Objective To discuss the application value of DHS and cannulated screws in treatment of the intertrochanteric fractures . Methods 23 cases of intertrochanteric fractures were treated with DHS and cannulated screws and 20 cases were followed up for an average period of 12 months. Results All the fractures healed . The recovery of function was excellent in 90%cases. Conclusions Using DHS and cannulated screws to treat the intertrochantenic fractures easily leads to anatomical reduction and rigid fixation, and gives large definitive rotational stability.

Objective To explore CT and MRI features of peripheral primitive neuroectodermal tumors (pPNET) .Methods CT and MRI findings were retrospectively analyzed in 9 cases with pPNET confirmed by pathology .Of them ,8 patients underwent CT imaging ,and 5 patients underwent MR imaging .Results The lesions occurred in head and neck in 2 cases ,chest in 3 cases ,scrotum in 1 case ,right scapular region in 1 case ,and lower extremity in 2 cases .The lesions were more solitary (7/9) with round ,lobular or irregular shape .The longest diameter was between 1 .6 cm -13 .8 cm ,and the median diameter was 6 .2 cm .8 cases had blurred boundary .On CT plain scanning ,the lesions were mixed density with predominant isodensity .On MR imaging ,the lesions were slightly T1 hypointensity and heterogeneous T2 hyperintensity .Enhancement patterns were varied ,and the common way was mild‐to‐moderate heterogeneous enhancement .3 cases of them were closely associated with bone ,and showed osteolytic bone destruction . Conclusion The CT and MRI features of pPNET has lack characteristics ,CT and MR imaging have some value for localization diagnosis .

Objective To explore the value of MR dynamic contrast-enhancement in diagnosis and differential diagnosis of infiltrating ductal carcinoma of breast at 3.0T MR magneton.Methods 17 cases of breast infiltrating ductal carcinoma underwent plain MRI and MR dynamic contrast-enhanced scan using 3.0T MR scanners with dedicated breast coil.All cases were confirmed by surgery and pathology.MRI signal intensity,morphology and hemodynamic characteristics of lesions were analysed.Results 17 breast infiltrating ductal carcinomas in 17 cases all appeared as masses,low(8/17)or equal(9/17)signal intensity on T_1WI,high(14/17)or equal(3/17)signal intensity on T_2WI.On morphology,the lesions were irregular and lobulated in shape(82.4%,14/17);undefinite margins(12/17)or non-smooth margins(15/17),glitch sign or astral sign(7/17);the lesions showed non-uniform marked enhancement(10/17)or ring enhancement(5/17)after intravenous administration of contrast agent.82.4%(14/17)of the lesions,the blood vessels could be seen gathering around the lesions on the maximum intensity projection(MIP)image.On hemodynamics,the early enhanced ratio for all cases was over 90%;88.2%(15/17)of the lesions,peak enhancement was less than three minutes;the time-signal intensity curve of the lesions appeared as type Ⅱ was 35.3%(6/17)and type Ⅲ was 58.8%(10/17)mostly.Conclusion Dynamic contrast-enhanced MRI manifestations of breast infiltrating ductal carcinoma are of certain characteristics,which may contribute to the diagnosis and differential diagnosis.

Objective To investigate CT and MRI features of abdominal huge liposarcoma,and improve the preoperative diagnostic accuracy. Methods The CT and MRI findings of 1 7 cases with abdominal huge liposarcoma proved by operation and pathology were analyzed and correlated with pathologic subtypes retrospectively.Results In 17 cases,16 cases were located in retroperitoneal,1 case was located in the abdominal cavity.The average maximal diameter of the lesions was 17 cm.In all cases,main components of well differentiated liposarcomata (n=7) were fat density on CT and MRI,and enhanced slightly,3 cases were multiple lesions,1 case of sclerosing liposarcoma contained massive patchy calcification,1 case was fatless.Myxoid liposarcoma (n=5)were similar to cystic on CT and MRI features,enhanced with latticed or cloudy components slightly to moderately .Dedifferentiated liposarcoma (n=2)has both fat and soft tissue inside and the dividing line was clear.The soft tissue mass unevenly obviously enhanced.Mixed liposarcoma (n=3)had the imaging characteristics above different types,2 cases contained no fat composition.Conclusion Liposarcoma pathological subtype has diversity,and various subtypes have certain characteristic on CT and MRI imaging features.

