Objective To observe the changes of diffusion weighted imaging (DWI) after diffuse axonal injury (DAI) in rats. Methods Models of various degrees of DAI (mild, moderate and severe) were established in 135 SD rats by Marmarou method, and MRI examinations were performed 4, 8 and 24 h after injury. Another 8 rats were served as control group. The findings of MRI were analysed, and the apparent diffusion coefficient (ADC) values were compared among each group. Results No clear traumatic lesion was found from MRI in rats after injury. Four hours after injury, ADC values decreased in each DAI group, and there were significant differences between moderate DAI group and control group, and between severe DAI group and control group (P<0.05). Eight hours after injury, ADC values increased in each DAI group, and there was no significant difference between DAI groups and control group (P>0.05). There were significant differences in ADC values between 8 h after injury and 4 h after injury in severe DAI group (P<0.05), while there was no significant difference in moderate and mild DAI groups (P>0.05). Twenty-four hours after injury, ADC values continuously increased, especially in severe trauma group. Conclusion ADC values may reveal traumatic changes that can not be demonstrated by MRI. ADC values decrease in acute phase of DAI in rats, then increased, and the degree of variation may be related to the severity of DAI.

Objective:In this study, the feasibility of this method was evaluated in children with large distance femoral lengthening cases, and the acute correction and staging surgeries were compared at healing speed. At the same time the key points of surgical techniques would be summarized, so as to clarify the application value of this technology in children patients.Methods:Since July 7 of 2014 to January 16 of 2018, a total of 10 cases of Lengthening Over Retrograde Nail (LORN) surgery have been formulated and carried out, including 9 males and 1 females.The average age of the operation was 13.10±2.18 y. In all cases, the osteotomy point was located in the metaphysis of the distal femur, and the records from the first meeting to the end of follow-up included gender, date of birth, reason of discrepancy and treatment history, age at surgery, lengthing distance, the length of duration with frame, healing time, ROM of the knee joint, complications, et al. To compare the healing time of acute correction and staging surgery. Statistical analysis was made by SPSS 22.0 software, and then reasonable treatment strategies were proposed.Results:The average lengthing distance of 7.07±1.01 cm. The median time of the duration with frame was 8.5 (4,16) months, and the median follow-up time was 39 (34, 54) months. All cases obtained good clinical and imaging healing (1.70±1.10 month/cm vs. 1.16±0.54 month/cm), and all regained to normal walking function (136.67°±20.82° vs. 125.71°±26.37°), without the occurrence of fracture after therapy. There were no statistically significant differences in the speed of healing, range of joint motion or complication rate between acute correction and staging treatment. Conclusion:It is feasible for femoral lengthening surgery assisted by retrograde intramedullary nail in the treatment of femoral shortening deformityin children. The correction of mild angular deformity and lengthening surgery can be performed simultaneously. The osteotomy site was proposed at distal metaphysealof the femur for better quality of osteogenesis and shorter duration for fixator. It is safe to osteotomy and lengthening in the area of enchondroma.

Objective To discuss the value of diffusion weighted imaging (DWI) in severity assessment and prognosis prediction of diffuse axonal injury (DAI). Methods A retrospective study was performed on the clinical imaging data and the follow-up results at six months after injury in 29 patients with DAI. The detection rate of DAI lesion by DWI and conventional MRI was compared by means of one-way ANOVA. The correlation between the number of lesion in different areas with GCS and GOS was analyzed with Spearman rank correlation test. Results (1)The average detected DAI lesions were 19.24±5.72 on DWI, 14.41 ±4.50 on FLAIR, 10.58±3.79 on T2WI and 4.83 ±2. 11 on TIWI, with the highest detection number of DAI lesion on DWI (P < 0, 05). (2) There was a significant correlation of the number of central lesions (in corpus callosum, basal ganglia and brain stem) with GCS and COS (P < 0. 05), but there was no correlation of total lesion number or periphery lesion with GCS and COS (P > 0.05). Conclusions DWI is a potentially useful imaging modality in detecting DAI lesion, when the number of central lesion on DWI can be served as an objective marker in severity assessment and prognosis prediction of DAI.

