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Two new glycosides suspensaside C (1) and 2,3,5,6-tetrahydro-jacaranone-4-O-β-D-glucopyranoside (2), together with four known compounds suspensaside A (3), rengynic acid-1'-O-β-D-glucopyranoside (4), forsythoside A (5), and rengynic acid (6), were isolated from the fruits of Forsythia suspense (Thunb.) Vahl. The structures of 1 and 2 were elucidated on the basis of chemical and spectral analysis, including 1D, 2D NMR analyses and HR-ESI-MS. All isolates were tested for their cytotoxicities against five human cancer cell lines (A549, Colo-205, Hep-3B, HL60, and KB). Compound 3 exhibited cytotoxicity against HL-60, Hep-3B, and A549 cancer cell lines.

One new sesquiterpene, (1α,4aβ,8aα)-1-isopropanol-4a-methyl-8-methylenedecahydronaphthalene (1), with one new phenylpropanoid, threo-2-(4-hydroxy-3,5-dimethoxyphenyl)-3-(4-hydroxy-3-methoxyphenyl)-3-ethoxypropan-1-ol (2), along with four known phenylpropanoids were isolated from Crataegus pinnatifida. The structures of compounds 1 and 2 were elucidated on the basis of 1D, 2D NMR analyses, and HR-ESI-MS. The antithrombotic activity in vitro of all isolates was assayed, and only compound 1 exhibited potent antithrombotic activity by inhibiting platelet aggregation in rat plasma by 81.4% at 1 mg/ml.

Aim: To study the chemical constituents and bioactivity of the seeds of Crataegus pinnatifida., Methods: The chemical constituents were isolated and purified by macroporous adsorptive resin D101, silica gel, and ODS column chromatography, and preparative HPLC. Their structures were elucidated on the basis of spectroscopic methods. In addition, the cytotoxic activities of compounds 1-4 were investigated on OPM2 and RPMI-8226 cells., Results: Four compounds were obtained and their structures were identified as (7S, 8S)-4-[2-hydroxy-2-(4-hydroxy-3-methoxyphenyl)-1-(hydroxymethyl)ethoxy]-3, 5-dimethoxybenzaldehyde (1), (+)-balanophonin (2), erythro-guaiacylglycerol-β-coniferyl aldehyde ether (3), buddlenol A (4)., Conclusion: Compound 1 is a novel norlignan, while compounds 1-4 exhibited marginal inhibition on the proliferation of OPM2 and RPMI-8226 cells., (Copyright © 2013 China Pharmaceutical University. Published by Elsevier B.V. All rights reserved.)

Objectives: To evaluate the association between dynamic progressive enhancing foci ("dynamic spot sign") in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion., Methods: One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed., Results: Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386-590.289), P < 0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123-1295.488), P < 0.0001., Conclusions: The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign., Key Points: • It is important to identify potential progression of spontaneous intracerebral haemorrhage. • Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion. • The CTP dynamic spot sign may be present throughout arterial to venous phase imaging. • The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.

Two new steroidal saponins, named anemarnoside A and anemarnoside B, along with three known compounds, timosaponin J, timosaponin B II, and timosaponin B, have been isolated from Anemarrhena asphodeloides. Their structures were established by spectroscopic techniques (IR, MS, 1D NMR, and 2D NMR) and by comparison with published data.

Four novel phenolic compounds (1-4) were isolated from the leaves of Crataegus pinnatifida, along with three known ones (5-7). Their structures were elucidated as: methyl 4-O-β-D-glucopyranosyl-3-[(2E,6E)-8-O-β-D-glucopyranosyl-3,7-dimethyl-2,6-octadienyl] benzoate (1), biphenyl-5-ol-3-O-β-D-glucoside (2), 3,4'-dimethoxy-biphenyl-5-ol-4-O-β-D-glucoside (3), (E)-6-(benzoyloxy)-1-hydroxyhex-3-en-2-O-β-D-glucoside (4), shanyenoside A (5), eriodectyol (6), and 2″-O-rhamnosyl vitexin (7), using a combination of mass spectroscopy, 1D and 2D NMR spectroscopy, and chemical analysis. The antithrombotic activity of the isolated compounds was investigated on the transgenic zebra fish system. Among them, eriodectyol (6) potently inhibited the production of thrombus., (Georg Thieme Verlag KG Stuttgart · New York.)

