Objective To investigate the characteristics of brain MRI in the patients with maple syrup urine disease(MSUD). Methods Nine patients with MSUD were diagnosed by gas chromatography mass spectrometry,tandem mass spectrometry and gene test.The MRI,clinical featuresand laboratory tests were analyzed.Results The 9 patients onset age were 3 days to 6 years old.The symptoms were varied such as poor response,lethargy,seizures and learning difficulties.Remarkable elevations of blood levels of leucine and valine were found in all patients.All patients had MRI examination,2 of them also took the examination of proton magnetic resonance spectroscopy (1 H-MRS).Involving cerebellar hemisphere,cerebellar peduncle,cerebral peduncle,brain stem,globus pallidus in 5 cases respectively,thalamus and posterior limb of internal capsule in 4 cases,centrum semiovale in 3 cases.2 cases also showed abnormal signal in corpus callosum,occipital,deep temporal lobe,and frontal lobe,parietal lobe.All lesions showed mild low signal intensity in T1 ,mild high signal intensity in T2 and obvious high signal intensity in DWI,except one case.1 H-MRS did not show a methyl resonance peak at 0.9 ppm in the two patients.Conclusion The MSUD lacked of specific clinical features.The MRI characteristics are the myelinated white matter such as the cerebellar hemispheres,posterior limb of the internal capsule,the brainstem,cerebellar peduncle,cerebral peduncle showing high signal in DWI.

0.05). CONCLUSION: Lornoxicam can relief pain in patients after open heart surgery safely and efficiently, and reduce the morphine consumption.

Objective To analyze CT characteristics of patients with primary parathyroid hyperplasia ( PPH) , parathyroid adenoma ( PA) , atypical parathyroid adenoma ( APA) , and parathyroid carcinoma ( PC) and to evaluate the value of CT in the diagnosis and differential diagnosis of primary hyperparathyroidism ( PHPT ) . Methods CT scan of 134 pathologically proved PHPT patients with complete clinical and laboratory data were retrorespectively analyzed .The similarities and differences of CT features in patients with PPH , PA, APA and PC were studied.Results Among 140 lesions in the 134 patients, 130 cases had solitary parathyroid mass and 4 cases had 10 parathyroid masses , including 22 lesions in 17 patients with PPH, with the diameter ranging from 0.6 cm to 2.8 cm(1.2 ±0.6)cm, 106 lesions in 105 patients with PA, with the diameter ranging from 0.3 cm to 3.2 cm (1.1 ±0.6)cm, 10 lesions in 10 patients with APA, with the diameter ranging from 0.9 cm to 3.3 cm(2.6 ± 0.6)cm, and 2 lesions in 2 patients with PC, with the diameter ranging from 2.1 cm to 3.0 cm(2.6 ±0.6)cm. 124 lesions were located in tracheo-esophageal groove or at the side of trachea on CT .The boundaries between the parathyroid and thyroid gland were low density .3 lesions did not appear .9 lesions were located at the area over the manubrium sterni among 13 lesions which were ectopic.CT images showed round (29.9%,41/137), oval (38.0%,52/137), triangular(19.7%, 27/137), and cylindrical(12.4%,17/137) tumors in 137 lesions.The density of lesions were 30-66 Hu(45.0 ±12.3)Hu on non-enhanced CT scan, and 59-209 Hu(121.8 ±32.7)Hu on enhanced scan .Different pathological lesions had no statistical difference on location ( left upper , left lower , right upper, right lower, ectopic)(χ2 =15.839), linear low density sign(χ2 =1.896), shape(χ2 =10.945), non-enhanced CT(χ2 =0.915) or enhancement CT(χ2 =6.165)(P>0.05).Different pathological lesions had statistical significance on sizes(χ2 =18.395, P<0.05).The diameter of APA-PC was bigger than that in PH-PA.99 lesions exhibited homogeneous enhancement , and 38 lesions exhibited heterogeneous enhancement .The necrosis rate of APA-PC was more than that of PH-PA(χ2 =7.929, P<0.05).Conclusions The lesions origi-nate from parathyroid if they are located in tracheo-esophageal groove or at the side of trachea with hyperparathy-roidism.Multiple lesions help in PH diagnosis .Large size and necrosis in lesions imply APA or PC .The location (left upper, left lower, right upper, right lower, ectopic), shape, density and the degree of enhancement of the lesions have not specificity for diagnosis of PHPT .

