Objective To study the motor evoked potential (MEP) evoked by transcranial electric stimulation in the masseter muscles of patients with amyotrophic lateral sclerosis (ALS), and to compare the results obtained from a control population, so as to establishe a method to evaluating the impairment of corticobulbar projections in ALS.Method Transcranial electrical stimulation was used in 20 patients with ALS and 30 matched normal control.Central motor conduction time (CMCT) was calculated.Results Responses to direct activation of the trigeminal motor root (R-MEP) were able to be recorded in all ALS.The latency and amplitude of R-MEP was (3.44?0.53) ms and (2.79?2.19) mV respectively.They had nonsignificant differences as compared to the controls.Responses to activation of corticobulbar descending fibers (C-MEP) were absent or delayed in 12 ALS patients, and CMCT was significantly prolonged ( P

Objective To assess the value of electromyography (EMG) of rectus abdominis muscle in the diagnosis of polyneuropathy. Methods 109 patients with polyneuropathy were studied. The routine nerve conduction study was done and standard EMG was recorded from rectus abdominis muscle, first dorsal interosseous muscle and tibialis anterior muscle. The parameters studied included spontaneous activity fibrillation potentials (fib) and positive sharp waves (psw); duration, amplitude and percentage of polyphasic wave of motor unit action potential (MUAP) and pattern of recruitment. A group of controls and patients with amyotrophic lateral sclerosis (ALS) were studied at the same time. EMG parameters of rectus abdominis muscles were compared among patients with polyneuropathy, patients with ALS and the controls.Results EMG of rectus abdominis muscle in the patients with polyneuropathy showed neurogenic change.The amplitude of motor unit potential in patients with polyneuropathy(451.67±75.01)μV was higher than that of the controls (373.78±56.46)μV (t=2. 01, P < 0. 04) and lower than that of patients with ALS (537.19±159. 04)μV (t=2. 32, P<0.03). Conclusion EMG of rectus abdominis muscle might be used to find the lesion of intercostal nerve in polyneuropathy.

BACKGROUND: Cervical intumescence is the earliest and easy attacking part of motor neuron disease (MND). With the development of patients'condition, cervical part and medulla oblongata region were involved early,and the trigemino-cervical reflex (TCR) was involved earliest.OBJECTIVE: To establish electromyography of TCR and analyze the value in the diagnosis of MND of the TCR.DESIGN: Case-control study.SETTING: Room of Electrophysiologic Study, Department of Neurology,Third Hospital, Peking University.PARTICIPANTS: Thirty MND patients,mainly amyotrophic lateral sclerosis (ALS) patients and 70 healthy volunteers who were examined at Third Hospital, Peking University from 2002 to 2005. MND patients accorded with the diagnostic standard of Spain El Escorial conference.METHODS: The subjects held the heads slightly raised when lying supine to make the sternocleidomastoid muscles contracted slightly. Electrical stimulation was applied to the infraorbital nerves and latency and amplitude of wave were recorded from the bilateral sternocleidomastoid muscles. The detecting instrument was Keypoint electromyography (EMG).The surface EMG activity was recorded via Ag/AgCl.MAIN OUTCOME MEASURES: Latency of positive wave/ negative wave (P20/N30); square root of the ratio of the amplitudes, that is, value A.RESULTS: Stimulation of the infraorbital nerve on one side of controlled people produced bilateral positive and negative waves. In the MND group,7 patients showed normal (23.3%), 8 patients showed absence of wave (26.7%), 11 patients were delayed in latency (36.7%), and extreme asymmetry of reflection of the two sides was found in 4 patients (13.3%).In the MND group, the latency of positive and negative waves of TCR (P20/N30) was markedly longer than that in the normal control group,and the difference was significant. Square root of the ratio between the amplitudes after and before stimulation (square root of the ratio between peak to peak value and amplitude of wave before stimulation, that was,value A) was lower remarkably than that in the normal control group, and the difference was significant.CONCLUSION: The TCR can be reliably measured. It may help examine the cervical-bulbar lesion and diagnosing motor neuron disease in an early period.

