 48 h after ligation, However the signal of the outer medulla was higher than normal kidney in the SWI, and punctuate or stripe haemorrhage occurred in the outer medulla.Respectively, the number of punctuate, stripe haemorrhage detected by SWI in the out medulla of kidney 0.5, 24 and 48 h after ligation were 0, 2.50, 6.75(F=52.17, P<0.01), Meanwhile, the number detected by T₂WI was 0, 1.13, 2.88(F=15.65, P<0.01); the number of hemorrhage which was detected by SWI and T₂WI in the outer medulla among different timepoint have the statistical significance(t=4.83, P<0.01).

SWI can clearly show early changes in IRI-renal, especially in the outer medulla of the renal, the technique was helpful to assess the early changes of renal IRI.

A 21-year-old female was admitted to Drum Tower Hospital affiliated to Nanjing University School of Medicine for more than 7 months due to physical examination of left ovarian mass. In July 2014, the patient detected a slightly stronger echoic mass in the left adnexal area, with a size of 68 mm ×50 mm ×19 mm, and considered the possibility of teratoma. Blood CA125 and other tumor markers were normal. Past menstrual rules. Physical examination: Flat and soft abdomen without tenderness, rebound pain and muscle tension, sign of ascites (–). Gynecological examination: vulva unmarried, uterus median, normal size. No obvious abnormalities were observed in the right adnexal area; A 6 cm ×5 cm mass was palpable in the left adnexal area with good mobility and no tenderness. Preoperative diagnosis: The nature of left ovarian mass is to be investigated. The patient underwent laparoscopic ovarian mass excision under general anesthesia on 4 February 2015. There were no abnormalities in uterus, right ovary and bilateral fallopian tubes during the operation; The left adnexal area was cystically enlarged (6 cm ×5 cm ×5 cm), the surface was smooth and blue-purple, and the cyst adhered to the surrounding membrane. After resection, it was sent to pathology for examination, and the postoperative recovery was good. Gross examination: A pile of gray-red broken tissue, with a total size of 6 cm ×6 cm ×3 cm, with dark red-gray-white cut surface, and some areas showed sponge-like and honeycomb-like changes. Under the microscope: the mass submitted for examination is composed of large pieces of differentiated and mature dilated thin-walled blood vessels, with lumens of varying sizes and anastomosis with each other (Figure 1), part of the lumen is filled with red blood cells, and thrombi can be seen, and some areas of the lumen can see a few abnormal spindle cells and collagenization of the tube wall. The inner wall of the lumen was covered with a single layer of flat endothelial cells, and the cells had no atypia (Figure 2)。 A small amount of ovarian tissue was seen in the tissue submitted for examination. Pathological diagnosis: The vascular structure showed tumor-like hyperplasia in the intraoperative rapid frozen section, and the cells had no obvious atypia, suggesting that there was no clear malignant basis, so the patient only underwent mass resection. The postoperative pathological diagnosis was: ovarian cavernous hemangioma with partial tumor degeneration and collagenization. Immunohistochemistry: Lumen endothelial cells expressed CD31 (+) (Figure 3), CD34 (+) (Figure 4), CR (-), CK (-), D2-40 (-), inhibin α (-), Desmin (-), Actin (-), Ki-67 about 1% (+).

Severe burn, trauma and major surgical stress can easily induce sepsis, and further development can lead to septic shock and multiple organ dysfunction syndrome (MODS), which is one of the most important causes of death in clinical burn, trauma and critical patients^[1]。 Although early fluid resuscitation, anti-infective therapy, nutritional metabolism and vital organ-assisted supportive therapy have made great progress, the mortality rate of sepsis has remained high because the exact etiology and pathogenesis of sepsis are still unclear. In recent years, trypsin inhibitors represented by ulinastatin (UTI) have been widely used in the clinical treatment of sepsis, and their efficacy has gradually been affirmed. Previous studies on UTI mainly focused on inhibiting protease hydrolysis, oxidative stress and anti-inflammatory aspects, but these data do not fully explain its effect in the clinical treatment of sepsis. Therefore, it is of great significance to analyze and discuss the exact role and intervention mechanism of UTI in cytoprotection in critical state for further understanding the pathogenesis of sepsis and the development of targeted drugs.

The rise of 3D printing (three-dimensional printing) technology has brought great impact and changes to traditional manufacturing, medical, cultural and creative industries, aerospace and other industries. Among them, the research of 3D printing technology in the medical field is even more eye-catching, which has set off the development upsurge of 3D printing technology in this field at home and abroad^[1]。 Neurosurgery is one of the most challenging departments in the medical field. Because of the complex anatomical structure, fine functions and complex diseases of the nervous system, it brings great challenges and difficulties to neurosurgeons, and also brings great hidden dangers to medical safety. In recent years, 3D printing technology has made rapid development in the field of neurosurgery. The research status and application prospects of 3D printing technology in the field of neurosurgery are summarized as follows.