Objective To compare direct magnetic resonance(MR)arthrography with arthroscopy of the wrist for evaluation of injury in the triangular fibrocartilage complex(TFCC).Methods Fourteen cases with suspicion of injury of triangular fibrocartilage complex were performed with conventional MR and direct MR arthrography,10 cases were done by arthroscopy.In the direct MR arthrography,needle placement was obtained using clinical landmark under sterile technique and fluoroscopy,intra-articular injection was performed at the radius-scaphoid space with 5-7 ml 0.3%mixture of Gadolinium (0.1 mmol/L)and saline(0.3 ml Gd-DTPA+100 ml saline).The findings of MRI and MR arthrography were analyzed with results of arthroscopy.Resuits (1)Among 14 cases with injury of TFCC,there were ulnar tear in 5cases,radius tear in 4 cases,complete tear in 5 cases(included 2 cases with long term rheumatoid).(2)High signal intensity and isointensity signal of injury of TFCC were revealed on STIR or T2 WI and T1 WIrespectively,normal hypointensity signal of the TFCC was partially or completely absent.Contrast media at the ulnar insertion(5 cases with ulnar tear)or radius attachment of the TFCC(4 cases with radius tear)were seen in the MR arthrography with difierent extent,5 cases with complete tear showed contrast media at the both ulnar insertion and radius attachment of the TFCC.The findings of MR arthrography were well corresponded with results of arthroscopy on the lesion site,including ulnar tear in 3 cases,radius tear in 4cases and complete tear in 3 cases.(3)Among 14 cases with TFCC,8 cases had dislocation of radius-ulnar joint,6 cases had bone contusion of radius or ulnar,synovial reaction was also clearly depicted on conventional MRI and direct MR arthrography in all cases.Conclusion Compared with results of arthroscopy,direct MR arthrography can adequately reveal the injury of the triangular fibrocartilage complex,synovial reaction and edema changes are depicted on conventional MRI.

Objective To evaluate the value and limitation of MRI in the diagnosis of meningovascular neurosyphilis. Methods Five cases of neurosyphilis confirmed by clinical history/laboratory were examined with MRI (3 plain MRI, 2 enhanced MRI). The results of blood and CSF TPPA/RPR were positive and HIV was negative. Results Abnormal signals were demonstrated in the temporal lobe in 3 cases, and infarction was revealed in the basal ganglion and periventricular white matter in another 2 cases. There was no marked contrast enhancement in the 2 cases. Conclusion Meningovascular neurosyphilis has no characteristic features on MRI, but MRI is an effective method in delineating the size, range, and characters of neurosyphilis, and it is also an useful modality to follow-up after antibiotic therapy.

Objective To observe the clinical efficacy of Qufeng Qingre Weiling Decoction combined with the decreasing amount of loratadine in treatment of chronic urticaria (CU). Methods Totally 108 CU patients were randomly divided into treatment group and control group, 54 cases in each group. The treatment group was given Qufeng Qingre Weiling Decoction combined with the decreasing amount of loratadine (10 mg, 1 time per day) according to symptom controlling situation, and control group with the decreasing amount of loratadine only. Both groups were treated for 4 treatment courses (2 weeks as a treatment course). Symptom score reduce index was used to calculate the effective rate after 8 weeks of treatment. And the taking antihistamine medicine score was recorded 4, 6, 8 weeks of treatment. The follow-up visits were made to observe long-term efficacy of the cured patients 1 month, 3 months and 6 months after discontinuing the medication. Results Totally 27 cases from the treatment group were cured, with a total short-term effective rate of 96.30%;13 cases from the control group were cured, with a total short-term effective rate of 65.38%, with statistical significance (P<0.05). The taking antihistamine medicine score in treatment group (0.553 ± 0.239) was lower than that in control group (0.721 ± 0.245), namely the symptom improvement in treatment group was better than that in control group by taking less antihistamine medicine. Long-term clinical efficacy showed that the treatment group was also distinctively better than the control group. Conclusion Qufeng Qingre Weiling Decoction combined with the decreasing amount of loratadine is more effective for CU, and with better short-term and long-term clinical efficacy than the control group.

Objective To investigate the number and activity changes of endothelial progenitor cells(EPCs) in hemodialysis patients,and explore its correlation with the risk factors of coronary heart disease.Methords Total mononuclear ceils(MNCs) were isolated from peripheral blood of patients with chronic renal failure in long-term hemodialysis and from a normal control group by Ficoll density gradient centrifugation and then were plated on humanfibronectin-coated dishes.Mter 7 days of culture,EPCs were characterized as adherent cells by double staining with FITC-UEA-I and DI-LDL,and were further identified by the expression of CD34,CD133 and KDR with flow cytometry.EPCs migration was determined with modified Boyden chamber assay.EPCs adhesive assay was performed by replanting EPCs on humanfibronectin-coated plates and then counting the adherent cells.The relationship of the EPCs' number and activity with Framingham Risk Score of ten years was also be assessed.Results Number of EPCs and the migratory & adhesive capacity were significantly lower in patients than in the control(P

