Objective:To perform a meta-analysis of randomized controlled trials ( RCTs) in multiple sclerosis ( MS) patients to evaluate the efficacy and safety of alemtuzumab.Methods: We searched PubMed,EMBASE,the Cochrane Library and so on up to February 2015 using the keywords:′multiple sclerosis′or ′MS′and the drug names:alemtuzumab.Two authors independently selected the articles and extracted the data.We performed meta-analysis using Review Manager ( RevMan) version 5.3 software.Results:Three RCTs with a total of 1 695 patients were selected.Compared to the interferon beta,the number of gadolinium-enhancing lesions ( odds ratio (OR)=0.33,95% Confidence interval (CI)=[0.23,0.48],P<0.000 01),the cumulative probability of sustained disability (Or=0.51,95%CI=[0.38,0.69],P<0.000 1) and the proportion of patients who had at least one relapse of MS(Or=0.42,95%CI=[0.34,0.52],P<0.000 1) were significantly less in the alemtuzumab group,meanwhile the number of new T2-hyperintense lesions (Or=0.10,95%CI=[0.01,1.75],P=0.11) showed no significant difference.Comparing adverse events between two groups, alemtuzumab treatment did not increase the frequency of serious adverse events (Or=1.00,95% CI=[0.80,1.26],P=0.99) but increase the frequency of any adverse events (Or=2.29,95% CI=[1.40,3.75],P=0.001).Conclusion: Alemtuzumab is a relatively effective and safe treatment for MS.

Objective To retrospectively analyze the ultrasonic imaging features and clinical out-comes of biliary complications after percutaneous ablation for hepatic malignant tumors .Methods The cli-nical data of patients with postablation biliary complications who underwent percutaneous ablation for hepatic malignant tumors in the past 7 years in our department were retrospectively analyzed .The ultrasonic imaging features and the clinical outcomes of biliary complications on follow-up of these patients were analyzed .Re-sults Postablation biliary complications occurred in 65 patients , including 34 patients with bile duct dilata-tion and 31 patients with biloma .In patients with bile duct dilatation , the dilated bile ducts were located dis-tal to the ablation lesions in all these patients .Among 30 patients with bile duct dilatation , the dilatation was progressive in 9 patients (9/30, 30.0%) and stable in 20 patients (20/30, 66.7%), while in one patient (1/30, 3.3%) it resolved on follow-up.The radiologic features of bilomas mainly manifested as four types:crescent , interspersed , circumferential and solitary nodular , and the number of patients with the four types were 13 (13/31, 41.9%), 13(13/31, 41.9%), 3(3/31, 9.7%) and 2(2/31, 6.5%), respectively. In 6 patients (6/31, 19.4%) the bilomas were subjected to interventional or surgical therapy while for the remaining 25 patients (6/31, 19.4%) they were treated conservatively .Three (3/25, 12.0%) of the lat-ter 25 patients had spontaneously disappearance of the biloma and 2 (2/25, 8.0%) of the remaining 22 pa-tients appeared to have progressive increase in size .In 17 (17/25, 68.0%) patients the biloma remained stable in size and in the remaining 3 patients (3/25, 12.0%) the bilomas resolved.Conclusions Postab-lation biliary complications of ultrasound-guided percutaneous ablation for hepatic malignant tumors mainly presented as biloma and bile duct dilatation .Dilated bile ducts were located in the distal side of the ablation zones.Crescent type and interspersed type were the most common morphological types of biloma .Although most patients with postablation biliary complications of ultrasound-guided percutaneous ablation remained sta-ble or resolved on follow-up, interventional or surgical therapy was necessary in the minority of patients .

Objective To study the effect electrode placement of transcutaneous electrical nerve stimulation(TENS) on phantom limb pain in the postoperative phase of amputation.Methods 60 cases with phantom limb pain after amputation were equal divided into the treatment group and the control group.The electrodes were placed in the contralateral side similar as phantom limb in the treatment group,but were placed at the stumps in the control group.Results After two course of treatment,93.3% of the treatment group improved,and 76.7% very improved,which were better than those of the control group(P<0.05).Conclusion Electrode placement of TENS effects the different result of treating phantom limb pain.

