Objective To investigate the clinical value of three dimensional dynamic contrast enhanced MRA(3D DCE MRA)on esophageal and gastric varices compared with endoscopy.Methods From April 2003 to June 2008,153 patients with portal hypertension who underwent both 3D DCE MRA and endoscopy were reviewed retrospectively.All the patients were divided into bleeding group and non-bleeding group according to the clinical symptoms.The location and degree of the esophagogastric varices on 3D DCE MRA were assessed with postprocessing images,including subtraction,MIP and thin-slab maximum intensity projection(thin-MIP),and were compared with the results of endoscopy.The maximum,minimum and mean diameters of esophagogastric varices inside and outside of the wall were measured on the reformed images.The correlation between the findings of 3D DCE MRA and endoscopy were analyzed with Spearman rank correlation coefficient test The rates of esophagogastric varices outside of the wall in bleeding and non-bleeding group were compared by means of Chi-square test Results In bleeding group,severe esophageal varices were documented in 59 patients,moderate in 6 patients,mild in 5 patients;in non-bleeding group,severe esophageal varices were documented in 32 patients,moderate in 4 patients,mild in 5 patients.Severe,moderate,and mild gastric varices were documented in 28,34 and 16 in bleeding group,while they were 7,12 and 9 in non-bleeding group.Esophageal and gastric varices can be wholly presented on MIP images after subtraction,while the esophagogastric varices inside and outside of the wall can be differentiated on thin-MIP images.The location and degree of esophagogastric varices on 3D DCE MRA were correlated with the findings of the endoscopy.The range of r was from 0.544 to 0.878(P＜0.01).In 91 patients with severe esophageal varices,27 patients presented outside esophageal varices in bleeding group(n=59)and 24 patients presented outside esophageal varices in non-bleeding group(n=32).There was a significant difference in ratio of outside esophageal varices between bleeding group and nonbleeding group(X~2=7.199,P＜0.01).In 35 patients with severe gastric varices,22 patients showed adventitial gastric varices in bleeding group(n=28)and 4 patients showed adventitial gastric varices in non-bleeding group(n=7).The ratio of adventitial gastric varices in bleeding group was not significantly different from that of non-bleeding group(P=0.340).Conclusions 3D DCE MRA can display and differentiate the esophagogastric varices both inside and outside of the wall by three dimensional reconstruction.The results of 3D DCE MRA and endoscopy have good correlation.It is of importance in evaluating the esophageal varices outside of the wall,because they may indicate decreased risk of haemorrhage in patients with severe degree of esophageal varices.

Objective To observe the effect of puerarin on the ICAM-1 gene expression in streptozotocin-Induced diabetic nephropathy rats. Methods Diabetic nephropathy rats were induced by intraperitoneal injection of STZ.Rats were allocated into normal control group,model group,and puerarin group.The puerarin treatment lasted for 16 weeks.During and after the treatment,the general health conditions,blood glucose levels,blood urea nitrogen,serum creatinine,urinary albumin excretion rate of 24-hours,and clearance rate of creatinine of the rats were observed.The ICAM-1mRNA expressions were also determined by in situ hybridization analysis in the kidney tissue of the rats.Results Diabetes mellitus and renal function lesion occurred in the model group and puerarin group.Puerarin could improve the general health of the rats,decrease blood urea nitrogen,serum creatinine,and urinary albumin excretion rate of 24-hours;and increase the clearance rate of creatinine.The ICAM-1mRNA expressions in the kidney were significantly inhibited by puerarin treatment.Conclusion Puerarin has a function of renal protection.

Objective To evaluate the apparent diffusion coefficient (ADC) of parenehyma and necrosis in distinguishing among metastatic lymph nodes, lymphoma and tuberculous lymph nodes. Methods Thirty-six patients with cervical lymph nodes metastasis from the head and neck squamous cell carcinomas,19 patients with lymphoma and 23 patients with lymph nodes tuberculosis underwent diffusion-weighted imaging. The ADC values were measured and compared in parenchyma and necrosis of 177 lymph nodes confirmed by histopathology (n = 114) and clinical follow-up (n = 63). The means between two groups were compared by t-test, and one-way analysis of variance (one-way ANOVA) was used to analyze the data among three or more groups. Results The mean ADC values of parenchyma in metastatic nodes, lymphoma and tuberculous nodes were (0.93±0.16) × 10-3mm2/s, (0.64±0.13) × 10-3mm2/s and (1.01±0.11) ×10 -3 mm2/s respectively (F = 82.928, P < 0.01) ; the ADC values of necrosis in metastatic and tuberculous nodes were (2.02 ± 0. 36) × 10-3 mm2/s and (1.25 ± 0.15) × 10-3 mm2/s respectively (t = 12.045, P <0.01). An ADC value of parenchyma lower than or equal to 0.77 × 10 -3mm2/s was used as the threshold for lymphoma, with a sensitivity 83% and specificity of 89%. An ADC value of necrotic area greater than or equal to 1.60 × 103mm2/s was used as the threshold for metastatic nodes, with a sensitivity of 88% and specificity of 100%. Conclusion The ADC value of lymph nodes, especially for their internal necrotic areas, can help judge the nature of the cervical lymph nodes.

