The conflict between doctors′ special right to intervene and patients′ right of informed consent is a main cause of the current tense doctor-patient relationship with the absence of related legislation.This article gave suggestions on legislation and possible ways for solving the problems after analyzing the two rights from the angles of basic connotation,research progress of comparative law,and the underlying reason for the two rights′ conflict.

Objective To investigate the effect of dexmedetomidine on protein kinase RNA-like endoplasmic reticulum kinase (PERK) signaling pathway in cardiomyocytes of the rats with severe scald.Methods Twenty-four healthy adult male Sprague-Dawley rats,weighing 220-280 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),severe scald group (group S),and scald + dexmedetomidine group (group D).Thirty percent of the total body surface area was shaved on the back and then exposed to 94 ℃ water for 12 s to establish the model of 3rd degree scald.Dexmedetomidine 30 μg/kg (2 μg/ml) was intraperitoneally injected immediately after scald in group D.Myocardial specimens were obtained at 12 h after scald for examination of the pathological changes and for determination of cell apoptosis and expression of C/EBP-homologous protein (CHOP),PERK,and phosphorylated PERK (p-PERK) by Western blot.The apoptosis index and p-PERK/PERK ratio were calculated.Results Compared with group C,the apoptosis index was significantly increased,the expression of CHOP,PERK and p-PERK was significantly up-regulated,and the p-PERK/PERK ratio was significantly increased in S and D groups (P＜0.05).Compared with group S,the apoptosis index was significantly decreased,the expression of CHOP,PERK and p-PERK was significantly down-regulated,and the p-PERK/PERK ratio was significantly decreased (P＜0.05),and the pathological changes of myocardium were significantly attenuated in group D.Conclusion The mechanism by which dexmedetomidine inhibits apoptosis in cardiomyocytes is related to inhibition of PERK signaling pathway in the rats with severe scald.

Objective To evaluate the effect of reference mAs on radiation dose and image quality characteristics of chest CT scanned with CARE kV technique compared with CARE Dose4D.Methods According to the date of examination,158 consecutive patients were selected in our department and randomly divided into 5 groups:CARE Dose4D group (30 cases,group 1); using CARE kV technology,reference mAs were 110 (32 cases),90 (31 cases),70 (33 cases),50 (32 cases),which were recorded asthe group from 2 to 5,respectively.Volume CT dose index (CTDIvol),dose length product (DLP) and the effective dose (ED) were analyzed.CT value and objective image noise were measured in the lungparenchyma and descending aorta.Two radiologists assessed the images for subjective noise,artefacts and diagnostic acceptability.The radiation dose,CT value and objective noise were compared with the analysis of variance,and the difference between two groups was compared with SNK test; the rank sum tests (Kruskal-Wallis) were used in subjective image quality score,and difference between two groups was compared with K-W test.Results The CTDIvol,DLP,ED values in five groups were (7.7±1.7),(7.7±2.0),(5.5±1.4),(4.2±1.5),(2.8±1.2)mGy,(290.7±67.4),(290.1±85.2),(194.2±52.1),(150.7±63.8),(96.5±38.9) mGy· cm,(4.1±0.9),(4.1±1.2),(2.7±0.7),(2.1 ± 0.9),(1.3±0.5) mSv,respectively.There were significant difference among the 5 groups(F=59.305,57.76,57.76,P＜0.01).With the decrease of the reference mAs,the radiation dose decreased significantly.There were no significant difference among the 5 groups on the average CT values of lung parenchyma and descending aorta(F=0.353,0.102,P＞0.05).The objective noise of 5 groups in pulmonary parenchyma and the descending aorta were (48.7 ± 9.1),(49.2 ± 10.0),(55.5± 11.2),(56.5± 8.3),(63.7 ± 13.2) HU; (9.2± 1.6),(9.5 ± 2.1),(10.7 ± 2.6),(11.6 ± 2.7),(13.6 ± 2.6) HU respectively,and the difference was significant(F=10.774,17.157,P＜0.01).Level assessment onsubjective noise of five groups by radiological expertsalso showed the significant difference (U=33.967,P＜0.01),butthe evaluation on motion,streak,blotchy pixellatedartefacts and diagnostic acceptability had no statistical difference (U=8.847,2.054,6.186,5.296,P＞0.05).Conclusion Comparedwith CARE Dose4D,the use of CARE kV technique of suitable reference mAs for unenhanced chest CT can reduce radiation dose significantly with diagnostically acceptable image quality.

