ALS is a progressive neurodegenerative disease affecting both lower and upper motor neurons,including the pyramidal tract.There have been no objective and effective method to evaluate the lesions of upper motor neurons.With non-invasive,sensitive and macroscopic advantages,the application of Regular MR,MRS,DWI,function MR and VBM on ALS will undoubtedly have great potentials in the diagnosis,disease monitor and therapy of ALS.

Objective To review the clinical features of lung nodule and the common misdiagnosed reasons and diseases. Methods A total of 44 literature on misdiagnosed lung nodule in the latest ten years were reviewed and their clinical characters, diagnosis methods were analyzed. Results Forty-four relative literatures were found, in which there were 319 misdiagnosed cases. The median of onset age was 43 years. Female patients were more than male. Cough, chest distress and fever were primary symptoms. 46. 39% of the patients were characterized with hilus of lung lymphadenectasis symmetrically. The most common misdiagnosis were tuberculosis, lung cancer and lymphadenoma ( 53.61%, 25. 71% and 10. 34% ). Majority of patients were correctly diagnosed by biopsy, especially through transbronchial lung or mucosa biopsy or lymphaden biopsy. Conclusion Clinicians should improve the understanding on lung nodule and comprehensively analyze and differentiate it with other diseases to reduce the misdiagnosis.

This article was aimed to research the spray drying technology of instant Asini Corii Colla. HPLC was used. Contents of four kinds of amino acid and collection rate of powder were used as the indexes. The single factor experiment and orthogonal test were combined in the optimization of process conditions. The results showed that the best technology of spray drying technology was medicine liquid density of 1.10 (determined under the temperature of 60℃), inlet air temperature at 165℃, the pressed air speed was 45 L·h-1, the fluid speed was 15%. It was conclud-ed that the technology was reasonable and reliable, which can provide certain reference in the industrial production.

Objective:To observe the effect of partial liquid ventilation (PLV) on gas exchange,pulmonary compliance and blood dynamics in the pulmonary edema rabbits after seawater drowning(PE-SWD). Methods:Totally 42 healthy male New Zealand rabbits were randomly allocated into 3 groups (n=14);each group was treated with various methods after PE-SWD model was established:PE group with no treatment,CMV group with conventional mechanical ventilation and positive end-expiratory pressure(PEEP),PLV group with CMV,PEEP and FDC.After being treated for 3 h,blood gases,pulmonary mechanics,hemodynamics,pulmonary histopathology and survival time were observed.Results:In PLV group,PaO 2 increased obviously and reached (262.84?64.33) mmHg (1 mmHg=0.133 kPa), airway pressure decreased by 23.4%,pulmonary static compliance increased by 31.3% and TNF-? decreased by 24.9%.HR and MAP showed no significant changes after treatment compared with PE group.Conclusion: Pulmonary gas exchange and compliance are improved significantly during PLV in the PE-SWD rabbits without obvious influence on hemodynamic status, although the survival time of PLV group is less than that of CMV group.

Background and purpose:Tamoxifen is the main endocrine therapy of premenopausal breast cancer with positive hormone receptors but numerous patients have developed advanced refractory breast cancer due to drug resistance.Our study investigated the role of combining oophorectomy and exemestane in the treatment of advanced refractory breast cancer.Methods:Oophorectomy was carried out in all patients.Exemestane was administered orally (25 mg/d) one week after the operation.The median time of progression (TTP),the median survival time as well as the survival rate were calculated using the Kaplan-Meier methods.Results:Seventeen patients ranging between the ages of 26 and 44 years (median:36 years) were treated resulting in an overall response rate of 64.70%,TTP was 8 months and the median survival time was 31 months.The survival rates for 1 year,3 years and 5 years were 88.24%,64.71%,29.41%,respectively.No grade Ⅲ and Ⅳ side effects appeared.Conclusion:Oophorectomy when combined with exemestane showed antitumor activity for advanced refractory premenopausal breast cancer through positive hormone receptor and it is also well-tolerated.

