Objective To discuss the value of 256 spiral CT dynamic volume scanning in the diagnosis of moyamoya disease.Methods Twenty-three patients with moyamoya disease undergoing 256 spiral CT dynamic volume scanning (moyamoya group) were selected,and 18 patients having cerebrovascular disease symptoms,but the brain artery without stenosis (control group) were also selected.The volume reconstruction (VR),maximum intensity projection (MIP) and cerebral CT perfusion imaging was displayed.The cerebral CT perfusion imaging parameters of anterior,middle,posterior cerebral artery were measured and analyzed.Results VR,MIP could well reproduce lesion location,degree of stenosis and skull base abnormal vascular network change.Compared with control group,the cerebral blood volume (CBV) was increased [(8.46 ±0.91) ml/100 g vs.(2.92 ±0.72) ml/100 g],time to peak (TTP) was increased [(30.27 ±5.02) s vs.(24.83 ±4.07) s] in anterior cerebral artery,and there was significant difference (P ＜ 0.01),but there was no significant difference in the cerebral blood flow (CBF),the mean transit time (MTT)(P ＞ 0.05).Compared with control group,CBV was increased [(8.06 ± 1.05) ml/100 g vs.(6.08 ± 0.56) ml/100 g],MTT,TTP was increased [(6.34 ± 1.01) s vs.(3.83 ± 0.83) s,(32.06 ± 2.55) s vs.(25.83 ± 2.34) s] in middle cerebral artery,and there was significant difference (P＜ 0.01),but there was no significant difference in CBF (P ＞ 0.05).Compared with control group,there was no significant difference in the cerebral CT perfusion imaging parameters of posterior cerebral artery (P ＞0.05).Conclusion 256 spiral CT dynamic volume scanning can be combined with morphology and function imagings,and has important guiding significance for diagnosis of moyamoya disease.

Objective To investigate different dosage of dexmedetomidine for preventing elderly postanes-thetic shivering.Methods 100 ASAⅠ~Ⅱ elderly patients (60~80 ages)scheduled for laparotomy were enrolled in this study.According to a computer-generated list of random numbers,patients were randomly allocated to receive dexmedetomidine in the four groups:group A (0.9%normal saline),group B (dexmedetomidine 0.25μg/kg),group C (dexmedetomidine 0.5μg/kg),group D (dexmedetomidine 0.75μg/kg).The occurrence of postanesthetic shive-ring and adverse reactions in perioperative period and post operation were observed.Results The incidence rate shiv-ering were 24% and 20% in group C and D,which were significantly lower than 64% in group A (χ2 =5.333,6. 876,all P<0.05),but there was no difference between C and D groups(χ2 =0.117,P>0.05).Rectal temperature was no difference among four groups(F=1.271,P>0.05).Extubation time was shorter in group A(21.6 ±4.0)min than that in group D(24.4 ±2.8)min(F=6.194,P<0.05).Conclusion Our results suggest that dexmedetomi-dine 0.5 or 0.75 μg/kg can prevent shivering after general anesthesia effectively.But potential for delayed extubation time with dexmedetomidine was noted.The loading dose of 0.5 μg/kg dexmedetomidine is recommeded to prevent eld-erly shivering after general anesthesia.

Objective To detect mitochondrial gene 3243 A to 1507 Chinese and analyze their clinical characteristics.Methods Classical PCR－ RFLP was used to detect the mutation and statistical analysis was performed on the data after stratification in accordance with presence or absence of diabetes.Results (1)In this study,prevalence of mitochondrial gene 3243 A to G mutation was 1.16～ 1.20％ .(2)Compared with MDM(mitochondrial diabetes),M－ NGT(normal glucose to lerance with mutation)showed no significant difference in body fat parameters,blood lipid and C－ peptide except for early onset and hearing loss(P=0.0028).(3)Compared with type 2 DM,MDM presented characteristics of early onset,weight loss,hearing loss,islet cell function decrease and maternal hereditary.Conclusion Follow－ up should be given to the carrying the mitochondrial gene 3243 A to G mutation but presenting generally normal clinical manifestation in order to give the patient in－ time diagnosis and treatment.

