BACKGROUND: Animal experiments show that hormone can induce femoral capillaries poor filling, decrease capillaries density in unit area, and reduce capillaries in cancellous bone inferior to cartilage. However, the involved mechanism remains unclear.OBJECTIVE: To explore the changes of vascular endothelial growth factor (VEGF) during the progress of glucocorticoid induced osteonecrosis.METHODS: The Chinese white rabbits were randomly divided into horse serum plus prednisone group and pradnisone alone group. Typical osteonecrosis model was established by Matsui Method. 10 mL/kg horse serum was injected into horse serum plusprednisone group through the ear margin veins, followed by additional injection after 2 weeks and intraparit0neal injection of prednisone, 45 mg/kg per day for 5 consecutive days. The control group was only subjected to prednisona, 45 mg/kg per day for 5 consecutive days. The VEGF expression was observed by means of reverse transcription polymerase chain react.ion (RT-PCR)before, 7, 14 days after administration, 1, 3, 7, 21, 35 and 49 days following the first application of hormone. The capillaries were quantified.RESULTS ANDCONCLUSION: The VEGF was significantly increased 7 days following horse serum, and gradually decreased to levels before treatment 1 days following hormone. The VEGF mRNA, expression decreased with increasing hormone treatment, in particular at 7 and 21 days (P ＜ 0.05), but cannot restore to normal level. Micrevascular count was decreased gradually, and at 21 days decreased to the minimum, positively correlated with VEGF expression. Results show that adrenal glucocorticoid inhibited VEGF expression in bone tissue and restrained angiogenesis, resulting in ischemia and hypoxia of the local environment in bone tissue. VEGF expression highly correlates with microvascular count and osteonecrosis degree.

BACKGROUND:Rehabilitation outcomes of patients with spinal cord injury are associated with degree of injury, therapeutic method, recovery time and subsequent treatment. Multidisciplinary, comprehensive, specialized rehabilitation unit can provide a better recovery after spinal cord injury. OBJECTIVE:To review the effect or combined effect of rehabilitation units after spinal cord injury. METHODS:A computer-based search of Springer and PubMed databases was done using the keywords of“spinal cord injury, rehabilitation practice, outcomes”, which appeared in the title and abstract. Final y, 44 English papers were included in result analysis. RESULTS AND CONCLUSION:Based on practical evidence, various rehabilitation practices are recognized, and then, the relevant information is connected with the outcomes to evaluate the efficacy of rehabilitation interventions. Studies have shown that age had no influence on rehabilitation outcomes in traumatic and non-traumatic mixed samples, and there is also little difference in the rehabilitation outcomes between male and female. Incidence of complications is lowest in the vast majority of patients with spinal cord injury who are initial y admitted to a specialist center of spinal cord injury. The hospital stay can be shorten in patients who can be admitted to a multidisciplinary, comprehensive, specialized division of spinal cord injury as early as possible. Patients who can receive regular, comprehensive outpatient fol ow-up show no significant differences in health perception, independence and depression, but the frequency and degree of certain secondary situations can be significantly reduced.

