Objective: This prospective study evaluated the feasibility of chemical exchange saturation transfer (CEST) MRI for assessing disease activity in thyroid-associated ophthalmopathy (TAO). Materials and Methods: A total of 88 patients with active TAO, 76 with inactive TAO, and 30 healthy controls were enrolled. CEST MRI-derived magnetization transfer ratio (MTR) and MTR asymmetry (MTRasym) at 1 ppm, 2 ppm, and 3.5 ppm were calculated. Clinical data, MTR, and MTRasym values for the extraocular muscles (one representative muscle per eye, yielding two measurements per participant) were compared among the groups. Spearman’s correlation was used to examine associations between imaging parameters and the clinical activity score (CAS) in patients with TAO. Logistic regression analysis was used to identify independent associations between imaging parameters and disease activity in patients with TAO (active vs. inactive). Receiver operating characteristic (ROC) analysis was conducted to evaluate the diagnostic performance for discriminating active from inactive TAO. Results: Patients with active TAO showed lower MTR values (P < 0.001) and higher MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) (all P < 0.001) compared with those with inactive TAO. MTR was negatively correlated with CAS (r = -0.402; P < 0.001), while MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) were positively correlated with CAS (r = 0.369, 0.350, and 0.349, respectively;all P < 0.001). MTR and MTRasym (1 ppm) were independently associated with TAO activity. The areas under the ROC curve (AUCs) for MTR and MTRasym (1 ppm) in discriminating active from inactive TAO were 0.772 and 0.730, respectively. Combining MTR with MTRasym (1 ppm) significantly improved diagnostic performance compared with either parameter alone, achieving an AUC of 0.805 (P = 0.029 and 0.001). Conclusion MTR and MTRasym (1 ppm) were independently associated with TAO activity. Their combination further enhanced diagnostic performance in distinguishing active from inactive TAO, suggesting their potential as quantitative imaging biomarkers to guide treatment in patients with TAO.

A 57-year-old male patient with epilepsy was additionally given topiramate 25 mg orally once at night because of poor curative effect of sodium valproate. Seven days later, the patient developed vision loss with eye pain and swelling. Ocular ultrasonography showed bilateral choroidal detachment, which was considered to be related to topiramate. Topiramate was discontinued and prednisone acetate 60 mg once daily was given, and 8 days later, the patient′s eye pain and swelling were improved. Ocular ultrasonography showed that choroidal detachment disappeared. Fifteen days after drug withdrawal, his ocular symptoms disappeared.

A 57-year-old male patient with epilepsy was additionally given topiramate 25 mg orally once at night because of poor curative effect of sodium valproate. Seven days later, the patient developed vision loss with eye pain and swelling. Ocular ultrasonography showed bilateral choroidal detachment, which was considered to be related to topiramate. Topiramate was discontinued and prednisone acetate 60 mg once daily was given, and 8 days later, the patient′s eye pain and swelling were improved. Ocular ultrasonography showed that choroidal detachment disappeared. Fifteen days after drug withdrawal, his ocular symptoms disappeared.

The current outpatient payment method based on fee-for-service induced serious demand, which increased the waste of medical insurance fund. The authors briefly introduced ambulatory patient groups(APG)with the same concept of diagnosis-related groups. According to the current situation of outpatient medical insurance payment and the degree of informatization in China, suggestions are put forward: launch a pilot project first and starting with chronic disease to promote reform; improve the quality of outpatient electronic medical records, and develop APG suitable for China; under the background of aging, cooperate with the total budget to ensure the security of medical insurance.

When facing a sudden danger or aversive condition while engaged in on-going forward motion, animals transiently slow down and make a turn to escape. The neural mechanisms underlying stimulation-induced deceleration in avoidance behavior are largely unknown. Here, we report that in Drosophila larvae, light-induced deceleration was commanded by a continuous neural pathway that included prothoracicotropic hormone neurons, eclosion hormone neurons, and tyrosine decarboxylase 2 motor neurons (the PET pathway). Inhibiting neurons in the PET pathway led to defects in light-avoidance due to insufficient deceleration and head casting. On the other hand, activation of PET pathway neurons specifically caused immediate deceleration in larval locomotion. Our findings reveal a neural substrate for the emergent deceleration response and provide a new understanding of the relationship between behavioral modules in animal avoidance responses.

OBJECTIVETo explore the repair effects of acupuncture for promoting the governor vessel and tranquilizing the mind (acupuncture technique) on cerebral white matter injury of premature infants.

