One-and-a-half syndrome with facial diplegia, also referred to as the fifteen-and-a-half syndrome, is an extremely rare clinical entity caused by involvement of bilateral tegmentum of pons. Herein, we report a 52-year-old male who presented with one-and-a-half syndrome with left facial paralysis, which was consistent with the so-called eight-and-a-half syndrome. Brain magnetic resonance imaging showed pontine infarction. Five days after initiation of antiplatelet therapy, the patient developed right facial paralysis, a diagnosis of fifteen-and-a-half syndrome was made, repeat MR imaging revealed bilateral pontine tegmentum infarction. Fifteen-and-a-half syndrome is a newly proposed concept associated with pontine infarction. The clinicoradiological features of this specific disease are as yet unclear due to its extreme rarity. The current case would help advance the current understanding of the disease spectrum of pontine infarction.

Based on the kidney controlling bones of traditional Chinese medicine theory,this article researched the effects of treating osteoporosis with the method of kidney-tonifying and bone-strengthening massage therapy.Commonly used method of modeling included ovariectomized rat model of osteoporosis (OVX),senile rat model of osteoporosis and glucocorticoid induced rat model of osteoporosis (GIOP),kidney-tonifying and bone-strengthening massage therapy were applied on these models,and the rat bone mineral density (BMD) and biochemical marker of bone metabolism changes were observed.Confirmed by animals experiment,it was effective to repair a bone in all rat osteoporosis models with kidney-tonifying and bone-strengthening massage,which provided theoretical basis and methodological guidance for the use of kidney-tonifying and bone-strengthening massage therapy in the clinical treatment of osteoporosis.

Background and purpose:Thermal ablation (radiofrequency ablation, RFA/microwave ablation, MWA) is the most commonly used minimally invasive technique for the treatment of liver cancer. Real-time shear wave elastography (SWE) is a new type of ultrasonic imaging technology, which was used in our study to monitor thermal ablation of liver cancer. This study aimed to investigate the stiffness change of liver cancer and that of surrounding liver parenchyma before and after thermal ablation, and to evaluate the application of SWE for monitoring thermal ablation for liver cancer.Methods:From Oct. 2014 to Apr. 2015, a total number of 36 patients, with 39 lesions, were treated with RFA or MWA and got complete response. SWE examination was performed before and after ablation. The SWE-mean, SWE-min, SWE-max, SWE-SD of lesions and the surrounding liver parenchyma were measured. Statistical analysis was made to compare the stiffness changes of liver cancer with those of the surrounding liver parenchyma before and after thermal ablation, and to determine whether there were differences between two different ablation modes.Results:Before and after ablation, the SWE-mean of lesions was (30.09±11.67) kPavs (52.11±17.56) kPa,SWE-min was (10.46±8.22) kPavs (20.57±11.42) kPa, SWE-max was (51.50±20.84) kPavs (88.54±27.75) kPa, SWE-SD was (10.63±4.30) kPavs (16.89±7.72) kPa; There were statistically signiifcant differences (P<0.05). Before and after ablation, the SWE-mean of surrounding liver parenchyma was (8.84±2.82) kPavs (8.91±2.78) kPa, SWE-min was (4.77±1.95) kPavs (4.69±1.90) kPa, SWE-max was (13.82±3.79) kPavs (14.34±3.97) kPa, SWE-SD was (3.24±1.32) kPavs (3.37±1.29) kPa; There were no statistically signiifcant differences (P>0.05). After ablation, the SWE-mean of RFA and MWA was (45.55±10.91) kPavs (60.59±20.99) kPa, SWE-min was (18.95±8.86) kPavs (25.93±10.93) kPa, SWE-max was (76.58±15.51) kPavs (104.01±32.59) kPa, SWE-SD was (13.82±3.52) kPavs (20.85±9.77) kPa; There were statistically signiifcant differences (P<0.05).Conclusion:SWE can quantitively analyze the stiffness of lesions. The ablation zone became stiffer after RFA or MWA, and the ablation zone of MWA was stiffer than that of RFA. Two kinds of ablation methods did not signiifcantly affect the stiffness of liver parenchyma around the lesion. SWE could potentially be used to monitor thermal ablation of liver cancer.

Objective To evaluate the effect of try psin on the proliferation,migration and adhesion of a skin squamous cell carcinoma cell line A431.Methods Cultured A431 cells were divided into several experimental groups treated with trypsin at concentrations of 0.1,1,10 and 100 nmol/L for 24,48 and 72 hours respectively,and a control group treated with DMEM complete medium only.Cell counting kit-8 (CCK8) assay was conducted to evaluate cellular proliferative activity to select the optimal concentration of trypsin.Then,some A431 cells treated with trypsin at the selected concentration for 24,48 and 72 hours respectively (or 48 hours only) served as the experimental groups (or group),and other A431 cells treated with DMEM complete medium served as the control group.Flow cytometry was performed to assess cell cycle distribution and proliferation index,fibronectin-based adhesion assay to estimate cell adhesive capacity,and wound healing assay and Transwell assay were conducted to evaluate the migratory capacity of cells in two-and three-dimensional space.Statistical analysis was carried out by using analysis of variance,paired samples t test and chi-square test.Results The proliferative activity of A431 cells increased along with the increase of trypsin concentrations,with the strongest increasing effect observed at 100 nmol/L.After treatment with 100 nmol/L trypsin,the experimental group showed a decrease in the percentage of G1-phase cells,but an increase in the percentage of S-phase cells,proliferation index,migratory and adhesive capacity compared with the control group (all P ＜ 0.05).Conclusion Trypsin can promote the proliferation,migration and adhesion of A431 cells.

