Objective To discuss the methods of primarily repairing scalp,skull and dura defects of separated type D craniopagus Methods The huge defects in craniopagus was primarily repaired by the application of scalp expander, transferring scalp flap, repairing dura with pedicle periosteums, repairing skull defects with Titanium plates Results The survival baby has a good sharp of skull and well healing of scalp postoperatively Conclusions Defects of separated type D craniopagus can be primarily repaired

Objective:To investigate the relationship between caspase recruitment domain protein 9 (CARD9) level and inflammatory response in cerebral tissue of ischemic brain injury mice.Methods:Totally 24 SPF BALB/c male mice were randomly(random number) divided into 4 groups: sham operated group, ischemia 3 h group, ischemia 6 h group, and ischemia 12 h group, 6 mice in each group. The permanant middle cerebral artery occlusion (pMCAO) model in the ischemia groups was established by using line embolism to block blood flow. Mice in each group were sacrificed at the predetermined time point after operation. CARD9 and p-p65NF-κB levels were detected by Western blot, and the inflammatory factors mRNA and protein including TNF-ɑ, IL-lβ and IL-6 were detected by RT-PCR and ELISA, respectively. The data were analyzed by SPSS 21.0 software, the comparison of measurement data between each two groups was analyzed by independent sample t test, and the correlations between CARD9 and inflammatory factors were analyzed by Pearson analysis. Results:Compared with the sham operated group, the CARD9 levels in the ischemia 3 h, 6 h and 12 h groups were increased significantly [(0.325±0.011) vs. (0.462±0.019), P=0.036; (0.735±0.036), P=0.003; (0.903±0.024), P=0.001], the p-p65NF-κB levels in the ischemia 3 h, 6 h and 12 h groups were increased significantly [(0.227±0.016) vs. (0.316±0.017), P=0.041; (0.445±0.021), P=0.016; (0.671±0.039), P=0.008], the TNF-ɑ levels in the ischemia 3 h, 6 h and 12 h groups were significantly increased [(0.53±0.06) vs. (1.06±0.10), P=0.009; (1.47±0.15), P=0.004; (2.78±0.18), P=0.001], the IL-lβ levels in the ischemia 3 h, 6 h and 12 h groups were significantly increased [(0.55±0.07) vs. (1.01±0.11), P=0.009; (2.13±0.16), P=0.003; (3.09±0.18), P=0.001], and the IL-6 levels in the ischemia 3 h, 6 h and 12 h groups were significantly increased [(1.99±0.18) vs. (4.10±0.41), P=0.006; (8.54±0.84), P=0.002; (11.56±0.96), P=0.001]. Pearson analysis showed that CARD9 was positively correlated with the p-p65NF-κB and TNF-ɑ, IL-lβ, IL-6 ( r=0.894, P=0.001; r=0.747, P=0.008; r=0.810, P=0.001; r=0.773, P=0.007). Conclusions:A positive correlation exists between CARD9 and inflammatory responses in the early stage of ischemic brain injury in mice

