Objective To obtain magnetic resonance imaging(MRI) symptoms that could be used in medical diagnosis and identification by analyzing the diverse MRI appearance of brain multiple sclerosis(MS).Methods MRI findings of 41 samples of clinically definite MS, including the numbers, distributions, sizes, and shapes of the lesions were analyzed. The symbolic characteristics and enhanced expression are also covered.Results Brain MS might happen singly and multiply, and more frequently with multiple happening. In a multiple case, 4—15 lesions were observed the most. Some samples showed with diffuse lesions which were unable to be counted accurately presenting as a “dirty-appearing white matter”. The distribution of the lesions was observed most frequently at the two sides of periventricle, and following by the subcortical, corpus callosum, and brainstem. Only two lesions were observed at cerebrum. The size of most lesions range from a few millimeters to 2 cm, accounting for about 75% of the total samples. Lesions with size above 2 cm were seen seldomly, with the biggest one of 6—7 cm. According to the shapes and symptoms, lesions might be categorized as an acute and chronic ones. The acute lesions had a shape of oval or circle, with a swelling appearance, low signal of T_1WI, and isointensity or a slightly higher signal on the circle. T_2WI showed a high signal, with different increase and showing “core+lunar” sign. This kind of lesions showed an enhancement with the circle enhancement as the most typical one, which had a complete circle or non-conplete arc shape enhancement, even the big lesions. The chronic lesion might also be divided into two categories. One was the quasi-symmetric lesion, with the distribution along two sides of periventricle and with the shape of small puncture/patch, part of them merged into the big patch; another kind of lesions was found scattered sparsely at frontal, parietal lobes and two sides of the periventricle, with small patches in shape. The chronic lesions had an appearance of shrinking, sharp edge, even signals, and had no lunar circle phenomena and obvious enhancement.Conclusion Brain MS have diverse MRI appearence, with some of which are unique and symbolic.

Objective To assess the clinical history and MRI findings of pituitary adenoma of different hormonesecreting type.Methods We retrospectively studied 200 postoperated patients,from 1996 to 2000,who all had the preoperated MRI exams.All cases had histopathological evalutions.Both clinical presentation(age,sex,symtom,sign)and MRI findings(size,form,signal intensity,extension)were investigated.Results There was a great span of age with sixty percent owing for 35～55 years old.The male and female proportion was 1∶2 in PRL hormone-secreting pituitary adenoma.12 cases with luleinizing hormone-secreting and 2 cases with thyrotropin hormone-secreting pituitary adenoma were just male.In other types the incidences were similar in man and woman.Clinical symptom and sign present overlapping.The volume of tumor was from 0.5 cm?0.8 cm?1 cm to 6 cm?7 cm?8 cm with most multihormone adenoma's maxium dimension out of 5 cm.The signal intensity was not characteristic pre-and post-enhancement.No calcification could be seen.In term of extension,most was to suprasellar,then infrasellar,unilateral or bilateral sinus cavernous,last was to lower part of the third ventricle.Conclusion Different hormonesecreting pituitary adenomas have some speciality in clinical and MRI presentation.Although an accurate diagnosis can not be made according to it,more information have been obtained.

Parpose:To observe the therapeutic effects of the ricin's intervention in treating the hepatic carcinoma and to compare the restraint effect to bone manrrow caused by ricin and mitomicin C.Materials and Methods:Use human grafted hepatic carcinoma to naked rat as transplanted rat's liver cancer model.The therapeutic effects of ricin(4?g/kg)were compared with that of lipiodel-emusified riein(8?g/kg)and mitomicin C(500ug/kg)(all the dosages were of the one third of the LD50),with saline injected liver cancers as the control.To observe the tumour's growth inhibition rate,-FP hemogram and marrow change.Results:The growth of turners in group of ricin,lipiodel-emulified ricin,mitomicin C was inhibited,result in tumour necrosis.The inhibition in marrow showed more obvious in mitomicin C than in ricin.The- FP's reduction was significant in comparision with that of the control group,however,there were no remarkable difference among the three drug forms.Conclusion:Ricin has remarkable therapeutic effect on hepatic carcinoma.Ricin's emulsion was stable providing experimentd basis for the toxicity to marrow is clearly lower than mitomicim C

