2010年 · 第123卷第14期

Abstract：Background Granulocyte colony-stimulating factor (G-CSF) seems to improve cardiac function and perfusion when used systemically through mobilization of stem cells into peripheral blood, but results of previous clinical trials remain controversial. This study was designed to investigate safety and efficacy of subcutaneous injection of G-CSF on left ventricular function in patients with impaired left ventricular function after ST-segment elevation myocardial infarction (STEMI).Methods Thirty-three patients (22 men; age, (68.5±6.1) years) with STEMI and with comorbidity of leukopenia were included after successful primary percutaneous coronary intervention within 12 hours after symptom onset. Patients were randomized into G-CSF group who received G-CSF (10 μg/kg of body weight, daily) for continuous 7 days and control group. Results of blood analyses, echocardiography and angiography were documented as well as possibly occurred adverse events.Results No severe adverse events occurred in both groups. Mean segmental wall thickening in infract segments increased significantly at 6-month follow up compared with baseline in both groups, but the longitudinal variation between two groups had no significant difference (P >0.05). The same change could also be found in longitudinal variation of wall motion score index of infarct segments (P >0.05). At 6-month follow-up, left ventricular end-diastolic volume of both groups increased to a greater extent, but there were no significant differences between the two groups when comparing the longitudinal variations (P >0.05). In both groups, left ventricular ejection fraction measured by echocardiography ameliorated significantly at 6-month follow-up (P <0.05), but difference of the longitudinal variation between two groups was not significant (P >0.05). When pay attention to left ventricular ejection fraction measured by angiocardiography,difference of the longitudinal variation between groups was significant (P=0.046). Early diastolic mitral flow velocity deceleration time changed significantly at 6-month follow-up in both groups (P=0.05).Conclusions Mobilization of stem cells by G-CSF after reperfusion of infarct myocardium is safe and seems to offer a pragmatic strategy for recovery of myocardial global function。

Abstract：Background Anxiety and depression are two of the commonest and most modifiable comorbidities of chronic obstructive pulmonary disease (COPD) and have an independent effect on health and prognosis. FEV1% has been shown to be a poor predictor of anxiety and depression. The body mass index, degree of airflow obstruction, dyspnea,and exercise capacity (BODE) index is a multidimensional assessment system which may predict health outcome in COPD patients. The purpose of this study was to investigate the predictive validity of the BODE index for anxious and depressive symptoms in COPD patients.Methods This was a multicenter prospective cross-sectional study in 256 patients with stable COPD. Anxious and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). The relationships between anxiety, depression and potential predictors (including the BODE index) were analyzed by a binary Logistic regression model. Results Subjects who were anxious and depressive walked a shorter six-minute walking distance (6MWD), had more dyspnea, a higher BODE index, and lower health-related quality of life (P <0.01). Anxiety and depression score was significantly correlated with BODE index, respectively (r=0.335, P <0.001; r=0.306, P <0.001). The prevalence of anxiety and depression increased with BODE stage increasing (P <0.05). On the basis of binary Logistic regression, the BODE index was a good and independent predictor of anxiety and depression because it comprised dyspnea and 6MWD, which were shown to be the main determinants.Conclusions The predictive validity of the BODE index for anxiety and depression was demonstrated. We propose that the BODE index should be included in assessment of COPD severity。

Abstract：Background Genome-wide association studies for type 2 diabetes mellitus (T2DM) identified FTO gene as a locus conferring increased risk for common obesity in many populations with European ancestry. However, the involvement of FTO gene in obesity or T2DM related metabolic traits has not been consistently established in Chinese populations. The objective of this study was to investigate the association of FTO genetic polymorphisms with metabolic syndrome (MetS) in Han Chinese.Methods We tested 41 FTO single nucleotide polymorphisms (SNPs) for association between FTO and MetS-related traits. There were a total of 236 unrelated subjects (108 cases and 128 controls), grouped according to the International Diabetes Federation (IDF) criteria.Results Of the 41 SNPs examined, only SNP rs8047395 exhibited statistical significance (P=0.026) under a recessive model, after Bonferroni adjustment for multiple testing (OR 1.64, 95% CI 1.11-2.42; P=0.014). The common distributions of this polymorphism among Chinese-with a minor allele frequency (MAF) of 36% in the control group versus 48% in the MetS group-greatly improved our test power in a relatively small sample size for an association study. Previously identified obesity-(or T2DM-) associated FTO SNPs were less common in Han Chinese and were not associated with MetS in this study. No significant associations were found between our FTO SNPs and any endophenotypes of MetS.Conclusions A more common risk-conferring variant of FTO for MetS was identified in Han Chinese. Our study substantiated that genetic variations in FTO locus are involved in the pathogenesis of MetS。

