Objective To study the conventional MRI features of adult Japanese encephalitis (JE)and explore the early features of diffusion weighted imaging(DWI).Methods Thirty-two patients with adult JE were included.MR scanning including T1 WI,T2 WI and FLAIR were done in all patients,and DWI in 28 patients.Twenty-three patients received DWI in the early stage (within 1 to 7 days),in which the appearances of DWI were analyzed,ADC graphs were obtained and the signal noise ratio and the ADC values of lesions were calculated.Results Twenty-eight cases were abnormal on MRI,and 4 patients were normal.The lesions of JE involved the thalamus in 22 cases,the substantia nigra of midbrain in 13,kellogg’s seahorse in 9,the basal ganglia in 7,the splenium corpo-ris callosi in 4,the pons in 6 and the insular lobe in 2,extensive cerebral edema in 2.The early features of DWI in 23 patients showed cytotoxic edema in 2,vasogenic edema in 12,both two edemas existing in 5,and normal in 3.DWI were superior to T2 WI in 6 cases,and T2 WI were superior to DWI in 9 cases,DWI was similar to T2 WI in 5 cases on showing the size and signal of the le-sions.Conclusion Adult JE often occurs in the thalamus,substantia nigra of midbrain and kellogg’s seahorse.DWI shows vasogenic edema in the early stage.Comprehensive analysis of DWI,ADC and T2 WI details helps to early detection and qualitative adult JE le-sions.

Objective To study the serum levels of homocysteine(Hcy) and the polymorphism of C677T mutation of methylenetetrahydrofolate reductase (MTHFR) gene in pregnant women to explore their role in the pathogenesis of pre-clampsia. Methods Fifty pregnant women with preclampsia (study group) including 14 mild pre-eclampsia and 36 severe pre-eclampsia and 40 healthy ones (control group) were selected. Hey concentration was determined by fluorescence polarization immunoassay. The mutations of the 677C→T and 1298A→C of MTHFR were investigated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results The mean level of plasma Hey in the study group was higher than that of control 1(12. 00±4. 59) μmol/L vs (7. 85:1:1.51) μmol/L, P<0.05], and that of the severe pre-eclampsia group was higher E(13. 30±2. 06) μmol/L, P<0. 01]. However, no significant difference was found between the control and the mild pre-clampsia group[(8. 63±3. 94) μmol/L, P>0.05]. There was significant difference in the genotype frequencies of MTHFR 677CT, TT genotype(C/T:42.0% ;T/T:14. 0%)and the total frequency of mutant T (T: 35.0%) allele between the study and control groups (P < 0. 05). Conclusions Hyperhomocysteinemia plays an important role in the pathogenesis of pre-clampsia. The polymorphism of MTHFR C677T might be associated with the development of pre-clampsia as it affects the metabolism of Hey.

Objective To evaluate the clinical application of MRI guided percutaneous biopsy for the lesions of infratemporal space.Methods An open design 0.2T MRI set was used for MRI guided percutaneous biopsy in seven patients with the masses of infratemporal space. Results Of this series, the accuracy of needle puncture was 100% with diagrostic accuracy of 85.7% and no complications.Conclusions MRI guided percutaneous biopsy is helpful in the diagnosis for the lesions of infratemproal space.

Objective To evaluate the surgical procedures and clinical efficacy of endoprosthetic replacement as a salvage procedure for intertrochanteric fracture suffered failure of internal fixation.Methods The study involved 18 intertrochanteric fracture patients that suffered failed internal fixation from 2001 to 2009,including 16 patients with failed dynamic hip screw (DHS) fixation and two with failed proximal femoral nail anti-rotation (PFNA).The patients were at mean age of 76.5 years (range,58-92 years).The treatment methods included total hip arthroplasty in five patients and the bipolar hemiarthroplasty in 13.Harris score was used to evaluate the function outcome during the follow-up.Results The mean operation time lasted for 115 minutes,with intraoperative blood loss of 500 ml.Two patients presented with intraoperative complications.Of all the patients,three patients died within three months after operation and three patients were lost to follow-up.The remaining 12 patients received complete follow-up for a mean of 2.3 years ( range,1-7 years).One patient with hip joint dislocation was treated with closed reduction and distraction for three weeks.At the latest follow-up,the pain disappeared or was reduced in all the patients,including two patients with moderate pain and four with mild pain after some movements.The average Harris score was increased from preoperative 34 points to 83 points at one year after operation.Conclusions Endoprosthetic replacement is an effective salvage procedure for the failed treatment of the intertrochanteric fracture,as it can attain satisfactory pain relief and functional improvement.