Antidepressant activity-guided fractionation of the MeOH extract of Valeriana fauriei Briq. roots resulted in the isolation of two new germacrane-type sesquiterpenes (1-2) in addition to seven known ones (3-9). Their structures were elucidated as 1β,10α-dihydroxyl-8α-acetoxyl-10β,11,11-trimethyl-4-formyl-bicyclogermacren-E-4(5)-ene (1), 1β-hydroxyl-8α-acetoxyl-11,11-dimethyl-4-formyl-bicyclogermacren-E-4(5),10(14)-diene (2), bicyclo[8,1,0]5β-hydroxyl-7β-1acetoxyl-5α,11,11'-trimethyl -E-1(10)-ene-4α,15-olide (3), 8α-acetoxyl-3α,4α,10-trihydroxyl-guaia-1(2)-ene-12,6α-olide (4), 2-Ethylhexyl-4-hydroxybenzoate (5), 11αH-gemacra-1(10)E,4Z-diene-3-one-12,6α-olide (6), β-Sitoterol (7), isovaleric acid (8), isoborneol acetate (9), using a combination of UV, IR, mass spectroscopy, 1D and 2D NMR spectroscopy. The antidepressant activity of compounds 1-4 was investigated by the FST on mice. Among them, compounds 3 and 4 showed the significant antidepressant activity (*, P<0.01)., (Copyright © 2012 Elsevier B.V. All rights reserved.)

As a study method of resting state network (RSN), resting state functional MRI (rfMRI) can be applied to detect low frequency fluctuate (LFF) in various cerebral areas based on resting state blood oxygen level dependence (BOLD) signals; and it is easier and more consistent than task-related fMRI. The development, features and methods of rfMRI as well as the application in epilepsy were reviewed in this article., (Copyright © 2011 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Crataegus pinnatifida have long been used in traditional Chinese medicine and European herbal medicine, and are widely consumed as food, in the form of juice, drink, jam and canned fruit. Four new compounds, a sesquiterpene and its glycoside (1-2), two monoterpene glycosides (3-4), together with eight known compounds (5-12), were isolated from the leaves of C. pinnatifida. Their structures were elucidated as (5Z)-6-[5-(2-hydroxypropan-2-yl)-2-methyltetrahydrofuran-2-yl]-3-methylhexa-1,5-dien-3-ol (1), (5Z)-6-[5-(2-O-β-d-glucopyranosyl-propan-2-yl)-2-methyl tetrahydrofuran-2-yl]-3-methylhexa-1,5-dien-3-ol (2), 5-ethenyl-2-[2-O-β-d-glucopyranosyl-(1″→6')-β-d-glucopyranosyl-propan-2-yl]-5-methyltetrahydrofuran-2-ol (3), 4-[4β-O-β-d-xylopyranosyl-(1″→6')-β-d-glucopyranosyl-2,6,6-trimethyl-1-cyclohexen-1-yl]-butan-2-one (4), (Z)-3-hexenyl O-β-d-glucopyranosyl-(1″→6')-β-d-glucopyranoside (5), (Z)-3-hexenyl O-β-d-xylopyranosyl-(1″→6')-β-d-glucopyranoside (6), (Z)-3-hexenyl O-β-d-rhamnopyranosyl-(1″→6')-β-d-glucopyranoside (7), (3R,5S,6S,7E,9S)-megastiman-7-ene-3,5,6,9-tetrol (8), (3R,5S,6S,7E,9S)-megastigman-7-ene-3,5,6,9-tetrol9-O-β-d-glucopyranoside (9), (6S,7E,9R)-6,9-dihydroxy-4,7-megastigmadien-3-one 9-O-[β-d-xylopyranosyl-(1″→6')-β-d-glucopyranoside] (10), Linarionoside C (11), and (3S,9R)-3,9-dihydroxy-megastigman-5-ene 3-O-primeveroside (12), using a combination of mass spectroscopy, 1D and 2D NMR spectroscopy and chemical analysis. Cytotoxicity of the new compounds was assayed against selected human glioma (U87) cell lines., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The structures of two new sesquiterpene lactones, 11,13beta-dihydroixerin Z (1) and Ixerin Z2 (2) isolated from Ixeris sonchifolia were determined to be 3-hydroxy-1(10),3-guaiadiene-12,6-olide-2-one-3-O-beta-D-glucopyranoside and 1(10),3,11 (13)-guaiatriene-12,6-olide-2-one-3-O-[6'-(4"-hydroxybenzyl lactyl)]-beta-D-glucopyranoside, respectively on the basis of detailed spectral analysis.