BACKGROUND:The carotid siphon has a complex structure, which is difficult for two-dimensional imaging observation due to shelter from the basicranial bone. Digital subtraction angiography is conducive to display the course of carotid siphon, but there is a lack of anatomical landmarks. Three-dimensional CT imaging is beneficial to show the structure of carotid siphon and have its measurement, which provides a new and effective means in relevant studies.
OBJECTIVE:To clarify the morphology and calcification distribution of the carotid siphon, thereby providing an objective basis for relevant clinical and basic research.
METHODS: A total of 206 patients, over 50 years old, with no lesions or variation under head and neck CT angiography were selected and divided into non-calcification group (n=70) and calcification group (n=136). The carotid siphon was reconstructed on the imaging workstation to observe the classification (“U”, “V”, “C” and “S” types) and calcification distribution, the bending angles of C4 and C5 segments as wel as lumen diameter were measured.
RESULTS AND CONCLUSION:The 70 patients in the non-calcification group were at a mean age of (59.17±10.27) years, and the “U” type accounted for 35.7%, “V” type for 30.7%, “C” type for 27.2%, and “S” type for 6.4%; Among them, 33.3% patients (25/70) had the same type at both sides; the lumen diameter was (4.92±0.63) mm, and the blending angles of C4 and C5 were (87.23±16.66)° and (49.21±16.01)°. In the calcification group, the mean age was (67.39±9.32) years, and there were 41.5% of “U” type, 33.1% of “V” type, 24.3% of “C” type, 1.1% of 24.3%, and among the 136 patients, 43.4% (59/136) showed the same type at both sides; the lumen diameter was (4.90±0.44) mm, and the blending angles of C4 and C5 segments were (84.44±17.20)° and (52.57±14.16)°. There were significant differences in age and “S” type between the two groups (P < 0.05), but no statistical difference in the lumen diameter and blending angles of C4 and C5 (P > 0.05). In the calcification group, the calcification percentage of inwardly and outwardly curved regions was 13.60% and 19.01% for C4, 27.34% and 16.52% for C5, 9.94% and 13.60% for C6. The morphology of the carotid siphon is mostly seen as “U”, “V”, “C” types, and over 50% types are different at both sides. Calcification of the lumen wal is seen most in the inwardly curved region of C5 segment, folowed by the outwardly curved region of C4 segment. The incidence of calcification is increased with age, which is lower in the S-type carotid siphon. The lumen diameter and blending angle of the carotid siphon show no correlation with calcifications.

Currently, medical ultrasound teaching focuses on the delivering the image infor-mation itself, while its connection with basic medicine and clinical medicine is neglected. Such a teaching method is not good for students to establish a systemic view. To conduct the ultrasound medi-cine education effectively in undergraduate students, we have tried some reforms, including: perform-ing diseases or problem based teaching, integrating basic medicine, ultrasound medicine and clinical medicine throughout the whole teaching process, providing as many practice opportunities as possible for the graduates and integrating the ultrasound imaging with other medical imaging modalities. The practice shows that with the reform, the students have a better understanding of ultrasonic knowledge itself, a better grasp of the whole medical knowledge structure, and also have a preliminary impression on how to diagnose the disease through reasonable application of different treatments. In addition, students have more passion for study.

Ikaros is a regulatory factor playing an important role in control of the development of hema-topoietic cells and immune system;and as a tumor suppressor,its aberration can cause both T and B lineage development arrest and neoplastic transformation,leading to insensitive to therapy and poor prognosis in actue lymphoblastic leukemia. Recently,researches on how Ikaros affects the leukemogenesis and prognosis become the focus of attention.

Objective To explore the clinical effects of sitagliptin alone or its combination with metformin on the patients with type 2 diabetes registered on their first clinic/hospital visits.Methods Eightytwo patients with type 2 diabetes who diagnosed with oral glucose tolerance test (OGTT),insulin test and glucagons stimulating C-peptide test from May 2011 to February 2012 in our hospital were randomly divided into two groups:the patients in control group took sitagliptin alone (control group,n =41) and the patients in experimental group took sitagliptin combined with metformin (experimental group,n =41).Eighty-two patients,after the mission,were given diabetic diet and moderate exercise therapy.Taking sitagliptin 100 mg,1 times/d;combined with metformin groups given sitagliptin 100 mg/d,metformin 250 mg,3 times/d.Six months later,the major indexes comparing between before and after treatment of weight,body Mass Index (BMI),glycosylated hemoglobin(HbA1c),OGTT,fasting plasma glucose (FPG),2 h plasma glucose (2 hPG),fasting insulin (FINS),2 h postprandial insulin (2 hINS),fasting C-peptide and 2 h postprandial C-peptide levels were measured to research the changes during the treatments.Results After treatments,all the indexes were decreased significantly,and the BMI,HbA1c,FPG,2 hPG,FINS,2 hINS,fasting C-peptide and 2 h postprandial C-peptide in the group with sitagliptin united with metformin were significantly lower than the group with sitagliptin((27.4 ± 1.2) kg/m2 vs.(27.9 ±1.5) kg/m2,t =-2.812;(8.1 ±1.2)％ vs.(8.8 ± 1.3)％,t =-2.953;(8.17 ±1.22) mmol/L vs.(9.22 ± 1.28) mmol/L,t =-4.940;(10.16 ± 1.68) mmol/L vs.(11.01 ± 1.62) mmol/L,t =-3.362; (9.22 ± 1.93) mU/L vs.(9.85 ± 1.59) mU/L,t =-2.212;(74.62±13.73) mU/L vs.(83.75 ± 13.12) mU/L,t =-5.235;(1.43 ±0.34) μg/L vs.(1.77 ±0.27)μg/L,t =-3.194; (6.80 ± 1.40) μg/L vs.(7.61 ± 1.64) μg/L,t =-4.480 ; P ＜ 0.05).Conclusion Sitagliptin is useful to treat type Ⅱ diabetes,plays important roles in improving patients' quality of life and insulin resistance,control of blood glucose,reduce the family and the burden of social health,and the effect will be more better when united with metformin.

