Objective To investigate the changes in brain MRI scan in neuromyelitis optica (NMO).Methods MRI images in 27 cases with NMO were examined in a retrospective study.Results Twenty-two of 27 patients (81.5%) had abnormal brain MRI findings,which were classified as nonspecific (7 cases),atypical (1 case),multiple sclerosis-like (3 cases) and ventricle-aqueduct-syringocoele lesions (11 cases).The lust type is the most common (40.7%).Furthermore,the analysis showed that the number of brain lesions positively correlated with lag time from the onset to the last MRI scan (r=0.475,P=0.025).Conclusions Brain lesions in NMO are diverse,which might result from different pathogenesis.However,ventricle-aqueduct-syringocoele is the most common lesion.Early brain MRI examination of suspected cases is essential.

Objective To study the effects of Fluvastatin on the expression of intercellular adhesion molecule-1 (ICAM-1) in human umbilical vein endothelial cells (HUVECs) induced by C-reactive protein (CRP). MethodsThe HUVECs were primary cultured. HUVECs from third to sixth generations were stimulated with different concentrations CRP and at different times. Then the cells were treated with Fluvastatin in different concentration of 10-7,10-6 and 10-5mol/L. The content of ICAM-1 protein was detected with ELISA, the mRNA expression of ICAM-1 was evaluated by RT-PCR. Results In the control group, HUVECs produce ICAM-1 protein and mRNA in low concentrations. In CRP group, the content of ICAM-1 protein was increased significantly (P

Objective To study the visfatin level changes in patients with rheumatoid arthritis (RA), and to study the correlation of visfatin level and atherosclerosis in RA.Methods Fifty cases of patients were divided to the plaque group (33 cases) and plaque-free group (17 cases) according to the carotid intima media thickness checked by carotid ultrasonography.In addition, their blood lipid level, homeostasis model assessment of insulin resistance (HOMA-IR), rheumatoid factors (RFs), anti-CCP, visfatin etc.were measured.Fifty healthy people were set as the control group.The correlation between the visfatin level of RA patients and atherosclerosis was analyzed.The statistical analysis was carried out with independent t-test,analysis of variance, Spearman correlation analysis and multiple stepwise regression.Results The serum visfatin level of RA plaques group was obviously higher than that of the plaque-free group [(47±22) μg/L vs (34±19) μg/L, t=4.361, P＜0.01].The serum visfatin level of RA patients was positively correlated to HOMA-IR (r=0.567, P=0.001), RF (r=0.502, P=0.003), anti-cyclic peptide containing citrulline, (anti-CCP) (r=0.420, P=0.038) and carotid artery IMT (r=0.596, P=0.001).High-density lipoprotein-C (OR=1.009, P=0.020), HOMA-IR (OR=1.450, P=0.006), anti-CCP (OR=1.005, P=0.014) and visfatin (OR=0.971, P=0.008) were independent relevant factors affecting carotid artery IMT.Conclusion The serum visfatin level of RA patients is closely related to atherosclerosis.

Objective To retrospectively review the clinical experience of percutaneous kyphoplasty (PKP) in the treatment of severe osteoporotic vertebral compression fracture (OVCF) during 10 years,and to propose a new classified treatment for OVCF.Methods 1200 patients with osteoporotic thoracolumbar vertebral compression fracture underwent percutaneous kyphoplasty from Aug.2003 to Aug.2013.There were 62 severe patients (5.2％,81 vertebraes),aged from 69 to 95 years (average 76.5 years),with 66.7％ to 78.9％ (average 71.3％) of vertebral body compression.Patients were followed up for 12 to 120 months (average 78 months).According to the preoperative imaging data,the fractures were classified into four types:simple type,pseudarthrosis type,cavern type,progressive type.Individualized PKP was performed on each patient.Results All the patients tolerated procedure well.The visual analogue scale (VAS) was reduced from (7.2± 2.1)preoperatively to (2.5±1.7) 3 days after PKP(t=13.197,P＜0.01).The Medical Outcomes Study (MOS) 36-Item Short Form Health Survey (SF-36) scales was improved from (29.5±8.2) to (46.5±9.9) 3 days after surgery(t=22.884,P＜0.01).Most patients were satisfied with the efficacy.The anterior height of vertebral body was increased from (14.21±2.44) mm preoperatively to (19.28 ±4.37) mm 3 days after surgery(t=9.108,P＜0.01).The Cobb angle were decreased from (16.45 ± ±5.37)° to (9.41±4.13)° 3 days after surgery(t=9.355,P＜0.01).The height of vertebrae was lost and the kyphosis angle aggravated with the follow-up time.New vertebral fractures were found in 21 patients (21/62,33.9％) at the last follow-up.Conclusions The preoperative accurate classification of severe osteoporosis vertebral compression fracture and individualized PKP can raise the successful operation rate and reduce the incidences of complications.