Abstract：Background A severe deficiency of ADAMTS13 activity contributes to the pathogenesis of thrombotic thrombocytopenic purpura (TTP). Measuring the activity of ADAMTS13 is helpful for the diagnosis of TTP and the prognostic monitor in TTP patients. Most available assays are cumbersome and costly, so not easily adapted to routine laboratories. ADAMTS13 cleaves von Willebrand factor (VWF) within the domain A2., located between domains A1 and A3. Therefore, specific assays for ADAMTS13 activity could be based on the different structures of VWF before and after the cleavage. Using this hypothesis we try to establish a new and simple method to determine ADAMTS13 activity.Methods First, plasma samples were exposed in denaturing condition to allow cleavage of VWF by ADAMTS13. Then, the ADAMTS13 activity was measured with two novel monoclonal antibodies, SZ-129 and SZ-125, which specifically recognize the VWF A1 and A3 domains by using a two-site sandwich ELISA. Compared with a residual-collagen binding assay (R-CBA), plasma ADAMTS13 activities in 161 samples were assessed, and the inhibitory activities of ADAMTS13 autoantibody in 24 TTP patients were determined. The relationship of these two assays was analyzed by linear correlation, and the sensitivity and specificity of the new assay was also evaluated.Results Plasma ADAMTS13 activities in normal people and TTP, acute myocardial infarction (AMI), and idiopathic thrombocytopenic purpura (ITP) patients determined by the new assay were (89.75±7.93)%, (17.63±18.71)%,(68.55±18.08)%, (85.83±9.84)%, respectively. Results were consistent with those of R-CBA, the squared correlation factor was 0.9183 of the two assays. The new assay can easily discriminate a TTP plasma sample from a non-TTP plasma sample (P <0.01), and the coefficient of variation for the new assay was 6.17%. In 23 idiopathic TTP patients, the inhibitor activity of ADAMTS13 autoantibody ranged from 12% to 100%, while no inhibitory activity was detected in one hereditary TTP patient.Conclusion This new and simple assay for ADAMTS13 activity could be used routinely in the clinic to determine the activitv of ADAMTS13。

Abstract：Background Alzheimer's disease (AD) is a neurodegenerative disorder and the leading cause of dementia in the elderly. The two hallmark lesions in AD brain are deposition of amyloid plaques and neurofibrillary tangles (NFTs).Hypercholesteremia is one of the risk factors of AD. But its role in the pathogenesis of AD is largely unknown. The aim of this study was to investigate the relationship between hypercholesteremia and tau phosphorylation or β-amyloid (Aβ),and evaluate the effect of atorvastatin on the level of tau phosphorylation and Aβ in the brains of rats fed with high cholesterol diet.Methods Sprague-Dawley (SD) rats were randomly divided into normal diet control group, high cholesterol diet group,and high cholesterol diet plus atorvastatin (Lipitor, 15 mg·kg-1·d-1) treated group. Blood from caudal vein was collected to measure total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high-density lipoprotein (HDL) at the end of the 3th and the 6th months by an enzymatic method. The animals were sacrificed 6 months later and brains were removed. All left brain hemispheres were fixed for immunohistochemistry. Hippocampus and cerebral cortex were separated from right hemispheres and homogenized separately. Tau phosphorylation and Aβ in the brain tissue were determined by Western blotting (using antibodies PHF-1 and Tau-1) and anti-Aβ40/anti-Aβ42, respectively.Results We found that high cholesterol diet led to hypercholesteremia of rats as well as hyperphosphorylation of tau and increased Aβ level in the brains. Treatment of the high cholesterol diet fed rats with atorvastatin prevented the changes of both tau phosphorylation and Aβ level induced by high cholesterol diet.Conclusions Hypercholesteremia could induce tau hyperphosphorylation and Aβ production in rat brain. Atorvastatin could inhibit tau hyperphosphorylation and decrease Aβ generation. It may play a protective role in the patho-process of hypercholesteremia-induced neurodegeneration in the brain。