Objective To compare two common techniques for motor unit number estimation (MUNE), multiple point stimulation(MPS) and incremental stimulation, and determine which is preferable in the follow-up study of patients with amyotrophic lateral sclerosis (ALS).Methods MPS or incremental stimulation MUNE was recorded respectively in 120 ALS patients at baseline and month 3, 6, 9 ,and 12 after study entry.The maximal baseline to negative peak compound muscle action potential (CMAP) amplitude was recorded.For multiple point stimulation, the stimuli sites included the skin of the wrist, 6 cm above the wrist, elbow and 6 cm above the elbow.Individual motor unit responses were obtained by moving thestimulating electrode and isolating threshold responses.Then, with finely graded stimulus intensity at one point, 3 steps in a CMAP were investigated.For incremental stimulation, stimulus intensity was slowlyincreased from subthreshold levels until a small, all-or-none response was evoked.The intensity was slowly increased until the response increased in a quantal fashion.This process was repeated for a total of 10 increments.Single motor unit potential were obtained by subtracting amplitudes of each response from that of the prior response.The values obtained from two methods were compared.Results The value of MUNE declined in the follow-up period.MUNE obtained from MPS was the same as that gained from incremental stimulation at the baseline and the 3rd, 9th, 12th month after study entry, while MUNE obtained in MPS was more than that obtained from incremental stimulation at the 6th month after study entry ( 88 ± 6 and 47 ± 5;t = 1.72, P = 0.04).Conclusions Both MPS and incremental stimulation are certain in the follow-up study of patients with amyotrophic lateral sclerosis.The value of MUNE obtained from two methods might be different in some period.

Objective To study the features of pain evoked potentials in patients with amyotrophic lateral sclemsis(ALS)and evaluate the pain pathway in these patients.Methods Sixty patients with ALS and 60 controls were set on supine position.The contact heat evoked potential stimulator with a diameter of 27 mm and an area of 573 mm2was used to elicit pain and contact heat evoked potentials(CHEP)in an accelerating speed of 70 ℃/s.Thermal stimuli were given at 54.5 ℃ to three body sites:the dorsum of hand,proximal volar for aml and C7. CHEP was recorded at spots of Cz and Pz.The features of CHEP was observed At the same time,somatosensory evoked potential(SEP)was assesed.Results The figure and latency of CHEP in ALS patients were normal.The latency was:the dorsum of hand:(561.2±28.6)ms; proximal volar forarm:(540.1±39.2)ms;C7:(512.7±31.4)ms.There were no significant differences of latency and SEP between tlle ALS patients and the controls((558.7±30.2),(536.6±23.5), (501.8±26.0)ms,t=4.23,4.51,3.74,P＞0.05).Conclusion Patients with ALS have a normal CHEP,suggesting that the pain pathway in patient with ALS is intact.

The efficient clinical treatment of oral squamous cell carcinoma(OSCC)is still a challenge that demands the development of effective new drugs.Phenformin has been shown to produce more potent anti-tumor activities than metformin on different tumors,however,not much is known about the influence of phenformin on OSCC cells.We found that phenformin suppresses OSCC cell proliferation,and promotes OSCC cell autophagy and apoptosis to significantly inhibit OSCC cell growth both in vivo and in vitro.RNA-seq analysis revealed that autophagy pathways were the main targets of phenformin and identified two new targets DDIT4(DNA damage inducible transcript 4)and NIBAN1(niban apoptosis regulator 1).We found that phenformin significantly induces the expression of both DDIT4 and NIBAN1 to promote OSCC autophagy.Further,the enhanced expression of DDIT4 and NIBAN1 elicited by phenformin was not blocked by the knockdown of AMPK but was suppressed by the knockdown of transcription factor ATF4(activation transcription factor 4),which was induced by phenformin treatment in OSCC cells.Mechanistically,these results revealed that phenformin triggers endoplasmic reticulum(ER)stress to activate PERK(protein kinase R-like ER kinase),which phosphorylates the transitional initial factor eIF2,and the increased phosphorylation of eIF2 leads to the increased translation of ATF4.In summary,we discovered that phenformin induces its new targets DDIT4 and especially NIBAN1 to promote autophagic and apoptotic cell death to suppress OSCC cell growth.Our study supports the potential clinical utility of phenformin for OSCC treatment in the future.