Objective To investigate the characteristic MRI appearance of neuromyelitis optics (NMO) and muhip]e sclerosis (MS) in the spinal cord.Methods Twenty cases of MS and 23 cases of NMO were examined by MRL All image appearances were analyzed.Results The characteristic MRI appearance of NMO patients in the spinal cord was linear medullary lesion (LML), linear medullospinal lesion (LMSL), linear spinal lesion (LSL) and longitudinally extensive transverse myelitis (LETM), and spinal cord MRI with contiguous T2-weighted signal abnormality extending over 3 or more vertebral segments (23 cases), while in MS, spinal cord MRI with contiguous T2-weighted signal abnormality often extended less than 3 vertebral segments (only 12 cases, χ2 = 19.142, P < 0.01), and the distribution of spinal lesion usually was eccentric (17 cases, compared with NMO group, χ2 = 25.256, P < 0.01).Conclusions NMO is distinct from MS.In MRI, spinal lesion in NMO usually conforms to the distribution of aquaporin 4, while spinal lesion in MS always conforms to the demyelination.NMO has neuroimaging features that move it ever closer to distinct disease status.

Objective To estimate the clinical value of percutaneous vertebroplasty (PVP)performed on the elderly patients aged 80 years and over with osteoporotic vertebral fractures.Methods Since January 2000, 19 patients aged 80 years and over were treated with PVP, and 17 patients from 60 to 79 years old underwent percutancous kyphoplasty (PKP). Visual analogue scale (VAS) was tested preoperatively and 1 to 7 days, 3 months, 6 months, 1 year and 2 years after operation. The time of radiation, volume of bone cement injection and hospital charges were compared betwecn two procedures. Results Over the 2-year follow-up, there were no significant differences in analgesia effects between thc two groups (P＞0.05). The radiation time of PVP and PKP was (107±37)s and (151±76)s respectively (t=2.24, P＜0.05). The hospital charges of PVP and PKP were ￥(16 124±5850) and ￥(34 265±6655) respectively (t=9.26,P＜0.01). Conclusions PVP is better than PKP for treating osteoporotic compression fractures in the elderly patients over 80 years, because of the former's simplicity and efficiency.

Objective To investigate the distribution and antimicrobial resistance profile of clinical gram-negative bacterial isolates in the First Afifliated Hospital of Nanjing Medical University during 2014.Methods Bacteria identiifcation was performed by API system or the VITEK-2 Compact automatic identiifcation system. Disk diffusion susceptibility testing or VITEK-2 Compact automatic identification system was used to determine the susceptibility to antimicrobial agents. All data were analyzed using WHONET 5.6 software.Results Among the total 7 931 clinical isolates in 2014, gram-negative bacteria accounted for 64.2% (5 088/7 931). The top three pathogens wereE. coli,A. baumannii andK. pneumoniae. Notably, during the year 2014, 195 strains of carbapenem-resistantEnterobacteriaceaewere isolated, about 6.9% of all theEnterobacteriaceae isolates. Meanwhile, 613 (66.5%) strains of multiple drug resistantA. baumannii and 197 (28.7%) strains of multiple drug resistantP. aeruginosa were isolated.Conclusion During the year 2014, the resistance of the gram-negative bacteria in this hospital is mainly characterized by carbapenem-resistantEnterobacteriaceae, multiple drug resistant A. baumanniiand multiple drug resistantP. aeruginosa. Surveillance of antimicrobial resistance is beneifcial for rational use of antibiotics.

ObjectiveTo investigate the expression and clinical significance of heat shock transcription factor 1 (HSF1) protein in human hepatocellular carcinoma (HCC) tissues,and deduce the probable molecular mechanism of HSF1 in the development and advancement of HCC.MethodsSixty-seven samples of HCC tissue and 21 samples of normal liver tissue were obtained from March 2006 to March 2007 at the Xijing Hospital.The expressions of HSF1 protein and heat shock protein 70 (HSP70) were detected by using immunohistochemistry.The probable molecular mechanism of HSF1 in the development and advancement of HCC was deduced according to the relationship between the expressions of HSF1 protein and HSP70.Positive rates of HSF1 protein in different tissues and the relationship between HSF1 protein expression in the HCC tissues and clinical pathological factors were analyzed by the chi-square test and by calculating Fisher exact probability,respectively.The correlation between the expressions of HSF1 protein and HSP70 in the HCC tissue was analyzed by the Spearman correlation coefficient.The survival curve was drawn by the Kaplan-Meier method,and the survival rate was analyzed by the Log-rank test.ResultsThe positive rates of HSF1 protein expression was 69％ (46/67) in the HCC tissue,which was significantly higher than 29％ (6/21) in the normal liver tissue ( x2 =10.628,P ＜ 0.05 ),The positive rates of HSP70 expression in the HCC tissue was 57％ (38/67),which was significantly higher than 24％ (5/21) in the normal liver tissue ( x2 =6.929,P ＜ 0.05 ).The expression of HSF1 protein in the HCC tissue was positively correlated with that of HSP70 (r=0.319,P ＜0.05).The high expression of HSF1 protein was correlated with the integrity of capsule of HCC,tumor differentiation and TNM stage (x2 =5.935,9.762,5.159,11.267,P＜0.05 ),while the high expression of HSF1 protein was not correlated with the gender,age,levels of hepatitis B surface antigen and alpha fetoprotein,and portal vein tumor thrombus ( x2 =0.822,0.172,2.059,P ＞0.05 ).The survival time was (21.4 ± 1.9 )months for patients with positive HSF1 protein expression and (29.8 ± 2.7 ) months for patients with negative HSF1 protein expression.There was a significant difference in the survival time between patients with positive and negative HSF1 protein expression ( x2 =4.276,P ＜ 0.05 ).Conclusions HSF1 is correlated with the development,advancement,invasion,metastasis and malignant prognosis of HCC.HSF1 takes effects by regulating the expression of HSP70,and it has a good perspective of clinical application for the diagnosis and treatment of HCC.