Abstract：Background Monolayer cell culture models are the traditional culture models used for in vitro research of pancreatic carcinoma chemosensitivity. However, these models neglect the interactions between tumor cells and the impact of the tumor microenvironment. Such tumor cell monolayers poorly mimic the solid tumor microenvironment. The present study aimed to investigate the chemosensitivity characteristics of pancreatic cancer cells in a three-dimensional culture system by analyzing the differences in drug sensitivity between a scattered cell culture model and a multicellular spheroid culture model.Methods Three pancreatic cancer cell lines (SW1990, ASPC-1 and PCT-3) were cultured in three-dimensional collagen gels as well as in traditional two-dimensional monolayers. The chemosensitivities of the pancreatic carcinoma cells to 5-fluorouracil (5-FU), gemcitabine, and oxaliplatin in vitro were detected by both the Cell Counting Kit-8 test and the collagen gel droplet-embedded culture drug-sensitivity test.Results In the two-dimensional culture model, differences in the chemosensitivities of the cloned pancreatic carcinoma cells and scattered cells existed for some concentrations of 5-FU, gemcitabine and oxaliplatin. In the three-dimensional culture model, there were significant differences in the chemosensitivities of the pancreatic cancer cells between the scattered cells and multicellular spheroids (P <0.05).Conclusion Pancreatic carcinoma cells exhibit multicellular resistance in three-dimensional cultures。

Abstract：Background In order to make posterior fossa decompression for the management of Chiari I malformation simple and less invasive while using direct visualization, a novel solely endoscopic procedure has been employed for the decompression of Chiari malformation type I. The objective of this study was to present neural endoscopic posterior fossa decompression and atlas laminectomy for Chiari type I patients.Methods Twenty-one patients with Chiari type I underwent neural endoscopic posterior fossa decompression and atlas laminectomy. We described the procedure for neural endoscopic posterior fossa decompression and atlas laminectomy. All patients in this series demonstrated cerebellar tonsil herniation below the foramen magnum in addition to syringomyelia. All patients in the reviewed study underwent preoperative MRI as well as 3-month postoperative MRI. Additional follow-up MRI varied but was usually repeated 12 months to 18 months after surgery. Postoperative MRI studies were retrospectively reviewed and compared with preoperative studies.Results All patients showed clinical improvements, and none had any complications. Patients with syringomyelia had symptoms entirely disappear. Eleven patients (52.4%) experienced radiographic improvement in syringomyelia (decreased size or resolution) during the follow-up period. Nine patients (42.8%) demonstrated decreased syrinx size and four (19%) demonstrated resolved syrinx. Of the 15 patients with symptomatic syringomyelia, 11 (73.3%)experienced symptomatic improvement. The median time to symptom improvement was four months after surgery. Post surgical MRI examinations indicated complete and sufficient decompression of foramen magnum region.Conclusions Endoscope atlanto-occipital decompression surgery is an innovative, safe and effective surgical procedure. It has similar results compared to traditional surgery, however with the added advantages of being minimal invasive, having fewer complications, decreased influence on stability of occipital bony structure, and a faster recovery as well as reduced hospital stay and expenses。

Abstract：Background Astrocyte swelling is an important consequence of hepatic encephalopathy, and aquaporin-4 has been reported to play a vital role in this swelling. Ammonia causes astrocyte swelling and is also known to modulate aquaporin-4 expression in the astrocyte foot processes. The purpose of this study was to explore the mechanism of ammonia-induced aquaporin-4 expression, which has been suggested to involve the p38 mitogen-activated protein kinase pathway.Methods We exposed cultured astrocytes to ammonium chloride, an in vitro model of hepatic encephalopathy. The purity of cultured astrocytes was evaluated by fluorescent glial fibrillary acidic protein labeling; cell morphology was assessed by light microscopy; the expression of aquaporin-4, phospho-p38, and p38 were detected by Western blotting analysis. Statistical analysis was performed by one-way factorial analysis of variance, and the relationship between variables was calculated by linear regression using SPSS version 13.0 program for Windows (SPSS, Chicago, IL, USA).Results The purity of cultured astrocytes was (96.6 ±1.4)%. Astrocytes swelled significantly when exposed to 5 mmol/L ammonium chloride for 24 hours as compared to non-exposed astrocytes. Co-treatment with 10 μmol/L SB203580 (an inhibitor of p38) attenuated the degree of ammonium chloride induced astrocyte swelling. Western blotting analysis revealed that the expression levels of phospho-p38 and aquaporin-4 in ammonium chloride treated cells were significantly increased relative to the control group (P <0.001); SB203580 co-treatment inhibited the increased expression of phospho-p38 and aquaporin-4 relative to the ammonium chloride treated group (P=0.002 and P=0.015 respectively). The phosphorylation of p38 and upregulation of aquaporin-4 were highly correlated (r=0.909). There were no significant differences in total p38 expression among the groups (P=0.341).Conclusions Ammonium chloride induced upregulation of aquaporin-4 in astrocytes is regulated by the p38 mitogen-activated protein kinase pathway. Inhibiting p38 activation prevented ammonium chloride induced aquaporin-4 protein upregulation。