Objective The purpose of our study was to investigate three dimensional dynamic contrast enhanced MR angiography(3D DCE M RA) in the detection of portosystemic collateral circulation in the falciform ligament in patients with portal hypertension. Methods From April 2003 to July 2008, 53 portal hypertension patients with varices in the falciform ligament were evaluated with 3D DCE MRA.Two radiologists independently assessed the number, diameter, location and drainages of the portosystemic collateral circulation in the falciform ligament according to the information on the 3D DCE MRA.Results The veins in the falciform ligament were classified into the superior and inferior groups, and both groups arise from the left trunk of the portal vein.In our study, the number of varices detected on 3D DCE MRA images varied from 1 to 3, and the diameters of these vessels varied from 0.4 to 2.6 cm.The inferior group consisted of paraumbilical/umbilical veins (47 cases), which flowed toward umbilicus and then drained upwards (n = 16) including deep superior epigastric veins (n = 7), superficial superior epigastric veins (n = 9), downwards (n = 40) including deep inferior epigastric veins (n = 7), superficial inferior epigastric veins (n = 33), or upwards and downwards at the same time (n = 9).The superior group of vessels in the falciform ligament were directly anastomosed with the internal thoracic vessels (n = 6).Conclusion In patients with portal hypertension, 3D DCE MRA can optimally demonstrate the portosystemic collateral circulation in the falciform ligament, which includes the superior and inferior drainage groups.

ObjectiveTo investigate the postoperative 3D MRI appearances and their evolvement patterns of ACL grafts and bone tunnels at follow-up.Methods There were 26 double bundles ACL reconstructions and 16 single bundle ACL reconstructions,and a total of 56 follow-up 3D MR Imaging.MR images were reconstructed with MPR technique to evaluate grafts,bone tunnels,fixers and associated.complications.Proportions of grafts with hypointensity or hyperintensity and occurrence rates of marrow edema around bone tunnels were calculated respectively among groups of different periods after operation.ResultsThere were 24 grafts of hypointensity and 32 grafts of hyperintensity.Grafts of 2 cases were suspended with cross pins within femoral tunnels,graft of 1 case was suspended with an endobutton within the femoral tunnel,and grafts of other sites were fixed with interference screws.In the three periods as 3 months,6 to 9 months and over 12 months after cruciate ligament reconstruction,proportions of hypointensive grafts were 20/25,0/14 and 4/10 respectively,while proportions of hyperintensive grafts were 5/25,14/14 and 6/10 respectively,occurrence proportions of marrow edema around bone tunnels were 54/54,10/32 and 4/26 respectively.There was 1 tear graft,4 tibial tunnels placed anteriorly with ACL graft impingement on the intercondylar roof,3 femoral tunnels placed anteriorly,and 2 bone tunnels with mismatching interference screws.Conclusion3D MRI can accurately demonstrate the state of ACL grafts,bone tunnels,fixers and associated complications.Intensity of grafts presented a rise and reduce pattern after operation.

Objective To investigate the effect of saw palmetto extract (SR) on GL261 glioma in rats and immune system.Methods The 40 rats were divided into 4 groups randomly,one was the control group without tumor (n =10),the other 30 rats were given subcutaneous inoculation of tumor cells and then divided into 3 groups:tumor-bearing group (n =10),low dose SR group (n =10),and high dose SR group (n =10).After 1 weeks feeded,the rats of SR groups were given the saw palmetto extract,low dose group 50 mg/kg once a day every other day and 300 mg/kg of high dose group every other day.The tumor-bearing groups received the same dose of distilled water.After 4 weeks feeding,we measured the tumor weight and the inhibition rate was calculated.The tumor cell apoptosis was detected by TdT mediated dUTP nick-end labeling (TUNEL) staining.The splenic T lymphocyte proliferation was tested by methyl thiazolyl tetrazolium (MTF).Results (1) The SR groups compared to tumor group,the tumor weight was significantly reduced (F =62.678,P =0.000).The tumor inhibition rate was significantly higher in high dose group.(2) The apoptosis of tumor cells in tumor-bearing group was significantly less than SR groups and the apoptosis was significantly increased after treatment with SR,especially in high dose SR group (F =1.287E3,P =0.000).(3) Compared to SR groups and control group,T lymphocyte proliferation of tumor-bearing group reduced obviously.After treated with SR,T lymphocyte proliferation significantly increased and was higher in high-dose group (F =103.565,P =0.000).Conclusions Saw palmetto extract can activate T lymphocytes and induce apoptosis to tumor cells.Its function was related to SR concentration.