Objective To investigate changes of the interhemispheric coordination integrity in patients with hemi-parkinsonism using resting-state functional magnetic resonance imaging(rs-fMRI) homotopy technique called voxel-mirrored homotopic connectivity(VMHC).Methods Sixteen Parkinson disease(PD) patients with right body side motor symptom onset(RPD),15 patients with left side onset(LPD),and 19 age-,gender-,and education-matched healthy controls(HC) were included in this study.rs-fMRI scanning and pre-processed the raw data were performed.Then by using analysis of variance(ANOVA) and two sample t tset,we performed VMHC analyses on rs-fMRI data of these participants(P＜0.05,corrected with AlphaSim,clusters≥16 voxels).Exploratory linear correlations analyses were performed between the VMHC of regions showing significant group differences and the clinical features of LPD or RPD patients.Results Compared with HCs,patients with LPD had significantly reduced VMHC in visual regions,sensorimotor regions,and the cerebellar cortex(voxels size of 17-77,t=-5.06--3.42,P＜0.05).Patients with RPD exhibited decreased VMHC in the prefrontal cortex and sensorimotor regions.Both LPD and RPD groups had increased VMHC in subcortical regions.When compared with the RPD group,the LPD group displayed decreased VMHC in the visual regions,sensorimotor regions(voxels=16 and 18; t=-3.68and-3.87,respectively,both P＜0.05) and increased VMHC in the supramarginal gyrus(voxels=4,t=4.72,P＜0.05);ROI-based correlation analyses indicated that the VMHC in the inferior occipital gyrus and the postcentral gyrus was negatively correlated with the BDI-Ⅱ scores in the LPD group(r=-0.58 and-0.59,respectively; both P＜0.05),and positively correlated with the MMSE scores(r=0.56 and 0.52,respectively;both P＜0.05).In the RPD group,a positive correlation was found for the VMHC in the supramarginal gyrus and the illness duration(r=0.56,P＜0.05) and for the VMHC in the postcentral gyrus and the(mini-mental state exam) MMSE(r=0.53,P＜0.05).Conclusions The differential pattern of deficits in the interhemispheric coordination integrity in hemi-parkinsonism reflected by VMHC may provide insights into the neurological pathophysiology underlying the asymmetry of symptom appearance in PD.

Norepinephrine transporter (NET) transfection leads to significant uptake of iodine-131-1abeled metaiodobenzylguanidine (131I-MIBG) in non-neuroendocrine tumors.However,the use of 131I-MIBG is limited by its short retention time in target cells.To prolong the retention of 131I-MIBG in target cells,we infected hepatocarcinoma (HepG2) cells with Lentivirus-encoding human NET and vesicular monoamine transporter 2 (VMAT2) genes to obtain NET-expressing,NET-VMAT2-coexpressing,and negative-control cell lines.We evaluated the uptake and efflux of 131I-MIBG both in vitro and in vivo in mice bearing transfected tumors.NET-expressing and NET-VMAT2-coexpressing cells respectively showed 2.24 and 2.22 times higher 131I-MIBG uptake than controls.Two hours after removal of 131I-MIBG-containing medium,25.4％ efflux was observed in NET-VMAT2-coexpressing cells and 38.6％ in NET-expressing cells.In vivo experiments were performed in nude mice bearing transfected tumors;results revealed that NET-VMAT2-coexpressing tumors had longer 131I-MIBG retention time than NET-expressing tumors.Meanwhile,NET-VMAT2-coexpressing and NET-expressing tumors displayed 0.54％ and 0.19％,respectively,of the injected dose per gram of tissue 24 h after 131I-MIBG administration.Cotransfection of HepG2 cells with NET and VMAT2 resulted in increased 131I-MIBG uptake and retention.However,the degree of increase was insufficient to be therapeutically effective in target cells.

Objective To present the surgical technique of transumbilical laparoendoscopic singlesite pyeloplasty (LESS-P) for pediatric patients with ureteropelvic junction obstruction (UPJO).Methods Twenty-four pediatric patients with UPJO had transumbilical LESS-P performed by the same surgeon from June to December 2010.Sixteen patients were male and eight female aged from 2 to 62 months with an average age of 14 months.Eighteen patients had obstruction on the left side and six on the right side.Dismembered LESS-P was carried out with the Anderson-Hynes anastomosis where 5-0 sutures were uswed over a double J ureteric stent.Results All operations were successful.None was converted to open surgery and no additional sheath tube or incision besides the umbilicus was needed.No intraoperative complications occurred.Ectopic blood vessels were found in two patients during surgery.The mean operative time was 145 min,and the average blood loss about 10 ml.Abdominal drainage tubes remained for 2 -9 d after surgery.The mean postoperative hospital time was 7 d.Two patients had postoperative urinary fistula,which naturally disappeared at 4 and 7 d postoperation,respectively.Follow-up with ultrasound and diuretic renal scintigraphy found 23 patients had significantly decreased renal pelvis diameter,the remaining case showed no obvious change,but diuretic renography showed significantly improved excretion.ConclusionsPediatric transumbilical LESS-P could be safe and effective.LESS-P could achieve comparable clinic outcomes to standard laparoscopy.