METHODSA total of 56 cases of cerebral whiter matter injury of premature infants, the fetal age less than 35 weeks were selected and randomized into an observation group (27 cases) and a control group (29 cases). The routine basic rehabilitation therapy was used in the two groups. Additionally, in the observation group, the acupuncture technique was added, once a day and the treatment for 15 days was as 1 course. Totally, 3 courses of treatment were required. Before and after treatment, the cranial magnetic resonance imaging (MRI) and the diffusion tensor imaging (DTI) were adopted to observe the location and severity of cerebral white matter injury. The Gesell developmental scale was used to assess the nerve motor development.

RESULTSAfter treatment, the difference was not significant statistically in the severity of cerebral white matter injury in the infants between the two groups (>0.05). The FA value of cerebral white matter in the interesting zone was increased as compared with that before treatment in the infants of the two groups (both<0.05). The result in the observation group was higher than that in the control groups (<0.05). After treatment, DQ value of each function zone in Gesell scale was all increased as compared with that before treatment in the two groups (all<0.05). After treatment, the DQ values of gross motor, fine motor and social adaptability in the observation group were higher than those in the control group (all<0.05). After treatment, the difference was not significant in DQ value of individual-social and speech behaviors between the two groups (both>0.05).

CONCLUSIONAcupuncture technique for promoting the governor vessel and tranquilizing the mind promotes the repair of the function in the premature infants with cerebral white matter injury and further benefits the promotion of the intelligence.

Objective To investigate the effect of complement C3a on mouse podocytes phenotype transformation.Methods Purified C3a recombinant protein was used to stimulate mature mouse podocytes.The expression of the mature podocyte markers synaptopodin,podocin,nephrin,CD2-associated protein (CD2AP) and the mesenchymal cell markers fibroblast specific protein 1 (FSP-1),α-smooth muscle actin (α-SMA) were detected by RT-PCR,Western blotting,immunochemistry and immunofluorescence,respectively.Some podocytes were transfected with integrin-linked kinase (ILK) siRNA before the administration of C3a,the expression of nephrin and α-SMA were accessed by Western blotting,and the expression of Snail and α-actinin 4 were accessed by Western blotting and immunochemical method.The migration ability of podocytes was observed by scratch test.Results Immunocytochemistry and immunofluorescence analysis showed that synaptopodin,podocin,nephrin,CD2AP were highly expressed by mature mouse podocytes.The expression of these podocyte markers could be markedly inhibited after 24 h of C3a (0.1 μmol/L) treatment,and accompanied by the induction of mesenchymal markers FSP-1 and α-SMA.Compared with control group,the mRNA levels of synaptopodin,podocin,CD2AP and nephrin were significantly repressed by the administration of C3a in a dose-dependent manner,whereas the transcription of FSP-1 and α-SMA were remarkably up-regulated by C3a treatment (P ＜ 0.05,respectively).Western blotting analysis also confirmed the decrease of synaptopodin,podocin,nephrin and CD2AP protein and the increase of FSP-1 and α-SMA protein were closely depend on the C3a concentration (P ＜ 0.05,respectively).To further assess the downstream of C3a,some podocytes were transfected with ILK siRNA before the administration of C3a.Compared with C3a group,the protein levels of nephrin and α-SMA were significantly changed by the administration of ILK siRNA (P ＜ 0.05,respectively).The expression of α-actinin 4 and Snail induced by C3a were inhibited by ILK knockdown (P ＜ 0.05,respectively),accompanied by a decline of cell migration potency.Conclusion Complement fragment C3a can induce transformation of mouse podocytes to mesenehymal cells,and ILK signaling pathway is involved in this cell type transformation.

OBJECTIVETo explore the effect of scalp acupuncture for children with cerebral palsy whose video-electroencephalogram(VEEG) showed epileptiform discharges.

METHODSA total of 184 children with cerebral palsy whose VEEG showed epileptiform discharges or those combined with epilepsy were randomly assigned into a combination group (99 cases) and a rehabilitation group (85 cases). All the cases were treated with the original antiepileptic drugs. The conventional physical training and massage were applied in the rehabilitation group for 3 courses with 20 d at the interval, once a day, 5 times a week and 15 times as one course. Based on the treatment as the rehabilitation group, scalp acupuncture was used in the combination group for 3 courses with 15 d at the interval, once the other day and 10 times as one course. Shenting (GV 24), Benshen (GB 13), Sishencong (EX-HN 1) were selected as the main acupoints, combined with motor zone, foot motor-sensory area, balance zone,and temple-three-needle etc. Clinical onset and VEEG results were observed before and after treatment.