ObjectiveTo compare the CT features of retroperitoneal ganglioneuroblastoma (GNB) and neuroblastoma (NB) in children,and summarize the differentiations between them.Methods From November 2007 to November 2011,19 patients with GNB and 21 patients with NB proven pathologically were enrolled in the study.The CT data of GNB and NB were analyzed retrospectively.These tumor parameters in CT included lesion location,size,shape,margin,calcification,across central line,style of contrast enhancement,degree of contrast enhancement,presence of small vessels in or around the tumor arranged in clumps or in line,tumor embolus,adjacent organs invasion or metastasis,lymph node metastasis,and relationship between tumor and surrounding great vessels.These parameters of both groups were compared by x2 and t test.ResultsIn GNB group,11 patients were located in adrenal gland and 8 patients in the retroperitoneal sympathetic chain; however,in NB group,18 patients were located in adrenal gland and 3 patients in the retroperitoneal sympathetic chain. The difference were statistical significances in the incidence rate of regular morphology,clear border,vessel encased by tumor,vessels displaced,presence of small vessels in /around the tumor arranged in clumps or in line,adjacent organs invasion or viscera metastasis,lymph node metastasis between NB (6/21,7/21,14/21,7/21,11/21,10/21,and 11/21,respectively) and GNB ( 12/19,13/19,6/19,13/19,4/19,3/19 and 4/19,respectively) ( P ＜ 0.05 ).However,there was no statistical significance in size,calcification,across central line,contrast enhancement type,contrast enhancement degree between them ( P ＞ 0.05 ).ConclusionsNB are more likely located at adrenal gland and presented a higher incidence rate of presence of small vessels in or around the tumor which arranged in clumps or in line,vessel encased by tumor,adjacent organs invasion or metastasis and lymph node metastasis.Regular morphology,clear border and vessels displaced are more frequently observed in GNB.

Objective To compare the clinical effects of patellar resurfacing with patella reservation and patellaplasty in the total knee arthroplasty(TKA)for osteoarthritis so as to discuss appropriate management of patellas in TKA.Methods A retrospective study was conducted on 198 patients with osteoarthritis treated by TKA from January 2002 to December 2008.There were 62 patients managed by patellaplasty(patellaplasty group)and 136 patients by patellar resurfacing with patella reservation(patellar resurfacing group).The osteophytes of the patella were removed to make the articular surface of patellas similar to the primary one.Knee Society Score(KSS),Bristol patellar score,satisfaction survey and evaluation of joint range of motion(ROM)were performed during the regular follow-up.Incidence of postoperative anterior knee pain were analyzed and X-ray films were reviewed to understand the condition of the implants.Results A total of 125 patients were followed up,including 43 patients from the patellaplasty group and 82 from the patellar resurfacing group.The mean follow-up period was 51 months(range,36-80 months).Both groups showed significant improvement of each score postoperatively.No significant differences were found between the two groups regarding KSS score,patellar score and patient satisfaction in the follow-up one year later;but KSS function score in the patellar resurfacing group was superior to that in the patellaplasty group,with statistical difference.The incidence of anterior knee pain of the two groups had no statistical significance.Postoperative radiographs revealed no significant differences between the two groups concerning patellofemoral congruence,incidence of postoperative anterior knee pain or incidence of patellar related complications.Conclusion Patellar resurfacing with patella reservation for osteoarthritis in TKA can achieve satisfactory patellofemoral congruence and low incidence of intraoperative anterior knee pain,with comparable mid-term results with patellaplasty.

Background and purpose:The expression of ERβin triple negative breast cancer(TNBC) might be associated with good prognosis in TNBC patients. ERβand ERαhave considerable homology. FOXA1 plays an important role in ERαexpression and function. The aim of this study was to analyze the expression of FOXA1 and ERβin TNBC and the relationship between them and the clinicopathologic characteristics and prognosis. Methods:The breast cancer samples in Peking Union Medical College Hospital were collected from Nov. in 2011 to Dec. in 2013, and TNBC were screened out based on the expression of ERα, PR and HER-2. Thirty ERβ-negative samples and 30 ERβ-positive samples were selected randomly according to the ERβexpression. We used immunohistochemical method to detect the expression of FOXA1. Finally, 48 TNBC samples were obtained to analyze the results. Results:The total positive rate of FOXA1 was 35.4%(17/48). In the ERβ-positive group, the positive rate of FOXA1 was 35.7%(10/28),and in the ERβ-negative group, the positive rate of FOXA1 was 35% (7/20). The expression of FOXA1 in these 2 groups had no signiifcant difference (P=0.83), which indicated that there was no relation between ERβand FOXA1. The FOXA1 positive group and FOXA1 negative group also showed no signiifcant difference in age, tumor size, and lymphatic metastasis number in axilla, tumor grade, tumor stage, NPI and DFS. However, Ki-67 showed negative correlation with FOXA1 expression (P<0.01). Conclusion:FOXA1 expression had no relationship with ERβexpression in TNBC. Ki-67 showed negative correlation with FOXA1 expression, which might hint that the proliferation of tumor cell was lower in FOXA1 positive TNBC.

