Objective:To investigate the diagnostic value of high resolution CT for temporal bone traumatic facial nerve paralysis and the guidance significance for surgery.Method:Twenty-nine patients of traumatic facial nerve paralysis were investigated.The predictive diagnosis was made according to the clinical data and the image features of HRCT,then a comparative analysis of the preoperative image features and the surgical findings were carried out.Result:The trend of temporal bone fracture displayed on the CT scan was basically consisted with the surgical findings.The direct CT signs of facial nerve injury include the bone fracture line went through the tube,bone tube rupture or continuity interruption,while the indirect CT signs include local incrassation of the facial nerve,lower bone density of the tube,geniculate fossa expansion,oppressed facial nerve,et al.The predictive diagnostic accordance rates of all the image features were above 90%as to the surgical findings.Conclusion:High resolution CT could localize the trend of temporal bone fracture,and is helpful to estimate the extent of facial nerve injury and other complications.High resolution CT could provide reliable basis for clinical diagnosis and trotment.

Objective To study the value of the semiquantitative-parameter analysis of wash out index of time-intensity curve (Swash-out) in evaluating the therapeutic effect of neoadjuvant chemotherapy for locally advanced breast cancer (LABC).Methods Fifty-nine women with LABC underwent dynamic contrast enhancedt MRI examination before chemotherapy,after the 2nd cycle and the 4th cycle of chemotherapy.All patients were divided into major histological response group (MHR) and non-major histological response group (NMHR) according to the final pathologic response.Swash-out and the variancetrends of Swash-out before NAC,after the 2nd cycle of NAC and after the 4th cycle of NAC were compared in each group and between the two groups.According to the gold standard of Miller & Payne criterion,Receiver operating characteristic curve (ROC) analysis was performed to evaluate the predicting effect of Swash-out for NAC response,and to compare it with Semi-quantitative TIC curve indicators Smax (steepest slope) and PPE (peak percent enhancement).Results Fifty-nine patients of LABC patients were divided into a MHR group of 34 patients and a NMHR group of 25 patients.Swash before NAC of MHR group was-16.99 (-56.72-41.20),Swash-out after the 2nd cycle of NAC was 5.66(-69.45-53.08),Swash-out after 4th cycle of NAC was 15.95 (-7.80-54.23).Swash-out before NAC of NMHR group was-23.08 (-64.24-34.39),Swash-out after the 2nd cycle of NAC of NMHR group was-23.01 (-52.72-28.70),Swash-out after 4th cycle of NAC of NMHR group was-11.45 (-50.49-50.93).Swash-out variance rate of MHR group after the 2nd and the 4th cycle of NAC were-1.18 (-31.32-60.86) and 1.50 (-86.27-3.61),respectively.Swash-out variance rate of NMHR group after the 2nd and the 4th cycle of NAC were-0.28(-3.24-9.46) and 0.27 (-5.34-3.11),respectively.Swash-out was not significantly different between the two groups before NAC (Z =-0.97,P ＞0.05).Swash-out and Swash-out variance rate of MHR group after the 2nd cycle of NAC were significant higher than that of NMHR group (Z =-3.97 and-3.02,P ＜0.01).Swash-out and Swash-out variance rate of MHR group after the 4th cycle of NAC were significant higher than that of NMHR group (Z =-3.96 and-3.16,P ＜ 0.01).Area under curve (Az) after the 2nd and the 4th cycle of NAC were 0.805 and 0.804,respectively,and no significant difference was found between them (Z =0.019,P ＞0.05).Diagnostic cut-off points were-8.670 for the 2nd cycle of NAC and 4.105 for the 4th cycle of NAC.Diagnostic sensitivity was 79.42％,specificity was 76.00％ and Youden index was 0.554,for after the 2nd and the 4th cycle of NAC.Conclusion Swash-out of TIC curve before NAC cannot predict the response of NAC,Swash-out of TIC curve after the 2nd cycle of NAC and after the 4th cycle of NAC are efficient in predicting the response of NAC.