Objective To present the CT and MRI findings of the fibrous dysplasia(FD) of the spine.Methods CT and MRI findings were retrospectively evaluated in 19 cases of FD of spine,all of which were confirmed pathologically.Nineteen patients underwent CT plain scanning(19/19) and 5 had enhanced CT scanning(5/19).Patients were also examined by MRI plain scan(11/11) or MRI enhanced scan (6/11).The location of tumors,the type of bone destruction,the boundary of lesions,internal intensity or signal,the enhancement pattern of lesions,and presence of compression fractures,spinal deformity were observed.Result Nine cases had monostotic FD,while 10 had polyostotic FD.In all the 49 lesions of 19 cases,13 lesions were located in the cervical vertebrae,23 lesions in the thoracic vertebrae,11 lesions in lumbar vertebrae,and 2 lesions in sacral vertebrae.Thirty-three lesions involved both vertebral body and appendix.Pure osteolysis were found in 26 lesions on CT examinations.Peripheral osteosclerosis rims (41/49) and expansive lesions(32/49) were seen.Residual bone crest(28/49) and ground-glass opacity(23/49)were noted.Different degrees of vertebral compression were found in 19 lesions.Five patients had spinal deformity.On T1WI,14 lesions showed intermediate or low signal,and 10 lesions presented as heterogeneous signal.On T2WI,6 lesions had low signal intensity,4 lesions were noted as hyperintensive,and 14 lesions presented as heterogeneous signal.Multiple fluid-fluid levels were found in 1 lesion.Low signal rims were seen in 14 lesions.Twenty lesions of 11 patients had significant enhancement.Conclusion Expansive pattern,ground-glass opacity,peripheral osteosclerosis rims and significant enhancement were helpful findings for the diagnosis of spinal FD.

PurposeThe increased radionuclide uptake of maxillary frontal process on bone scan is not uncommon but dififcult to diagnose with relatively rare research. This study aims to explore this phenomenon through investigating its biological behavior and causes.Materials and Methods Twenty-one patients with increased uptake of maxillary frontal process but without typical feature of metastasis on bone scan were retrospectively enrolled in the study. The scintigraphic features were evaluated and compared with the bone scans in the follow up. The corresponding CT imaging features including the lesions'location, number, size, shape and attenuation were analyzed.Results Seventeen patients had unilateral involvement and 4 had bilateral ones. One patient was found accompanied with other cranial lesions. All the lesions remained stable and no new lesions were detected on the following bone scans in 14 patients. Sixteen lesions with increased radionuclide uptake in 12 patients were detected on bone scintigraphy, 15 of which were positive on CT and 14 of which were located around the nasolacrimal canal at the base of frontal process. All the lesions were well demarcated with mean axial maximum diameter of 7.1 mm. Ten had homogeneous ground-glass density and 5 showed heterogeneous with internal lower attenuation.Conclusion Lesions of maxillary frontal process with increased radionuclide uptake detected on bone scan are likely to be benign. Fibrous dysplasia-like lesions might help account for abnormal uptake indicated by CT.

0.05). Conclusions The gap junction formed by CX43 should be an important role in switching and developing the epilepsy. The synthetic polypeptide corresponding to amino acid sequence of CX43 would be a kind of new type antiepileptic drug, which might have less side effects and more potent pertinency.