Objective To evaluate the feasibility of MR PWI in judging maturity and variability of tumor vasculature in gliomas in rats.Methods Twenty male SD rats were randomly assigned to tumor group and control group.Four weeks after implantation of C6 glioma cells in the brains of tumor group and injection of saline in the brains of control group,all rats were examined using MR PWI before and after inhalation of a mixture of 10% CO2 and 90%air.PaCO2 and blood pH values of rats were monitored.Relative cerebral blood volume(rCBV)and relative cerebral blood flow(rCBF)values of tumors and normal brain tissue were measured.Brain sample were examined histologically using HE and immunohistochemical staining for smooth muscle actin(SMA).The histological features of gliomas were observed and SMA positively stained vessels of each tumor were counted manually using a light microscope.Perfusion data and pathological findings were analyzed statistically with SPSS for Windows.Results PaCO2 increased significantly[from(4.69±0.62)kPa to(7.62±0.81)kPa in tumor group and from(4.67±0.51)kPa to(7.63±0.78)kPa in control group,P＜0.05)after inhalation of the mixed gas.The rCBV and rCBF values of tumor core were remarkably greater than those of normal contralateral brain tissue.The increasing rate of rCBV and rCBF values in gliomas[(26±17)%and(26±18)%respectively]were significantly less than those in normal brain tissue[(90±32)%and(45±14)%repectively](t=5.05 and 2.355,P＜0.05)Immunohistochemical staining of 10 tumors as well as contralateral brain tissue all demonstrated positive SMA expression in the smooth muscles of the vessels.The vascular walls of positive SMA labeled vessels within tumors were thinner and their vascular lumen wider than those within normal brain tissues.The number of SMA(+)vessels in tumors[(6.7±2.8)/HP]was statistically less than that in contralateral brain tissue[(12.7±2.8)/HP](t=1.86,P＜0.01).Changing rate of rCBV,rCBF of the tumor cores and number of the positive SMA labeled vessels showed no correlation(r=0.504 and 0.607,P＞0.05),while changing rate of rCBV,rCBF in normal brain tissue correlated well with number of positive SMA labeled vessels(r=0.721 and 0.525,P＜0.05).Conclusion PWI can detect the hemodynamic change induced by PaCO2 increase in the normal brain and in the tumor.It may be a useful technique to measure maturity of tumor vessels.

Objective To evaluate the value of Multi-slice spiral CT angiography for spinal cord vessels.Methods 11 adult subjects with suspected of myelopathy were performed with Multi-slice spiral CT angiography,An iodine contrast agent was injected at 3.5 ml/s,for total 100 ml.The parameters were axial 16 slice mode,0.625 mm slice thickness,0.8 s rotation,delay time depending on smartprep (15—25 s), multi-phase scan.The coronal and sagittal MPR and SSD were generated on a workstation compared with spinal digital subtraction angiography (DSA) to analyze normal or abnormal spinal cord vessels.Results Normal findings at spinal CTA and digital subtraction angiography in six adult normal subjects and spinal cord vascular malformations( 1 intradural extramedullary AVF,4 dural AVFs) in five cases,Recognizable intradural vessels corresponding to anterior median (midline) veins and/or anterior spinal arteries were show in six adult normal subjects.Abnormal intradural vessels were detected in all five spinal cord vascular malformation with CT angiography ,in comparison with digital subtraction angiography these vessels were primarily enlarged veins of the coronal venous plexus on the cord surface,radiculomedullary-dural arteries could not be clearly shown in four dural AVF,only one anterior spinal artery was detected in one patient with intradural medullary AVF,which direct shunt between anterior spinal artery and perimedullary vein with tortuous draining vessel.Conclusion Multi-slice CT angiography is able to visualize the normal or abnormal spinal cord vessels.It could be used as a noninvasive method to screen the spinal cord vascular disease.

Objective To evaluate the clinical utility and accuracy of dynamic MR digital subtraction angiography(MR-DSA) in the detection of intracranial arteriovenous malformations before and after embolization. Methods A prospective blinded comparison of MR-DSA, 3D contrast-enhanced T_1-weighted MR angiography(3D-CEMRA), proton-weighted imaging and conventional digital subtraction angiography(DSA) were underwent in 22 consecutive AVMs patients before and after embolization. Two readers independently interpreted images and compared with DSA images. Results There was complete agreement between MR-DSA and DSA for classification and size of nidus before and after embolization in all cases. MR-DSA showed the modified hemodynamic features(the time of nidus, early venous enhancement delayed after carotid arteries appearance) in 17 cases, and nidus size were reduced in 13 cases (including 4 complete embolized cases) after embolization, which were 100% consistence compared with DSA. MR-DSA failed to depict 1 intranidal aneurysm and missed 1 less dilated artery and draining vein after embolization respectively, which were demonstrated clearly by 3D-CEMRA confirmed with DSA. The relatively more or less hyperintensity could be seen on proton-weighted imaging in all cases after embolization than before. Conclusion MR-DSA is a fast, efficient, and noninvasive technique to provide hemodynamic information relevant for AVMs before and after embolization. Proton imaging is sensitive in delineation of the embolized region, MR-DSA, 3D-CEMRA and proton-weighted imaging should be combined in the evaluation and follow-up AVMs after partial embolization.