Objective To study MRI characteristics of the gray matter lesions in multiple sclerosis (MS) patients, and to investigate the occult damage in normal appearing gray matter (NAGM) by quantitative analysis using diffusion tensor imaging (DTI). Methods Conventional brain MRI and DTI were performed in 34 clinically defined MS patients and 25 non-MS healthy volunteers. Main signs of the GMlesions detected by conventional MRI were analyzed, including the distribution, numbers, shape, size,signal intensity and enhanced pattern. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values derived by DTI were measured in normal appearing deep gray matter for all participants and the differences between the two groups were compared. Results MRI examination revealed 83 lesions in cerebral gray matter, 18. 7% of the total 443 lesions. The GM lesions distributed over all brain lobes especially in frontal lobe, temporal lobe, and thalamus. Thirty-four, 60, 78, and 36 plaques were detected on T1WI, T,2WI, FLAIR, and reconstructed DWI images, respectively. Nine small lesions were identified on DWI more easily than on T2WI and FALIR. The ADC values of the head of caudatum (8. 0±0. 7) ×10-4mm2/s, t=-3.079, P<0.05), putamen (7.4±0.5)× 10-4mm2/s, t= -2.564, P<0.05),and thalamus (7.7± 0. 4) × 10-4mm<'2>/s, t = -2. 722, P < 0. 05) in MS group were significantly higher than those in healthy controls [ the ADC values of head of candatum (7.4 ± 0. 6) × 10-4 mm2/s, putamen(7.0±0.5) ×10-4 mm2/s,and thalamus(7.2±0.7)×10-4mm2/s]. Conclusions This study confirms the presence of GM damage in MS. It shows MRI characteristics of the macro-lesions, and combination of FLAIR and DWI can improve the detection of GM lesions. Occult micro-change in NAGM can be evaluated by using DTI quantitative analysis.

BACKGROUND:Hereditary factor occupies a certain position in suicidal behavior of depression. The researches in the past are focused on the hereditary effect on bipolar depression suicide.How do hereditary patterns and effects work in suicidal behavior in unipolar depression?OBJECTIVE: To probe into hereditary patterns and effects on suicidal behavior in unipolar depression.DESIGN:Retrospective investigation.SETTING:A municipal psychiatric hygienic centerPARTICIPANTS:Unipolar depression group included 115 outpatients and inpatients diagnosed in Wuxi Psychiatric Hygienic Center from June 1st 1983 to May 31st 2002.The diagnosis tallied with Standards on Depression Onset in Categories and Diagnostic Standards on Psychiatric Disturbance in China of 3rd Edition and with Standards on Severe Depression Onset in Manual of Diagnosis and Statistics of Psychiatric Disturbance in America of 4th Edition.The attack frequency of all the cases ≥ 3 times or the cases had been relieved ≥8 years after a couple of attacks.METHODS:The patients who tallied with the standards on unipolar depression received the investigation in every family tree under the instruction of 2 physicians-in-charge and more than 2 physicians and filled up the self-made investigation form of psychiatric family tree,including mainly the data of social demography of patients and their first grade relatives,characters of disease onset,frequency of attack,history of treatment and suicide. After re-diagnosed by 2 physicians-incharge and more than 2 physicians and checked by one physician-incharge,the cases were collected in patient group. The interview was carried on for the patients with suicidal behavior among all of the survived patients (107 cases) and first grade relatives (14 cases).The interview (337 cases) and investigation with letter (380 cases) were carried on for the first grade relatives without suicidal behavior. The investigation forms of 13 dead cases (8 cases of patients, 5 cases of first-grade relatives) were provided and filled-up by one or two first grade relatives. Two researchers interviewed the cases in the control,inquired the first grade relatives and filled up the investigation form of family tree.Single factor analysis was used for all the data and Falconer pattern of polygenetic threshold-value theory was used to estimate hereditary rate and standard error in suicidal behavior.Separation analysis in medical hereditary mathematic method and polygenetic threshold-value theory were applied to discuss the hereditary patterns.MAIN OUTCOME MEASURES:Hereditary effects and patterns of suicidal behavior in unipolar depressed patients.RESULTS:Suicidal risk of unipolar depressed patients(51.30%,59/115)was higher than their first grade relatives (2.58%,19/736) (x2=283.16,P ＜ 0.01).Suicidal risk of the first grade relatives (2.58%,19/736) of unipolar depressed patients was higher than the control (0.12%,3/2469)(x2=50.36,P ＜ 0.01).Suicidal risk of the first grade relatives of the patients with suicidal behavior (3.8%,14/372) was higher than that of the first grade relatives of the patients without suicidal behavior (1.4%,5/363)(x2=4.14,P＜ 0.05).The weighted average hereditary rate and standard error was (70.16±0.79)% for suicidal behavior in unipolar depression.The predictive morbidity of suicidal behavior in the first grade relatives was 3.1% and the real morbidity was 2.6%,which did not indicate significant difference (u =0.766, P ＞ 0.05).CONCLUSION:Suicidal behavior of unipolar depression presents obvious hereditary effects and its hereditary patterns tally with polygenetic inheritance.