BACKGROUND: Nano-hydroxyapatite has been widely used as reconstructive and prosthetic material for osseous tissue, owing to its excellent biocompatibility and bioactivity. But, its brittleness is one of the most serious obstacles for its wider applications as load-bearing implants. Therefore, hydroxyapatite/chitosan composites have been widely studied as bone substitute, due to their excellent biocompatibUity and suitable mechanical properties.OBJECTIVE: To review various preparation methods of hydroxya patite/chitosan composites and the development trend in this field.METHODS: Articles were searched in Medline Database (1995-01/2009-03), VIP Database (1995-01/2009-03) and "qinghuatongfang" Database (1995-01/2009-03) with the keywords of "nano-hydroxyapatite, chitosan, preparation, development trend".RESULTS AND CONCLUSION: Total 2 034 related articles were collected, including 1 634 in Chinese and 670 in English. Following excluding earilier published, duplicate, and similar studies, we brought into 37 sub-standard literatures. Hydroxyapatite/chitosan composite in nanometer size, with similar structure as natural bone, has better biological function compared with corresponding micrometer composite. Simultaneously, optimized material composition, structure and technology will obtain more suitable bone substitute in mechanical property compared with natural bone. This paper reviews preparation methods at home and abroad in recent years, with the rapid development of biological materials, hydroxyapatite compositematerials have been wisely used in bone tissue repair and replacement surgery, but its poor mechanical properties limits its clinical application.

Objective To evaluate the clinical significance of the axillary conservative surgery by sentinel lymph node biopsy (SLNB) using preoperative lymphoscintigraph technique with 99mTc-SC and methylene blue in early-stage breast cancer patients. Methods The sentinel lymph node (SLN) of 187 patients were located with preoperative lymphoscintigraph technique with 99mTc-SC and labeled with methylene blue during the operations. The metastasis of SLN was detected using frozen section technique. There were 51 patients whose SLN were positive having been carried with modified radical mastectomy of breast cancer and axillary lymph node dissection (ALND), 136 patients' SLN were negative,58 patients of those were carried with mammectomy or partial mastcctomy and ALND (group A),while 78 patients were carried out with mammectomy or partial mastectomy only (group B). The sentinel lymph nodes were detected with HE stain after surgery. All the patients were treated with chemotherapy,and the patients with partial mastcctomy must be treated with radiotherapy. There were 2 patients with micrometastasis in group B being treated with mammectomy or partial mastcctomy only,and carried out with ALND again. Results The number of cases with upper limb numbness, edema, dysfunction in group A were 36,8 and 45 cases, in group B were 2,0,0 case respectively. Group A compared with group B was increased significantly (P< 0.05). The number of local recurrence within 1, 3 and 5 years were 0,0,2 cases;lymphatic metastasis were 1,5,8 cases; the distant metastasis were 2,8,12 cases; the disease-free survival were 60,57,49 cases. In group B, the number of local recurrence within 1, 3 and 5 years were 0,0,6 cases, lymphatic metastasis were 3,8,12cases,the distant metastasis were 4,8,16 cases,the disease-free survival were 76,70,61 cases. There were not significant differences between the two groups(P> 0.05). Conclusion It is simple and accurate to carry out SLNB using preoperative lymphoscintigraph technique with 99mTc-SC combined with methylene blue,and the effect is reliable.

Objective To assess the correlations between muscle strength and amplitude of compound muscle action potential(CMAP)with blood potassium level in hypokalemic periodic paralysis after long exercise test(ET).Methods ET of abductor digiti minimi(ADM)was performed on 78 patients with hypokalemic periodic paralysis.Ulnar and median CMAP amplitude,blood potassium level,muscle strength of ADM,palmar interossei muscle and abductor pollicis brevis were measured before and 120 minutes after exercise.The correlations of muscle strength,CMAP amplitude and blood potassium level were analyzed.Results Ulnar CMAP amplitude was(4.6 ±2.7)mV after ET and(9.6 ±3.2)mV before ET(t =16.047,P =0.000)in 78 patients with hypokalemic periodic paralysis,respectively.Median CMAP amplitude was(10.9 ± 4.2)mV after ET and(11.2 ± 3.9)mV before ET(t =0.673,P =0.822),respectively.After ET,muscle strength of ADM decreased in 76 patients,score on MRC was less than Ⅲ in ADM but V in palmar interossei muscle and abductor pollicis brevis in 41 patients,the blood potassium level was tested in 10 of them,which was(3.8 ±0.3)mmol/L before ET and(3.9 ±0.4)mmol/L after ET(t =0.395,P =0.702).Conclusion In patients with hypokalemic periodic paralysis,blood potassium level is not the key factor affecting muscle strength and CMAP amplitude after ET.