Objective: We explored the relationship between predicted infarct core, predicted ischemic penumbras and predicted final infarct volumes obtained though apparent diffusion coefficient (ADC)-based method, as well as other clinical variables, and functional outcome., Methods: Patients with acute cerebral ischemic stroke were retrospectively recruited. The National Institutes of Health Stroke Scale score was evaluated at baseline and the modified Rankin Scale (mRS) at day 90. Favorable outcome was defined as an mRS score of 0 to 2, and unfavorable outcome as 3 to 6. Multimodal stroke magnetic resonance imaging was carried out at presentation. The volumes of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) were measured using the regions of interest (ROI) method. The volumes of predicted infarct core, predicted ischemic penumbra and predicted final infarct were obtained by an automated image analysis system based on baseline ADC maps. The association between baseline magnetic resonance imaging volumes, baseline clinical variables, and functional outcome was statistically analyzed., Results: The study included 30 males and 20 females (mean±SD age, 56±10 years). Baseline DWI, PWI and PWI-DWI mismatch volumes were not correlated with day-90 mRS (P>0.05). Predicted infarct core, predicted ischemic penumbra and predicted final infarct through ADC-based method were all correlated with day-90 mRS (P<0.05). A better outcome was associated with a smaller predicted volume. Low baseline National Institutes of Health Stroke Scale and recanalization also demonstrated a trend toward a favorable outcome. Receiver operating characteristic analysis showed that the area under the curve of predicted final infarct volume and recanalization were higher with statistical significance (P<0.001)., Discussion: Predicted volumes obtained from ADC-based methods, especially predicted final infarct volume, as well as baseline National Institutes of Health Stroke Scale and recanalization may have effect on functional outcome in acute ischemic stroke.

Background: Although the principles of antibiotics prophylaxis are well established, more than 60% of hospitals that joined the international quality indicator project failed to discontinue the use of prophylactic antibiotics within 24h after coronary artery bypass grafting (CABG). Our specific aims are to disseminate the gain obtained from breakthrough series model in knee arthroplasty and abdominal hysterectomy to increase the rate of prophylactic duration not longer than 24h in patients with CABG., Methods: The control and intervention groups enrolled 55 and 78 patients with CABG before and after the project. Measurements were prophylactic interval and duration, surgical site infection, hospital and antibiotics costs. Two strategies were developed. The key cardiac surgeon was invited to attend quality improvement activities. Knowledge and rationale of medical quality indicators would thus be communicated. Secondly, we proposed a regional symposium in which a level of competition was subconsciously established, and practitioners would present their level of compliance., Results: Instances of prophylactic interval within 1h prior to incision were significantly increased from 66.7% to 97.4%. Rates of prophylactic duration less than 24h were significantly increased from 2.8% to 66.1%. The average hospital cost was reduced by 16.4%, and antibiotics cost was reduced by 91.8%. No significant changes in surgical site infection within 30 d of CABG were observed., Conclusions: We successfully disseminated the gain of breakthrough project in improving antimicrobial prophylaxis to CABG. By implementing this model, we are able to optimize the timing and duration of antimicrobial prophylaxis in patients with CABG to a level above worldwide average., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Wall shear stress is an important factor in the destabilization of atherosclerotic plaques. The purpose of this study was to assess the distribution of wall shear stress in advanced carotid plaques using high resolution magnetic resonance imaging and computational fluid dynamics., Methods: Eight diseased internal carotid arteries in seven patients were evaluated. High resolution magnetic resonance imaging was used to visualize the plaque structures, and the mechanic stress in the plaque was obtained by combining vascular imaging post-processing with computational fluid dynamics., Results: Wall shear stresses in the plaques in all cases were higher than those in control group. Maximal shear stresses in the plaques were observed at the top of plaque hills, as well as the shoulders of the plaques. Among them, the maximal shear stress in the ruptured plaque was observed in the rupture location in three cases and at the shoulder of fibrous cap in two cases. The maximal shear stress was also seen at the region of calcification, in thrombus region and in the thickest region of plaque in the other three cases, respectively., Conclusion: Determination of maximal shear stress at the plaque may be useful for predicting the rupture location of the plaque and may play an important role in assessing plaque vulnerability.