Objective To investigate CT and MRI features of extragonadal primary seminoma and improve its diagnostic accuracy.Methods The clinical and imaging features of 8 patients with extragonadal primary seminoma proved by histopathology were analyzed retrospectively.Results In 8 cases,4 cases were located in intracranial regions,4 cases in the abdominal and pelvic cavity.Detailedly,roundlike solid and cystic tumors were seen in the basal ganglia and thalamus in 2 cases.The mass density and signal were inhomogeneous in the necrotic area with slight peritumoral edema and heterogeneous enhancement,and hemorrhage and metastasis of the third ventricle were occurred inone case.Shallow lobulated tumor was occurred in the pineal region forone case,which MRI features included slightly low signal on T1 WI,equal or higher signal on T2 WI,with obvious enhancement and peripheral cystic change.There was one case in the sella area with slight high density on CT routine scan,and on MRI,slight equal signal on T1 WI,equal or higher signal on T2 WI.The pituitary stalk was involved with thickening.Tumor in suprasellar region was obviously enhanced,with a small uniformity enhancement nodule in the mouth of corpus callosum.4 cases were occurred in the abdominal and pelvic cavity,shallow lobulated tumors with varying degrees of necrosis were found on CT with infiltrating growth and slight to moderate enhancement,and swollen lymph nodes were found in retroperitoneal and mesenteric root areas.Conclusion Extragonadal primary seminoma is rare,there are some characteristic imaging findings,which contributes to improve diagnosis accuracy when combining with clinical data.

Objective To investigate the difference of cerebral inter-hemispheric functional connectivity between the patients with amyotrophic lateral sclerosis ( ALS) and healthy controls ( HC) by a newly developed voxel-mirrored homotopic connectivity ( VMHC) method based on resting-state functional MRI ( rs-fMRI) , as well as its correlation to the structural imaging indices and clinical neurological scales .Methods Twenty patients with ALS ( ALS group ) and 20 age-, and sex-matched healthy controls ( HC group) were examined by rs-fMRI and diffusion tensor imaging ( DTI ) on 3.0 T MR imaging system ( Siemens Trio Tim ).The rs-fMRI data preprocessing were performed using data processing assistant for rs-fMRI ( DPARSF) based on Matlab 2009a, and the rs-fMRI data analysis toolkit ( REST) with an automated VMHC approach was utilized to calculate and compare the VMHC correlation coefficients between the ALS group and the HC group[P<0.05, corrected with false discovery rate (FDR)].Region of interest (ROIs) were prescribed on the regions which showed abnormal VMHC coefficients in ALS group , then the mean time series of the ROIs were extracted to examine the difference of the seed ( ROIs)-based functional connectivity between the ALS and HC groups.At last, linear correlations were performed to assess the relationships among the VMHC coefficients and clinical measures including the revised amyotrophic lateral sclerosis functional rating scale ( ALSFRS-r) score, disease duration , the rate of disease progression and fractional anisotropy ( FA) values of the corpus callosum ( CC).Results Compared with HC group , the patients with ALS showed lower VMHC coefficients in the precentral gyrus ( M1 ) , postcentral gyrus ( PCG ) , inferior parietal lobule (IPL), cuneus/precuneus (Cu/Pcu), and anterior cingulate gyrus (ACC).Higher VMHC coefficients were found in the supplementary motor area , superior frontal gyrus , and middle occipital gyrus (P<0.05,FDR corrected).Significant functional connectivity alterations were detected in motor cortex and frontal/temporal/occipital lobe between the ALS and HC groups using seed ( ROIs )-based functional connectivity based on the regions which showed abnormal VMHC coefficients in ALS group ( P <0.05, AlphaSim corrected, clusters≥228 voxels).Significant positive correlation was detected between the VMHC coefficients (0.311 ±0.108) of M1 and FA values (0.394 ±0.016) of CC III region (r=0.530, P=0.016), between the VMHC coefficients (0.767 ±0.043) of ACC and FA values (0.360 ±0.105) of CC I region (r=0.513, P=0.021), respectively.Significant positive correlation was observed between VMHC coefficients (0.311 ±0.108) of M1 and the ALSFRS-r score (35.4 ±2.5) in ALS patients(r=0.447, P=0.048).There was not significant correlation observed between the VMHC coefficients and disease duration , or the ratio of disease prognosis (P>0.05).Conclusions Abnormal VMHC coefficients were detected in ALS patients.The decreased VMHC in ACC and M1 are associated with the reduced micro-structure integrity of CC, meanwhile, and they may be related to disease severity.

Objective To investigate the alterations of regional spontaneous activity in patients with classical trigeminal neuralgia (CTN) during resting state.Methods Twenty-seven patients with CTN (CTN group) and 27 healthy subjects (control group) were recruited and underwent a rest-state functional MRI.The regional homogeneity (ReHo) analysis was used to compare the differences of regional synchronization of spontaneous brain activity.And correlation tests were performed between ReHo values in the abnormal brain areas and clinical metrics (visual analogue scale and disease duration) of the disease.Results Compared with control group (P＜0.05,Gaussian random field correction),ReHo increased in bilateral primary somatosensory cortex (S1) and primary motor cortex (M1),right supplementary motor area (SMA),inferotemporal cortex and cerebellum,left thalamus,limbic lobe,parahippocampa gyrus,middle and superior temporal gyrus in CTN group;ReHo decreased in bilateral insula,prefrontal cortex and orbitofrontal cortex,right frontal medial cortex and superior temporal gyrus,left anterior cingulate area,supramarginal gyrus and cerebellum in CTN group.ReHo values in right frontal medial cortex was negatively correlated with the course of disease (r=-0.45,P=0.03).The ReHo values of left primary sensorimotor cortex were positively correlated with the visual analogue scale scores (r=0.46,P=0.02).Conclusion CTN patients has abnormal functional homogeneity of spontaneous brain activity in regions involved in the pain processing,which can help understanding mechanism of CTN.