Vertebral augmentation has been widely used for treating the osteoporotic vertebral compression fractures. However, the occurrence of new fractures in adjacent vertebrae is also common. In order to understand the mechanism of adjacent vertebral fractures to prevent its happening, many scholars have carried out a lot of experiments and clinical studies by different research methods for years. As a result, many theories about the mechanism of adjacent vertebral fracture have been formed. Including the patients' general conditions (age, gender, bone mineral density, body mass index, et al), material characteristics of bone cement, distribution of bone cement (volume of bone cement and under-endplate distribution, acentric or bilateral distribution, compact and solid cement filling pattern, bone cement leakage), factors of spinal sagittal imbalance, factors of anti-osteoporosis treatment and the behavioral therapy, the location of initial injured vertebral level, the degeneration of adjacent disc, all of above were considered as potential risk factors. However, various researches lead to diverse conclusions because of different methods were used and different research factors were included, some conclusions were even opposite. Therefore, it is still controversial that whether some of the risk factors were effective. In this research, the current researches and the reliability and limitations of various research methods were reviewed to put forward a relatively objective interpretation, in order to provide evidences for understanding the risks of adjacent vertebral fracture after vertebral augmentation, and to provide reference for treatment.

Objective Finite element method was used to clarify the biomechanics effect of cement intervertebral leakage during vertebral augmentation.Present a novel classification of bone cement intervertebral leakage.Analyze the effect of stress changing of bone cement intervertebral leakage on adjacent endplate by finite element method.Methods Based on Churojana's classification method,we redefined diverse kinds of intervertebral leakage:as the Type Ⅰ (intervertebral-extradiscal leakage),Type Ⅱ (intradiscal leakage) and Type Ⅲ (combined leakage).Type Ⅱ was also been divided into Ⅱa (anterior),Ⅱb (central),Ⅱc(posterior),Ⅱd (lateral) and Ⅱe (cross-region) due to the location of the leaked bone cement.All the Type Ⅱ cases were divided into 1 or 2 two subtypes according to whether the cement had reached the adjacent vertebral endplate.We established 3D reconstruction of volunteer thoracolumbar spine using Mimics 17.0 software,and using Geomagic 2015 to generate L1 vertebral compression fracture model.In the Ansys 17.0 software,we simulated the L1 bone cement leakage into the T12/L1 intervertebral space model.After validating the validity of the model,calculate the solution of the intact model,non-leakage model and various leakage models,the stress distribution of the caudal endplate of T12 was analyzed in neutral,flexion,extension,lateral bending and torsion.Results The maximum stress of inferior endplate of T12 vertebra of intact model is 11.476 MPa,19.517 MPa,16.879 MPa,42.346 MPa,43.033 MPa,6.568 MPa,6.568 MPa in neutral,flexion,extension,left bending,right bending,left rotation,right rotation respectively.For the non-leakage model,the maximal stress of adjacent vertebral endplate was 12.967 MPa (112.99％),23.134 MPa (118.53％) and 20.403 MPa (120.88％) in neutral,flexion and extension compared to the intact model.No significant increasing can be found in other conditions.Compared to the non-leakage model,the stress of adjacent vertebral endplate is similar when type Ⅰ leakage occurs.In type Ⅱ leakage,the Ⅱa1 was 28.506 MPa (123.40％) in the flexion;the Ⅱa2 was 84.791 MPa (366.52％) in the flexion;the Ⅱb2 was 14.138 MPa (122.82％) in the neutral and 27.313 MPa (118.06％) in the flexion;the Ⅱc1 was 19.695 MPa (128.50％) in the extension;the Ⅱc2 was 67.740 MPa (441.97％) in the extension,and the Ⅱd2(right) was 123.940 MPa (285.83％) in the right bending.In the left/right rotation motions,the stress values are small,ranging from 5.095-15.585 MPa.Conclusion After vertebral augmentation,the stress of adjacent vertebral endplate increased slightly.Type Ⅰ leakage did not further increase the stress of adjacent vertebral endplates.Type Ⅱ leakage increases the stress of adjacent endplates in the direction of leaked cement.Subtype 2 of Type Ⅱ offer more stress than subtype 1.When the peripheral type of leakage (Ⅱa,Ⅱc and Ⅱd) occurred,if the spine flexes in the direction of leakage,then the stress increase of adjacent endplates will increase further.