OBJECTIVE:To investigate the mechanism of cross allergy reaction during the application of β-lactam antibiotics, and to provide reference for rational drug use in clinic. METHODS:Based on study experience of author in UIC and its affiliated hospital during advanced study,according to the experience of drug use safety management in patients allergic to β-lactam antibiot-ics from Rush University Medical Center,the mechanism of cross allergy reaction during the application of β-lactam antibiotics was summarized,and the disposal procedure for patients allergic to β-lactam antibiotics in the Affiliated Hospital of UIC was intro-duced. RESULTS:The principal reason for cross allergy reaction induced by β-lactam antibiotics were same or similar side chains between drugs. Cross allergy reaction occurred when IgE recognized these side chains. The disposal procedure for patients allergic to β-lactam antibiotics in the Affiliated Hospital of UIC included that the indication of β-lactam use was evaluated;standard penicil-lin skin testing according to evaluation results,anti-infection treatment by Grade challenge β-lactam antibiotics and course and rap-id drug tolerance induction. CONCLUSIONS:The disposal method for patients allergic to β-lactam antibiotics in the Affiliated Hos-pital of UIC can provide new thought for domestic clinical pharmacists in rational drug use among the patiens with reported aller-gies to special group as pregnant women,children.

Objective To determine the moisture content in Polygoni multiflori Radix rapidly by near-infrared spectroscopy. Methods The moisture content of the samples were determined by oven drying method and the near-infrared spectrum data were collected by near-infrared spectroscopy.The quantitative test model of moisture content in Polygoni multiflori Radix was established by chemometrics methods and was validated with validation samples. Results The correlation coefficients, root-mean-square error of calibration (RMSEC), root-mean-square error of predication (RMSCP) and the root-mean-square error of cross-validation ( RMSECV ) of the calibration model was 0. 984 75, 0. 161, 0. 181 and 0. 471 64, respectively.The absolute deviation of the analytical and predictive values of 21 validation samples was -0.35%-0.28%, and the average recovery was 99. 87%. Conclusion Near-infrared spectroscopy can be used to determine the moisture content of Polygoni multiflori Radix rapidly and accurately.

Objective:To assess the safety and efficacy of riboflavin/ultraviolet-A-induced accelerated epithelium-off corneal collagen cross-linking (CXL) for teenagers with keratoconus.Methods:In this case series study, 25 eyes of 18 patients with primary keratoconus who underwent riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL in Zhengzhou Second People's Hospital from January 2017 to February 2018 were included, and the average age of patients was (14.4±1.3) years.The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), maximum keratometry reading (K max), thinnest corneal thickness (TCT), posterior corneal elevation (PCE) and endothelial cell density (ECD) were measured before and after CXL.The patients were followed up for one year.The complications and adverse reactions were recorded.The study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Zhengzhou Second People's Hospital (No.KY2017002). Written informed consent was obtained from each patient and their guardian prior to the surgery. Results:The mean UCVA (LogMAR) was 0.96±0.35 at baseline, which was significantly improved to 0.84±0.33 at 1 year postoperatively ( t=-5.765, P<0.01). The mean BCVA (LogMAR) was 0.45±0.22 preoperatively, which was significantly improved to 0.34±0.26 at 1 year postoperatively ( t=-4.843, P<0.01). The mean SE was (8.66±5.11)D at baseline, which was significantly higher than (8.07±5.21)D at 1 year postoperatively ( t=-3.253, P=0.003). The K max was reduced from (58.58±9.07)D preoperatively to (56.25±9.98)D at 1 year postoperatively, with significant difference between the two time points ( t=-4.357, P<0.01). The K max was reduced more than 1 D in 17 eyes (68%), was stable in 6 eyes(24%), and was increased more than 1 D in 2 eyes (8%). The TCT was reduced from (485.0±32.5)μm at baseline to (475.3±35.5)μm at 1 year postoperatively, with significant difference between the two time points ( t=-4.266, P<0.01). The differences of PCE and ECD between preoperative and postoperative 1 year were not statistically significant ( t=1.023, P=0.316; t=-1.424, P=0.167). There was one eye suffering peripheral sterile corneal infiltrate 2 days postoperatively, and favorable prognosis was achieved after the topical steroids application.No complication was encountered in other subjects. Conclusions:Riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL is safe and effective in teenagers with keratoconus during the 1-year follow-up.The long-term effects need further observation.