Objective To explore the association between PI3K polymorphisms in insulin signal transduction pathway and Alzheimer's disease (AD)risk.Methods There were three groups,including 112 cases for AD +T2D group,231 cases for only AD group,and 231 cases for healthy controls group.The polymorphisms in PI3K gene was sequenced by PCR and the concentration of PI3K in serum was tested by enzyme -linked immunosorbent assay (ELISA).Results Overall,there was significantly statistical difference in PI3K rs3730087 polymorphism among three groups (χ2 =20.99,P =0.000 3).The CC frequency of PI3K rs3730087 polymorphism in AD with T2D group and AD control group was significantly higher than that in the healthy control group.The PI3K protein level of differ-ent genotype was statistically significant (F =27.450,P <0.000 1).As for CC genotypes of PI3K rs3730087 poly-morphism,the PI3K protein level was statistically different among these three groups (F =8.096,P =0.000 6).Moreover,the PI3K protein level of the three groups was different (F =9.034,P =0.000 1),which in both AD group was lower as compared with healthy control group.Conclusion The study suggested that CC genotype of PI3K rs3730087 polymorphism in insulin signaling transduction pathway might be a risk factor for AD with T2D and it also affects the expression level of PI3K protein.However,the polymorphism is not shown to be exclusive in AD patients with T2D.

Objective To explore the preventive effect of twin-tube laryngeal mask airway on gastric lavage and aspiration pneumonia. Methods Between January 2015 and June 2017, 305 cases of poisoning coma patients were admitted to Emergency Department, The First Affiliated Hospital of Nanchang University. According to the inclusion criteria and exclusion criteria, 255 cases of poisoning coma patients were enrolled and randomly(random number) divided into 3 groups (n=85 in each group):group A (normal gastric lavage machine method), group B (gastric lavage endotracheal intubation), and group C (gastric lavage twin-tube laryngeal mask airway placement). Whether there was aspiration pneumonia within 12 hours after the onset was observed, and the length of hospital stay, hospitalization cost and mortality were recorded. The mean value of the two samples was compared with t test, and the four-grid data were checked by chi-square test. P<0.05 was statistically significant. Results Compared with group A, the incidence of aspiration pneumonia was significantly lower in group B and group C (group A 56.47％, group B 32.94％, group C 23.53％, P<0.01). Compared with group A, the length of hospital stay in group C was shorter [(3.39±2.12) d vs. (6.06±4.91) d,P<0.05], and the hospitalization cost was less [(25687.52±20803.44) yuan vs. (52213.91±37267.56)yuan,P<0.05]. There was no significant difference of mortality between the three groups (P>0.05).Compared with group B, the length of hospital stay in group C was shorter [(3.39±2.12) d vs.(5.51±4.37) d, P<0.05], and the hospitalization cost was less [(25687.52±20803.44)yuan vs.(50887.82±32399.76) yuan, P<0.05]. There was no significant difference of mortality between the three groups (P>0.05). Conclusions Twin-tube laryngeal mask airway for poisoning coma patients with gastric lavage, can not only ensures effective ventilation, but also reduces the probability of concurrent aspiration pneumonia, shortens hospital stay, and reduces hospitalization cost, but has no obvious effect on mortality.