Liver transplantation is a major treatment for patients with alcoholic liver disease (ALD)-related end-stage cirrhosis, liver failure, hepatocellular carcinoma (HCC) and severe alcoholic hepatitis. In this article, the latest research progress on liver transplantation in ALD patients was summarized from the aspects of surgical indications, survival status, alcohol-drinking management and systemic disease management of the recipients, aiming to provide reference for better clinical management of ALD recipients undergoing liver transplantation.

Objective: To explore differences in the detection rate of elevated blood pressure (BP) in children aged 6-8 years old, and to verify the apparent existence of white-coat hypertension (BP) in children. Methods: Based on census data(PROC), and three subsequent BP readings were taken during follow-ups which were carried out from October 2018 to June 2019. A total of 1 785 children were included in the present study. Using updating blood pressure reference for Chinese children aged 3-17 years, compared the BP detection rate at baseline, at the first follow-up, and the average value of the last two BP readings. Fluctuations in the detection rate of elevated BP in children at different time-points were analyzed. Results: The detection rates of the three elevated BP measurements of 6-8-year-old children were 57.65%, 25.88% and 15.46%, respectively, and the detection rate was higher among boys than girls. The detection rate of baseline BP was higher than that of the first follow-up BP measurements and the average of the last two BP measurements(P<0.01). Given the agreement in the diagnosis of high SBP, high DBP, high BP at baseline, and the average of the last two follow-up BP measurements, elevated BP at baseline was the lowest among the three groups and SBP was higher than DBP. Conclusion Blood Pressure fluctuations might be caused by transient tension that was experienced during the baseline BP measurement and during the first of the three follow-ups. Therefore, the average value of last two BP measurements may better reflect the real BP level in children.

Objective:In this study, lengthening over nail (LON) and plating after lengthening (PAL) were compared by the process of treatment and therapeutic effect in the children's femoral lengthening cases,to guide treatment choices; and in the PAL group there was another comparison between different timeline of plate fixation after lengthening to formulate reasonable technical route.Methods:Since January 7, 2014 to September 10, 2018, a total of 21 cases of LON and PAL surgery had been carried out, including 12 males and 9 females. The average age at their operation was 12.43±3.12 years. There were 10 patients in the LON group and 11 patients in the PAL group, in the PAL group 5 cases was synchronous fixation, which means removal of the external fixator and plate fixation would be performed in the same surgery, 6 cases was asynchronous fixation, which means plate fixation would be performed at least 2 weeks later after the removal offixator to reduce the risk of infection. The recorded data includesgender, date of birth, reason of discrepancy and treatment history, age at surgery, lengthening distance, the length of duration with frame, healing time, total duration time and total blood loss of seriesoperations, ROM of the knee joint, complications, etc.Statistical analysis was made by SPSS 22.0 software, and then reasonable treatment strategies were proposed.Results:In the LON group, the medianlengthening distance was 7.10 (6.63, 7.70) cm, the median total duration time was 300 (240, 330) min, the medianspeed of healing was 1.12 (0.78, 1.72) month/cm, complications were found in 3 cases, the median ROM of knee joint was 125.00° (117.50°, 150.00°); in the PAL group, the data respectively were 6.00 (5.00, 8.00) cm, 260 (230, 465) min, 1.00 (0.75,1.71) month/cm, 3 cases, 100.00° (90.00°, 150.00°), the difference between them was not statistically significant (all P>0.05). 2. In the PAL group, the difference of number of surgeries, total duration time, total blood loss, complication rate, healing speed and postoperative function between synchronous and asynchronous fixation was not statistically significant (all P>0.05). Conclusion:They are similarbetween LON and PAL techniques in the process of treatment and therapeutic effect. The surgeons could make choices according to the growth potential of the patients and their own custom operation methods. In the case of the current sample size, there is no statistical difference in the therapeutic effect between the synchronous and asynchronous plate fixation in the PAL method, but the sample size needs to be increased for further study.

