The growth of brain metastasis needs appropriate microenvironment, and the change of normal brain microenvironment is the basis for exploring metastasis with MRI. Through the local magnetic field changes and the application of contrast agents for improving the discrepancy of the cerebral tissue, MR can accurately detect brain metastasis in position, number, size, and shape. MR with contrast-enhanced technique is the first choice for screening brain metastasis. The application of all kinds of new MR techniques, sequences and intracellular contrast agents can not only further improve the specificity of detection, but also improve the sensitivity of MRI, which is favorable to formulating reasonable treatment and prolonging the lifetime of the patients. The microenvironment of brain metastasis and advances in the new MR techniques were reviewed in this article.

Objective:To investigate the clinical efficacy of radial extracorporeal shockwave therapy(ESWT)for scapulohumeral periarthritis in the elderly.Methods:A total of 82 patients diagnosed with scapulohumeral periarthritis at the rehabilitation medicine department of our hospital from July 2016 to January 2019 were retrospectively analyzed.The visual analogue score(VAS), Constant-Murley score(CMS), range of motion(ROM), adverse reactions, curative effectiveness and survival analysis were examined before treatment and at several time points within 6 months of treatment.Results:Compared with pre-treatment, the VAS, CMS, ROM, curative effects and survival analysis of patients with primary and secondary scapulohumeral periarthritis improved after treatment in both the conventional rehabilitation therapy group and the conventional rehabilitation therapy combined with ESWT group(all P<0.05). The short-term effects(2 weeks and 1 month after treatment)were better in the conventional rehabilitation therapy combined with ESWT group than in the conventional rehabilitation therapy group( P<0.05). There was no significant difference in long-term effects(2, 4 and 6 months after treatment)between the two groups( P>0.05). For patients with primary scapulohumeral periarthritis, conventional rehabilitation therapy combined with ESWT had advantages over conventional rehabilitation therapy in reducing the VAS score and improving shoulder function(CMS score and ROM)( P<0.05). For patients with secondary scapulohumeral periarthritis, conventional rehabilitation therapy combined with ESWT was better in reducing VAS than conventional rehabilitation therapy( P<0.05), while there was no significant difference in shoulder function improvement between the two groups(all P>0.05). Conclusions:Conventional rehabilitation combined with ESWT can relieve shoulder pain, improve range of motion and has a good safety profile in the treatment of scapulohumeral periarthritis in the elderly, but there is no significant difference in long-term efficacy between conventional rehabilitation therapy and conventional rehabilitation therapy combined with ESWT.

Objective:To observe the clinical effect of Governor Vessel-regulating and brain-unblocking acupuncture on post-stroke depression.
Methods:A total of 70 eligible cases were randomly allocated into an observation group and a control group according to the random number table. Patients in the observation group were treated with Governor Vessel-regulating and brain-unblocking acupuncture, whereas patients in the control group were treated with oral Escitalopram Oxalate tablet. The treatment lasted for 8 weeks. The Hamilton depression scale (HAMD), Montgomery Asberg depression rating scale (MADRS), and Barthel Index (BI) were used to evaluate the patients’ condition before, 4 weeks and 8 weeks after treatment respectively. In addition, adverse reactions were also recorded.
Results:After 4 weeks of treatment, the HAMD and MADRS scores were significantly decreased in both groups (P<0.05); and the BI scores were significantly increased in both groups (P<0.05). There was no between-group statistical difference in HAMD score (P>0.05); the MADRS score in the observation group was significantly lower than that in the control group (P<0.05) and the BI score in the observation group was significantly higher than that in the control group (P<0.05). After 8 weeks of treatment, there were no between-group statistical differences in all aspects (P>0.05); however, the adverse reactions in the observation group were significantly less than those in the control group.
Conclusion:The Governor Vessel-regulating and brain-unblocking acupuncture is safe and effective for post-stroke depression and can obtain similar efficacy as Escitalopram Oxalate tablet. In addition, it can fast alleviate core symptoms of depression and improve the activities of daily living (ADL) and has fewer adverse reactions.

Objective:To observe the effect of Governor Vessel-unblocking and mind-calming acupuncture on insomnia and further develop the academic idea on Gao’s lineage acupuncture. Methods:A total of 68 insomnia cases were randomly allocated into an acupuncture group (n=34) and a medication group (n=34) according to their sequences of consultation. Patients in the acupuncture group received acupuncture treatment once a day, 5 d a week, for 4 weeks. Patients in the medication group took 1 mg of Estazolam before sleep for each dose, one dose a day, for 4 weeks. Before and after treatment, the sleep quality was evaluated using the Pittsburgh sleep quality index (PSQI), and the efficacy was assessed using the PSQI reductive rate. Results:After treatment, the global PSQI score and scores of each component in the acupuncture group were significantly decreased (allP<0.01). The global PSQI score in the medication group was significantly decreased (P<0.01). Except for sleep disturbance, scores of the rest of components were significantly decreased (P<0.01 orP<0.05). The between-group difference was statistically significant in global PSQI score (P<0.01). Except for sleep latency and duration, scores of the sleep quality, efficiency, disturbance and daytime dysfunction in the acupuncture group were significantly lower than those in the medication group (allP<0.05). In addition, the recovery and marked effect rate in the acupuncture group was significantly higher than that in the medication group (P<0.05). Conclusion:The Governor Vessel-unblocking and mind-calming acupuncture is safe, reliable for insomnia and has better efficacy than Estazolam.