Objective:To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA).Methods: We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital.A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study.There were 17 males and 5 females,and the median age was 48 years(range: 34-67 years).All the surgery was done by DAA method by two senior surgeons.The clinic characters,early surgery treatment results and complications were analyzed.Results: We used the cementless stems in all the cases.The average operating time was (167±23) min;the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL;the wound drainage in average was (111±73) mL Most of the patients could move out of the bed by themselves on the first day after operation,5 patients could walk without crutches on the first operating day,and 13 patients could squat on the third days after operation.The patients were discharged averagely 4 days after operation.We followed up all the patients for averagely 16 months (range: 8-24 months).There was no loosening or failure case in the latest follow up.In the study,2 patients had great trochanter fracture,2 patients had thigh pain,4 patients had lateral femoral cutaneous nerve palsy,and 3 patients had muscle damage.The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01).Conclusion: The DAA THA can achieve faster recovery and flexible hip joint after operation.However it is a kind of surgery with high technique demanding.Carefully selected patients,and skilled technique,can help the surgeon avoid the early complications.It is associated with high complication rate in the learning curve for bilateral DAA THA.

Objective To investigate the spatiotemporal expression patterns of transforming growth factor-β(TGF-β) receptors type Ⅰ and type Ⅱ and their relationships with development of outflow tract(OFT) in mouse embryonic heart. Methods Serial sections of mouse embryos from embryonic day 9 (E9d) to embryonic day 14 (E14d) were stained using PAP immunohistochemical methods. Results Expressions of TGF-β receptors type Ⅰ (TGF-βRⅠ) and type II(TGF-βRⅡ) in the myocardial wall of OFT started at E10d, reached the reflection with splanchnic epithelium on the dorsal wall of the pericardial cavity at E11d. At E12d, expression intensity of TGF-βRⅠ and TGF-βRⅡ in myocardium increased to its highest level, and TGF-βRⅡ positive mesenchymal cells in OFT ridges could be detected. After E13d the staining intensity of TGF-βRⅠ and TGF-βRⅡ decreased rapidly,and at E14d,their expressions had fallen at the lowest.Conclusion The expressions of TGF-βRⅠ and TGF-βRⅡ in OFT are confined to the period of E10d to E14d, they may play important roles in regulating the myocardial cell proliferation, remodeling and septation of OFT, and promoting the differentiation from mesenchymal cells in the secondary heart field into smooth muscle cells in the distal end of OFT.

Objective To investigate the clinical characteristics,treatment effect,long-term follow up results,guanosine triphosphate (GTP) cyrclohydrolase Ⅰ (GCH Ⅰ)gene and tyrosine hydroxylase(TH) gene mutations in patients with dopa-responsive dystonia (DRD).Methods The clinical features of 3 families with 4 affected members were analyzed and all of 4 patients were screened for mutations of the GCH Ⅰ gene and TH gene with DNA sequences.Results Four patients were females,average age at onset was (15.3 ± 5.6) years (range:from 9 to 20 years).The initial symptoms were a gait disorder,stiffness or tremor of the lower limbs in all patients presented with diurnal fluctuation.As the increase of disease duration,bilateral hand tremor was found in three patients,systemic torsion was found in one patient and torticollis was found in one patient.All patients' symptoms were in complete remission after administration of low dose of levodopa.Four patients were followed up for 0.5 to 10.0 years,and all were still responsive to the levodopa treatment and effective dosage was decreased as the increase of the disease duration.No longterm side effects of levodopa had occurred after long-term treatment.One patient was found to have c.607G ＞A(p,Gly203Arg) heterogenetic mutation in GCH I gene.Molecular analysis revealed a compound heterozygous mutation in the TH gene (p.Y447Ter and p.V468M) in one patient.No point mutations in both genes were found in other patients.Conclusions DRD patients have dramatic and sustained response to levodopa and no long-term side effects of levodopa after long-term treatment.The detection of GCH Ⅰ and TH gene mutations is helpful in early diagnosis but the negative results could not exclude the diagnosis of DRD.

