Objective To investigate the clinical application and manifestation of dynamic contrastenhanced MRI (DCE-MRI) in differentiating true progession from pseudoprogression in patients with gliobastomas.Methods Twenty five glioma patients were treated with postoperative concurrent chemoradiotherapy and enrolled in this study.All patients were underwent DCE-MRI using a 1.5T scanner.Fifteen patients were confimmed by secondary pathology or clinical and imaging follow-up of patients with gliomas true progession (TP),10 patients were pseudoprogress (PP).Nonparametric Mann-Whitney test was used to compare perfusion parameters between two groups (TP and PP),were used for receiver operating characteristic (ROC) curve analysis to clear if these parameters can be the indicators to differentiate true progession from pseudoprogression.Results Ktrans (volume transfer constant),Ve (fractional volume of extravascular extracellular) values between TP and PP glioma groups were statistically significant,K and Ve values were significantly higher in the TP group than in the PP group (P ＜ 0.05).The areas under the ROC curve are 0.990 and 0.847,respectively.Kep (efflux rate constant) value,Vp (fractional volume of plasma) value in the identification of glioma TP group and PP group was not statistically significant (P ＞ 0.05).Conclusions DCE-MRI can be used to identify glioma TP and PP,Ktrans value and Ve value have clinical significance.

Objective To explore the characteristics of MRI images and pathological features of demyelinating pseudotumor (DPT).Methods Five patients with demyelinating pseudotumor were histologically confirmed.Their MR imaging were re-viewed and the enhancement patterns were analyzed.Results Among the five cases with demyelinating pseudotumor,single le-sion was found in 4 cases,and multiple lesions in 1 case.Most lesions had a clear boundary and these space occupying lesions were irregular (3 cases).The signal intensity on T1 WI was lower than edema,and it had a specific “core and halo”feature,du-al-high signal with different intensity on T2 WI,slightly higher signal intensity on DWI,and on enhanced MRI,nodular or patch-y enhancement and open ring enhancement with edema around the lesions were observed.The pathological results showed that the demyelination occurred but the neuraxon survived,lymphocytes were infiltrated,glial cells were proliferated,megakaryo-cytes also could be found,and multiple monocyte-macrophages were all around the lesions.Conclusion The MRI of DPT has some characteristic features.

Objective To investigate the surgical operation technique,clinical curative effect and the choice of the indication in the treatment of cervical spondylosis by radiofrequency nucleoplasty.Methods From January to July in 2006,the ArthroCare system 2000 radio frequency instrument that the American ArthroCare company produce were odopted,to treat 20 patients with cervical spondylosis by radiofrequency nucleoplasty under the leading of the C form grill X-ray fluoroscopic machine.Among them,there were 9 males and 11 females with age from 38 to 62 years,equally 45.12 years old,the average course of illness was 2 years. 15 cases with lumbar disc herniation,4 cases with nerve-root cervical sDandylosis and 1 case with spinal cervical spondylosis.Single segment affection in 4 cases,double or multistage segment affection in 16 cases.Among those multistage segment eases,all choose 2 segments for research according to fixed physical sign the body advertise for and the MRI image.After the operation all cases underwent follow-up.with follow-up time for 1-6 months.Results The results shown an effect among those 20 sufferers of excellence in 16 cases,valid in 4 cases,efficient power reach to 100%in short term.Ahhough this case was limited.the early case choice compares strictly,the subjective satisfaction of sufferer was higher.Conclusion Application of radiofrequency nucleoplasty in the treatment of cervical sDondylosis has advantages of small wound,safety and high efficacy in short term.However, its indication still need further research.

Objective To evaluate the academic level of Chinese Journal of Internal Medicine by analyzing its citation status by using bibliometrics method.Methods The distribution of articles published in Chinese Journal of Internal Medicine from January,2005 to December,2011 indexed by Chinese Science Citation Database (CSCD) was analyzed.Results A total of 2809 articles were published in Chinese Journal of Internal Medicine between January,2005 and December,2011.Among them,832 (29.62％) articles were cited for totally 1993 times.There were 14 authors whose total citation number in 2005-2011 was ≥ 10 times.Authors of the cited articles came from 25 provinces,autonomous regions and municipalities.The regions from where the articles had the highest citation were Beijing (341 articles),Shanghai (87 articles),Guangdong (64 articles),Jiangsu (45 articles) and Zhejiang (43 articles).The medical institutions with the highest citation were Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences (205 times),Peking University People's Hospital (77 times),and Chinese PLA General Hospital (76 times).Conclusions Quite a few high level academic papers had been published in Chinese Journal of Internal Medicine in recent years.Chinese Journal of Internal Medicine plays a good role in enhancing academic exchange.

