With wide applications of invasive diagnostic and therapeutic techniques,as well as immu-nosuppressors clinically,the morbidity of invasive pulmonary fungal infections( IPFIs)in children were in-creasing considerably and becoming one of the important diseases threat to life. The mortality of IPFIs in chil-dren would be reduced and the prognosis would be improved significantly with early diagnosis and treatment in-time. Radiological examinations were the basal component of the clinical evidences for diagnosing IPFIs. The main presentations include pulmonary nodules,some with“halo sign”in invasive pulmonary aspergillo-sis and pulmonary candidiasis,lobular consolidations and a little pleural effusion. Although there was no spe-cific findings radiologically,they would provide the proofs and clues for diagnosis of IPFIs combining with the data of clinics and laboratory.

Objective To evaluate the clinical effect of thoracic discectomy via trans-facet-joint approach in the treatment of thoracic disc herniation.Methods Thirty-three cases were included in this group from October 1994 to August 2009.There were 27 males and 6 females.The age ranged from 18 to 72 years old,with an average of 41.8 years.The course of disease ranged from 12 days to 36 months and was lesser than one month in 13 cases.The weakness and numbness of lower limbs occurred after trauma in 9 cases.Fifteen cases were diagnosed as simple thoracic disc herniation.Six cases were associated with ossification of posterior longitudinal ligament and 12 cases were associated with ossification or hypertrophy of yellow ligament.A total of 45 discs were involved,including 32 in lower thoracic segments(71.11%),8 in upper thoracic segments(17.78%)and 5 in middle thoracic segments(11.11%).All the herniated discs and the ossified OPLL were excised via the trans-facet-joint approach.For the cases with ossification or hypertrophy of yellow ligament,the laminectomy and replantation were performed.The screw-rod system was used on both sides in 14 cases,on one side in 19 cases.Results Follow-up was acquired in 27 patients,ranged from 12 to 63 months(mean,37 months).According to Epstein and Schwall grade,there were excellent in 15 cases,good in 10 cases,improved in 2 cases and poor in 2 cases.The excellent and good rate was 86.21% and total effective rate was 93.10%.Postoperative complications occurred in 3 cases,including exacerbation of preexisting deficits in 2 cases and implant failure in 1 case.The former 2 cases were treated with methylprednisolone,dehydrant,neural nutrition and hyperbaric oxygen.One patient had recovered to preoperative level,the other had not recovered to the preoperative level.The implant was removed 18 months after operation for the implant failure.The post-operative CT or MRI showed that all the replanted lamina obtained fusion,and the canal decompression was complete.Conclusion Thoracic discectomy via trans-facet-joint approach can improve the clinical result obviously.

ObjectiveTo assess the clinical value of minimally invasive transforaminal lumbar interbody fusion(TLIF) through the Wiltse approach for the treatment of lumbar spondylolisthesis. Methods Sixty-nine patients with lumbar spondylolisthesis were randomly divided into two groups. Group A underwent minimally invasive TLIF via the Wiltse approach, Group B via the traditional approach. There were 31 cases in group A, the affected level was L4.5 in 19 cases and L5S1 in 12. The degree of vertebrae slippage was Ⅰ degree in 17 cases,and Ⅱ degree in 14. There were 38 cases in group B, the affected level was L4,5 in 22 cases and L5S1 in 16. The degree of vertebrae slippage was Ⅰ in 21 cases, and Ⅱ in 17. The Japanese Orthopaedics Association (JOA) score, visual analogue scale (VAS) of low back pain and leg pain were evaluated at 3, 6, and 12 months follow-up. The post-operative dynamic X-rays, CT and/or MRI were used for image evaluation. ResultsThere was no statistically difference in operating time between the two groups. The incision length, blood loss and exposing time of group A were shorter than those of group B. The JOA scores, recovery rate, VAS of low back pain and leg pain, interbody fusion rate and atrophy rate of multifidus in group A were 24.7±3.5, 77.0％±3.1％, 1.0±0.7, 1.1±0.3, 71.0％±5.8％, 2.1±0.2, respectively, and in group B were 24.3±2.8, 73.6％±6.4％, 3.1±0.6, 1.8±0.5, 76.3％±6.1％, 0.5±0.1, respectively. The VAS of low back pain was lower in group A than in group B. The atrophy rate was better in group A than in group B. Conclusion Both TLIF approaches can acquire satisfactory clinical results. Minimally invasive TLIF through the Wiltse approach can significantly reduced damage of multifidus and incidence of chronic low back pain postoperative.