The department of radiology, as one of the public platforms for standardized residency training, is very crucial to the training of high level clinicians and essential to improve quality of medical care. According to the present situation and existing problems of standardized residency training for the non-imaging professional residents in the department of radiology in China, combining with our practice, this article primarily explores the improvement of the rules and regulations, the specific arrangement of the rotation, daily and graduation examination forms, and training quality supervision, etc. We hope to improve the training quality of the non-imaging professional residents' rotation in the department of radiology and explore more suitable and effective medical educative strategies.

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Objective To analyze the feasibility of low dose temporal bone CT scans in children.Methods We obtained an optimized low-dose protocol in pre-experiment.The optimized protocol was used to examine 27 consecutive children.And then we retrospectively analyzed 27 examinations underwent a standard temporal bone CT scan acquired with 120 kV and 250 mAs.The interobserveragreement (Kappa value) for the 2 reviewers was calculated.The children were then divided into 4 subgroups according to age-specific effective dose conversion coefficient.The effective dose and image quality between the two protocols at the same age were compared by t test.Results The result of pre-experiment showed that radiation dose was significantly reduced when the parameters were 100 kV and 70 mAs.The interobserver agreement(Kappa value)was high (0.784).The interobserver agreement for both low-dose (0.641) and high-dose (0.815) groups were high.The effective doses of low-dose group were (0.707 5±0.029 1)(0,1.0 year old),(0.431 6±0.051 3)(1.1 to 5.0 years old); (0.309 5±0.138 4) mSv (5.1 to 10.0 years old) respectively.The effective doses of high-dose group were (3.166 2±0.462 5),(2.048 6±0.224 7),(1.492 0±0.422 1) mSv respectively.The difference between low and high dose groupswas significant in all of the subgroups (t=-10.612,-26.22,-79.84,P＜0.05).The image quality of low-dose group was75.5±0.6,75.6±3.5,75.4± 2.4 respectively.The image quality of high-dose group was78.8± 1.0,79.8± 2.2,79.5± 1.0 respectively.The effective dose for the forth subgroup (10.1 to 18.0 years old) wasl.194 9 and 0.228 1 mSv respectively.Though the image quality of low-dose group was significantly lower than that of high-dose group (t=-3.667,-26.220,-6.315,P＜0.05).All the images of low-dose scan were diagnostic.The image quality of both groups was 80.The radiation dose was 5 to 6 times lower thanstandard protocol used in daily work.The effective dose for infants is higher than the older children underwent the same protocol.Conclusion Low-dose temporal bone CT scan allows an accurate evaluation of middle and inner ear structures and is feasible in children.

Objective To explore the value of axillary MRI in differential diagnosis of metastatic axillary lymph nodes in patients with breast cancer.Methods Axillary MRI was performed in 44 breast cancer patients proved by pathology.Long axis,short axis,cortex thickness,ADC value,hilus,margin,perifocal fat gap,signal intensity on DWI,enhancement pattern and time-signal intensity curve were analyzed.The diagnostic ability of long axis,short axis,cortex thickness and ADC value were analyzed with ROC curves.Results Twenty-four patients (24/44,54.55 ％) were proved with metastases axillary lymph nodes,the other 20 patients (20/44,45.45％) were negative.Long axis,short axis,cortex thickness,ADC value,hilus absence,irregular margin,fuzzy perifocal fat gap,high signal intensity on DWI and heterogeneous enhancement showed statistically significant between patients with metastatic and without metastatic axillary lymph nodes (all P＜0.05).The area under ROC curve of long axis,short axis,cortex thickness and ADC value were 0.797,0.765,0.848,0.749 respectively.Conclusion MRI plays an important role in differential diagnosis of axillary lymph nodes me tastasis.The cortex thickness larger than 0.54 cm can help to predict metastatic axillary lymph nodes.