ObjectiveStudy the ADC value and the maximal diameter and their changes of breast cancer before and after neoadjuvant chemotherapy,to determine the relationship with different expression level of Ki-67.Methods Forty eight patients with breast cancer confirmed by biopsy underwent MR DWI and enhanced scan before and after 4 cyclesneoadjuvant chemotherapy.ReviewtheMRimages retrospectively.The ADC value and the maximum diameter( D)of the cancer foci were measured before and after chemotherapy,and the rate of their changes △ADC％ and △D％ were calculated.Using different Ki-67 index level,all the foci were divided into three groups:group A with Ki-67 ＜ 20％,group B with Ki-67 between 20％ and 60％,and group C with Ki-67 ＞ 60％.Using nonparameter test to compare the ADC values,△ADC％,D and △D％ of the three groups before and after chemotherapy,determine whether there were differences.ResultsBefore chemotherapy,the ADC value of group A ( n = 15 ) was 1.1 ×10-3 mm2/s[ (0.9 × 10-3—1.2 × 10-3) mm2/s],which was higher than that of group B[n = 8,0.9 ×10-3 mm2/s(0.9 × 10-3-1.0 × 10-3) mm2/s] and C [n =25,0.9 × 10-3 mm2/s(0.7 × 10-3—1.2 ×10-3) mm2/s],and the difference was statistically significant (P ＜0.05 ) ; while the ADC value of group C after chemotherapy was 1.3 × 10 -3 mm2/s[ (0.2 × 10 -3—1.4 × 10 -3 ) mm2/s],which was higher than that of group A [1.1 × 10-3 mm2/s,(1.0 × 10-3—1.2 × 10-3) mm2/s] and B[1.1 × 10-3 mm2/s,( 1.0 × 10-3-1.1 × 10 -3 ) mm2/s],and the differences were statistically significance ( P ＜ 0.01 ) ; the ADC change rate( △ADC％ ) of group C was 45.5％ ( - 12.0％ —78.6％ ),which was greater than group A [45.5％ ( - 12.0％—78.6％ ) ] and B [ 45.5％ ( - 12.0％—78.6％ ) ],the difference was significant (P ＜ 0.01 ).The maximum diameters of group A were 2.2 cm (2.0—2.4 cm)and 1.0 cm(0.0—1.4 cm)before and after chemotherapy,lower than those of group B [ 3.7 cm ( 3.6—3.9 cm ) before NAC,2.9 cm (0.0-3.1 em) after NAC] and group C[3.4 cm(2.7—4.2 cm) before NAC,1.9 cm(0.0—2.2 cm) after NAC ],and the differences were statistically significant ( P ＜ 0.05 ) ; the change rate of the maximum diameter in group B was 21.6％ ( - 15.2％—27.5％ ),which was less than group A [52.7％ ( -23.6％—72.1％)] (P＜0.01) and C [51.2％ ( -10.3％—92.6％)] (P ＜0.05),and the difference was statistically significant.Conclusion The ADC values and the maximal diameter of breast cancer differed with different expression levels of Ki-67 index before and after neoadjuvant chemotherapy,and the response to neoadjuvant chemotherapy of which varied as well.

Objective To investigate the clinical value of tumor's longest diameter and volume in assessing pathologic response in locally advanced breast cancer treated with neoadjuvant chemotherapy(NAC).Methods A prospective study was undertaken in women undergoing NAC for locally advanced breast cancer in order to determine the ability of quantitative MRI to assess the final pathologic response. 36 cases with pathologically confirmed locally advanced breast cancer who had been undergone four courses of NAC underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller & Payne grading system, of which grade 4 and 5 defined as major histological response (MHR), and grade 1 to 3 as non-major histological response (NMHR). The tumor's longest diameters and volumes in MHR were compared with those in NMHR by Mann-Whitney U test before, after the second and fourth cycle of NAC. Concordance correlation coefficient (CCC) were assessed to evaluate the agreement between the two method. Receiver operating characteristic curve (ROC) analysis was carried out to assess the clinical value of tumor size and the change rate.Results Before,after the second and the fourth cycle of NAC, the difference of tumor's longest diameters and their first change rate between MHR [(2.75±1.16) cm,(2.19±1.07) cm ,(1.58±0.75) cm and (21.70±15.09)%]respectively,and NMHR [(2.71±1.10) cm,(2.33±0.90) cm,(2.01±0.94) cm and (11.68±10.27)%] respectively were not significant(P>0.05). The second change rate of tumor's longest diameter in MHR [(39.00±15.38)% ] was significantly higher than that in NMHR[ (25.83±21.77)% ](P=0.04). Before, after the second and the fourth cycly of NAC, the differences of tumor volumes and their first change rate between MHR [ median 14.00 cm~3 ( range 2.96～83.41 cm~3 ) , median 7.31 cm~3 (range 0.05～55.35 cm~3), median 2.69 cm~3 (range 0～33.40 cm~3 ) , median 48.65% (range 33.64%～98.48%) ] and NMHR [median 4.25 cm~3 (range 4.78～106.55 cm~3), median 10.53 cm~3 (range 1.72～42.85 cm~3), median 7.56 cm~3 (range 0.68～156.58 cm~3), median 52.04% (range-35.79%～78.31%) ] were not significant. The second changing rate of tumor's volume in MHR [median 85.37% (ranged 27.52%～100%)] was significantly higher than that in NMHR [median 68.80% (ranged -289.60%～94.24%)](P=0.01). CCC was computed before and (0.82), after the second cycle (0.67) and after the fourth cycle (0.55), in all examinations pooled together (0.78).The second change rates of tumor's longest diameter and volume were equal to predict the final pathologic response, and the area under curve were 0.75 and 0.80, respectively (P=0.61). Conclusion The agreement between the tumor's longest diameters and tumor's volumes is good in all in breast carcinoma. The assessment efficacy of the change rate of tumor's longest diameter and that of volume were low.