Bioassay-guided fractionation of an EtOAc extract of the leaves of Rosa laevigata afforded two new 19-oxo-18,19-seco-ursane-type triterpenes (1 and 3), a new ursane-type nortriterpene (2), a new ursane-type triterpene lactone saponin (4), and two new oleanane-type triterpenoids (5 and 6), together with eight known triterpenoids (7-14). Compound 1, a 19-oxo-18,19-seco-28-norursane, possesses a conjugated diene between C-12 and C-17. Several of the isolated compounds (1, 5, 7, 11, and 13) exhibited moderate activities in anti-inflammatory assays in vitro.

Objective: To investigate the effect of modified Qianyang Pellet (MQYP) on extravascular lung water and its correlated factors at the early fluid resuscitation stage of septic shock., Methods: Forty-eight patients with septic shock were randomly assigned to the treatment group (26 patients) and the control group (22 patients). They were treated with basic treatment combined with fluid resuscitation until the central venous pressure (CVP) reached > or = 8 mm Hg. Besides, patients in the treatment group received MQYP additionally. The haemodynamic indices, including CVP, cardiac index (CI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and oxygenation index (PaO2/ FiO2) were monitored at 8 (T8), 16 (T16) and 24 h (T24) after ending fluid resuscitation, and the 28-day mortality was observed., Results: Compared with the control group, CI, GEDVI and PaO2/FiO2 increased significantly at T8, T16 and T24, while EVLWI and 28-day mortality lowered in the treatment group (P < 0.05 or P < 0.01). But the difference in terms of CVP and SVRI between the two groups at corresponding time points was statistically insignificant (P > 0.05)., Conclusion: On the basis of the fluid resuscitation and basic treatment, MQYP could further improve CI, GEDVI and PaO2/FiO2, decrease EVLWI and 28-day mortality, but showed no effect on CVP or SVRI at the early fluid resuscitation stage of septic shock.

Rationale and Objectives: To investigate whether baseline apparent diffusion coefficient (ADC) maps can be employed to predict both infarct core and salvageable ischemic tissue volumes in acute ischemic stroke., Materials and Methods: An automated image analysis system based on baseline ADC maps was tested against 30 patients with acute ischemic stroke of anterior circulation to predict both infarct core and salvageable ischemic tissue volumes. The predicted infarct core and predicted salvageable ischemic tissue were quantitatively and qualitatively compared with follow-up imaging data in recanalization and no recanalization groups, respectively. Direct comparisons with perfusion- and diffusion- weighted magnetic resonance imaging measures were also made. Wilcoxon signed-rank test, Spearman rank correlation, and Bland-Altman plots were performed., Results: In the recanalization group, the predicted infarct core volume was significantly correlated with the final infarct volume (r = 0. 868, P < .001). In the no recanalization group, the predicted final infarct volume (sum of the predicted infarct core and salvageable ischemic tissue volumes), as well as the predicted salvageable ischemic tissue volume, was also significantly correlated with the true final infarct volume (r = 0.955, P < .001) and infarct growth (r = 0.918, P < .001), respectively. The volumes of perfusion-diffusion mismatch were significantly larger than those of infarct growth and predicted salvageable ischemic tissue. Good agreement between predicted and true final infarct lesions was visualized by Bland-Altman plots in two groups. Direct visual comparative analysis revealed good qualitative agreement between the true final infarct and predicted lesions in 21 patients., Conclusion: The proposed ADC based approach may be a feasible and practical tool to predict the volumes of infarct core and salvageable ischemic tissue without intravenous contrast media-enhanced perfusion-weighted imaging at baseline., (Copyright © 2010 AUR. Published by Elsevier Inc. All rights reserved.)

Background: Cerebral microbleeds (CMBs) occur frequently in patients suspected of cerebrovascular disease and they are the principle radiographic findings in patients with sub-clinical neurological impairment. The objective of this study was to assess the prevalence, distribution, severity and associated clinical features of CMBs in a prospective hospital patient based cohort undergoing brain MRI for suspected cerebrovascular disease, excluding cases with known intracranial hemorrhage or prior large-area stroke., Methods: The study population consisted of 447 patients who were evaluated with T2*-gradient echo sequences to detect the CMBs lesion number, location, and their association with white matter hyperintensities and clinical parameters, including blood pressure., Results: CMB lesions were presented in 95 of the 447 patients (21.3%). The distribution of CMBs was 43.95% cortical, 19.77% thalamic, 14.41% in the brainstem, 11.58% cerebellar, 6.21% periventricular white matter, 5.64% involving the basal ganglia regions, and 0.28% involving the hippocampus. There was a statistically significant association between the presence of CMBs and advancing age (adjusted OR 2.082, P < 0.01), the severity of hypertension (adjusted OR 2.208, P < 0.01). Also there was a statistically significant (P < 0.01) correlation between the presence of CMBs and the severity of hypertension and white matter lesions., Conclusions: CMBs occur frequently in patients with no prior large-area stroke who were referred for brain MRI for suspected cerebrovascular disease. The severity of CMBs correlates with the severity of hypertension and the presence of cerebral white matter changes detected by MRI.