Objective To assess the volumetric variation of liver and spleen in early diagnosis of liver fibrosis and cirrhosis.Methods One hundred and thirty-seven subjects underwent dynamic enhanced examination of liver and spleen using multi-slice CT(MSCT).Forty potential living liver donors were served as controls.Sixty-three histologically proved fibrotic patients were divided into slight liver fibrosis(F≤2,n=44)and advanced liver fibrosis(F≥3,n=19)according to the Ishak system.Liver cirrhosis group consisted of 34 patients diagnosed clinically and radiologically.The measurement of total liver volume(TLV),right liver lobe volume(RV),left lateral liver segment volume(LLV),left medial liver segment volume(LMV),eaudate lobe volume(CV)and spleen volume(SV)were obtained bv MSCT.The ratios of segmental liver and SV to TLV were also calculated.Results The values of liver volumes(TLV,RV and LMV)reduced gradually among control(1470.38 cm3,933.34 cm3,216.20 cm3,respectively),slight liver fibrosis(1239.99 cm3,799.74 cm3,184.69 cm3,respectively),advanced liver fibrosis(1219.76 cm3,765.22 cm3,179.44 cm3,respectively)and cirrhosis(1078.21 cm3,543.73 cm3,163.12 cm3,respectively) groups.The volume of SV and the ratios of CV/TLV and SV/TLV increased gradually among control (256.29 cm3,3.09%,17.53%),slight liver fibrosis(284.41 cm3,3.20%,22.91%),advanced liver fibrosis(343.13 cm3,3.58%,28.80%)and cirrhosis(863.38 cm3,4.16%,82.91%)groups.There was significant difference among control,liver fibrosis and cirrhosis group in TLV,RV,LMV and SV/TLV(P＜0.05),but there was no significant difference in all parameters between the slight liver fibrosis group and the advanced liver fibrosis group(P＞0.05).There was significant correlation of TLV,LMV,SV,RV,CV/TLV,SV/TLV,RV/TLV and LLV/TLV with liver cirrhosis and its staging.Conclusion Variations in liver and spleen volume,the ratios of segmental liver and SV/TLV are correlated with the extent of liver fibrosis and cirrhosis.which will be helpful in early detection of liver fibrosis and cirrhosis.

Objective:To observe the dynamic changes of the temporomandibular joint (TMJ) disc in joint movement under different Angle′s classification, providing reference for understanding joint functional movement and providing a basis for more accurate clinical imaging diagnosis.Methods:A total of 30 patients (13 males and 17 females) with temporomandibular disorders who were admitted to Beijing Friendship Hospital, Capital Medical University and General Hospital of the People′s Liberation Army from January 2022 to April 2024 were enrolled. Thirty adults (13 males and 17 females) with different Angle′s classification, with an average age of (34.4±8.5) years, were subjected to dynamic imaging of their TMJ from the closed position to the maximum opening position, and then to the closed position using MRI. The position and morphological changes of the articular discs were observed.Results:The results showed that volunteers with no displacement of the articular disc in class Ⅰ, Ⅱ, and Ⅲ relationships had different shapes of the articular disc during open and closed mouth movements. However, in the maximum opening position, the articular disc were all located directly below the maxillary nodules, and their shape is double concave. In terms of irreversible anterior displacement of the articular disc, in class Ⅰ Angle, the posterior zone of the disc contacts the anterior inclined plane of condyle from the maximum opening position back to the front of the closing position. In class Ⅱ, the posterior zone of the disc contacts the anterior inclined plane of condyle from the beginning of opening position to maximum opening position. In class Ⅲ, the posterior zone of the disc is always in contact with the anterior inclined plane of condyle throughout the entire movement process. And among them, the articular disc presents a forward displacement state at the closing position, its morphology undergoes folding phenomenon. When the openness is 2.5 cm, the articular disc moves up to a certain extent, and is closer to the anterior inclined plane of condyle, and its shape is also partially changed. When the openness is 4.3 cm, the shape of the articular disc, located between the anterior inclined plane of the joint node and the posterior inclined plane of the condyle, is typical double concave, which is sufficient to show that the articular disc is reversible when maximum opening position is reached. In terms of reversible anterior disc displacement, in class Ⅰ Angle, the posterior zone of the disc contact with the anterior inclined plane of condyle at the beginning of the opening position and the end of the closing position. In classⅡ Angle, the posterior zone of the articular disc is not in contact with the anterior inclined plane of condyle. In class Ⅲ Angle, the posterior zone of the articular disc contact with the anterior inclined plane of condyle at the end of the closing position.Conclusions:Multi level dynamic MR imaging data of the temporomandibular joint can dynamically observe the movement of the temporomandibular joint, intuitively and accurately display the position and shape of the articular disc during movement, and can serve as a useful supplement to static conventional MR imaging of the TMJ. The patient's TMJ needs to reach the maximum opening position in order to determine whether the joint disc displacement can be reversible or not.