Objective To investigate the relationship between the MR findings of lumbar elements and chronic low back pain(CLBP).Methods The patients underwent lumbar MRI examinations and sent for a questionnaires of low back pain (LBP).Among them,139 patients whose questionnaires illustrated with CLBP were enrolled.The enrolled patients included 68 patients with nerve roots compression and 71 patients without.Meanwhile,198 hospital staffs underwent lumbar MRI examinations and were sentfor a LBP questionnaire.Among them,62 patients without LBP and nerve roots compression were enrolled.Categorical regression was used to analyze the relationship between MR findings and CLBP.The MR findings iucluded nerve roots compression,average disk degeneration scores(ADD),high-intensity zones (HIZ),Schmorlnodes,Modic Ⅰ change,average facet joints degeneration scores(AZZ),facet joint effusion,high T2 signal in interspinous ligament and subcutaneousparaspinal muscles edema.The regression model was used to analyze the MR imaging and CLBP.Results The regression model was statistically significant (F=9.478,P＜0.01).All predictors yielded an adjusted value was 0.446.Among all predictors,nerve roots compression,ADD,AZZ,subcutaneous or paraspinal muscles edema were statistically associated with the VAS degree (P＜0.05).The sum of the importance of the four predictors above was 0.983.The quantification of predicted VAS degree increased as ADD level increased.The quantification of predicted VAS degree increased to the top at the 2 AZZ level and then decreased.Nerve roots compression and Subcutaneous or paraspinal muscles edema yielded higher quantification of predicted VAS degree level.Conclusion ADD,AZZ,subcutaneousparaspinal muscles edema were probably associated with CLBP degree after adjusting for nerve roots compression.

Objective To evaluate the effect of acute hypervolemic hemodilution (AHH) on myocardial damage in severely burned rabbits.Methods Eighteen healthy adult rabbits,weighing 2.0-2.5 kg,were randomly divided into 3 groups (n =6 each) using a random number table:control group (group C),burn group (B group) and AHH group.Rabbits were subjected to 3rd degree burn covering 40％ of the total body surface area.After the model was established,6％ hydroxyethyl starch 130/0.4 was infused intravenously,and the target Hct was 25％ in AHH group.Before AHH (To) and at 2,4 and 8 h after AHH (T1-3),left ventricular systolic pressure (LVSP),left ventricular end-diastolic pressure (LVEDP),+dp/dtmax and-dp/dtmax were recorded,and blood samples from femoral veins were taken to determine the concentration of serum cardiac troponin I (cTnI) by ELISA.The rabbits were sacrificed at T3,and myocardial specimens were removed for microscopic examination of pathological changes with light microscope.Results Compared with group C,the serum cTnI concentration and LVEDP were significantly increased,LVSP and +dp/dtmaxwere decreased at T1-3 in B and AHH groups,and-dp/dtmax at T1-3 in group B and-dp/dtmax at T3 in group AHH were decreased.Compared with group B,LVSP,+dp/dtmax and-dp/dtm,x were significantly increased at T1-3,and no significant change was found in serum cTnI concentration and LVEDP in group AHH.There was no significant difference in the pathological changes between group B and group AHH.Conclusion AHH can not aggravate the early myocardial damage in severely burned rabbits.