Background and Purpose: CT perfusion (CTP) mapping has been reported to be useful in the differentiation of the infarct core and ischemic penumbra. However, the value of the CTP source imaging (CTP-SI) during the arterial and venous phases has not been fully investigated. The purpose of this study was to develop a CTP-SI methodology for acute ischemic stroke and compare its efficacy with cerebral blood flow (CBF) and cerebral blood volume (CBV) in predicting infarct core and penumbra., Materials and Methods: CT examinations, including non-contrast-enhanced CT, CTP, and CT angiography (CTA), were performed in 42 patients with symptoms of stroke for <9 hours. The Alberta Stroke Program Early CT Score (ASPECTS) was analyzed on the arterial phase CTP-SI and venous phase CTP-SI and then compared with the ASPECTS on CBF and CBV for efficacy assessment., Results: The ASPECTS on the arterial phase CTP-SI was closely correlated with the ASPECTS on CBF, the Pearson correlation coefficient was 0.88 (P < .001), and the concordance correlation coefficient was 0.7603 (95% confidence interval [CI], 0.6331-0.8476). The ASPECTS on the venous phase CTP-SI revealed a significant correlation with the ASPECTS on CBV, the Pearson correlation coefficient was 0.92 (P < .001), and the concordance correlation coefficient was 0.8880 (95% CI, 0.8148-0.9334). Significant differences were shown between the arterial phase CTP-SI/ venous phase CTP-SI (P < .001) and CBF/CBV (P < .001)., Conclusions: This study provides preliminary evidence that the arterial phase and venous phase CTP-SI mismatch model could possibly be applied to ischemic regions in the acute stage of stroke to determine penumbra and infarct core.

Computed tomography perfusion (CTP) map can sensitively and accurately distinguish between infarct core and ischemic penumbra. However, CTP mapping software might not generate a perfusion map because of head movement; thus, analysing CTP source images (CTP-SI) is necessary in this situation to provide information for stroke diagnosis and therapy. In our work, 'one-stop shop' computed tomography (CT) examination including non-contrast-enhanced CT (NCCT), CTP, CT angiography (CTA) were performed in 24 patients with symptoms of acute stroke less than 9 hours. We divided patients into two groups (with and without delayed perfusion on CTP-SI), and compared the Alberta Stroke Program Early CT Score (ASPECTS) on CTP-SI and CTA-SI with follow-up imaging. Using follow-up imaging ASPECTS as the final infarct size, our results suggests that the ASPECTS of both CTP-SI and CTA-SI effectively predict final infarct core in the group without delayed perfusion, whereas CTP-SI has a potential advantage over CTA-SI in being able to predict final infarct core in the group with delayed perfusion. In conclusion, CTP-SI provides useful complementary information when CTP map software could not generate perfusion maps.

Objective: The purpose of this study was to develop a methodology on computed tomography (CT) perfusion source images for an acute ischemic stroke in predicting infarct core and penumbra., Methods: Computed tomography examinations, including non-contrast enhanced CT, CT perfusion and CT angiography, were performed on 24 patients with symptoms of stroke in less than 9 hours. The Alberta Stroke Program Early CT Score (ASPECTS) was analysed on arterial and venous phase CT perfusion source images and then compared with the ASPECTS on follow-up imaging for an efficacy assessment., Results: The ASPECTS on arterial phase CT perfusion source images was significantly different from venous phase CT perfusion source images (z=-2.812, p=0.005); linear regression analysis revealed that there was a statistically significant relationship between venous phase CT perfusion source images and the follow-up imaging (beta=0.715, p=0.003)., Conclusion: The limited data suggested that CT perfusion source images of both arterial and venous phases may have the potential of being used as an assessment for infarct core and penumbra in acute ischemic stroke.

