Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves' ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging.

Purpose: To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves' ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment. Methods: Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2-weighted, fat-suppressed fast spin echo imaging (T2WI-fs) and T1-weighted, fat-suppressed, contrast-enhanced fast spin echo imaging (T1WI-fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non-effective group. Independent t-test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t-test was used to compare SIR and T of LPS muscle before and after treatment. Then cut-off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed. Results: Sixty-two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non-effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI-fs and T1WI-fs + C decreased after treatment in the effective group (PT2 < 0.001, PT1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non-effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non-effective treatment group on T1WI-fs + C (P < 0.001). SIR of LPS muscle on T1WI-fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840). Conclusion: In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy.

Cerebral Functional Reorganization in Ischemic Stroke after Repetitive Transcranial Magnetic Stimulation: An fMRI Study.

AIMS: Our study aimed to figure out brain functional reorganization evidence after repetitive transcranial magnetic stimulation (rTMS) using the resting-state functional magnetic resonance imaging (rsfMRI). METHODS: Twelve patients with unilateral subcortex lesion in the middle cerebral artery territory were recruited. Seven of them received a 10-day rTMS treatment beginning at about 5 days after stroke onset. The remaining five received sham treatment. RsfMRI and motor functional scores were obtained before and after rTMS or sham rTMS. RESULTS: The rTMS group showed motor recovery according to the behavioral testing scores, while there was no significant difference of motor functional scores in the sham group before and after the sham rTMS. It proved that rTMS facilitates motor recovery of early ischemic stroke patients. Compared with the sham, the rTMS treatment group achieved increased functional connectivity (FC) between ipsilesional M1 and contralesional M1, supplementary motor area, bilateral thalamus, and contralesional postcentral gyrus. And decreased FC was found between ipsilesional M1 and ipsilesional M1, postcentral gyrus and inferior and middle frontal gyrus. CONCLUSION: Increased or decreased FC detected by rsfMRI is an important finding to understand the mechanism of brain functional reorganization. The rTMS treatment is a promising therapeutic approach to facilitate motor rehabilitation for early stroke patients.

Normative measurements of extraocular musculature by multislice computed tomography.

Objective To establish the normal measurements of diameter of extraocular muscles (EOMs) by multislice computed tomography (CT). Methods Orbits of 50 volunteers (25 male and 25 female) were scanned with a multislice CT scanner. For each subject, one axial image at the central level of the eyeball, one coronal image about 1 cm behind globe, and two oblique sagittal images respectively along the left and right optic nerve were used for measurements of the thickness and width of EOMs. The statistic significance of measurement value between male and female and between left and right eyes was evaluated. Results There were no significant differences in the thickness and width of superior muscle group, lateral rectus, medial rectus, lateral rectus, superior oblique, inferior oblique and the thickness of levator palpebrae superioris between the left and right eyes as well as between male and female groups (all P>0.05). The thickness of superior muscle group and inferior rectus had not significant difference (2.9±0.7 vs. 3.3±0.8 mm, P=0.162), while the thickness of medial rectus was significantly higher than that of lateral rectus (3.1±0.5 vs. 2.2±0.6 mm, P=0.000). Conclusions The CT measurement of extraocular musculature is simple and time-saving and can be applied in the clinical work. The normative data obtained may be useful in determining pathologic enlargement of the EOMs in both thyroid-associated orbitopathy patients and other various orbital conditions.

[Study on preparation process of artesunate polylactic acid microspheres].

This study aims to investigate the preparation process and in vitro release behavior of artesunate polylactic acid microspheres, in order to prepare an artesunate polylactic acid (PLA) administration method suitable for hepatic arterial embolization. With PLA as the material and polyvinyl alcohol (PVA) as the emulsifier, O/W emulsion/solvent evaporation method was adopted to prepare artesunate polylactic acid microspheres, and optimize the preparation process. With drug loading capacity, encapsulation efficiency and particle size as indexes, a single factor analysis was made on PLA concentration, PVA concentration, drug loading ratio and stirring velocity. Through an orthogonal experiment, the optimal processing conditions were determined as follows: PLA concentration was 9. 0% , PVA concentration was 0. 9% , drug loading ratio was 1:2 and stirring velocity was 1 000 r x min(-1). According to the verification of the optimal process, microsphere size, drug loading and entrapment rate of artesunate polylactic acid microspheres were (101.7 +/- 0.37) microm, (30.8 +/- 0.84)%, (53.6 +/- 0.62)%, respectively. The results showed that the optimal process was so reasonable and stable that it could lay foundation for further studies.

Clinical application of magnetic resonance imaging in preoperative evaluation of endometrial cancer.