Objective To compare the image quality of chest low dose CT (LDCT) using automatic exposure control (AEC) and constant current control (CCC) and explore a more reasonable scanning protocol. Methods Two hundred and eighty participants were examined with 64 CT scanner at 7 centers in China. All were divided into 4 groups. Two groups underwent LDCT using AEC with standard deviation set at 25 (A1) and 30 (A2) respectively and the tube current ranged from 10 mA to 80 mA. The other two groups underwent LDCT using CCC with tube current set at 40 mA (C1) and 50 mA (C2) respectively. The axial and MPR images were evaluated by two radiologists who were blinded to the scanning protocols.The radiation dose, noise and the image quality of the 4 groups were compared and analyzed statistically.Differences of radiation dose and noise among groups were determined with variance analysis and t test,image quality with Mann-Whitney test and the consistency of diagnosis with Kappa test. Results There was a significant lower DLP in AEC group than in CCC group [(82.62±40.31)vs ( 110.81±18.21) mGy·cm (F =56. 88 ,P ＜ 0. 01 )], whereas no significant difference was observed between group A2 and group A1 0. 05]. The noisy of AEC group was higher than that of CCC group both on lung window(41.50±9.58 vs 40.86±7.03) and mediastinum window (41.19±7.83 vs 40.92±9.89), but there was no significant difference( Flung =0.835, P=0.476, Fmediastinum =1.910, P=0.128).The quality score of axial image in AEC group was higher than that in CCC group (superior margin of the brachiocephalic vein level: 4.49±0.56 vs4.38±0.64,superior margin of the aortic arch: 4.86±0.23 vs 4.81±0.32,the right superior lobar bronchus Level:4.87±0.27 vs 4. 84 ± 0. 22, the right middle lobar bronchus Level: 4.90±0.25 vs 4.88±0.21) except on the right inferior pulmonary vein level(4. 92 ±0. 25 vs 4. 93 ±0. 17) and superior margin of the left diaphragmatic dome level (4. 91±0.27 vs 4.93±0.22) on lung window, but no significant differences (F=0.076-1.748, P＞0.05) were observed. A significant higher score in AEC group was observed on mediastinum window compared with CCC group on superior margin of brachiocephalic vein level (2.57±0.77 vs 2. 46 ± 0. 59, F = 8. 459, P ＜ 0. 05 ), however, the score of AEC group was lower than that of CCC group on other levels without significant differences (superior margin of the aortic arch:3.36 ±0. 63 vs 3.45 ±0. 60,the right superior lobar bronchus level: 3.94 ±0. 56 vs 3. 95 ±0. 51 ,the right middle lobar bronchus Level: 3.80 ±0. 58 vs 3. 87 ±0. 50,the right inferior pulmonary vein level: 3.72 ±0. 56 vs 3.78 ±0. 53, superior margin of the left diaphragmatic dome level: 3.58 ± 0.63 vs 3.68±0.56,F=0.083-3.380,P ＞ 0.05 ). The MPR image quality of AEC group was better than that of CCC group both on lung window and mediastinum window (Zlung =-2.258, Zmedlastinum=-1.330, P＞0.05). For all participants including the underweighted group, the normal group and the overweighted group, the image quality of A1 group was better than that of A2 group without significant differences (the underweighted group: Zlung=0.000, P=1.000, Zmedastinum= 0.000, P=1.000;the normal group: Zlung =-0.062, P=0.950, Zmediastinum =-0.746, P = 0.456; the overweighted group: Zlung = - 1.177, P = 0.239,Zmediastinum =-1.715, P=0.144) both on lung and mediastinum windows, and for the higher BMI participants, a better image quality was obtained in A1 group than in A2 group on the mediastinum window (Z = -1. 715, P = 0. 144). Conclusions The total radiation exposure dose of AEC group is significantly lower than that of CCC group, but no statistical significant differences are observed between both groups in image quality and noise level. The AEC technique is highly recommended in thoracic LDCT scan for screening program, and the SD25 ( SD value = 25) scan protocol is suggested for higher BMI population while the SD30 (SD value = 30) scan protocol for lower BMI population.