Objective To investigate the usefulness of parametric imaging of contrast-enhanced ultrasound(CEUS) in evaluating hepatocellular carcinoma ( HCC) and focal nodular hyperplasia(FNH). Methods Thirty clinically or pathologically proven HCCs and 30 pathologically proven FNHs that had undergone CEUS were randomly included. SonoLiver CAP software were used to quantitatively anlalyze the CEUS and reconstruct DVP parametric images. Results The rise time, time to peak and mean transit time in HCC and FNH were (16. 7 ± 11. 1)s and (21.9±9. 0)s (P = 0. 052) ,(29. 9 ± 14. l)s and (33. 2 ±11.1)s ( P =0. 322), (115. 0±90. 9)s and (271. 5 ± 147. 6)s ( P = 0. 000),respectively. The perfusion index was 90. 4 + 102. 5 in HCC and 42. 6 + 37. 1 in FNH( P = 0. 022). DVP curve and DVP parametric image could both be divided into three types: washout, non-washout and cystic type. In DVP curve, the percentages of which were 76. 7% (23/30),20. 0% (6/30),3. 3% (1/30) in HCC, and 43. 3% (13/30) , 53. 3% (16/30) , 3. 3%(l/30) in FNH,respectively ( P = 0. 023). In DVP parametric image, the percentages of which were 66. 7%(20/30) ,30. 0%(9/30) ,3. 3%(l/30) in HCC,and 33. 3%(10/30) ,60. 0%(18/30) ,6. 7%(2/30) in FNH,respectively ( P = 0. 033). 30. 0% (9/30) of FNH had a clear spoke-wheel pattern in DVP parametric image. Conclusions In parametric imaging of CEUS, the mean transit time of HCC was shorter than that of FNH,and the perfusion index of HCC was higher than that of FNH. The DVP parametric image can display the rapid change and detail of the enhancement clearly.

OBJECTIVETo explore the mechanism of acupuncture on promoting the restoration of interstitial cells of Cajal (ICCs).

METHODSThirty SD rats were randomly divided into a blank group, a model group and an acupuncture group, ten rats in each one. The rats in the model group and acupuncture group were treated with colonic anastomosis to establish the model. After successful establishment of the model, the rats in the acupuncture group were treated with acupuncture at bilateral "Zusanli" (ST 36), "Sanyinjiao" (SP 6) and "Taichong" (LR 3) for 15 min, once a day for 10 days. Rats in the model group and blank group were put into the fixator for 15 min at the same time daily. The propulsive rate of small intestine was measured in each group. Colonic tissues were collected to detect c-kit expression by using immunohistochemistry. The nitricoxide (NO) content was measured by nitrate reductase method and nitric oxide synthase (NOS) activity was measured by method of L-arginine.

RESULTSCompared with the blank group, the propulsive rate of small intestine in the model group was decreased; NO content was increased; iNOS activity was elevated; cNOS activity was declined; total NOS (tNOS) activity was increased and the counting of c-kit positive ICCs was decreased (all P < 0.05). Compared with the model group, the propulsive rate of small intestine in the acupuncture group was increased; NO content was decreased; iNOS activity was reduced; cNOS activity was elevated; NOS activity was decreased and the counting of c-kit positive ICCs was increased (all P < 0.05).

CONCLUSIONAcupuncture can regulate NO content and NOS activity in postoperative restoration environment of ICCs, which may participate in the process of acupuncture promoting the restoration of ICCs.