Objective To investigate CT features of primary ileocecum lymphoma (PIL),to improve the ability of CT diagnosis for the disease.Methods CT data of 12 patients with PIL confirmed by surgery and pathology were analyzed retrospectively.All of the patients underwent plain CT, and 8 cases of them also underwent enhanced CT.Results Among the 12 cases of PIL, there were mass type in 2 and diffused thickness type in 10.The length of the intestinal lesions ranged from 7.8 to 18.5 cm (mean 10.2 cm).Lumen was irregular or aneurysmal dilation in 9, and obvious stenosis in 3.Intestinal wall was soft in 10,and rigid in 2.Plain CT showed that the thickened intestinal wall was soft tissue density.Among the 8 cases performed enhanced CT,6 were approximately homogeneous enhancement, and 2 had small necrosis area without enhancement.Maximum intensity projection(MIP) displayed the lesion had blood supply from the branches of the superior mesenteric artery.Enlarged lymph nodes were detected around the lesions, in root of the mesentery, and in the retroperitoneum in 9.1 case was accompanied with intestinal obstruction,1 case was accompanied with intestinal perforation.Conclusion If CT examination found a homogeneous soft tissue mass in ileocecum with long extent, lumen dilation, soft intestinal wall,mild-to-moderate delayed homogeneous enhancement, PIL should be considered.

OBJECTIVETo evaluate the outcomes of arthroscopy-assisted treatment of severe comminuted distal radial fracture with external fixators and kirschner wire fixation.

METHODSTwenty-seven cases of severe comminuted distal radial fracture treated between March, 2010 and January, 2012 were reviewed. During the operation, the carpal joint space was expanded with the external fixator, and the fracture was fixed by Kirschner wire after open reduction. The carpal joint was observed intraoperatively with arthroscopy to ensure full reduction, and the distal posterior interosseous nerve was then severed. The results of postoperative X-ray and wrist functional status of the carpal joints were recorded. Another 27 cases of severe comminuted distal radial fracture treated by conventional surgical approach served as the control group.

RESULTSThe patients were followed up for a mean of 13.2 (5-27) months. Compared with the conventional surgical approach, arthroscopy-assisted treatment resulted in a significantly shorter operative time with better appearance of the articular surface and also better wrist function assessed using the Krimmer system (P<0.05).

CONCLUSIONArthroscopy-assisted external fixator treatment is effective for management of severe comminuted distal radial fracture and avoids the stair-like appearance of the articular surface to achieve the maximal functional recovery of the carpal joints and reduce traumatic arthritis.

Adult ; Arthroscopy ; External Fixators ; Female ; Fracture Fixation ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Treatment Outcome

Objective To determine kinetics of TNF-α and miR-146a (microRNA-146a)expressions in lipopolysaccharide (LPS)-induced NR8383 alveolar macrophages (AM) at different intervals and their relationships in order to explore regulatory effect and mechanism of miR-146a on alveolar macrophages inflammatory responses.Methods NR8383 alveolar macrophages were seeded in a 6-well plate,and stimulated with 1 μg/ml of LPS for 0 h,3 h,6 h and 12 h separately after 90 min.Cells were harvested and supernatant were collected 0 h,3 h,6 h and 12 h after incubation.The expressions of miR146a and TNF-α mRNA in cells were detected by real-time qPCR and the levels of TNF-α protein in the supematant of cells were assayed by enzyme-linked immunosorbent assay ( ELISA ).Pearson correlation analysis was used to analyze the correlation between miR-146a and TNF-α mRNA.Results ①The level of TNF-α protein in the supernatant of cell was significantly increased 3 h after LPS challenge ( 359.80 ±57.54) pg/ml (P ＜0.01 ),and peaked 12 h later (729.22 ±50.40) pg/ml (P＜0.01 ) ; ②the expression of TNF-α mRNA peaked 3 h after LPS challenge (67.48 ±24.52) fold,P ＜0.01 ),and then decreased gradually; ③the expression of miR-146a mRNA increased continuously until 6 h or 12 h after LPS challenge 6 h:(5.33 ±0.81) fold,12 h:(8.21 ±1.19) fold,(P＜0.01),and it showed an upward tendency;④ the expression of miR-146a mRNA was negatively correlated with TNF-α mRNA ( r =-0.895,P ＜0.01).Conclusions The miR-146a mRNA showed a negative correlation with TNF-α mRNA present in lipopolysaccharide-stimulated alveolar macrophages,suggesting miR-146a mRNA involved in regulating the inflammatory response of alveolar macrophages.