Objective To analyze the articles and citation published in the Chinese Journal of Internal Medicine from 2008 to 2010,in order to investigate the influence factors of impact factor (IF).Methods All articles published in the Chinese Journal of Internal Medicine covered by Chinese Medical Citation Index(CMCI) from 2008 to 2010 were searched and downloaded.Some article related attributions were manual added and their influences to IF were analyzed.Results A total of 1164 academic papers were published in the journal in 3 years,with 9.95 references per paper.The total citation was 1029 times,with 0.93 time per paper and 0.31 time per page.Among them,736 articles were not cited,accounting for 63.2％.Original articles,pure clinical articles had good citation output.For fund supporting,the citation of articles without fund was higher than those with fund.The articles on hematology,cardiology and gastroenterology accounted the most,while ICU,emergency and nephrology were the least internal medicine reported specialties.Although there exists citation difference among different subjects,for considering the absolute values,neurology/psychiatry (0.73 time per paper),cardiology (0.65 time per paper) and gastroenterology (0.54 time per paper) had better citation output,while hematology,basic research and rheumatology had no good performance to IF.Conclusion We should further strengthen acquisition and dissemination of excellent articles,reduce the number of non-cited paper,expand periodical visibility,and provide a quick and convenient way of literature reading.

Objective:To investigate the long-term efficacy of self-designed posterior atlas polyaxial screw-plate in the treatment of unstable atlas fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 20 patients with unstable atlas fracture who were admitted to Affiliated Honghui Hospital of Xi′an Jiaotong University from January 2011 to April 2013, including 14 males and 6 females, aged 23-60 years [(42.7±8.6)years]. All the patients were treated with internal fixation using self-designed posterior atlas polyaxial screw-plate. The operation time and intraoperative bleeding volume were recorded. The fracture reduction was evaluated by CT scan at 3 days after surgery. The bone healing was observed by X-ray (anterior-posterior and lateral views of the cervical spine) and CT scan at 9 months after surgery. The delayed spinal cord injuries were evaluated by Frankel grade at 1 and 2 years after surgery and at the last follow-up. The Visual Analogue Scale (VAS) before surgery, at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. The axial rotation, flexion and extension range of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. Intraoperative and postoperative complications were observed.Results:All the patients were followed up for 121-148 months [(135.0±6.8)months]. The operation duration was 68-122 minutes [(86.0±14.1)minutes], with the intraoperative blood loss of 90-400 ml [(120.0±67.9)ml]. The CT scan of the cervical spine at 3 days after surgery showed all satisfactory fracture reduction. Satisfactory bone reunion was observed at 9 months after surgery. All patients were scaled as Frankel grade E at 1 year, 2 years and at the last follow-up after surgery, with no delayed spinal cord injuries observed. The VAS scores of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were 2.0(1.3, 3.0)points, 1.0(1.0, 1.8)points, 1.0(0.3, 1.0)points and 1.0(0.3, 1.0)points, which were significantly lower than that before surgery [7.0(6.0, 7.8)points] ( P<0.05), with significantly lower scores at 1-, 2-year after surgeny and at the last follow-up than at 3 months after surgery ( P<0.05). There were no significant differences among the other time points ( P>0.05). The axial rotation ranges of the cervical spine were (103.0±8.3)°, (128.3± 11.4)° and (129.8±13.6)° at 1 year, 2 years after surgery and at the last follow-up respectively, which were significantly higher than that at 3 months after surgery [(85.3±7.0)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference at the last follow-up compared with that at 2 years after surgery ( P>0.05). The flexion and extension range of the cervical spine at 1 year, 2 years after surgery and at the last follow-up were (65.5±4.8)°, (78.3±6.5)° and (79.3±6.9)° respectively, which were significantly higher than that at 3 months after surgery [(54.3±4.4)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference between the last follow-up and 2 years after surgery ( P>0.05). No intraoperative injuries such as arteriovenous injury were observed. No incision infection or dehiscence occurred after surgery, with no complications caused by long-term bed rest such as lung or urinary tract infection, pressure sore formation or deep vein thrombosis occurred. No loosening or breakage of the screw and atlas plate was observed at the long-term follow-up. One patient had mild cervical pain, snap during rotation, and limited range of motion at the last follow-up. Conclusion:Self-designed posterior atlas polyaxial screw-plate has merits including small surgical wounds, satisfactory reduction, solid fixation, obvious pain relief, effective preservation of the previous cervical motion, few complications, and satisfactory long-term efficacy in the treatment of unstable atlas fracture.