Abstract：Background Cryopreserved embryo transfer has become indispensable in reproductive technology. More and more children are conceived from frozen-thawed embryo transfer (FET). The risk of birth defects associated with frozen-thawed embryo transfer has been evaluated and conflict results are obtained. The aim of this study was to compare the rate of major malformations in children conceived from cryopreserved embryos with that of children from fresh embryos. Methods A retrospective analysis was performed on children conceived from frozen-thawed embryos and fresh embryos between January 2005 and December 2008 at the Reproduction Center of the Third Hospital, Peking University.The major malformation rates were compared between two groups for all children, as well as singletons or twins,separately. The frequencies of different subtypes of malformations classified according to different organ system were also compared.Results Thirty-four of 3125 children from cryopreserved embryos had a major malformation. The malformation rate was 1.09%, which was comparable to that for children after fresh embryos transfer (1.53%(55/3604), OR:0.71, 95% CI; 0.46-1.09). The malformation rate was also similar when the analysis was limited to children from cryopreserved embryos resulted from in vitro fertilization (IVF)(1.39%)and fresh IVF(1.3%). However, children from cryopreserved embryos resulted from intracytoplasmic sperm injections (ICSI) had much lower malformation rate than from fresh ICSI(0.63% vs.1.83%, OR: 0.34, 95% CI: 0.16-0.75). No difference was found in the incidence of major malformations in singletons from cryo ICSI (0.73%) and fresh ICS1(1.9%), or from cryo IVF(1.49%) and fresh IVF(1.67%). Similar malformation rate was found in multiples from cryo ICSI(0.52%) and fresh ICSI(1.76%), or cryo IVF(1.30%) and fresh IVF(0.90%). The distribution and risk of the subtype of malformations, such as cardiovascular, gastrointestinal, neural tube, urogenital, rnusculoskeletal and facial abnormalities was not different between the cryo group and fresh group. Conclusions The major malformation rate is similar between fetuses/children conceived from cryopreserved embryos and those from fresh embryos. Large prospective and long-term follow-up studies are needed to get exact results concerning the birth defects of the children bern after cryopreserved embryos。

Abstract：Background The prevalence of dermatophytoses and the development of new antifungal agents has focused interest on susceptibility tests of dermatophytes. The method used universally for susceptibility tests of dermatophytes was published as document (M38-A) in 2002 by the Clinical and Laboratory Standards Institute (CLSI), dealing with the standardization of susceptibility tests in filamentous fungi, though not including dermatophytes especially. However, it is not a very practical method for the clinical laboratory in routine susceptibility testing. In this test, we developed a novel rapid susceptibility assay --glucose consumption method (GCM) for dermatophytes.Methods In this study, we investigated the antifungal susceptibilities of dermatophytes to itraconazole (ITC),voriconazole (VOC), econazole nitrate (ECN) and terbinafine (TBF) by glucose consumption method (GCM), in comparison to the Clinical and Laboratory Standards Institute (CLSI) M38-A method. Twenty-eight dermatophyte isolates,including Trichophyton rubrum ( T. Rubrum) (n=14) and Trichophyton mentagrophytes ( T. Mentagrophytes) (n=14), were tested. In the GCM, the minimum inhibitory concentrations (MICs) were determined spectrophotometrically at 490 nm after addition of enzyme substrate color mix. For the CLSI method, the MICs were determined visually.Results Comparison revealed best agreement for TBF against T. Mentagrophytes and T. Rubrum, since MIC range, MIC50, and MIC90 were identical from two methods. However, for ITC and VOC, GCM showed wider MIC ranges and higher MICs than CLSI methods in most isolates. For ECN against T. Rubrum, high MICs were tested by GCM (0.125-16 μg/ml) but not M38-A method (0.5-1 μg/ml). The overall agreements for all isolates between the two methods within one dilution and two dilutions for ITC, VOC, ECN and TBF was 53.6% and 75.0%, 57.1% and 75.0%, 82.1% and 89.3%, and 85.7 and 85.7%, respectively.Conclusion Measurement of glucose uptake can predict the susceptibility of T. Rubrum and T. Mentagrophytes to ECN and TBF。

