Objective To summarized the diseases which were demonstrated as hyperintensity lesions on high diffusion sensitive gradien(high b value) diffusion weighted imaging(DWI) To investigate the differential diagnosis of the diseases and to discuss the corresponding biophysics mechanism Methods 90 cases were studied, which were clinically highly suspected of brain ischemic stroke onset and in which hyperintensity lesions were demonstrated on DWI The patients were divided to 2 groups according to the time between the onset and the MR examination:group A(1 5-6 0 h)with 13cases, group B(7 h to 8 d)with 77cases The appearances of the lesions on conventional MRI, ADC values and anistropy(CV )of the lesions were studied Results hyperintensity lesions on high b value DWI were demonstrated in following diseases: acute ischmia, hematoma, abcesses, mengioma, mutiple sclerosis(MS) The ADC value was decreased to(5 87?1 02)(10 -4 mm 2/s in superacute cerebral ischemia, while the ADC value increased to (8 08?1 15)?10 -4 mm 2/s in active MS The CV in cerebral ischemia lesions was higher than the control group( P

Objective To summarize the appearances of MS lesions on DWI, and to quantitatively study the ADC and AI values in different clinical MS subgroups Methods One hundred and eighty seven lesions were studied in 18 cases of MS at different clinical stages Routine MR and DWI were performed in all cases ADC and AI were calculated in the lesions,NAWM, and normal control group Results Hyperintensity (edema like on T 2WI) was demonstrated on DWI at acute primary progressive MS lesions Hyperintense ring sign was found at acute relapse MS lesions ADC increased in all subgroups of MS Significant difference of ADC was demonstrated among MS lesions, NAWM, and normal control groups Significant decrease of AI was demonstrated at later stages Hyperintensity was found in all MS lesions on T 2WI The hyperintensity lesions on DWI had enhanced or non enhanced appearances on CE T 1WI The ADC value of enhanced MS lesions was less than that of the non enhanced lesions ( t =4 19, P 0 05) Conclusion DWI could give quantitative information for different pathological changes in MS lesions of different clinical subgroups Quantitative measurement of diffusion has great potential value in the diagnosis, differential diagnosis, and the prediction of prognosis in MS

Objective: To investigate the interaction between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and sleeping duration on risk of stroke in a Chinese Han ethnic population. Methods: In the case-control study and epidemiological investigation, the self-reported sleep duration and MTHFR C677T polymorphism of 245 patients with cerebral infarction, 222 patients with cerebral hemorrhage and 282 controls were collected. Multiple logistic regression was performed to analyze the interaction between MTHFR C677T polymorphism and sleeping duration on risk of stroke. Results: After adjustment for major confounding variables, multiple logistic regression analysis showed that: (1) There was significant association between long sleep duration (>8 hours of sleep per night) and cerebral infarction (OR=3.90; 95% CI:2.43-6.26), but not for cerebral hemorrhage (OR=1.16, 95% CI: 0.71-1.92). On the other hand, insomnia (sleep duration less than 6 hours) was neither associated with cerebral infarction nor hemorrhage. (2) MTHFR TT genotype increased the risk of cerebral infarction significantly (OR=2.01; 95% CI:1.12-3.61), but not for cerebral hemorrhage (OR=1.16,95% CI:0.71-1.92). (3) There was a significant synergistic effect of interaction between MTHFR TT677 genotype and long sleep duration on risk of cerebral infarction (OR=6.22; 95% CI:2.44-15.83). Conclusion: MTHFR TT677 genotype and long sleep duration increase the risk of cerebral infarction independent of confounding factors, respectively. Furthermore, there is a significant synergistic effect between MTHFR TT677 genotype and long sleep duration on risk of cerebral infarction in the Chinese Han ethnic population.

Objective： To study the changes of water molecular diffusion in the ischemic region by using MR dephase technique and discuss the potential mechanism of the diffusion changes at early stage. Methods: Totally 43 cases were studied retrospectively. There were 10 cases whose MRI examinations were performed within 6 hours，12 cases from 7－24 hours，7 cases from 2－7 days, 8 cases from 8－14 days, 6 cases from 15 days to 2 months. The apparent diffusion coefficients in the ischemic region were calculated. Results: The ADCav in the grey matter was 8.61×10－4mm2*s－1. The ADCav decreased to (4.72×10－4±1.51×10－4) mm2*s－1 in ischemic region at superacute stage, ADCav ratio to contralateral corresponding region was 0.55±0.18, and ADCav increased to (5.68×10－4±1.22×10－4) mm2*s－1 during the time range of 2-7 days, （9.22×10－4±2.07×10－4） during the time range of 8－14 days, and approaching （26.42×10－4+9.65×10－4） mm2*s－1 during the time range of 2 months. The pearson product- moment correlation between the changes of diffusion value and time was sighificent (r=0.95, P<0.001). ADCv increased at superacute stage and decreased over time. Conclusion: The diffusion of water molecules in ischemic region decreased at superacute stage, and the ADC increased over time. The anisotropy increased at superacute stage and decreased as the course developed. DWI could detect ischemic lesion much earlier than CT and routine MR examination. DWI has great value in the diagnosis of superacute stroke. The mechanism of the diffusion changes at early stage may be the intracellular toxicity edema.