Objective To evaluate the diagnostic value of gray-scale ultrasonography (GSU) combined with contrast-enhanced ultrasonography (CEUS) and real-time elastography imaging (EI) in solid thyroid nodules.Methods A total of 124 solid nodules were collected from Xuanwu Hospital of Capital Medical University from September 2011 to November 2014, including 49 benign nodules and 75 malignant nodules conifrmed by surgical pathology. The data of multimodal imaging were retrospectively analyzed and compared with the pathological results. The parameters among the groups were compared byχ2 test. Four diagnostic models including the statistically signiifcant independent variables were established accord to different combinations of routine ultrasound examination. The binary Logistic regression equation using the pathological results as the dependent variable Y and the ultrasound features of thyroid nodules as independent variableX was established for calculating the area under the receiver operator curve (ROC) and multiple regression analysis furthermore.Results There were statistically significant differences in aspect ratio, margin condition, echo type, CEUS features, elastic imaging score and elastic strain rate of benign and malignant thyroid nodules(χ2=13.966, 7.106, 24.215, 17.250 and 27.158,P<0.05).The four Logistic regression models were statistically signiifcant (χ2=5.37, 5.37, 8.155, 8.155, allP<0.05). By using modelⅠ,Ⅱ,Ⅲ andⅣ, the diagnostic sensitivity, speciifcity and accuracy of malignant nodules were (73.8%, 75.9%, 79.7%, 83.3%), (67.5%, 70.7%, 85.2%, 86.7%), and (71.8%, 74.2% 81.8%, 84.4%) respectively. The area under the ROC of logistic equation predicted values were (0.778, 0.809, 0.875 and 0.898, allP<0.01). Multivariate categorical analysis showed that aspect ratio, margin condition and the elastic strain rate ratio (χ2=13.73, 7.541 and 11.461, allP<0.05) of thyroid nodules were effective diagnostic indicators. Conclusions Our study indicated that CEUS and EI could be helpful modality for GSU to improve the diagnostic accuracy of thyroid nodules. The combined application of multi mode ultrasound examination has a high diagnostic value.

Objective To assess the diagnostic value of contrast enhanced ultrasound (CEUS),elastography and their combined use in diagnosing thyroid nodules of thyroid imaging reporting and data system (TI-RADS) 4. Methods From November 2011 to August 2016, 159 TI-RADS 4 nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CEUS and elastography before surgery. Multivariate logistic regression models were established for CEUS and CEUS combined with elastography to diagnose thyroid malignancy. The diagnostic performances of CEUS, elastography and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The sensitivity,specificity, accuracy, positive predictive value, negative predictive value and omission diagnostic rate of CEUS, elastography and their combined use were compared by Chi-square test. Results The CEUS features significantly predicting malignancy were heterogeneous enhancement, hypoenhancement, without or incomplete ring-enhancement and later time to peak than the surrounding parenchyma (χ2=24.378, 69.194,29.434 and 7.375, all P < 0.01). Furthermore, the multivariate logistic regression for CEUS combined with elastography showed that heterogeneous enhancement, ring enhancement and elasticity score were the independent predictors of thyroid malignancy. The area under the ROC curve of CEUS combined with elastography was (0.921±0.023) which was higher than that of CEUS and elatography (0.88±0.029 and 0.80±0.038, respectively; both P < 0.05). Moreover, the sensitivity, accuracy and negative predictive value of CEUS combined with elastography were 92.1%, 86.2% and 84.6%, respectively. The omission diagnostic rate of CEUS combined with elastography (7.9%) was reduced. And the diagnostic accuracy of CEUS combined with elastography was significantly higher than that of CEUS and elastography (P < 0.05). While the diagnostic accuracy of CEUS was close to the elastography, the difference was not statistically significant (P > 0.05). Conclusion The diagnostic value of CEUS combined with elastography was remarkably significant in the differential diagnosis of TI-RADS 4 nodules.