Objective To investigate degrees of fibrosis of adenomyosis(AM)myometrium and explore its relationship with dysmenorrhea. Methods Thirty AM patients who had hysterectomy from July, 2015 to December, 2016 in Beijing Obstetrics and Gynecology Hospital were selected as AM group; 28 cases of hysterectomy due to cervical lesions(none AM)were selected as control group. The area ratio of collagen fiber in the two groups was analysed by modified Masson stain, and the expression of collagen type Ⅰprotein in the two groups was analysed by immunohistochemical method. Results (1)The degree of fibrosis:the area ratio of collagen fiber and the expression of collagen type Ⅰof AM group [(34.5±5.1)％, 0.23±0.06] were significantly higher than those of control group [(26.7±10.1)％,0.18±0.08; all P<0.05].(2)The relationship between the degree of fibrosis and dysmenorrhea: the area ratio of collagen fiber and the expression of collagen type Ⅰ in severe dysmenorrhea, moderate dysmenorrhea, and none-mild dysmenorrhea were(35.3± 4.3)％,0.25±0.05;(35.7±3.2)％, 0.26±0.06;(25.0±2.9)％,0.15±0.03, there were significantly different among them(all P<0.01). And the area ratio of collagen fiber, the expression of collagen type Ⅰ were positively correlated with the degree of dysmenorrhea(r=0.50, 0.50; all P<0.05). Conclusions The area ratio of collagen fiber and the expression of collagen type Ⅰin AM are higher than in control group, and positively correlated with the severity of dysmenorrhea. These results suggest the degrees of fibrosis might be correlated with dysmenorrhea.

Objective:To explore the advantages of the modified right renal artery dissection in the laparoscopic resection of right renal carcinoma combined with venous tumor thrombus.Methods:From January 2016 to June 2016, a retrospective analysis of the three-dimensional CT images of renal blood vessels in 70 patients with full abdominal CT plain scan plus enhanced scan from Shandong Provincial Hospital Affiliated to Shandong First Medical University was performed. On the sagittal plane of the right margin of the aorta, the right renal artery was detected to locate above the left renal vein in 14 cases (20.0%), posterior in 33 cases(47.1%), and below in 23 cases(32.9%). In addition, on the sagittal plane of the left margin of the inferior vena cava, the right renal artery was detected to locate above the left renal vein in 1 case (1.4%), posterior in 26 cases(37.1%), and below in 43 cases (61.4%). Based on this finding, 11 patients with right kidney cancer combined with venous tumor thrombus, admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2016 to December 2019, were retrospectively analyzed. The average age of the patients was(58.7±6.8)(45-68) years old. The CT three-dimensional reconstruction of the renal blood vessels was shown on the sagittal plane of the right margin of the aorta before the operation, and the right renal artery was detected to locate above the left renal vein in 0 cases, posterior in 7 cases, and lower in 4 cases. On the sagittal plane of the left margin of the inferior vena cava, the right renal artery was detected to locate above the left renal vein in 0 case, behind in 3 cases, and below in 8 cases. Renal tumors are located in the upper middle in 5 cases and in the lower middle in 6 cases. The maximum diameter of the tumor to be resected was 8.5-12.0 cm, with an average of (10.0±1.4) cm. Among them, 4 cases had Mayo grade 0 tumor thrombus, 4 cases were grade Ⅰ tumor thrombus, and 3 cases were grade Ⅱ tumor thrombus. All 11 cases underwent transperitoneal laparoscopic surgery. During the operation, it was found that the relationship between the right renal artery and the left renal vein was consistent with the preoperative three-dimensional reconstruction of renal blood vessels. The modified right renal artery dissection method was used, that is, the right renal artery was detected and ligated between the inferior vena cava and the aorta, using the left renal vein as a mark, and then the right kidneys and vein tumor thrombi were removed.Results:All of the 11 operations in this group were completed successfully. The operation time was (110.5±29.8)(70-150) min, the average time of right renal artery dissection was(28.5±5.8)(16- 33) min, and the amount of intraoperative bleeding was(112.7±83.5)(20-300) ml. No serious complications occurred during the operation in 11 cases. Postoperative pathological examination showed 10 cases of clear cell carcinoma and 1 case of papillary cell carcinoma. The postoperative hospital stay was 4.2 (4.18±0.75) days. There were no complications such as secondary bleeding, infection, lower extremity venous thrombosis or pulmonary embolism. All 11 patients were followed up for 3 to 42 months, with an average of(19.5±12.1) months. One patient died 23 months after the operation, and no tumor recurrence or metastasis occurred in the remaining patients.Conclusions:When the right renal artery runs to the left edge of the inferior vena cava, it is mostly behind the left renal vein. In the laparoscopic resection of right renal cancer with venous tumor thrombus, the modified right renal artery dissection method can quickly find and dissociate the right renal artery. The operation time is short, the intraoperative bleeding is less, and no postoperative complications occur.