ObjectiveTo observe the efficacy and safety of dihydroergotoxine in the treatment of acute ischemic stroke. Methods30 patients with acute ischemic stroke were randomly given dihydroergotoxine 0.6 mg(group 1), 1.5 mg (group 2) or Danshen injection 40 ml (group 3) respectively each day for 14 days,each for 10 cases. ResultsBefore and after treatment, the Scandinavian stroke scores of the three groups were increased(P<0.05). There was no significant difference(P>0.05) between the scores of group 1 and the group 3, but the scores of group 2 was higher than that of the group 3 and group 1(P<0.05). The common side-effect of both dihydroergotoxine groups were nausea, vomit, headache, palpitation and transient hypotention, which was more frequently apeared in group of 1.5 mg. ConclusionDihydroergotoxine and Danshen injection are all useful in the treatment of acute ischemic stroke. It is more efficient using higher dose of dihydroergotoxine. But as the dose going on, there will be more side-effect.

Objective To evaluate the imaging diagnosis of anomalous origin of coronary artery from the pulmonary artery(ACAPA).Methods A total of 11 cases with ACAPA were included in the present study.Chest films,echocardiography,cardioangiography,and electron beam computed tomography (EBCT) were employed as diagnostic modalities.Macroscopic anatomy at operation was referred. Results Ten cases were classified as anomalous origin of left coronary artery from the pulmonary artery(ALCAPA) and 1 case as anomalous origin of right coronary artery from the pulmonary artery(ARCAPA).They could not be diagnosed by chest films,but could be diagnosed by echocardiography in 3 cases,by EBCT in 1 case,and by cardioangiography in all cases.In ALCAPA,cardioangiography showed that the left coronary arteries arising from the posterior sinus or posterior wall of the pulmonary artery were perfused retrogradely via the collaterals from the dilated right coronary artery.In ARCAPA,the right coronary artery originated from the right sinus of the pulmonary artery.Gross anatomy at operation showed that the sites of the anomalous origins were the same as that of cardioangiography.Ischemic fibrosis of the anterior papillary muscles,mitral valve annulus enlargement,and prolapse of mitral valve,which led to mitral valve insufficiency,were found in 3 cases.Conclusion Chest film has limitation in the diagnosis and echocardiography should be further improved.Cardioangiography remains the “gold standard” of the preoperative diagnosis.

Objective To investigate the multi-slice spiral CT characteristics of inner ear in child sensorineural deafness and its application analysis.Methods A total of 41 children patients(82 ears) with sensory deafness treated in this hospital from March 5,2016 to March 5,2017 were selected.The screening test was adopted to observe the accuracy rate of multi-slice spiral CT and monolayer spiral CT for diagnosing the inner ear malformation.The inner ear characteristics in child sensorineural deafness revealed by multi-slice spiral CT were observed.Results The sensitivity of multi-slice spiral CT for diagnosing child sensorineural deafness was 87.72 ％,the specificity was 80.00 ％ and the Gordon index was 0.68;the diagnostic sensitivity and specificity in the single-slice spiral CT were 59.65 ％ and 68.00 ％ respectively,the Gordon index 0.28;the sensitivity of the multi-slice spiral CT group was significantly higher than that of the single-slice spiral CT group,the difference was statistically significant(x2 =4.31,P＜ 0.05).The multi-slice spiral CT results showed 36 cases(63.2 ％) of vestibular aqueduct abnormalities,which were significantly higher than 16 cases (28.1％) of cochlear deformity,vestibular deformity in 18 cases (31.6 ％),semicircular canal deformity in 22 cases(38.6％) and inner ear canal deformity in 16 cases(28.1 ％),the differences were statistically significant(x2 =21.11,P＜0.05).Coclusion Multi-slice spiral CT can more completely display the inner ear deformity structure to provide more comprehensive and accurate diagnostic information.

Objective To investigate the risk factors of repeated episodes of child otitis media with effusion(OME).Methods One hundred and twenty-one children cases of repeated OME within 1 year in the Affiliated Children's Hospital of Nanjing Medical University from February 2013 to August 2015 were selected as the repeated group and contemporaneous 125 cases of non-repeated OME were selected as the control group.The repeated OME related factors were performed the univariate and multivariate analysis.Furthermore the occurrence rates of main risk factors and annual onset frequency of nasal disease were compared among different age groups.Results The Logistic multivariate regression analysis results indicated that younger age,allergic rhinitis,recurrent upper respiratory tract infections,tonsil hypertrophy Ⅳ°,adenoid hypertrophy Ⅲ °and Ⅳ ° and poor mastoid gasification were major risk factors for recurrence of OME.The incidence rate of repeated upper respiratory tract infections in the 3-＜7 years old group and ＜3 years old group was obviously higher than that in the7-14 years old group(P＜0.05),adenoid hypertrophy in the ＜3 years old group and 7-14 years old group was lower than that in the 3-＜7 years old group(P＜0.05).The annual onset frequency of nasal disease in the repeated group was significantly higher than that in the control group(P=0.000).Conclusion Child OME is the results of multivariate factors combined action.The smaller the age,the more the annual onset frequency and the higher the possibility of OME repeated onset.