Objective To investigate the influence of murine cytomegalovirus ( MCMV) infection on the expression of downstream differentiation related target genes of Wnt signaling pathway in neural stem cells (NSCs) in vitro and explore the molecular mechanism of fetal encephalodysplasia caused by CMV infection. Methods NSCs were separated from fetal BALB/c mouse and cultured in vitro. The NSCs infected by MCMV at a MOI (multiplicity of infection) of 5, 1 and 0.1, respectively, were cultured in differentiation medium. The dynamic expression of the downstream differentiation related target genes ( c-myc, cyclinD1, ngn-1 and ngn-2) of Wnt signal pathway in NSCs were measured by Western blot. Real-time RT-PCR was employed to measure the expression levels of the key differentiation genes ngn-1 in Wnt signal pathway of NSCs post infection. Results The protein levels of c-myc in the infected groups were significantly lower than that in the normal control at 0.5-5 d (P＜0.05) ; At 0. 5 d and 1 d post-infection (p. i. ) , the protein levels of cyclinDl in the infected groups were lower than that in the normal control (P＜0.05). At 2 d and 3 d p. i. , the cyclinD1 expression in the infected groups was higher than that in the control group (P ＜ 0. 05). However, at 4 d and 5 d p. i. , the cyclinD1 levels in the group of the MOI of 5 were lower than in other three groups (F＜0.05). The expression of ngn-1 protein in the infected groups was reduced importantly compared with normal control at 1 -5 d p. i. ( P ＜ 0.05 ). The expression of ngn-1 mRNA in the infected groups was lower than that in the control group at all time points (P ＜ 0. 05 ). The expression of ngn-2 protein decreased at first and then increased, which was opposite to the normal control. The peak of ngn-2 expression in groups of the MOT of 0.1 and 1 occurred later and were significantly lower than that in the normal control (P ＜0. 05). No distinct peak was seen in the group of the MOI of 5. At 1 d p. i. , the expression of ngn-2 of all infected groups was significantly lower than that in the normal control ( P ＜ 0. 05 ). At 2 d p. i. , the expression of in the group of the MOI of 5 was still lower (P ＜ 0.05). While at 3 d, 4 d and 5 d p. i. , the protein levels in all infected groups were higher than that in the normal control (P ＜ 0. 05). The protein expression of these genes increased following the increase of MOI. Conclusion MCMV inhibited the protein expression of c-myc and ngn-1 in differentiated NSCs, repressed the mRNA expression of ngn-1 and caused the perturbed expression of cyclinDl and ngn-2 in a MOI-dependent manner. These data suggest that inhibition of or interference with the protein expression of downstream differentiation related target genes of Wnt signaling pathway in NSCs by MCMV may be one of the important mechanisms, by which proliferation and differentiation of NSCs are inhibited and thus fetal brain is impaired after MCMV infection.

Objective To investigate the gender difference of the plasma lactic acid(LA) levels in type 2 diabetics with normal renal and hepatic function, and the effect of metformin on LA levels in the difference gender. Methods A total of 1 021 type 2 diabetic inpatients with normal renal and hepatic functions were collected,including metformin treatment group (213 males and 210 females) and metformin non-treatment group (299 males and 299 females). LA was measured with enzyme-electrode assay. Fasting plasma glucose ( FPG), creatinine ( Cr), and alanine aminotransferase ( ALT) levels were determined. Results LA level in metformin treatment group was significantly higher than that in metformin non-treatment group [ (1.32±0.53 vs 1.14±0.49) mmol/L,P<0.01],and 61 cases had hyperlactacidemia but no lactic acidosis was found. Spearman correlation analysis showed that LA level was positively associated with gender,metformin, and body mass index( BMI) apart from Cr and ALT( P<0.01). Multivariate logistic regression analysis showed that gender,Cr,ALT,and metformin were independent correlated factors of hyperlactacidemia. LA levels in females were higher than those of males in the whole group and two groups treated or not treated with metformin (all P<0. 05 ). LA levels in females were higher compared to male in Cr and ALT subgroups,as well as age subgroups,especially with age younger than 45 years old (P=0.021). Conclusions There is gender difference of lactate level in diabetic patients,and the effect of metformin on the plasma lactate levels of different gender is varied. The plasma LA level in females,especially those approaching menopause,are prone to hoist.