Acupuncture Points ; Acupuncture Therapy ; Anastomosis, Surgical ; Animals ; Colon ; metabolism ; surgery ; Colonic Diseases ; enzymology ; metabolism ; surgery ; therapy ; Female ; Humans ; Interstitial Cells of Cajal ; enzymology ; metabolism ; Male ; Nitric Oxide ; metabolism ; Nitric Oxide Synthase Type II ; metabolism ; Rats ; Rats, Sprague-Dawley

Objective:To evaluate a Meta-analysis of randomized controlled trials ( RCTs) in multiple sclerosis ( MS) patients to evaluate the efficacy of vitamin D as add-on therapy. Methods: Searched Pubmed,EMbase,the Cochrane Library,CNKI,Wanfang Data base and so on up to february 2016 using the keywords:multiple sclerosis or MS and the drug names:vitamin D orCholecalciferol. Two authors independently selected the articles and extracted the data. We performed meta-analysis using Review Manager ( RevMan) version 5. 3 software. Results:Four RCTs with a total of 247 patients were selected.①Compared to the placebo, the EDSS score[MD=-0. 33,95% Confidence interval (CI)= (0. 68,0. 01),P=0. 05],the annual relapse rate[MD=-0. 08, 95%CI=(-0.37,0.21),P=0.60]and the number of gadolinium-enhancing lesions[MD=-0.16,95%CI=(-0.57,0.25),P=0. 45] showed no significant difference at 12 months,meanwhile the EDSS score[MD=-0. 48,95%CI=(0. 87,-0. 09),P=0. 02] and the annual relapse rate[MD=-0. 27,95%CI=(-0. 52,-0. 02),P=0. 03] were significantly less in the vitamin D group at 24 months.②Safety evaluation:There was no hypercalcaemia in vitamin D treated patients in each studies,main adverse events reported were diarrhoea, fever, constipation, dyspepsia, headache and so on. These symptoms were mild, after stopping drug can relieve the general. Conclusion: Vitamin D as an added in the treatment of MS showed as same as the placebo in some clinical indicators. However,after a longer treatment, the clinical indicators were significantly lower in the vitamin D group. Due to limited quantity and quality of the included studies,further larger and more prolonged studies are merited to verify the above conclusion.

Objective To evaluate the sonographic features of testicular adrenal rests tumors in minor males. Methods The sonographic feature of pathologically or clinically confirmed testicular adrenal rests tumor in 13 minor males was retrospectively analyzed;we analyzed the number, morphology and size of affected testis; the involvement of testicular mediastinum; lesion location; the growth pattern, shape, boundaries, size, internal echo and blood supply of lesions. Results All of the 13 cases were bilateral and there were 26 lesions in all, 5 cases (5/13, 39%) had normal testicular size and morphology, testicular mediastinum were seen in 12 cases (12/13, 92%);26 (26/26, 100%) TARTs were all located near the testicular mediastinum or the testis hilar;21 (21/26, 81%) lesions had irregular shape while 5 (5/26, 19%) lesions were round;26 (26/26, 100%) lesions all had clear boundary but had no echo envelope;the lesion size was (1.5 ± 1.0) cm in average;13 (13/26 , 50%) lesions showed homogeneous hypoecho, 11 (11/26, 42%) lesions showed inhomogeneous hypoecho and 2 (2/26, 8%) lesions showed inhomogeneous isoecho; 19 (19/26,73%) lesions displayed rich blood supply and 7 (7/26, 27%) lesions displayed scarce blood supply. Conclusion The sonographic appearance of TART in minor males was characteristic, ultrasonography has important clinical value.