Objective To investigate the serum levels of homocysteine(HCY)and cystatin C(Cys-C)in patients with antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV)associated renal injury,and to explore the diagnostic value of combined detection of HCY and Cys-C in ANCA-associated renal injury.Methods We selected 70 ANCA-positive patients with renal injury admitted to the Department of Nephrology in our hospital from January 2016 to January 2019.Another 48 patients with ANCA-positive but not complicated with renal injury were in simple ANCA positive group while 50 patients with physical examination who came to the hospital during the same period were in control group.Healthy patients served as the control group.By comparing the differences in the test results of different groups,the area under the curve(AUC)of each test index for ANCA-positive renal injury was determined,and the correlation and diagnostic value of combined detection of HCY and Cys-C for ANCA-related renal injury were calculated.Results The levels of HCY and Cys-C in the ANCA positive combined with renal injury group,the pure ANCA positive group,and the control group differed significantly(P＜0.05).The positive rates of HCY and Cys-C in the two groups were significantly different(P＜0.05).The sensitivity and specificity of HCY and Cys-C in combination for the diagnosis of ANCA-positive related renal injury were significantly higher than those of the above indicators alone(P＜0.05).ROC curve results showed that HCY combined with Cys-C had a better diagnosis for patients with positive ANCA and associated renal injury and a higher correlation.Conclusion HCY combined with Cys-C is closely correlated to ANCA-related renal injury,and the combined detection has a positive effect on the diagnosis of patients with ANCA-positive related renal injury,and has guiding value for the treatment of patients.

Objective:To evaluate changes of large-scale motor and cognition related networks′ function in patients with amyotrophic lateral sclerosis (ALS) and their relationship with corresponding clinical symptoms using independent component analysis combined with dual regression.Methods:Forty-six ALS patients (ALS group) who were treated in the First Affiliated Hospital of Xi′an Jiaotong University from January 2014 to June 2016 were prospectively collected, and 40 gender- and age-matched normal controls (control group) were recruited. All the participants completed the motor and multi-dimensional cognitive function evaluation[including Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Semantic Fluency (SVF), Phonological Fluency (PVF), Digital Span Forward (DS_F), Digital Span backward (DS_B), frontal assessment battery (FAB), Wisconsin Card Sorting Test (WCST) for classification accuracy, classification error, persistent response classification, persistent error response classification, non-persistent error classification and Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA)]. The resting-state MRI data of all subjects were collected, and independent component analysis was carried out with multivariate interpretation linear optimization independent component decomposition. Dual regression analysis was performed to compare network differences between groups based on voxel level in sensorimotor network (SMN), default mode network (DMN) and frontal-parietal control network (FPCN). Multivariate covariance analysis was used to evaluate the differences of different cognitive function indexes between ALS group and normal control group, the comparison of brain network differences between the two groups was performed by nonparametric permutation test, corrected by family-wise error (FWE), P<0.008 as the statistical threshold; partial correlation and multiple linear regression were used to evaluate the relationship between changes in functional connectivity of different brain regions and cognitive functions. Results:The scores of MMSE, MoCa, SVF, PVF, DS_B, and classification accuracy were lower, while the number of error classifications, the non-persistent error classifications, HAMD and HAMA scores were higher in patients with ALS group than those in control group ( P<0.05). After adjusting for gender and age, there was no significant difference in the SMN between ALS group and control group (FWE correction, P>0.008). Compared with control group, patients with ALS showed increased functional connectivity in the left ventromedial prefrontal cortex (vmPFC) of the DMN, and decreased functional connectivity in the right anterior cingulate gyrus (ACC), the right posterior cingulate gyrus, the left inferior parietal lobule and the left inferior temporal gyrus of the FPCN (FWE correction, P<0.008). Increased functional connectivity of the vmPFC in ALS patients was negatively correlated with MoCa score ( r=-0.565, P<0.001), FAB score ( r=-0.373, P=0.015) and the classification accuracy of WCST ( r=-0.478, P=0.002), SVF ( r=-0.458, P=0.002) scores, and was positively correlated with the number of error classifications and HAMA scores ( r=0.416, P=0.007; r=0.388, P=0.011). Decreased functional connectivity were detected in multiple brain regions of FPCN, and the functional connectivity of the ACC was positively correlated with the DS_F ( r=0.341, P=0.027) and MMSE ( r=0.351, P=0.023). The effect of increased vmPFC functional connectivity accounted for 49.6% changes on MoCa score; 35.2% and 34.2% for FAB and HAMA respectively. While the impact of increased functional connectivity in the vmPFC was less than 30% on classification accuracy, classification error of WCST and SVF. The reduced functional connectivity in the ACC accounted for 37.7% impact on the DS_F score. Conclusions:Large-scale brain network changes are dominated by the frontotemporal core brain regions in ALS patients. DMN and FPCN network changes are closely related to the clinical cognitive performance of ALS patients.