To study the contribution of T cell subsets in the pathogenesis of Murine hepatitis virus Type3 (MHV-3) induced chronic viral hepatitis in C3H/Hej mice, ninety C3H/Hej mice were chosen to individually receive 10 plaque forming units (PFU) of MHV-3 intraperitoneally. The changes of virus titer and pathology in liver tissue were examined by standard plaque assay and by the hematoxylin/eosin (HE) staining method from 2 days post MHV-3 infection. The ratios of T cell subsets including CD3+CD4+CD8-, CD3+CD4-CD8+, CD3+CD4-CD8-, CD3+CD4+CD25+, CD3+CD4+CD25- and CD3+CD4-CD25+ T lymphocyte of total T lymphocytes in blood, spleen and liver were examined at 0, 2, 4, 6,8, 10, 12, 15, 20, 25, 30, 40 days post MHV-3 infection by flow cytosorting. We observed that the virus titer raised and showed persistent virus duplications and inflammatory changes in the livers of C3H/Hej mice from 2 days post MHV-3 infection. The double negative T cell (DN Treg cell) and CD4+CD25+ T cell ratios increased significantly from 2 days post MHV-3 infection in C3H/Hej mice, and CD3+CD4+CD8-, CD3+CD4-CD8+, CD3+CD4+CD25- and CD3+CD4-CD25+ T cell ratios decreased accordingly. In conclusion, the changes of virus titer and pathology in the livers of C3H/Hej mice post MHV-3 suggest their contribution to viral persistence. Further characterizations of DN Treg cells are that infection indicates that MHV-3 could induce the chronic inflammation in livers of C3H/Hej mice.The increase of the DN Treg cell and CD4+CD25+ T cell ratios in C3H/Hej mice post MHV-3 infection suggests that DN Treg cells and CD4+CD25+ T cells may both have important suppressive immunomodulation functions in the development of chronic viral hepatitis and have important roles in the virus persistent infection. Further characterizations of DNT cell and CD4+CD25+ T cell are under investigation.

Objective To investigate the early change of MR DWI parameters of breast cancer after neoadjuvant chemotherapy (NAC) and assess the relationship between the changes of the NAC response. Methods Patients with local advanced breast cancer diagnosed by biopsy were enrolled in the prospective study. They received DWI examination before NAC and then received DWI examination at 24 h after the first cycle of NAC. The pathological results of breast cancers were recorded after NAC finished. 14 patients (15 lesions) were enrolled in this study.The minimum ADC values of breast cancer before NAC and after the first cycle of NAC were recorded, and their change rates were calculated. Two weeks after NAC,all cases were divided into clinical complete response (cCR) and non-clinical complete response group according to clinical NAC response evaluation. Then lesions were divided into pathological complete response (pCR) and non-pathological complete response group according to pathological NAC response evaluation. Using the Paired samples t test,we analysed the change of ADC values 24 h after the first cycle of NAC. The ADC values and change rates were compared between cCR and non-cCR group using Mann-Whitney U test. The ADC values and change rates were also compared between pCR and non-pCR group using Mann-Whitney U test.Results The 15 cases were all invasive ductal carcinoma patients. According to clinical NAC response evaluation, 5 cases were cCR and 10 cases were non-cCR. According to pathological NAC response evaluation, 6 cases were pCR and 9 cases were non-pCR. Before NAC, the minimum ADC value of breast cancer was(0.78±0.15)×10-3 mm2/s. After the first cycle of NAC, the minimum ADC value of breast cancer was(0.91 ± 0.16) × 10-3 mm2/s. The minimum ADC value of breast cancer significantly increased 24 h after the first cycle of NAC (t=-2.954,P=0.010). But ADC value and its change rate were not significantly different between cCR and non-cCR groups, also between pCR and non-pCR groups (P>0.05). Conclusion Significant change in the minimum ADC value of breast cancer could be observed 24 h after the first cycle of NAC, but the change do not relate to clinical and pathological NAC response in this study.