Objective To observe the clinical advantage of treating the dens fracture with cannulated screws by microendoscopy system and navigation system through anterior approach. Methods From October 2002 to August 2004, 6 dens fracture (type Ⅱ) patients had undergone single cannulated screws fixation by the microendoscopy system and image guidance through the anterior approach, including 2 females and 4 males with an average of 53.2 years (range from 23 to 65 years). The preoperative Frankel grade was D in 1 case and E in 5 cases. 4 cases had fracture displacement. All patients accepted skull traction and external fixation before surgery. The patients accepted the MR examination and the images were reconstructed by the Vector Vision spinal navigation system in order to make the proper surgical plan, including the nails' direction and length in three-dimension. After affirming the reduction of the dens fractures according the C-arm fluoroscopy, the work channel was inserted through 2 cm long incision at the C5 level, then extended to the C2 level, to excise part of inferior C2 vertebral body. Under the navigation system guide, a guidance needle was inserted and the fracture was fixed by cannulated screw through the work channel. The patients did not need any C-arm fluoroscopy during the surgery. After the surgery the patients were with external fixation for 2 months. Results The surgery lasted 80 min (range from 50 to 150 min), blood loss was 75 ml (40 to 90 ml). There was no related complication during and after surgery including odynophagia or dysphagia. Follow-up period extended from 6 to 37 months (mean 13.5 months). All dens fractures were reduced and healed satisfactory during the follow up. All patients' postoperative Frankel grade was E in the most recent follow-up. Conclusion To fix the dens fracture through microendoscopy and navigation system guide can reduce the soft tissue injury and the incidence of odynophagia or dysphagia, make the surgery safer, avert the repeated C-arm check-up during the surgery compared with the traditional anterior fixation method. The procedure is very safe, simple and can reduce the surgical time effectively.

ObjectiveTo observe the clinical effectiveness and potential mechanism of combined tongue three-needle acupuncture and acupoint application on Lianquan （CV 23） for patients with dysphagia after ischemic stroke. MethodsA prospective study was conducted on 160 patients with post-stroke dysphagia， who were randomly divided into a treatment group and a control group， with 80 cases in each group. The control group received conventional rehabilitation training， while the treatment group received tongue three-needle acupuncture combined with acupoint application on Lianquan （CV 23） on the basis of conventional rehabilitation training， for 4 weeks in both groups. We compared the clinical effectivenss of both groups after treatment， and assessed the swallowing function including videofluoroscopic swallowing study （VFSS）， standardized swallowing assessment （SSA） and functional oral intake scale （FIOS）， swallowing contrast test including hyoid maximum displacement （HmaxD）， pharyngeal transit time （PTT）， and upper esophageal sphincter （UES） opening， surface electromyography （sEMG） test including maximum amplitude and swallowing duration as well as swallowing quality of life questionnaire （SWAL-QOL） score of the patients in both groups before treatment， after 2 weeks and 4 weeks of treatment， respectively. ResultsThe total effective rate in treatment group was 82.50% （66/80）， significantly higher than 66.25% （53/80） in control group （P＜0.05）. The VFSS， and FOIS scores， UES opening rate and HmaxD， sEMG maximal amplitude values， and SWAL-QOL scores were increased in both groups after 2 weeks and 4 weeks of treatment compared with the values before treatment （P＜0.05）， while SSA scores， PTT， and swallowing duration were decreased compared within group before treatment （P＜0.05）. VFSS and FOIS scores， UES opening rate and HmaxD， sEMG maximal amplitude values， and SWAL-QOL scores after 2 and 4 weeks of treatment in the treatment group were higher （P＜0.05）， while SSA scores， PTT， and swallowing duration were lower （P＜0.05） than those in the control group at the same time. ConclusionCombined tongue three-needle acupuncture and acupoint application on Lianquan （CV 23） for patients with dysphagia after ischemic stroke can significantly improve swallowing activities， and its mechanism of action may be related to the improvement of the contraction ability and coordination of swallowing-related muscle groups.