RESULTSAfter treatment in the combination group, 27 cases improved; 47 cases had no effect; 25 cases aggravated. While in the rehabilitation group, 11 cases improved; 46 cases had no effect; 28 cases aggravated. There was no statistically significance between the two groups (>0.05). As for the cases with epilepsy onset in the combination group, 8 cases improved; 4 cases had no effect; 4 cases aggravated. In the rehabilitation group, 4 cases had no effect; 7 cases aggravated. The result in the combination group was better than that in the rehabilitation group (<0.05). As for the cases with epileptiform discharges in the combination group, 19 cases improved; 43 cases had no effect; 21 cases aggravated. In the rehabilitation group, 11 cases improved; 42 cases had no effect; 21 cases aggravated. There was no significance between the two groups (>0.05).

CONCLUSIONSScalp acupuncture therapy does not increase the risk of onset or epileptiform discharges in the children with cerebral palsy combined with epilepsy or epileptiform discharges. Scalp acupuncture combined with rehabilitation is better than simple rehabilitation for thosewith cerebral palsy and epilepsy onset.

Objective To follow up the long-term prognosis of acute kidney injury (AKI) patients with normal basic renal function,and to further identify the clinical features as well as risk factors associated with the prognosis of AKI patients.Methods Clinical date of 166 patients who occurred AKI episode during hospitalization from Jan 1 2011 to Dec 31 2014 in The First Affiliated Hospital of Fujian Medical University were retrospectively analyzed.All these patients had normal basic renal function and had follow-up of more than two years after discharge.According to their renal function after two years,patients were divided into recover and non-recover group.The clinical features and risk factors associated with the prognosis of AKI patients were identified using multivariate logistic regression,and the proportion of renal function progression was calculated during follow-up period.Results One hundred and sixty-six patients were enrolled in this observational study,including 114 male,52 female with an average age of 58.1± 16.6.Eighty-seven patients were AKI stage 1,39 AKI stage 2,and 40 AKI stage 3.Thirty-seven patients were caused by pre-renal factors,113 patients by renal causes and 16 patients by post-renal causes.Renal function when discharged (P=0.002,OR=2.980) and infection (P=0.003,OR=2.786) were the risk factors of failing to restore after two years.Eighty-four patients' renal function returned to normal when discharged,but the number of patients whose renal function progressed to CKD 3 stage and even worse 1 year and two years later were 12 (14.3％) and 20 (23.8％) respectively.Fifty-four patients were diagnosed as partial recovery and 28 patients as non-recovery when discharged.One year later 22 (40.7％) and 12 (42.9％) patients' renal function progressed to CKD 3 stage and more,while those numbers became 28 (51.9％) and 16 (57.1％) two years later.Conclusions The risk factors of AKI long-term outcome include unrecovered renal function when discharged and infection.After AKI episode,even with fully recovered renal function,patients are still possible to progress to CKD,highlighting the importance of follow-up observation.

Objective To detect gap junction protein Cx45, gap junction protein Cx40 and Tumor Necrosis Fαctor-α(TNF-α) expression in the infarcted myocardium, and to study their combined effects. Methods Immunohisto-chemical staining (S-P immunohistochemical staining method) and qRT PCR detection of gap junction were used to identify protein Cx45, Cx40 and TNF-α respectively in 30 cases of late early myocardial ischemic stroke group and 30 cases of myocardial infarction due to sudden death group with control group being 20 cases of normal expression in myocardial group. The effect of the different expressions was compared in the different groups. Results Immuno-histochemical results: Between the two groups, Cx45 expression was higher in the sudden death group compared to normal myocardium. Cx40 expression was decreased significantly in the sudden death group when compared to normal myocardial group while TNF-α expression was high. The expressions had significant differences in the three groups (P<0.05). Qrt - PCR results showed that the mRNΑ expression of Cx45, Cx40 and TNF-α was consistent with their respective protein expression and that there was statistically significant difference in three groups (P<0.01). Cx45, Cx40 and TNF-α had a correlation in the three groups of cardiac muscle. Conclusion Gap junction protein Cx45, Cx40 and TNF-α expression can be useful indicators for the diagnosis of the cause of sudden cardiac death.