Abstract：Background Postconditioning has been shown to reduce infarct size, ischemic/reperfusion injury and myocardial injury in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). This study tested the hypothesis that postconditioning attenuates the elevation of tumor necrosis factor-α (TNF-α) and improves heart function in patients with AMI after PCI.Methods A total of 75 patients were randomly assigned to 1 of 3 groups: the routine group (n=26), in which no intervention was given at the onset of reperfusion; and the Postcon-30s (n=25) or Postcon-60 s (n=24) groups, in which 3 cycles of 30- or 60-second balloon deflation and inflation were repetitively performed. TNF-α serum concentration was measured by ELISA. Global and regional left ventricular systolic function was determined by echocardiography at 1 year.Thirty-four normal controls (NC) were enrolled in the study.Results The TNF-α concentration in patients with AMI was significantly elevated at baseline compared to controls (P <0.01). Concentration levels increased in the routine and Postcon-30s, but not in Postcon-60s group at 7 days (P <0.05).As for linear associations among the three groups, left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were ranked as follows: Postcon-60s >Postcon-30s>routine (P values all <0.05, 65% vs. 57% vs. 52% and 1.10 vs. 1.27 vs. 1.53) after 1 year. More importantly, there was a significant relevance between the soluble TNF-α serum concentration at 7 days and LVEF or WMSI after 1 year (P values all <0.0001).Conclusions Postconditioning, in particular Postcon-60s was associated with long-term cardioprotective effects for inhibition of the inflammatory response and reperfusion injury. The soluble TNF-α serum concentration provided powerful prognostic information of global and regional left ventricular systolic function in patients with AMI。

Abstract：Background Delay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI.Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review.Results The median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%),radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P <0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P <0.001) compared to those who interpreted their symptoms as cardiac in origin.Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS)。

Abstract：Background The accuracy of microelectrode-guided localization can make the operation safe and effective, but only experienced neurosurgeons are capable of performing this operation. A good index to identify neuronal discharges between globus pallidus intema and globus pallidus extema is needed. The aim of this research was to establish a good and practical electrophysiologic index to distinguish neuronal discharge in the interior globus pallidus from neuronal discharge in the exterior globus pallidus region of the brain in Parkinson's disease. The effect of neurons having an atypical discharge on successful surgical localization was also quantitatively evaluated Methods The study included 30 patients with primary Parkinson's disease who underwent pallidotomy between September 2000 and October 2002. During each pallidotomy, the neuronal discharges in the pallidum and its vicinity were recorded. The recorded spikes were used to calculate the frequency, burst index, pause index, and pause ratio of the single-unit discharge. The interior and exterior globus pallidus regions were compared in terms of frequency, burst index, pause index, and pause ratio. The sensitivity, specificity, false-negative ratio, false-positive ratio, and accuracy of those indices were then evaluated. Results The values of frequency, burst index, pause index, and pause ratio in the interior globus pallidus were (96±43) Hz, 2.31±1.81, 0.05±0.05, and 0.27±0.26, respectively, and in the exterior globus pallidus were (59±27) Hz, 0.88±0.63, 0.20±0.14, and 1.54±1.17, respectively. Use of the four indices to distinguish the two neuron types produced a sensitivity of 0.84, 0.78, 0.77, and 0.93 with a specificity of 0.64, 0.79, 0.88, and 0.87, respectively. The false-positive ratio was 0.36,0.21, 0.12, and 0.13 and the false-negative ratio was 0.16, 0.22, 0.23, and 0.07 while the accuracy was 0.72, 0.79, 0.80, and 0.90, respectively.Conclusions Pause ratio is a relatively reliable index to distinguish neuronal discharges between the interior and exterior globus pallidus regions in Parkinson's disease. The effect of neurons with atypical discharge on the successful surgical localization would be reduced to 10% when the pause ratio is used as the index。