Objective:To compare the concordance between subjective experience and clinician-rated in different treatment phrase of elderly patients with depressive disorder,and to explore the relevant factors.Methods:Sixty-nine consecutive elderly patiems with depressive disorder diagnosed with International Classification of Diseases-10 criteria were included.The Visual Scale for Depression(VSD) were used to evaluate subjective experience of depression,while the Hamilton Depression Scale (HAMD),Hamilton Anxiety Scale (HAMA),Minimum Mental State Examination (MMSE) were used by clinician to evaluate depression symptom,anxiety symptom and cognition at baseline,2-,4-and 52-week of the treatment respectively.Results:Compared with baseline,VSD scores were increased at 2 weeks and 4 weeks [(2.7 ± 1.6),(5.3 ± 2.0) vs.(7.0 ± 1.8),P ＜ 0.001],HAMD scores were decreased at 2 weeks and 4 weeks [(36 ± 11),(17 ±9) vs.(9 ±8),P ＜0.001],HAMA scores were decreased at 2 weeks and 4 weeks [(27 ± 10),(14 ±8) vs.(7 ±6),P ＜0.001].No significant differences were found between 4 weeks and 52 weeks.There was no correlation between VSD and HAMD scores at baseline and 2 weeks.There were significant correlations among scores of VSD and HAMD(r =-0.31,-0.74,Ps ＜ 0.05),HAMA (r =-0.36,-0.76,Ps ＜ 0.05) at 4 weeks and 52 weeks.Using logistic regression analysis,the concordance between VSD and HAMD related with the factors of HAMD,higher scores of anxiety/somatization factor were associated with lower concordance (OR =0.87),and higher scores of weight factor (OR =1.86),diurnal variation factor (OR =2.00),hopelessness factor (OR =1.13) were associated with higher concordance.Conclusion:Compared with acute depression phase,concordance between subjective experience and clinician-rated for depression may be higher at depression remission phase in elderly patients with depression,which suggests that characteristics of depression symptom may have a certain impact on the self-awareness for depression experience.

Objective The calcium oxalate stone is the most common type of the kidney stones.By building the rat renal calcium oxalate stone model, preliminary study the function of CaSR-Claudin14 regulating pathways on renal calcium oxalate stone for-mation model in rats. Methods 30 Male S-D rats were randomly divided into control group (n=15) and model group (n=15). Adult male S-D rats were given ethylene glycol and ammonium chloride to induce urolithiasis.Application of full automatic biochemical analyzer to test rat renal function and the changes of urine biochemical index.Immunohistochemistry was used to detect the expression of CaSR protein;RT-PCR was used to detect the Claudin-14 mRNA expression;Western Blotting was used to detect the expression of CaSR and Claudin-14 protein respectively. Results By observing model group has large stones crystallization under light microsco-py;model group rats 24 h urine calcium are significantly higher than control group([9.66 ±1.10]mmol vs [3.26 ±0.60]mmol, P<0.01); and model group 24 h urine volume are significantly higher than control group ([21.27 ±1.08]mL vs [13.2 ±0.55]mL, P<0.01 ); and urinary PH has no significant difference between the groups( P >0.05 ) .Expression of Claudin-14 mRNA in the model group is significantly higher than normal control group([0.150 ± 0.004] vs [0.047 ±0.008], P<0.01); Expression of Claudin-14 protein in the model group is significantly higher than normal control group([1.526 ±0.089] vs 0, P<0.01).Expression of CaSR protein in the model group is significantly higher than normal control group([6.697 ±0.051] vs [5.016 ±0.053], P<0.05). Conclusion CaSR can raise the expression of Claudin-14, increase re-nal tubular urinary calcium excretion to promote renal calcium oxalate stone formation.

Objective To explore the difference of autobiographical memory (AM) between depressive patients with and without alexithymia,and correlation between AM and alexithymia in depressive patients with alexithymia.Methods 29 depressive patients with alexithymia,34 depressive patients without alexithymia were enrolled.All patients were measured by autobiographical memory test (AMT),Toronto alexithymia scale-20 (TAS20),Hamilton depression scale-24 (HAMD-24).Results ①The negative overgeneral AM score was higher in depressive patients with alexithymia than those without alexithymia ((3.34± 1.80),(2.51 ± 1.12),respectively t=2.19,P＜0.05).②The total overgeneral AM score was higher in depressive patients with alexithymia than those without alexithymia ((6.14±2.44),(4.86±2.06),respectively t=2.21,P＜0.05).③)The correlation coefficient (r value) between the total score of overgeneral AM and total score of TAS,TAS-Ⅲ scores of TAS in depressive patients with alexithymia were significantly positively correlated (r=0.240～0.611,P＜0.05).However,the correlation coefficient between the total score of specific AM and total score of TAS,TAS-Ⅲ scores of TAS in depressive patients with alexithymia were significantly negatively correlated(r=-0.502～-0.205,P＜0.05).Conclusion Compared with depressive patients without alexithymia,the overgeneral AM in depressive patients with alexithymia is more severe,and the alexithymia can increase the severity of overgeneral AM.