Objective To investigate the value of shear wave elastography (SWE) and quasi-static elastography in the evaluation of radiofrequency ablation of pork.Methods Twelve pieces of fresh pork were underwent radiofrequency ablation (RFA) with different target temperatures.Before and after RFA,conventional ultrasound (US),SWE and quasi-static elastography were conducted to visualize the boundaries of RFA zones.The size of ablation zones obtained from conventional ultrasound,SWE and quasi-static elastography measurement were observed and detected the correlativity with pathology findings.Moreover,the Young's modulus and stain ratio of ablated zone were recorded.Results Most ablated boundaries were clearly delineated by both elastography techniques,except one with a low target temperature of 70 ℃.The sizes of ablated zones measured by SWE and quasi-static elastography were closely correlated with pathological findings.However,no ablated zones could be visualized by conventional US.Before and after RFA,the mean,minimum and maximum values of Young's modulus were (24.2 ± 3.8) kPa vs (97.6 ± 29.1) kPa,(9.2 ± 0.7)kPa vs (44.5 ± 7.7)kPa and (29.9 ± 3.8)kPa vs (181.5 ± 36.7)kPa,respectively (all P ＜0.001).With the increase of target temperature of RFA,the Young's modulus values and the mean strain ratio were significantly increased (all P ＜ 0.01).Conclusions Both SWE and quasi-static elastography are useful tools for evaluating the ablation,which are superior to conventional US.Moreover,SWE can be used to monitor the procedure of ablation.

Objective To evaluate the diagnostic performance of real-time contrast-enhanced ultrasound (CEUS)in characterizing complex cystic focal liver lesions(FLLs).Methods Sixty seven complex cystic FLLs in 65 patients were examined with baseline ultrasound(BUS)and CEUS.BUS and CEUS images were reviewed by a resident radiologist and a staff radiologist independently.Diagnostic performance was evaluated using receiver operating characteristic(ROC)analysis and the interobserver agreement was analyzed by weighted k statistics.Results After ROC analysis,the areas under the ROC curve(Az)were 0.917 for the staff radiologist and 0.774(P=0.044)for the resident radiologist on BUS,and were 0.935 and 0.922(P=0.42)on CEUS.A significant difference in Az between BUS and CEUS was found for the resident radiologist(0.774 versus 0.922,P=0.047),whereas not found for the staff radiologist(0.917 versus 0.935,P=0.38).Better results of specific diagnosis were obtained on CEUS[28.4%(19/67)before versus 58.2%(39/67)after review of CEUS images for resident radiologist,and 26.9%(18/67)versus 76.1%(51/67)for staff radiologist,both P＜0.001].Interobserver agreement was improved after review of CEUS images[K=0.325(95%confidence interval:0.214-0.436)on BUS versus k=0.774(95%confidence interval:0.688-0.860)on CEUS].Conclusions Real-time CEUS improves the capability of discrimination between malignant and benign lesions and specific characterization for complex cystic FLLs,as well as the interobserver agreement.

Objective To evaluate the ablation zone and temperature changes in the liver caused by laser ablation in vitro and in vivo.Methods Single needle single point laser ablation was performed in vitro with porcine liver using 5 W and 7 W-power and in vivo with rabbit liver using 5 W-power.All energy outputs were 1 800 J.The ablation zone and temperature changes were evaluated.Results Coagulation caused by laser ablation was divided into a black carbonized area and a brown white necrotic area from inside to out,respectively.The mean in vitro ablation range obtained by 5 W and 7 W-power laser ablation was 1.9 cm × 1.2 cm × 1.2 cm and 2.5 cm × 1.5 cm × 1.5 cm,respectively.The mean in vitro black carbonized range obtained by 5 W and 7 W-power laser ablation was 1.1 cm × 0.5 cm × 0.5 cm and 1.4 cm × 0.7 cm ×0.7 cm,respectively.The average maximum temperature using 5 W-power was 243.57 ℃,62.47 ℃ and 34.27 ℃ in the ablation center,5 mm from the center,and 10 mm from the center,respectively.For in vivo liver experimentation,the average maximum temperature using 5 W-power was 62.26 ℃ and 44.35 ℃5 mm and 10 mm from the center,respectively.Conclusion Laser ablation can cause coagulation necrosis of the liver tissue in vitro and in vivo,and the ablation range increased with increasing power.Laser ablation may have potential use in the ablation of tumor localized in critical sites.