OBJECTIVETo study the basic pathogenesis of "asthenia of healthy energy and blood stasis" in liver cirrhosis studied by Chinese syndromes and serum proteomics.

METHODSThe information of four methods of examinations and serum samples were collected from 44 cases of male cirrhotic patients and 17 cases of healthy male volunteers. The different syndrome groups were summarized according to syndrome differentiation and frequency analysis using the patient's information of four methods of examinations. The serum proteins were isolated by magnetic beads and detected by matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS). The proteins expressed differently between cirrhotic patients of different syndrome types and healthy volunteers were analyzed by statistical analysis software (product of Bruker Corporation ClinProTools 2.1 software). The diagnosis model was established by QC algorithm.

RESULTSThe liver cirrhosis syndrome with the appearance frequency of more than 30% was sequenced from high to low as fatigue, listlessness, spider telangiectasia, liver palms, anorexia, bleeding from the nose, the gum or the subcutaneous tissue, the abdominal distention, shortness of breath while moving, dim facial complexion, pricking pain of the flank, weak waist and knees, dull pain in the flank, burning sensation of five centers, or low fever, hectic fever, and night sweat. The cases belonging to Child-Pugh A in the seventeen patients of the Pi-qi asthenia syndrome group accounted for 64.7%. The cases belonging to Child-Pugh C in the twelve patients of the Gan-Shen yin deficiency syndrome group accounted for 66.7%. The cases belonging to Child-Pugh A were similar to the cases belonging to Child-Pugh C in the fifteen patients of the blood stasis syndrome group, being more than 40%. Such syndromes as spider telangiectasia, liver palms, shortness of breath while moving, burning sensation of five centers, or low fever, hectic fever, and night sweat, varicose vein of the abdominal wall, and edema of lower extremities appeared more frequently in Child-Pugh C than in Child-Pugh A (all P < 0.05). The characteristic protein expression peak with mass-to-charge ratio of 4642.81, 4963.91, 5247.8, 5805.95, 6305.27, and 12447.7 in the Pi-qi asthenia syndrome diagnosis model were chosen. The former five peaks could be found in Child-Pugh A and Child-Pugh C. The protein expression peak with mass-to-charge ratio of 9 290. 3 was the characteristic protein expression peak in the Gan-Shen yin deficiency syndrome diagnosis model. The protein expression peak with mass-to-charge ratio of 9290.06 and 7 768. 29 were down-regulated in the Gan-Shen yin deficiency syndrome group compared with the other two syndromes groups. The protein expression peaks 9290.3 and 7768.29 were included in the diagnosis model of hepatitis B cirrhosis. They did not appear in Child-Pugh A, while they were gradually down-regulated in Child-Pugh B and Child-Pugh C. Of the other seventeen protein expression peaks in patients of the Gan-Shen yin deficiency syndrome, eight expressed in Child-Pugh A. The protein expression peaks 4964.55 and 5806.83 that expressed both in Child-Pugh A and Child-Pugh C constituted the characteristic protein peaks of the hepatitis B cirrhosis blood stasis diagnosis model. The diagnosis model of the Pi-qi asthenia syndrome was established with the sensitivity of 100% and the specificity of 82.35%. The diagnosis model of the Gan-Shen yin deficiency syndrome was established with the sensitivity of 100% and the specificity of 94.12%. The diagnosis model of the blood stasis syndrome was established with the sensitivity of 100% and the specificity of 100%.

CONCLUSIONSAsthenia of healthy energy and blood stasis was the basic pathogenesis during the whole process of liver cirrhosis. Asthenia of healthy energy covers Pi-qi asthenia and Gan-Shen yin deficiency. Gan-Shen yin deficiency was obvious in the compensation stage of liver cirrhosis, but it has manifested in this stage. So early treatment was necessary.

Adult ; Aged ; Blood Proteins ; metabolism ; Case-Control Studies ; Humans ; Liver Cirrhosis ; blood ; diagnosis ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Proteomics ; Serum ; metabolism ; Yang Deficiency ; blood ; diagnosis ; Yin Deficiency ; blood ; diagnosis

OBJECTIVETo probe the safe depth and angle of needling the point Yaotu for treatment of prolapse of intervertebral disc.

METHODSCT technique was used for scanning investigation of the depth and angle of needling the point Yaotu.

RESULTSWhen the acupuncture needle was inserted vertically to the external space of intervertebral foramen of human body with arrival of qi, the tip of needle could reach to 73 mm deep, which is the best needling depth and angle.

CONCLUSIONThe needle vertically inserting to the external space of intervertebral foramen at the point Yaotu is proper in treatment of prolapse of intervertebral disc.