Objective to assess the utility of segmental motor nerve conduction study in differential diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy(CIDP)and Charcot-Marie-Tooth type 1(CMT1).Methods A segmental motor nerve conduction study was performed on 16 patients with CIDP and 13 patients with CMT1.Distal motor latency,motor nerve conduction velocity,the changes of amplitude,area and duration of compound motor action potential over conventional segment were compared between the groups.ResultsDistal motor latency was (5.6±3.4) ms in CIDP and (9.3±2.1) ms in CMT1(t=5.347 P=0.000),motor nerve conduction velocity was (31.1±14.3) m/s in CIDP and(22.2±5.8)m/s(t=6.369,P=0.000),M50 of the decrease in amplitude over conventional segment was 29.7% in CIDP and 4.9% in CMT1 (Z=7.141,P=0.000).Distal motor latency was normal in 40.3% (25/62) nerves and motor nerve conduction velocity was normal in 18.1% (26/44)of segments in CIDP,while distal motor latency and motor nerve conduction velocity were abnormal in all nerves in CMT1.Motor nerve conduction block or abnormal temporal dispersion was detected in 29.2% segments in CIDP and 3.0% in CMT1 (x2=20.829,P=0.000).Conclusions The segmental motor nerve conduction study can help separate CIDP and CMT1.When motor nerve conduction block or abnormal temporal dispersion is detected,the motor nerve conduction velocity is distinctly various in different segments,the diagnosis of CIDP but not CMT1 should be considered.

Objective To investigate the F-wave and nerve conduction in patients with amyotrophic lateral sclerosis (ALS) and explore the correlation between these parameters and muscle strength, disease duration and onset site.Methods The data of outpatients and inpatients diagnosed with ALS were collected in Peking Union Medical College Hospital from January 1997 to May 2008.Standard sensory and motor nerve conduction study of the median nerve, ulnar nerve and tibial nerve was performed in 205 patients with ALS.F-wave velocity and frequency was measured in median nerve.Parameters for analyses included sensory conduction velocity and amplitude, distal motor latency (DML), and compound muscle action potential (CMAP) amplitude.Correlation between muscle strength and DML, CMAP amplitude or F-wave frequency were also explored.Results Delayed DML of the median nerve, ulnar nerve and tibial nerve were found in 24.9% (48/193), 15.3% (25/163), 21.2% (7/33) of patients respectively.Decreased CMAP amplitudes were found in 57.0% (110/193), 49.7% (81/163), 39.4% (13/33) of patients respectively.Decreased F-wave frequency of the median nerve was found in 68.9% (122/177) of patients.The abnormality of DML,CMAP amplitude and F-wave frequency of median nerve were increased in weaker muscles.Decreased median nerve CMAP amplitude (81.5% (53/65)) and F-wave abnormality (decreased persistence 70.9%(44/62), absent responses 45.1% (28/62)) in spinal onset groups were significantly higher than those in bulbar onset groups (CMAP 32.4% (11/34); F-wave: decreased persistence 38.2% (13/34), absent responses 14.7% (5/34); x2 = 23.629, 9.753, 9.029,all P <0.01).Compared with the bulbar onset group,the abnormality of DML in spinal onset group was higher, but not reach statistical significance.Logistic regression revealed a strong direct association between decreased CMAP amplitudes and upperextremity muscles strength, disease duration and onset symptom.Abnormality of F-wave frequency was associated with upper-extremity muscles strength and onset symptom.Conclusions Delayed DML and decreased amplitude of CMAP are found in ALS patients.CMAP amplitude is a sensitive parameter related to the severity of ALS.F-wave velocity is relatively normal while F-wave frequency of the median nerve is correlated with muscle strength.Decreasing CMAP amplitude and F-wave frequency are correlated strongly with muscle weakening,disease duration and symptom onset over limbs.