Multidrug resistance (MDR) remains the major obstacle to the success of clinical cancer chemotherapy. P-glycoprotein (P-gp), encoded by the MDR1, is an important part with complex mechanisms associated with the MDR. In order to overcome the MDR of tumors, we in the present experimental design incorporated small interfering RNA (siRNA) targeting MDR1 gene and anticancer drug paclitaxel (PTX) into the solid lipid nanoparticles (SLNs) to achieve the combinational therapeutic effects of genetherapy and chemotherapy. In this study, siRNA-PTX-SLNs were successfully prepared. The cytotoxicity of blank SLNs and siRNA-PTX-SLNs in MCF-7 cells and MCF-7/ADR cells were detected by MTT; and the uptake efficiency of PTX in MCF-7/ADR cells were detected via HPLC method; quantitative real-time PCR and flow cytometry were performed to investigate the silencing effect of siRNA-PTX- SLNs on MDR1 gene in MCF-7/ADR cells. The results showed that PTX loaded SLNs could significantly inhibit the growth of tumor cells, and more importantly, the MDR tumor cells treated with siRNA-PTX-SLNs showed the lowest viability. HPLC study showed that SLNs could enhance the cellular uptake for PTX. Meanwhile, siRNA delivered by SLNs significantly decreased the P-gp expression in MDR tumor cells, thus increased the cellular accumulation of rhodamine123 as a P-gp substrate. In conclusion, the MDR1 gene could be silenced by siRNA-PTX-SLNs, which could promote the growth inhibition efficiency of PTX on tumor cells, leading to synergetic effect on MDR tumor therapy.
ATP Binding Cassette Transporter, Sub-Family B ; genetics ; Antineoplastic Agents ; pharmacology ; Breast Neoplasms ; pathology ; Drug Delivery Systems ; Drug Resistance, Multiple ; Drug Resistance, Neoplasm ; Humans ; Lipids ; chemistry ; MCF-7 Cells ; drug effects ; Nanoparticles ; chemistry ; Paclitaxel ; pharmacology ; RNA, Small Interfering ; pharmacology ; Real-Time Polymerase Chain Reaction

Objective To investigate the characteristics of cognitive impairment in neuromyelitis optica (NMO) patients.Methods 12 NMO patients,15 multiple sclerosis(MS) patients and 15 healthy people were collected and grouped as NMO group,MS group and normal control group.The five cognitive domains including working memory and information processing speed,verbal memory ability,semantic fluency,visual spatial structure and visuospatial recall ability,and executive function were evaluated respectively by the five tests,which are the 3/2 second edition of Chinese Version Auditory Continuous Addition test (PASAT3/2),the Chinese Rey Auditory Verbal Learning test (CRAVLT),Verbal Fluency test (VFT),the Rey Complex Figure test (RCFT) and the Chinese Version of the Stroop Colour-Word test (Stroop).The severity of somatic dysfunction and disability,depression,anxiety,fatigue and the sleep quality were evaluated both in NMO and MS patients by the Expanded Disability Status Scale Rating Scale (EDSS),Hamilton Depression Rating Scale (HAMD),Hamilton Anxiety Scale (HAMA),Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI).Analysis of variance,MannWhitney and Kruskal-Wallis H test were performed to determine significant differences among three groups.Results The PASAT3 accomplishments were (33.3 ± 9.6),(38.9 ± 14.3),(45.5 ± 8.6) respectively,the VFT scores were (24.8 ± 8.7),(26.4 ± 8.4),(31.7 ± 4.7) respectively in NMO group,MS group and control group,and the differences of PASAT3 and VFT among three groups were significant (P ＜ 0.05).However,PASAT2,CRAVLT (N1-5,N6,7,8,9),RCFT and Stroop test scores were not significant differenence (P ＞ 0.05).Conclusion NMO patients exist obstacle in working memory and information processing speed,semantic fluency,but still retain other aspects of the verbal memory capacity,executive function,visual-spatial structures and visual memory ability.The characteristics of cognitive impairment in NMO patients are not exactly the same as in MS patients.

