with pyramidat tract and/or peripheral nerve symptoms.

Objective To improve the recognition of early diagnosis and pathogenesis of non-traumatic rhabdomyolysis and prevent the occurrence of rhabdomyolysis.Methods Seven cases of non-traumatic rhabdomyolysis were collected,whose clinical data and related review were analyzed.Results The clinical features included weakness of limbs,myalgias,myoglobinuria,and an elevated serum creatine kinase.pathogenesis of non-traumatic rhabdomyolysis include drug in three cases,diabetic ketoacidosis in one case and metabolic myopathy in one case.Conclusion Multiple diseases can cause non-traumatic rhabdomyolysis.The early diagnosis and investigation of causes of non-traumatic rhabdomyolysis are important.

In recent years,the basal and clinical research in gonadal dysgenesis has achieved great progress.Considerable literatures concerning the diagnosis and therapy of these diseases have been published.In this review,we analyzed and summarized some more instructive literatures for clinical practice,discussed the problems and defects in gonadal dysgenesis research in China,and proposed some suggestions.

Objective To explore the early diagnosis of germinoma originating from the basal ganglia (BG) and thalamus during juveniles. Methods Retrospective analysis was done with the clinical cases of germinomas in BG and thalamus from 2000 to 2009. The symptoms, signs, neuroimaging,cerebrospinal fluid (CSF) findings were analyzed and related literature were reviewed. Results Eight patents were collected. The main symptoms were hemiplegia, associated with aphasia and/or impaired cognition. Brain CT showed high density and calcification. Abnormal T1 and T2 signal were found in brain MRI frequently associated with ipsilateral hemisphere atrophy. MRS showed increased choline and decreased N-acetylaspartate level. Elevated CSF human chorionic gonadotrophin level were found in two of them.Conclusions Germinoma in BG and thalamus predominates in a boy. The neuroimaging features are very informative for early diagnosis.

Objective To explore causes and solutions of false estimates of elevated serum creatinine in patients with Walden‐strom′s macroglobulinemia throug wet chemical enzymatic method .Methods 5 cases of patients hospitalized in the Bethune Inter‐national Peace Hospital were enrolled as subjects from 2010 to 2012 .The large molecular proteins were removal from serum sam‐ples collected from patients with Waldenstrom′s macroglobulinemia by using centrifugal ultrafiltration tube .The serum creatinine levels were detected through using the wet chemical enzymatic method ,wet chemical picric acid method and dry chemical enzymatic method before and after ultrafiltration ,and data were compared .Results Before ultrafiltration ,the levels of serum creatinine of 2 cases of patients with Waldenstrom′s macroglobulinemia detected by using wet chemical enzymatic method differed with those de‐tected by using wet chemical picric acid method and dry chemical enzymatic method .While there were no obvious differences be‐tween levels of serum creatinine detected by wet chemical picric acid method and dry chemical enzymatic method .While ,after ultra‐filtration ,no obvious differences were founded in levels of serum creatinine detected by the thress methods .Conclusion The large molecular proteins should be eliminated when using the wet chemical enzymatic method in the detection of serum creatinine levels , in order to avoid abnormal increase .And the wet chemical picric acid method and dry chemical enzymatic method could also be uti‐lized to determine the accuracy ,and provide reliable determination results .

Objective To investigate the difference of serum C-reactive protein (CRP) concentrations in subjects with various glucose tolerances and the change of serum CRP concentrations in cases of impaired glucose tolerance (IGT) treated with acarbose. Methods A total of 154 subjects participated in the study and according to oral 75 g glucose tolerance test (OGTT), among them there were 44 subjects with normal glucose tolerance (NGT), 89 cases with IGT and 21 cases with type 2 diabetes (DM). Sixty IGT subjects were recruited into randomized, double-blind, placebo-controlled study. The IGT subjects received either 150 mg acarbose daily or placebo for 16 weeks. The serum CRP concentration was detected with immunoscattering assay. Results (1) The serumCRPconcentration〔median(25%, 75%)〕 was 4.60(4.10-5.25)mg/L in NGT subjects, 5.25(4.50-6.00)mg/L in IGT subjects, 5.70(5.20-7.50)mg/L in type 2 DM patients (F=157.00, P0.05). Conclusion (1) The serum CRP concentration is gradually increased with the worsening of glucose tolerence; (2) The serum CRP concentration is positively correlated with OGTT 2 h blood glucose, HbA 1C , TC, TG; (3) The serum CRP concentration is decreased in IGT subjects treated with acarbose following the improvement of hyperglycemia.