Objective:To explore the clinical effect of radial extracorporeal shockwave therapy on delayed union of forearm fractures in children with ultrasonic guidance.Methods:A retrospective analysis of information on 18 children with delayed forearm fracture union who received ultrasonic guided extracorporeal shockwave therapy from February 2018 to June 2019 was conducted. Among them, there were 14 males and 4 females; Age: 9.44±3.75 years (range, 3-15 years); All the children were closed forearm fractures, including 13 cases of ulna and 5 cases of radius. Initial fixation methods: intramedullary nails fixation in 8 cases, Kirschner wire fixation in 4 cases, steel plate fixation in 2 cases, external fixation in 2 cases, conservative treatment in 2 cases; The classification of fracture nonunion were: 14 cases of hypertrophy, 4 cases of atrophy; The course of disease was 4.0 (3.0, 6.0) months. The front and lateral X-ray films of the affected side forearm were taken before treatment, 3 months and 6 months after treatment. The scores of callus condition were performed using Lane-Sandhu X-ray scoring standard and Fernandez-Esteve X-ray evaluation standard of callus grade.Results:All children completed treatment and were followed up for 6 months. The bone healing standard was the disappearance of the fracture line shown by anterior and lateral X-ray films. Within 6 months after treatment, 11 patients got bone union. The healing rate was 61.11% (11/18). The average of Lane-Sandhu X-ray scores before treatment, 3 months and 6 months after treatment were 3.0 (1.0, 4.0), 6.0 (4.0, 8.0) and 10.0 (5.0, 12.0), respectively, there were statistically significant differences in pairwise comparisons at each time point. And the average scores of Fernandez-Esteve X-ray evaluation standard for callus grade were 1.0 (1.0, 2.0), 3.0 (2.0, 4.0), and 4.0 (3.0, 4.0), respectively, there were statistically significant differences from 3 months and 6 months after treatment to preoperative group, while there was no statistically significant difference between 3 months and 6 months after treatment. The mixed effects model analysis results showed that only the Lane Sandhu X-ray score and Fernandez Esteve X-ray standard score of callus grade at different follow-up time points were significantly different. There was no statistically significant difference in age, gender, number of shockwave treatments and interval time from the first treatment after the initial fixation.Conclusion:The radial extracorporeal shockwave therapy can effectively treat the delayed healing of forearm fractures in children; the X-ray score has been significantly improved. The treatment is highly accepted by children and their parents, and can be used as one of the methods to treat delayed healing of fractures in children in the future.

Objective:To analyze the associated symptoms of progressive symmetrical erythema keratosis (PSEK) and the related literature was reviewed.Methods:Two Mongolian PSEK families in the dermatology department of the People′s Hospital of Inner Mongolia Autonomous Region from 2016 to 2017 were collected, and 40 complete PSEK families and 156 sporadic cases at home and abroad published since 1980 to 2020 were searched by using the database to analyze the concomitant symptoms of PSEK.Results:A total of 40 complete PSEK families were included, including 714 cases. The incidence of PSEK was 57.38% in foreign countries and 37.42% in China; The most common concomitant symptoms abroad were palmoplantar keratosis (PPK), followed by nail changes, neurological symptoms, dysplasia, combined with variable erythema keratosis (EKV), and the concomitant symptoms were more serious; The most common concomitant symptoms in China were nail changes, followed by PPK, damp hyperhidrosis, pruritus, pain and some skin diseases, and the concurrent symptoms were mild.Conclusions:PSEK has many associated symptoms and the molecular genetic mechanism is still unclear. It is necessary to conduct a more comprehensive and in-depth study and understanding of the disease through the development of sequencing technology and the expansion of clinical cases.