Objective To observe the injury of myocardium and to investigate the role of oxidative stress after limbs ischemia reperfusion in rats. Methods 20 male healthy Wistar rats were randomly divided into 2 groups: control group(C) and ischemia-reperfusion group (IR). The biochemical methods were used to measure the contents of malondialdehyde (MDA), myeloperoxidase (MPO), ATP, lactic acid (LD) and ATPase of myocardium. The levels of creatine kinase (CK) and creatine kinase MB isoenzyme (CK-MB) in plasma were also observed. The morphologic changes of myocardium were observed with microscope. Results It was found that after rats’ limbs suffering from ischemia-reperfusion, the level of ATP decreased, the activities of three kinds of ATPase (Na~+-K~+-ATPase, Ca~ 2+ ATPase and Mg~ 2+ ATPase) decreased in different degree (P

ObjectiveTo observe and quantify the effec ts of respiration on hemodynamics in patients with pericardial effusion (PE) and to verify our new proposed hypothesis about the mechanism of respiratory effects on cardiac function from clinical point of view. MethodsPulsed-wave Doppler spectra of the four cardiac valves were recorded with Acuson Sequoia 512 and 128 XP/10 in 10 patients with PE and 18 healthy control subjects with no apparent cardiac and pulmonary abnormalities. Electrocardiogram and respiratory tracing by a nasal thermistor were recorded simultaneously with the echocardiograms. The blood flow velocities of each valve during inspiration and expiration were averaged separately and those were again averaged for 5 consecutive respiratory cycles, and the respiratory variation indices (RVI) were calculated both in the patients and the control groups. ResultsThe peak E velocity across the mitral valve and that across the aortic valve significantly increased during expiration and decreased during inspiration, while that across the tricuspid valve and that across the pulmonary valve increased remarkably during inspiration and decreased during expiration in all of the subjects. The RVI of the velocities across the mitral and the aortic valves increased significantly in the patients with PE compared with the control subjects [MV: ( 14.57 ? 7.89 )% vs ( 9.71 ? 3.39 )%, P

0.05). Conclusions Ultrasound contrast agent Levovist improves signal of blood flow obviously. It increases the diagnostic accuracy for intracranial aneurysms and the level of confidence.

Objective To observe characteristic imaging of traumatic arteriovenous fistulas(TAVF) and to evaluate the methods of differential diagnosis of TAVF by Doppler ultrasonography. Methods Eleven patients suffering from TAVF were selected to have the examination of Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow character of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Localization of arteriovenous fistulas was observed directly in eight patients, which presented as intercepted wall of the affected vessels and irregular mosaic flashes flowing towards enlarged vein from artery. Pulsed wave Doppler showed unilateral continuant spectral with maximum velocity 300-390 cm/s when sampled in the fistula. Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance. Arterialized flow pattern was observed in affected veins. Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance. Reversed centrifugal blood flow was observed in the distal veins of the fistulas in 4 cases. Conclusions Unilateral shunt in both diastole and systole in the fistula and arterialized flow with high velocity in veins are characteristic presentation of TAVF. Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of TAVF.