Objective To explore the clinical and radiological features of bilateral thalamus venous infarction.Methods The cases definitely diagnosed as thalamus venous infarction were collected and the corresponding clinical and radiological data were retrospectively analyzed.Results Four cases confirmed as thalamus venous infarction by digital substraction angiography (DSA) were collected.Bilateral thalamus lesions were detected in all cases by brain MRI scans which mainly presented as thalamus edema with high T1 and T2 signals with partial enhancement.Mild hemorrage was also shown in one case.Acute or subacute onset with clinical manifestations of headache,hypomnesia and hypersomnia were reported in all cases.The neurological examination showed conscious disturbance,memory impairment and positive Babinski sign.The venous thrombi were formed mainly in the transverse and the straight sinuses in 3 cases with the deep cerebral venous involved in 2 cases.All patients were improved after the anticoagulation therapy.Dural arteriovenous fistula was found in the other case drained by the Rosenthal's vein,and the symptoms were ameliorated after the embolotherapy.Conclusions As the thalamus is drained by the thalamostriate vein and the lateral thalamic vein towards the internal cerebral vein with the caudate portion drained particularly by the Rosenthal's vein,venous thrombosis or fistula drainage into these veins would probably disturb the normal drainage of the thalamus and result in further edema and infarction.Thus,the venous infarction should be taken into consideration whenever bilateral thalamus lesions are encountered in clinical practice and DSA is necessary to confirm the diagnosis.

Objective To discuss the diagnostic paradigm of non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement.Methods Clinical features of one patient with non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement,manifesting fever of undetermined origin and refractory hyponatremia,were analyzed retrospectively.The related literature was reviewed,and experience in diagnosis of non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement was summarized.Results Clinical manifestations of the patient was nonspecific,and there was definite evidence to support the diagnosis of infectious and autoimmune diseases.However,the abnormal elevation of serum lactate dehydrogenase(LDH)and ?2 microglobulin,which were suggestive of the diagnosis of lymphoma.The diagnosis of non-Hodgkin lymphoma with bilateral adrenal gland involvement was finally established by adrenal gland biopsy under CT.On the other hand,the endocrine evaluation indicated there was pituitarism even though the lesion was not obvious on the MRI image.However,18F fluorodeoxyglucose-positron emission tomography-computed tomography(18F-FDG PET-CT)clearly showed lesions in pituitary,liver and lymph node of neck.With supplementation of hydrocortisone,sodium the serum level gradually elevated to above the normal range,and the lesions in pituitary and adrenal glands disappeared after three courses of CHOP chemotherapy.The functions of pituitary and adrenal gland recovered 3 months later.Conclusions Non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement is a rare disease.Early diagnosis relies on the logical clinical evaluation and 18F-FDG PET-CT image.

Objective To study the expression of miR-146a in the serum of sepsis and the diagnostic value.Methods Serum miR-146a expression was detected in 98 patients diagnosed with sepsis,69 patients with severe sepsis and 30 healthy controls.ROC plots were used to evaluate the diagnostic value.Results The expression of miR-146a was decreased successively in healthy group,general sepsis group and severe sepsis group.In the diagnosis of sepsis,at the optimal expression cutoff miR-146a value of 0.805,the sensitivity was 0.967 and specificity 0.940,with an AUC of 0.983.In the diagnosis of sepsis severity degree,at the optimal expression cutoff miR-146a value of 0.530,the sensitivity was 0.796 and specificity 0.986,with an AUC of 0.943.Conclusion miR-146a can be a potential marker in diagnosis of sepsis and severity degree .