ObjectivesTo detect the effects of P-selectin on deep venous thrombosis (DVT) in nephrotic syndrome (NS). and to evaluate the molecular magnetic resonance imaging (MRI) with a P-selectin targeted conlrost agent in diagnosis of thrombosis in the early phase. Methods(1) Forty-one patients with NS hospitalized in our department from 2005 to 2006 were enrolled in this study. They were assigned into DVT group and non-DVT group according to lower limbs radionuclide imaging (RNV) with 99mTc MAA. Blood P-selectin level was measured by ELISA method. (2) P-selectin was detected both in injured vein and blood immediately, 1 h and 3 h after the dog DVT model was established. (3) The P-selectin-targeted contrast agent was developed by conjugating anti-P-selectin lectin-EGF domain monoclonal antibody (PsL-EGFmAb) which was prepared by our lab. The potential of this contrast agent used in vitro molecular imaging experiment as well as in vivo experiment in dog DVT model was investigated. Results (1) Blood P-selectin level was elevated in patients with NS. It was much higher in DVT group than that in non-DVT group. (2) Blood P-selectin level was also elevated in DVT dogs and P-selectin expressed immediately in tunica intima of injured vein and subsequently in thrombus after the model established. (3) Mural thrombus showed higher signal visualization than surrounding muscle in 30 rain after contrast agent injection. These enhanced signals exhibited P-selectin specificity and persisted from the initiation of intima lesions to 3 h after development of thrombosis. There was signficant Differences in contrast-to-noise ratio (CNR) of the experiment group and the control group (11.50±2.32 vs 2.71±0.86, P＜0.01). The same results were derived from 30 rain to 1 hafter contrast agent being injected in distal to heart part of the injured vessel, and the signal decreased 24 h later. Differences in CNR of the experiment group and the control group were also statistically significant (10.40±2.15 vs 1.93±0.57, P＜0.01). Moreover, the contrast agent did not affect the vital signs of the dog. The function of the heart, lung, liver and kidney functions remained normal after contrast administration. Conclusions P-selectin*targeted new MR contrast can be used to early locate thrombus in vivo in an early stage, which does not compromise the function of the important organs. It may become a new method for early diagnosis of thrombosis.

Objective To evaluate the effects of magnesium sulphate on the analgestic efficacy of nerve block analgesia with ropivacaine. Methods Sixty cases who used femoral nerve block analgesia after unilateral total knee arthroplasty under the general anesthesia were selected,and according to digital table they were randomly divided into two groups( n=30 each):magnesium sulfate plus ropivacaine( group M) and ropivacaine( group C) . The solution (20mL) of 0. 2% ropivacaine and 0. 15% magnesium sulphate were administered to group M,and 20mL solution of 0.2% ropivacaine was given to the group C. The pain score was measured by visual analogue scale(VAS). The supplementary usage and cumulative dosage of morphine were recorded and the analgesia relevant complications were observed. Results The results of this study indicated that 4h,8h,12h and 24h after the operation,the VAS scores had no statistically significant difference ( all P > 0. 05 ) at rest, which in group M was significantly decreased compared with group C at 12h(t=2. 800,P=0. 009) and 24h(t=2. 934,P=0. 012) after treated with continuous passive motion ( CPM) postoperatively. The cumulative dosages of morphine when patients undergo CPM of knee joint in group M were (2.78 ±0.32)mg,(2.05 ±0.16)mg,respectively,which were significantly lower than those in the groupC[(4.10±0.85)mg,(2.44±0.25)mg](t=7.960,2.632,all P<0.05).No obvious analgesia relevant complications occurred in both two groups. Conclusion Magnesium sulphate can enhance the efficacy of postopera-tive femoral nerve block analgesia with ropivacaine, reduce the usage of morphine without increasing the analgesia relevant complications.

Objective To evaluate the role of Toll-like receptor 4 (TLR4) in non-medullary andmedullary cells in lung ischemia-reperfusion (I/R) injury in mice.Methods Ten healthy male TLR4+/+ in non-medullary cells/TLR4+/+ in medullary cells (WT/WT) mice,10 TLR4-/-in non-medullary cells/ TLR4-/-in medullary cells (KO/KO) homozygote mice,10 TLR4+/+ in non-medullary cells/TLR4-/-in medullary cells (WT/KO) mice,and 10 TLR4-/-in non-medullary cells/TLR4+/+ in medullary cells (KO/WT) heterozygote mice,aged 6-8 weeks,weighing 20-25 g,were used in the study.Lung I/R was induced by occlusion of the left hilum for 60 min followed by 240 min of reperfusion in anesthetized mice.Blood samples were obtained from the femoral artery at 240 min of reperfusion for blood gas analysis,and the oxygenation index (PaO2/FiO2) was calculated.The animals were then sacrificed and lung tissues were immediately removed for determination of wet/dry weight ratio,myeloperoxidase activity and contents of tumor necrosis factor-alpha,interleukin-1beta (IL-1β) and IL-6 (by enzyme-linked immunosorbent assay) and for microscopic examination of the pathological changes of lungs which were scored.Results Compared with WT/WT mice,the oxygenation index was significantly increased in sequence,and lung injury scores,wet/dry weight ratio,myeloperoxidase activity and contents of tumor necrosis factor-alpha,IL-1β and IL-6 were decreased in sequence in WT/KO,KO/WT and KO/KO mice (P＜0.05).Conclusion TLR4 in non-medullary cells plays a rnore important role in lung I/R injury than that in medullary cells of mice.