Objective To improve recognition of posterior reversible encephalopathy syndrome (PRES) in children. Methods Two children with PRES admitted to children's hospital were included. Clinical data were retrospectively studied and related literatures were reviewed. Results The primary diseases of the two patients are systemic lupus erythematosus and nephritic syndrome, respectively. They all developed an acute onset of headache, visual changes, consciousness disturbance, hypertension and seizures. Cranial MRI showed bilateral parietal, temporal and occipital cortical or subcortical lesions with hypointensity on Tl-weighted imaging and hyperintensity on T2-weighted imaging. Clinical symptoms resolved soon and radiographic recovery occurred within 14 to 21 days with prompt anti-hypertension treatment and supportive care. Among the mechanisms which might contribute to the development of PRES, acute elevated blood pressure seems to be the most important factors in these two cases. Prompt anti-hypertension treatment usually can reverse the PRES lesion. Conclusions It is important to improve cognition of PRES in children. Delayed treatment can cause permanent neurological impairment. Doctors should be alert to this syndrome. Early diagnosis and prompt treatment are very important. (J Clin Pediatr,2010,28(2):168-170)

Objective To measure the average value of CT lung density at the phase of end inspiration and end expiration in children under 5 years.Methods Sixty patients with normal lungs who underwent chest CT for reasons caused by trauma etc.in our institute from January 2010 to March 2012 were enrolled to the study.All of the patients were divided into end inspiration group and end expiration group through random number table.CT images of the phase of end inspiration and end expiration were taken.Three levels of CT images were chosen to measure the lung density,which were 2 cm above the arch,1 cm below the carina and 2 cm above diaphragm.Lung density was measured at anterior,posterior,lateral,medial and central of the images at each level in each lung.The average lung density of each and entire lung were respectively calculated.The influence of phase,level,location was quantified using analysis of variance methods and LSD method.Results The average lung density at end inspiration was (-766 ±56)HU for the left,right and both lung.At end expiration,the average lung density of the left,right and both lungs was (-625 ± 86),(-647 ± 85) and (-636 ± 86) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the left lung at end inspiration were (-798±63),(-733±68),(-767±64),(-754 ±65),(-775 ±63)HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-796 ± 70),(-736 ± 65),(-769 ± 64),(-754 ± 62),(-776-± 59) HU respectively.At end expiration phase,the average densities at anterior,posterior,lateral,medial and central of the left lung were (-692±91),(-555±116),(-639±91),(-598±103),(-640±98) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-712 ± 90),(-575±121),(-657±90),(-619±95),(-670±87) HU respectively.The statistical differences of these five measurement areas were significant at both inspiration and expiration phase (F=12.55,11.29,23.31,25.47,P＜0.01).The posterior lung density was the highest and the anterior was the lowest.As for the other measurement areas,in descending order were medial,lateral,and central.Conclusion The lung density at end inspiration and end expiration in children under 5 years old is described to provide reference for the clinical work.

Objective To compare the X-ray features between Hirschsprung alied disease (HAD)and Hirschsprung disease ( HD), and analyze the differentiations. Methods From December 2004 to December 2009, nineteen cases of HAD, aged from 30 days to 10 years (median, 14 months), received barium enema examinations in our institution. Other 19 cases with HD, also received barium enema examinations, were chosen randomly. They were aged from 42 days to 8 years ( median, 8 months). The imaging features of HAD and HD were analyzed retrospectively. The incidence rate of colon stenosis,"truncation sign" and spasm notch and R/C ratio (the longest diameter of rectum/colon) were calculated and compared between these two groups. In all these cases, diagnosis was confirmed by postoperative histopathology. The position of barium retained was also evaluated. These parameters of both groups were compared by x2 and Fisher test. Results There was statistical significance in the incidence rate of colon stenosis between HAD (9/19) and HD (18/19) (x2 = 10.364, P ＜0.01). However, there was no statistical significance in "truncation sign" and spasm notch between HAD (4/19 and 3/19, respectively)and HD ( 1/19 and 1/19, respectively) (P ＞0. 05 for both). R/C ratio was 0. 42 ±0. 15 in HAD group and 0.29±0. 12 in HD group, and there was statistical significance between them (t =2.892,P＜0.01). In HAD group, barium retained in distal sigmoid colon in 1 case (1/19), in distal descending colon in 7 cases (7/19), in distal transverse colon in 1 case (1/19), in total colon in 6 cases (6/19); However, in HD group, barium retained in distal rectum in 3 cases (3/19), in distal sigmoid colon in 13 cases ( 13/19), in distal descending colon in 3 cases (3/19). Conclusions There were some differences in the imaging features between HAD and HD though they presented similar clinic experience. HAD cases presented a lower incidence rate of colon stenosis and a higher R/C ratio than HD cases. In HAD cases, the most common site of barium retained is distal descending colon, while in HD cases, it is distal sigmoid colon.