AIM: Tyrosinase gene was transfected into HEK293 cell as a reporter gene, it's property of synthesizing melanin, which can be examined by magnetic resonance imaging(MRI), is used to evaluate the tyrosinase gene's expression. The aim of this study was to search a way to evaluate the results of gene expression by MRI in vitro .METHODS: The plasmid of pcDNA3tyr which carried the full-length cDNA of tyrosinase gene was transfected into HEK293 cell by lipofectin. To observe the MRI signals of expressed melanin,the transfected cells were scanned by MRI sequences of T 1WI, T 1WI/SPIR and T 2WI. On the other hand, fontana stain was used to search for melanin granules in transfected cells, RT-PCR method was used to search for cDNA of tyrosinase gene. RESULTS: (1) Plasmids of pcDNA3tyr could be transfected into HEK293 cells and could synthesize a large amount of melanin. The synthetic melanins of 10 6 cells, which had been transfected 5?g, 10?g, 20?g plasmids of pcDNA3tyr separately, were all sufficient to be detected by MRI and appeared high signal in MRI T 1WI、T 1WI/SPIR、T 2WI sequences. The signal intensities of MRI imaging were related to the amounts of transfected plasmids positively. (2) The melanin granules could be found in HEK293 cells by Fontana stain. (3) The cDNA fragment of tyrosinase gene could be detected in transfected HEK293 cells by RT-PCR. CONCLUSION: The fact that MRI could detect the synthetic melanin of HEK293 cells, which controlled by expression of exogenous gene, demonstrates that medical imaging connecting with molecular biology technology can evaluate the result of gene expression in vitro .

Objective To investigate the variation law of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in patients with cerebral infarction, and to explore the relationship between the changes and the prognosis of cerebral infarct patients. Methods Sixteen patients with cerebral infarction were recruited and divided into 2 groups:good recovery and poor rehabilitation. ADC and FA values were calculated in infarct areas and control areas which were the regions with symmetrical position and the same area as infarct areas. The difference of ADC and FA values in patients at acute and earlier chronic stage between the two areas were analyzed. Results ①At acute stage, ADC values in infarct areas were lower than those in control areas (P<0.05). At early chronic stage, there was no significant difference of ADC values between infarct areas and control areas (P>0.05), moreover ADC values were higher than that at acute phase (P<0.05). ②FA values in infarct areas were lower than those in control areas at both acute and early chronic stage (P<0.05). At early chronic stage, FA values were lower than those at acute stage (P<0.05). ③There was no significant difference of ADC and FA values at both acute and early chronic stage between good recovery group compared with poor rehabilitation group (P>0.05). Conclusion There are certainly rules in changes of ADC and FA values in patients with cerebral infarction at acute and earlier chronic stage.

Objective To evaluate the acceptance of the Mobile Delirium Assessment App based on confusion assessment method for intensive care unit (CAM-ICU )nurses.Methods Using the technology acceptance model as the theoretical framework to design the user acceptance questionnaire,1 03 ICU nurses were selected by convenient sampling to participate in the study from 5 level three class A hospitals in Beijing from October 201 5 to January 201 6.Results Effective collected 1 01 questionnaires showed that the average scores of each dimensions intelligentized CAM-ICU delirium assessment system included perceived usefulness(4.62 ± 0.44)points,perceived ease of use(4.31 ±0.39)points,perceived ease of adoption(4.28 ±0.49)points,trust (4.36 ±0.62)points,attitude toward use (4.46 ±0.50)points and behavioral intention to use (4.61 ± 0.52)points.There were differences in perceived ease of use,trust and attitude toward use among nurses with different ages and different length of service (P <0.05 ).Pearson correlation analysis showed a positive correlation between perceived usefulness,perceived ease of use,trust and attitude toward use (P <0.01 ).A positive correlation was between perceived usefulness,perceived ease of use,attitude toward use and behavioral intention to use (P <0.05).A positive correlation was between perceived usefulness and perceived ease of use (P <0.01 ).Conclusions The acceptance of intelligentized CAM-ICU is satisfactory in ICU nurses,and which examine the from the simple and ease to use of delirium evaluation system subjective view.With the increasing of age and working years in ICU nurses,the acceptance increase for intelligentized CAM-ICU.Except the ease to learn,the correlation analysis showed the correlations in each dimensions are in accordance of hypnosis of theory model.

Objective To investigate the current status of ICU delirium management so as to provide reference for the clinical management of ICU delirium.Methods A total of 6 ICU units from two class Ⅲ grade A hospitals in Beijing were selected by convenient sampling. The spot investigation method was used to investigate the delirium management status and effect from June to September 2016.Results Six ICU units had neither developed a complete delirium management system and standardized process, nor systematically evaluated delirium risk factors. When delirium patients had symptoms, delirium was diagnosed according to the clinical experience in 6 ICU units, while specialist consultation was used in 3 ICU units. None of these units used any delirium screening tool. The delirium prevention rate was from 46.2% to 76.9%. The implementation rate of delirium treatment was 65.8%. Among 38 cases of delirium patients diagnosed by medical staff, 25 cases (65.8%) of which were treated. During the study, there were 106 cases of delirium patients; the incidence of delirium was 30.8%; the delirium identification rate of medical staff was 35.8%.Conclusions The normalization of routine monitoring of delirium in ICU is necessary. Prevention and treatment for delirium is inadequate. The effect of delirium management needs to be further improved.