OBJECTIVE: To investigate the value of magnetic resonance imaging (MRI) in the preoperative assessment of endometrial cancer. METHODS: Ninety-four patients with histopathologically confirmed endometrial carcinoma were retrospectively enrolled in this study. MRI findings were compared with the pathologic findings in all cases. The depth of myometrial invasion and lymph node metastasis were evaluated by T2 weighted imaging (T2WI) combined with contrast enhancement or diffusion weighted imaging (DWI). RESULTS: Among these 94 patients,62 had no or superficial myometrial involvement and 32 cases had deep myometrial involvement. Meanwhile, 24 groups of metastatic lymph nodes and 164 groups of non-metastatic lymph nodes were detected. The accuracy, specificity, sensitivity, negative predictive value, and positive predictive value of T2WI combined with contrast enhancement in discriminating no/superficial myometrial involvement from deep myometrial involvement were 88.3%, 90.3%, 84.4%, 91.8%, and 81.8%, whereas those of T2WI combined with DWI were 81.9%, 87.1%, 71.9%, 85.7%, and 74.2%, respectively. The accuracy, specificity, sensitivity, negative predictive value, and positive predictive value of T2WI combined with contrast enhancement in identifying metastatic lymph nodes were 89.4%, 96.8%, 54.5%, 90.9%, and 78.3%, whereas those of T2WI combined with DWI were 91.5%, 95.5%, 72.7%, 94.3%, and 77.4%, respectively. CONCLUSIONS: T2WI combined with contrast enhancement is superior to T2WI combined with DWI in evaluation of the depth of myometrial invasion. However, DWI is more sensitive in identifying lymph node metastasis than T2WI combined with contrast enhancement.

Quantitative evaluation of extraocular muscle with high-field magnetic resonance in patients with Graves' ophthalmopathy with upper-lid retraction.

OBJECTIVE: To evaluate the feasibility of high-field magnetic resonance in measuring the thickness and width of extraocular muscles, calculate the ratio of thickness to width, and summarize the characters of the diameters and its ratio in patients with Graves' ophthalmopathy (GO) with upper-lid retraction. METHODS: Sixteen GO patients with upper-lid retraction (GO group) and 14 healthy control group were enrolled in this study. All the patients underwent enhanced high-field magnetic resonance orbital scan. The thickness and width of extraocular muscles were measured on axial, coronal or oblique sagittal enhanced T1 weighted images. The ratio of thickness to width (R1) and width to thickness (R2) were calculated. The diameters or ratio was evaluated as enlarged when they were 2 standard deviation greater than mean values of extraocular muscle in healthy control. RESULTS: The thickness of levator palpebrae superioris, medial rectus, and inferior rectus muscles in GO group were significantly larger than those in the control group (P=0.000, P=0.017, P=0.032, respectively. The width of superior oblique muscles in GO group was significantly larger than that in control group (P=0.000). The R1 values of levator palpebrae superioris, inferior rectus, medial rectus, and lateral rectus muscles in GO group were significant larger than those in the control group (P=0.000,P=0.037, P=0.019,P=0.032, respectively. The R2 value of superior oblique muscles was significant larger than that in the control group (P=0.027). Aslo in GO group, 32 extraocular muscles showed an increased thickness. 47% of thickened extraocular muscles had an increased R1. CONCLUSIONS: Enhanced orbit imaging with high-field magnetic resonance is helpful in the quantitative assessment of the thickness and width of extraocular muscles. In GO patients, in addition to the levator palpebrae superioris muscles, some other extraocular muscles also becomes thicker. Moreover, the increased diameters of superior oblique muscles is mainly due to the increase of its width R1 and R2 values can reflect the thickness and width of extraocular muscles and their relationship.

[Construction of a recombinant Lactobacillus acidophilus expressing high levels of Helicobacter pylori adhesin Hp0410].

OBJECTIVE: To construct a recombinant Lactobacillus acidophilus that expresses high levels of Helicobacter pylori (Hp) adhesin Hp0410. METHODS: The gene fragment encoding Hp0410 was amplified by PCR from the DNA of H. pylori NCTC11639 strain and cloned into the shuttle plasmid pMG36e to construct pMG36e-Hp0410, which was transformed into Lactobacillus acidophilus by electroporation. The target protein was confirmed with SDS-PAGE and silver nitrate staining and analyzed by Western blotting. The stability of the recombinant plasmid was assessed by drawing the growth curve of the recombinant Lactobacillus acidophilus. RESULTS: A 750-bp fragment was inserted into the pMG36e plasmid and transformed into Lactobacillus lactis. The transformed bacterium expressed the target protein with a relative molecular mass of about 34 kD. Western blotting confirmed that the expressed proteins could be recognized by the serum of patients with Hp infection. The recombinant plasmid pMG36e-Hp0410 exhibited good stability in the presence or absence of erythromycin. CONCLUSIONS: The recombinant Lactobacillus acidophilus with high constitutive expression of Hp0410 has been constructed successfully.