Acupuncture Analgesia ; Acupuncture Points ; Humans ; Intervertebral Disc Displacement ; therapy ; Lumbar Vertebrae ; Medicine, Chinese Traditional ; Tomography, X-Ray Computed

Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by paroxysmal tachycardia, increased blood pressure, tachypnea, hyperthermia, profuse sweating, abnormal posture or dystonia. It occurs in diseases such as moderate to severe brain injury, cerebral hypoxia, hydrocephalus, brain tumor and encephalitis. At present, the etiology and pathogenesis are still unclear, and it is easy to be misdiagnosed as epilepsy clinically. This article reports a 43-year-old male patient with late-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) confirmed by genetic testing. During hospitalization, he suddenly developed episodic involuntary limb movements, profuse sweating, tachycardia, and arterial hypertension. He was initially diagnosed with symptomatic epilepsy, but long-term electroencephalogram monitoring showed no synchronized discharge, and he was given antiepileptic drugs. The treatment was also ineffective. Brain magnetic resonance imaging revealed a new lesion in the left insular and insular operculum. Dexmedetomidine, baclofen, and gabapentin were given to suppress sympathetic nerve excitability. Drugs were effective, so the diagnosis was corrected to PSH. There is no report of MELAS complicated with PSH in the previous literature. It is speculated that it may be related to the low clinical cognition of PSH. In this case, new lesions in the insula and insular operculum appeared during the onset of PSH, suggesting that may be related to the pathogenesis of PSH.

Objective To firstly report the clinical features,diagnosis and treatment response of patients with anti-γ-aminobutyric acid type A receptor (GABAAR) encephalitis in China,thus raising neurologists' awareness of this emerging type of autoimmune encephalitis.Methods Specific anti-GABAAR autoantibodies in the serum and cerebrospinal fluid (CSF) of patients with suspected autoimmune encephalitis but negative for commercial available antibody tests were detected by live cell-based assay (CBA).The clinical features,laboratory examinations and treatment of two cases of autoimmune encephalitis with anti-GABAAR autoantibodies were analyzed,who admitted to Huashan Hospital,Fudan University between 2013 and 2014.Results By using live CBA,serum and CSF of the two patients diagnosed with possible autoimmune encephalitis both contained autoantibodies targeted to the GABAAR.These two patients had onset symptom of seizure or refractory seizures.Memory impairment,psychiatric symptoms and decreased consciousness were also presented.One patient was combined with mass in anterior superior mediastinum.Both patients had multifocal cortical and subcortical T2 /fluid attenuated inversion recovery-weighted images hyperintensity signal on brain magnetic resonance imaging.The two patients had poor response to antiepileptic drugs,but showed noticeable recovery with sufficient immunotherapeutic treatments.Conclusions Anti-GABAAR encephalitis is characterized by prominent epilepsy and multifocal abnormalities on brain magnetic resonance imaging.Autoantibodies specifically against GABAAR could be detected by CBA in this group of patients.Early diagnosis and immunotherapy are critical to improve clinical symptoms and outcomes of the disease.

Objective To conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above. Study subjects would include those with characteristics of TB suspicious symptoms,diabetes and close contacts. Methods Purpose-sampling method was applied to choose 3 counties in Shandong province as the study sites,relying on the local basic public health service,for those elderly under 65 years old or above. The study team would introduce the process and contents of this study to the subjects followed by chest X-ray and sputum smears on those registered tuberculosis suspects,patients with diabetes,TB close contacts in the past 2 years,from January to September,2013. Results 82 active pulmonary TB cases were identified among 9 041 cases who received the examination,with a crude prevalence rate as 9.1‰. From patients having both suspicious TB and diabetic symptoms,patients with diabetes or having suspicious symptoms of TB,the prevalence rates of active TB were 115‰,3.4‰,0.9‰respectively. No active pulmonary TB case was found in the TB close contacts,patients with diabetes,or those people with suspicious TB symptoms. TB prevalence rates among all the above mentioned groups were significantly different(χ2=697.478, P=0.000). Prevalence rate of active pulmonary TB with diabetes was 18 times(RR=17.951)higher than those non-diabetic patients,and 2 times higher than those with suspicious symptoms (RR=3.860). Results from single factor analysis showed that diabetes were closely related to the prevalence of pulmonary tuberculosis(χ2=46.637,P=0.000),the longer duration of diabetes and the higher risk of tuberculosis (RR>1). Conclusion Our data showed that active pulmonary TB prevalence was high in elderly diabetes patients which suggesting that‘Key crowd screening program’should be introduced into case-finding strategy on TB,with special focus on TB patients with diabetes or those people having suspicious symptoms of TB.