OBJECTIVE To discuss the diagnosis and endoscopic treatment of congenital basal encephaloceles in infants.METHODS We retrospectively reviewed the clinical data of 6 infants with congenital basal encephaloceles in Beijing Children's Hospital between January 2014 to September 2016. CT and MRI were performed routinely. All patients underwent endoscopic resection of encephaloceles and repair of skull base defects. RESULTS Five patients presented with transethmoidal encephaloceles and one transsphenoidal encephaloceles. All patients underwent endoscopic procedure successfully. There were no complications except for one 7-month old girl who got purulent meningitis. All patients had favorable clinical outcomes during a follow-up of 3 to 29 months.CONCLUSION For infants with persistent nasal obstruction and nasal neoplasms, congenital basal encephaloceles should be considered. Nasal coronary CT and sagital MRI are of paramount importance in the diagnosis of congenital basal encephaloceles in infants. The endoscopic procedure is the safe and effective method for the management of congenital basal encephaloceles in infants.

Objective To construct a novel bioartificial liver (BAL) system and evaluate its functions in vitro. Methods Chinese experimental minipig hepatocytes were isolated by in situ recirculating collagenase perfusion method and 1.0?10~(10) hepatocytes were cultured in serum-free medium with restriction of(attachment), and using spinner method to form hepatocyte(spheroids).cted by inoculating the hepatocyte(spheroids) into cell circuit of a hollow fiber bioreactor from BIOLIV A3A. Observing the number and viability of the(hepatocytes), the changes of alanine aminotransferase (ALT), total bilirubin (TBI), albumin (ALB) in(circulating) hepatocyte suspension and(RPMI1640) medium; in addition, lidocaine metabolism test was(determined),(during) 6h circulation of the system. (Results) There were no significant differences in number and viability of the hepatocytes before and after 6h(circulation). The BAL system has relatively strong albumin synthesis and lidocaine(metabolism) functions. (Conclusions) The BAL system that we developed had ability to support liver functions and could be used in the treatment of liver failure, or to provide temporary liver support for candidates of liver(transplantation).

Aiming at the existing problem of inequality and being unscientific in the evaluation of comprehensive quality of medical students, through literature research and expert opinion method, and from multi angles , the author constructed the evaluation index system of comprehensive quality of scientific medicine, using AHP to determine the weights of evaluation indexes, and established a fuzzy evaluation model of the comprehensive quality of medical students, and on this basis, improved the calculation method of fuzzy evaluation and the maximal subjection degree of the evaluation result. The specific examples of the evaluation results showed that the method was effective and could reflect the comprehensive quality of med-ical students in a comprehensive and objective way, and it had great significance to the comprehensive quality evaluation of medical students.

Objective To observe the effects of Kechuanning capsules on airway inflammation cells and inflammatory mediators in patients with COPD.Methods Totally 110 patients with stable COPD were randomly divided into therapy group and control group, 55 cases in each group. Both of the groups were given compound ipratropium bromide solution for inhalation, at the same time, patients in the therapy group took Kechuanning capsules orally, 4 softgels each time, 3 times a day, and patients in the control group took the same amount of placebo capsules. The treatment lasted three months. Differential counting of inflammatory cells and levels of inflammatory factors in serum and sputum supernatant were observed.Results In terms of differential counting of inflammatory cells, the sputum neutrophils of the therapy group decreased significantly (P<0.05) and macrophages increased (P<0.05) after treatment, with statistical significance compared with the control group (P<0.05). In terms of inflammatory mediators, the levels of IL-6, IL-8, LTB4 in serum did not change significantly (P>0.05) in two groups before and after treatment;IL-6, IL-8, LTB4 levels in the sputum supernatant of the therapy group were lower than those before treatment (P<0.05), with statistical significance compared with the control group (P<0.05). Conclusion Kechuanning capsules have an obvious inhibitory effect on airway inflammatory cells in patients with stable COPD as well as the release of inflammatory mediators.

Objective To explore the clinical phenotype of 22q11.2 deletion syndrome with imperforate anus. Methods The clinical diagnosis and treatment of one case of 22q11.2 deletion syndrome complicated with anal atresia were retrospectively analyzed. Gene and phenotype of this disease were analyzed, and the related literature was reviewed. Results An elder male test tube infant of twins, born to a G2P2 mother were found to have special facial features, cleft palate, congenital heart disease, and imperforate anus after birth. A genome-wide microarray scan revealed 22q11.2 deletion syndrome. In related literatures, 22q11.2 deletion syndrome could be affected by TBX1 gene, histone modification, Ranbp1 gene, and even microRNA; while imperforate anus were influenced by multiple elements such as genetic, maternal, and environmental factors and multiple embryonic developments related genes could be involved in its pathogenesis. Conclusions Congenital imperforate anus and 22q11.2 deletion syndrome are mostly sporadic cases in epidemiology and are incidental accidents in development. Whether there is a common interaction factor between them needs to be further studied and defined.

Objective To observe the clinical efficacy of Kechuanning capsules for the treatment of chronic obstructive pulmonary disease (COPD) in stable phase.Methods Totally 110 patients with stable COPD were randomly divided into the therapy group and the control group, 55 cases in each group. Patients in both groups were given ipratropium bromide solution for inhalation. On the basis of western medicine treatment, the therapy group took Kechuanning capsules orally at the same time, 4 softgels for each time, 3 times a day;on the basis of western medicine treatment, the control group took the same amount of placebo capsules. The treatment lasted three months. Meanwhile, the clinical efficacy, BODE index, CAT score and ADRs of patients in the two groups were observed.Results The clinical efficacy in the therapy group was 96.00% (48/50), and 88.24% (45/51) in the control group, with statistical significance (P<0.05). BODE index and CAT score in the two groups decreased and the therapy group was lower than the control group (P<0.05). Liver and kidney function had no obvious abnormalities in the treatment group before and after treatment.Conclusion Kechuanning capsules can effectively reduce the BODE index and CAT score in patients with stable COPD, improve patients' life quality and clinical outcomes, and no obvious side effect has been found.