Background Idiopathic orbital inflammatory pseudotumor (IOIP) is a common orbital disease, but its etiology is still unclear,so the effect of glucocorticoid treatment is unsatisfied.Objective This study was to investigate the effects of dexamethasone on orbital fibroblasts from IOIP patients and explore the action machanism.Methods Six pieces of IOIP tissues from 6 IOIP patients and 3 pieces of normal orbital connective tissues from lacrimal gland prolapse patients were obtained during the surgery in Beijing Tongren Hospital from November 2011 to January 2012.The orbital fibroblasts were cultured using explant culture method.The morphology of the cells were observed under the optical microscope,and biomarks of the cells were detected by immunochemistry.The growth and proliferation of the cells were assayed using WST-8.The expression of ICAM-1 in the cells in both the control group and the IOIP group was detected by immunochemistry.The fibroblasts were incubated in 96-well plates, and different concentrations of dexamethasone (0,1 × 10-3 , 1 × 10-4 , 1 × 10-5 and 1 × 10-6 mol/L) were respectively added into the medium for 24,48 and 72 hours,and then the proliferation of the cells was detected by WST-8 assay.The contents of ICAM-1 in different concentrations of dexamethasone groups were assayed by ELISA.Results The characteristics of the cells were similar between the control group and the IOIP group with the spindle shape and long protructions.The cells showed the positive response for vimentin and absent response for desmin, S-100, cytokeratin (CK).Compared with the control group,the growth speed of fibroblasts was fast in the IOIP group.The proliferative values of the cells (absorbancy) were gradually reduced with the increase of dexamethasone concentrations (F ion =36.27,P=0.00) and the lapse of acting time (Ftime =3.69 ,P=0.00).In cultured cells without dexamethasone for 24,48 and 72 hours,the mean expression levels of ICAM-1 were 0.298±0.008,0.312±0.003 and 0.319±0.011, showing a gradually increasing trend.However,the expression of ICAM-1 was gradually reduced with the increases of concentrations and the lapse of acting time of dexamethasone (Fconcentration =75.17,P=0.00;Ftime =3.11,P=0.00).Conclusions Occurrence and development of IOIP is probably associated with the over-expression of ICAM-1 in orbital fibroblasts.Dexamethasone plays anti-inflammation and treating effects on IOIP by down-regulating the expression of ICAM-1 and inhibiting the proliferation of orbital fibroblasts.

To investigate the features of various hepatitis virus infection in intravenous drug users (IVDU), we conducted an epidemiological survey of hepatitis viruses including hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis G virus (HGV) in IVDU. The correlation of TH lymphocyte cytokine and hepatitis virus infection was examined. A study population of 406 IVDU consisted of 383 males and 23 females. HBV-DNA and HCV-RNA were detected by fluorescence quantitative polymerase chain reaction. HBsAg, HBeAg, anti-HBc, anti-HCV, HDV-Ag and anti-HGV were assayed by ELISA. The levels of cytokines of TH1 and TH2 were measured by ELISA. The similar indices taken from 102 healthy persons served as controls. The infection rate of each virus among IVDU was 36.45 % for HBV, 69.7 % for HCV, 2.22 % for HDV, and 1.97 % for HGV, respectively. The co-infection rate of HBV and HCV was detected in 113 of 406 (27.83 %). In contrast, among controls, the infection rate was 17.65 % for HBV and 0 % for the other hepatitis viruses. The levels of PHA-induced cytokines (IFN-gamma and IL-4) and the level of serum IL-2 were obviously decreased in IVDU. On the other hand, the level of serum IL-4 was increased. The IFN-gamma level was continuously decreased when the IVDU was infected with HBV/HCV. In conclusion, HBV and HCV infection were common in this population of IVDU and they had led to a high incidence of impaired TH1 cytokine levels.

Objective:To evaluate the effectiveness of conducting multiple arthroplasty to treat multiple joints disease in terms of quality of life ( QOL) and function improvement.Methods:We compared our results with the reported results of single and dual arthroplasty to see if there is any improvement in QOL, functional scores or complications.In this study, 13 patients admitted to Department of Adult Reconstruc-tive Surgery, Beijing Jishuitan hospital from 2005 to 2009 were included.Questionnaires SF-36 were used to evaluate the QOL.Harris hip score, American Knee Society Score ( KSS) were used to evaluate the joint function.The patients were evaluated before surgery to the latest follow up.Results:SF-36 has changed as follow:physical function 4.17 ±14.43→65.83 ±24.76, role physical 25.00 ±26.11→60.42 ±45.8, bodily pain 23.83 ±21.41→76.88 ±20.89, general health 53.33 ±33.87→76.67 ± 14.67, vitality 50.42 ±17.25→71.67 ±16.28, social functioning 29.17 ±33.50→73.96 ±33.90, role emotional 22.08 ±35.61→77.77 ±41.03, mental health 53.33 ±25.70→82.67 ±14.41, which indicated that they all improved greatly after the surgery ( P <0.05 ) .Harris score increased from 37.68 ±14.71 before the surgery to 83.36 ±13.54 after the surgery.KSS has also showed sharp im-provement (P<0.001) in both clinical score (42.52 ±23.83→77.74 ±20.67) and function score (-2.61 ±22.56→65.65 ±30.76).Conclusion:Multiple arthroplasty is one of the most effective me-thods which can markedly improve the quality of life in patients with multiple joints disease.But compli-cations are common and joint functions are relatively poor.