Objective To investigate the differential value of contrast-enhanced ultrasonography (CEUS) and time-intensity curves(TIC) in diagnosing testicular and epididymal mass lesions.Methods CEUS via intravenous bolus injection of SonoVue and TIC were performed for quantitative analysis of testicular and epididymal mass lesions.Forty-one patients with 42 testicular and epididymal mass lesions and 26 normal testicles were examined with CUES,the perfusion progress were recorded dynamically,which findings were compared with surgery.Results Twenty-three (54.76％) malignant masses displayed enhanced pattern as evenly enhanced,fast-in and fast-out (8.7％),evenly enhanced,fast-in and slow-out (65.2 ％ ),unevenly enhanced,fast-in and slow-out (26.1％ ).Ninteen (45.24 ％ ) benign masses revealed enhanced pattern as unevenly enhanced,fast-in and slow-out ( 10.5 ％),evenly enhanced,slow-in and slowout ( 10.5 ％ ),unevenly enhanced,slow-in and slow-out ( 36.9 ％ ),without enhancement ( 42.1％ ).There was statistical difference of peak intensity,time to peak and areas among malignant group,benign group and normal group ( P ＜ 0.05).Conclusions CEUS combined with TIC could provide differential diagnostic value for testicular and epididymal mass lesions.

Glaucoma is a group of diseases which can threaten and damage the optic nerve and its visual pathway, leading to visual impairment as a result. Glaucomatous optic neuropathy is a chronic disease accompanied by apoptosis of retinal ganglion cells ( RGCs ) , visual field defect and cupping of optic nerve head. The gold standard in functional glaucoma evaluation is standard automated perimetry ( SAP) , but it is often limited to the subjective feelings of the patients. Still, visual electrophysiological techniques cannot replace the conventional inspection, but with its rapid development, it has provided a new strategy for the early diagnosis of glaucoma as a supplement because it can show changes in amplitude and latency before visual field defect. Here we review three special electroretinograms and multifocal focal visually evoked potentials in the early diagnosis of glaucoma.

Objective To analyze the clinical manifestations,diagnosis and treatment of cerebral amyloid angiopathy (CAA) associated intracerebral hemorrhage.Methods The clinical manifestations,treatment and prognosis of CAA associated intracerebral hemorrhage were analyzed in 4 patients who were identified as CAA-related hemorrhage (CAAH) by pathology.Results All of the 4 patients showed massive lobar intracranial hemorrhage,and underwent craniotomy evacuation of hematoma.One patient had postoperative hemorrhage,and 2 patients were treated with recombinant activated factor Ⅶ after operation.In the next 6 months,re-hemorrhage was found in 3 patients in whom one patient died due to massive hemorrhage.Conclusions CAAH has varied clinical manifestations with high risk of cerebral hemorrhage,and pathological diagnosis is necessary for a definite diagnosis.The very elderly patients with CAAH can benefit from the craniotomy evacuation of hematoma.Although surgery for massive hemorrhage has risks in very elderly patients,it is a better treatment to save their lives.

Objective To compare the expression of nitric oxide synthase (NOS ) in patients with gastroesophageal reflex disease (GERD)and healthy controls.Methods The distribution and relative protein amount of two NOS subtypes (nNOS and iNOS)were determined with immunohistological method,and their mRNA levels were measured with real-time PCR method.Results The nNOS and iNOS were mostly distributed in the cytoplasm in epithelia of esophageal mucosa.The nNOS and iNOS in reflux esophagitis (RE)were significantly higher than in non-erosive reflux disease (NERD)patients and healthy controls (P <0.05 ).The mRNA levels of nNOS and iNOS were also significantly higher in RE patients than in NERD patients and healthy controls (P <0.05).Conclusion The expressions of nNOS and iNOS were increased in the esophagus of RE patients,which may be related to the effects of NO on the onset of GERD.