Objective:To investigate the accuracy of 3.0 T MR in the diagnosis of full thickness tear and partial thickness tear of the supraspinatus-infraspinatus tendon, and to analyze the causes of missed diagnosis and misdiagnosis of the supraspinatus-infraspinatus tendon tear.Methods:The MRI diagnosis report and arthroscopic surgery records of 210 patients with shoulder joint injuries in Peking University Third Hospital were analyzed retrospectively. Taking the results of arthroscopic surgery as the gold standard, the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive values of 3.0 T MR for full thickness tear and partial thickness tear of the supraspinatus-infraspinatus tendon were calculated, and the reasons of missed diagnosis and misdiagnosis were analyzed.Results:In 210 patients with rotator cuff injury, the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI for full thickness tear of the supraspinatus-infraspinatus tendon were 81.4% (171/210), 83.1% (98/118), 79.3% (73/92), 83.7% (98/117) and 78.4% (73/93) respectively. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI for partial tears of the supraspinatus-infraspinatus tendons were 77.6% (163/210), 65.7% (44/67), 83.2% (119/143), 64.7% (44/68) and 83.8% (119/142) respectively. Among the 44 cases of missed diagnosis and misdiagnosis of the supraspinatus-infraspinatus tendon tear, 21 cases (47.7%) occurred in the junction supraspinatus and infraspinatus tendon-osseous (stop). Among the 7 cases of intra-tendon tear of supraspinatus and infraspinatus muscle, 6 cases were misdiagnosed cases, which was the most easily missed diagnosed type of partial tear. The reason for missed diagnosis was that the signal of partial tear was not high (no fluid signal was shown on T 2WI). Complex laceration was also a type of missed diagnosis in partial tears. Among the 4 cases of superior and inferior surface tendons combined with intra-tendon lacerations, 3 cases were missed diagnosed. Conclusion:3.0 T MR has higher accuracy for the diagnosis of full thickness tear and partial thickness tear of supraspinatus-infraspinatus tendon, but there is still a certain rate of misdiagnosis and missed diagnosis. A full understanding of the causes of misdiagnosis and missed diagnosis of MR in the diagnosis of rotator cuff tears of supraspinatus and infraspinatus tendons is helpful to further improve the accuracy of MR in the diagnosis of supraspinatus and infraspinatus tendon injuries of shoulder joint.

Objective To evaluate the microstructural integrity of white matter (WM) in mild cognitive impairment ( MCI ) and Alzheimer disease (AD) using DTI technique, and to explore the relationship between WM abnormalities and cognitive dysfunction. Methods Nine cases of amnestic MCI, 15 cases of mild probable AD and 11 cases of normal controls (NC) with normal-appearing WM (NAWM) were studied using 3. 0 T MR system. Fractional anisotropy (FA) and mean diffusivity (MD) were measured in different WM areas. One-way analysis of variance was used to test the difference among the three groups for DTI indices. Spearman Correlation analysis was applied to reveal the correlation between the DTI indices and the MMSE and CASI scores. Results The FA value in parietal, centrum semiovale, posterior cingulate gyrus, parahippocampus, temporal and frontal WM in MCI was 0. 31 ± 0.03,0. 39 ± 0. 03,0. 62 ± 0. 05,0. 59 ± 0. 05,0. 47 ± 0. 08,0. 32 ± 0. 04, respectely, and MD value was ( 899 ± 30 ) × 10-6,(782±53) × 10-6, (732±45) × 10-6, (806±38) × 10-6, (772 ± 55) × 10-6, (792 ± 35) × 10-6 mm2/s. The FA value of these regions in AD was 0. 28 ± 0. 04, 0. 37 ± 0. 03,0. 55 ± 0. 06,0. 52 ± 0.05,0.40±0. 05,0. 27 ± 0. 04,and MD value was (912±37) × 10-6,(800 ± 67) × 10-6, (762 ± 46) × 10-6, (874±57)×10-6,(822±55)×10-6, (822±39)×10-6 mm2/s. The FA value in NC was 0.36±0.03,0.43±0.05,0.64±0.05, 0.60±0.05, 0.52±0.05,0.33±0.03, and MD value was (866±37)×10-6,(754±54)×10-6,(718±32)×10-6,(810±39)×10-6,(755±48) × 10-6, (785±23)×10-6 mm2/s. Compared with NC, the FA value in parietal WM was significantly decreased in MCI(P<0. 01 ), The significantly reduced FA values in parietal, centrum semiovale, posterior cingulate gyrus, parahippocampus, temporal and frontal WM , as well as significantly elevated MD values were found in AD(P <0. 05). There was significant correlation between these DTI indices and MMSE and CASI scores (P<0.05). Conclusions MR DTI can detect WM abnormalities in AD and MCI. The parietal WM abnormalities and the disconnection of WM circuitry may play an important role in the development of dementia.