Objective To investigate the effect of clinical pathway on inpatients for rehabilitation. Methods The hospital expense, the ex-pense for medicine and length of stay in hospital were compared in patients with cerebral hemorrhage, cerebral infarction, spinal cord injury and spastic cerebral palsy before (January 1st, 2012 to April 30th, 2013) and after (May 1st, 2013 to December 31st, 2015) clinical pathway implementation, 50 inpatients for each disease, totally 200 patients. Results The length of stay in hospital reduced after of clinical pathway implementation, in all the diseases (t>5.226, P<0.001), with the decrease of hospital expense for cerebral infarction (t=3.327, P<0.001). There was no significant increase in any expense in the disease (t<1.777, P>0.05). Conclusion The implementation of rehabilitation clinical pathway can reduce the length of stay in hospital for the patients rehabilitation in hospital, without increasing their cost.

Objective To investigate the dose response of S100A4 gene expression in the irradiated lymphoblastoid cells AHH-1 at different time points post irradiation.Methods AHH-1 cells was exposed to different doses(0,1,3,5,8,10,15 and 18 Gy)of 60Co γ-rays,and its mRNA levels of S100A4 was detected by reverse transcription PCR and real-time PCR at 4,8,12,24,48 and 72 h after irradiation.Results Within the range of applied doses,the level of S100A4 gene expression was upregulated with a good dose-response (R2 =0.79-0.93,P ＜ 0.05) and had obvious difference at different time points (F =8.91,P ＜ 0.01).Conclusion S100A4 gene expression at transcriptional level could be detected easily and had optimum dose-responses at certain time points after irradiation,and hence is applicable as a dosimeter.

Objective To quantitatively analyze the histological and MR images of repaired tissue (RT) following microfracture for knee joint osteochondritis dissecans (OCD) in rabbit models at different time points,make comparisons with the RT performances of joint debribement,explore the efficiency of the microfracture treatment for OCD.Methods Twenty-seven New Zealand rabbits were randomly assigned into 3 groups (sacrificed at the end of 3,5 and 7 weeks post-operation respectively),with 9 in each group.For each rabbit,one knee joint was made into an OCD model.In each group,6 were for microfracture treatment,and the other 3 were for joint debridement as control.MR scan,which mainly included sequences of 3D double echo steady state sequence (3D-DESS) and T2-mapping,was taken at 3,5 and 7 weeks postoperation.The thickness index and T2 value index of RT were calculated and T2-mapping of repaired region was drafted.Then the operation sites were removed to make histological sections of HE and Masson staining.The modified O' Driscoll score system was employed to make semi-quantitative evaluation for the histological performance of RT.Comparisons were made with respect to MR and histological findings between two treatments at each time point using unpaired Student t test.Effects of two treatments were evaluated longitudinally by comparing the results of three time points using one-way ANOVA.Results The post-operation thickness indexes of two groups increased gradually (F =33.940,28.841,P ＜ 0.05),T2 value indexes decreased (F =80.183,206.206,P ＜ 0.05),and O'driscoll scores increased gradually (F =29.867,17.167,P ＜ 0.05).At each time point,the thickness index of microfracture was higher than that of debridement group(3-week:0.743 ±0.048 vs 0.624 ±0.013,t =4.077 ;5-week:0.813 ±0.031 vs 0.734 ±0.015,t =4.107 ; 7-week: 0.972 ± 0.064 vs 0.777 ± 0.039,t =4.782 ; P ＜ 0.05),and the defects of microfracture in 7-week group were almost fully recovered while the defects of the debridement in 7-week group were not.The T2 value index of microfracture group was lower than that of debridement group at 3-week point(1.338 ±0.043 vs 1.510 ± 0.009,t =6.583,P ＜ 0.05),but it was higher than that of debridement group at 5-week and 7-week points (5-week: 1.284 ± 0.097 vs 1.116 ± 0.068,t =2.663 ; 7-week: 0.916 ± 0.036 vs 0.843 ± 0.016,t =3.283 ; P ＜ 0.05).The O'Driscoll score of microfracture group was higher than that of joint debridement at every time point(3-week:7.167 ±0.753 vs 4.667 ±0.577,t =5.000;5-week: 9.833 ± 1.169 vs 7.667 ± 0.577,t =2.960 ; 7-week: 11.167 ± 0.753 vs 8.333 ± 1.155,t =4.520 ; P ＜ 0.05).For microfracture group,the RT was mainly repaired by fibrocartilage and got matured gradually with more production of well-distributed collagen fibrils ; while for joint debridement group,the RT was mainly repaired by fibrous and scar tissue.Conclusions The post-operation repairing thickness and tissue composition of microfracture for OCD are superior to that of joint debridement.MR 3D-DESS and T2-mapping can show the thickness and tissue composition of the RT after OCD treatments,provide effective evaluation of repairing conditions,and they are of great importance on the OCD post-op follow-up.