Abstract：Background RTVue spectral-domain optical coherence tomography (OCT) is a new, ultra high-speed and high-resolution instrument, potentially to measure the presence of glaucoma or its progression accurately. The objective of this study was to evaluate its reproducibility of retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) measurements in normal and glaucoma eyes. Methods This study was an observational clinical study. One eye was selected randomly from each of 89 normal individuals and 63 glaucoma patients in a range of severity. RNFL thickness and ONH were measured 3 times on the same day to determine intrasession variability. The same instrument was used by the same operator for all scans. Intrasession within-subject standard deviation (Sw), precision (1.96×Sw), coefficient of variation (CVw, 100×Sw/overall mean), and intraclass coefficient (ICC) were calculated to evaluate reproducibility.Results RTVue OCT demonstrated double hump patterns in the RNFL profiles. High reproducibility was observed in all ONH parameters. For normal eyes, the value of ICC ranged between 0.98 and 1.00. For eyes with different extent of glaucoma, it ranged between 0.94 and 1.00. High reproducibility was also observed in RNFL thickness measurements.The values of ICC for averaged RNFL thickness ranged between 0.95 and 1.00 in all cases. For regional parameters, it ranged from 0.94 to 0.98 for normal eyes, 0.94 to 1.00 for mild glaucoma eyes, 0.87 to 1.00 for moderate glaucoma eyes, and 0.77 to 0.97 for severe glaucoma eyes. The nasal regions of severe glaucoma appeared to be most variable, as nasal lower region and inferior nasal region had the ICC values of 0.77 and 0.87. Conclusion Reproducibility of RTVue RNFL and ONH measurements was excellent in normal and glaucoma groups。

Abstract：Background Internet addition disorder (lAD) is currently becoming a serious mental health problem among Chinese adolescents. The pathogenesis of IAD, however, remains unclear. The purpose of this study applied regional homogeneity (ReHo) method to analyze encephalic functional characteristic of IAD college students under resting state. Methods Functional magnetic resonanc image (fMRI) was performed in 19 IAD college students and 19 controls under resting state. ReHo method was used to analyze the differences between the average ReHo in two groups. Results The following increased ReHo brain regions were found in IAD group compared with control group: cerebellum,brainstem, right cingulate gyrus, bilateral parahippocampus, right frontal lobe (rectal gyrus, inferior frontal gyrus and middle frontal gyrus), left superior frontal gyrus, left precuneus, right postcentral gyrus, right middle occipital gyrus, right inferior temporal gyrus, left superior temporal gyrus and middle temporal gyrus. The decreased ReHo brain regions were not found in the IAD group compared with the control group. Conclusions There are abnormalities in regional homogeneity in IAD college students compared with the controls and enhancement of synchronization in most encephalic regions can be found. The results reflect the functional change of brain in IAD college students. The connections between the enhancement of synchronization among cerebellum, brainstem, limbic lobe, frontal lobe and apical lobe may be relative to reward pathways。

Wilms' tumor is the most common pediatric tumor of the kidney. The most important factor affecting long term survival of this malignancy is recurrence after surgery. Early diagnosis, treatment and regular follow-up are critical to prevent recurrence and improve long-term survival rate. Currently, the diagnosis, clinical staging and postoperative monitoring of Wilms' tumor rely on clinical symptoms and imaging technology, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), plain X-ray pyelography of the urinary tract (urography). However, imaging diagnoses are not as accurate and informative as pathological examinations for tumor staging. Furthermore, CT is mainly used for the diagnosis of Wilms' tumor when the tumor diameter is more than 3 cm.1 A more sensitive and specific method is expected to help the patients receive timely and accurate treatment.DOh 10.3760/cma.j.issn.0366-6999.2010.14.019

Sézary syndrome (SS) is an erythrodermic, aggressive,cutaneous T-cell lymphoma (CTCL) characterized by a malignant T-cell clone that localizes in the blood and skin, and its diagnosis is based on clinical, histological and biological features. Here we describe a typical case of SS。

WHAT IS MEDICAL SCREENING? Worldwide chronic diseases have become a major cause of suffering, disability and mortality. When patients are diagnosed as a result of the appearance of symptoms, it is often too late and treatment options are limited. Hoping that early diagnosis and early treatment can retard or stop disease progression, medical screening is proposed as a secondary prevention method in which people without specific medical complaints are invited to undergo interventions to identify and modify risk factors, or to find disease early in its course so that early treatment prevents further severe complications.l'2

To the editor: Reactive arthritis (ReA) in tuberculosis (TB) is known as Poncet's disease. It is a rare aseptic form of arthritis observed in patients with active TB. It has been suggested that Poncet's disease mainly occurs in patients with extrapulmonary TB.1,2 We report here a case of Poncet's disease in a patient with retroperitoneal tuberculous lymphadenitis.