Objective: To study clinical and imaging features of hypothalamic hamartoma in children., Methods: Imaging findings and clinical manifestations of 38 children with hypothalamic hamartomas were retrospectively reviewed. The patients included 25 boys and 13 girls, ranging in age of onset from 1 month to 15 years. All the 38 patients were examined with pre-contrast and post-contrast T1 weighted MR imaging and with non-contrast T2 weighted MR imaging. Meanwhile, 10 patients received CT scan. Hypothalamic hamartomas were confimed by pathologic examinations in the 38 patients., Results: Gelastic epilepsy, precocious puberty, other types of epilepsy and disturbance of intelligence were main manifestations in the 38 patients. Gelastic epilepsy was found as an initial clinical symptom in 17 cases, precocious puberty in 13 cases and other types of epilepsy in 8 cases. All masses were located in the suprasellar and interpeduncular cistern. They showed iso-density on CT scan, and homogeneous signal iso-intense to gray matter on T1 and T2 weighted MR images. With contrast MR images, there was no enhancement in the mass. The size or pedunculation of the mass was not correlated with clinical features., Conclusions: Hypothalamic hamartoma may be characterized by precocious puberty and/or gelastic epilepsy and specific imaging findings mentioned above.

Objective: We investigated whether baseline vessel status evaluated by magnetic resonance angiography (MRA) can be the foremost factor to classify acute ischemic stroke patients into subgroups for thrombolytic therapy within 3-6 hours of symptom onset., Methods: Acute ischemic stroke patients beyond 3 hours after symptom onset were examined by stroke magnetic resonance imaging (MRI) (diffusion- and perfusion-weighted imaging, and MRA) before and after thrombolysis treatment within 24-48 hours. Stroke MRI was used to classify acute ischemic stroke patients into subgroups and select optimal patients for thrombolytic treatment. Clinical scores were compared to determine whether there were significant differences among subgroups., Results: The difference in day 90 modified Rankin scale (mRS) between treated salvageable and untreated salvageable patients with recombinant tissue plasminogen activator (rt-PA) was remarkably statistically significant (p=0.02). Treated salvageable patients had more favorable clinical outcomes as compared with the untreated salvageable patients. Patients who did not have baseline artery occlusion were associated with more favorable clinical outcomes than untreated salvageable patients (p<0.001). The difference between treated salvageable and patients without artery occlusion in 90 day mRS score was not statistically significant (p=0.058)., Conclusion: Baseline vessel status evaluated by MRA may be used as the first factor ahead of mismatch to categorize acute ischemic stroke patients into subgroups. Patients who do not have initial vessel occlusion may not need thrombolytic therapy.

Background: Magnetic resonance elastography (MRE) is a recently developed imaging technique that can directly visualize and quantitatively measure tissue elasticity., Purpose: To evaluate the safety of brain MRE on human subjects., Material and Methods: The study included 20 healthy volunteers. MRE sequence scan (drive signal not applied to external force actuator) and MRE study were separately performed on each volunteer at an interval of more than 24 hours. The heart rate and blood pressure of each volunteer were measured immediately before and after MRE sequence scan and MRE study. Electroencephalography (EEG) was also performed within 2 hours after each scan. The volunteers were asked about their experience of the two scans. Randomized-block analysis of variance (ANOVA) was used to analyze the data of blood pressure and heart rate. Paired t test was used to analyze the data of the two EEG examinations. The volunteers were followed up 1 week after the examination., Results: All procedures were performed on each volunteer, and no one complained of obvious discomfort. No related adverse events were reported during follow-up. There was no statistically significant difference in heart rate or blood pressure. There was a statistically significant difference (P<0.05) in EEG results in the right temporoparietal region. Increased power was found in the theta, delta, alpha, and beta2 bands. No brain injury was detected by the EEG examinations., Conclusion: Based on the study results, brain MRE examinations are safe to perform on human subjects.

Objective: To study the clinical value of 1H-magnetic resonance spectroscopy (1H-MRS) in differential diagnosis of brain low-grade gliomas and demyelinating diseases., Methods: 1H-MRS was performed in 24 patients with low-grade gliomas and 22 patients with demyelinating diseases and the results were retrospectively reviewed. The metabolites including N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr) were detected in different areas including lesions and the normal brain. The ratios of NAA/Cr, NAA/Cho, and Cho/Cr were also computed., Results: Compared with the normal brain tissue, low-grade gliomas and demyelinating diseases had significantly different ratios of NAA/Cr, NAA/Cho, and Cho/Cr (P < 0.05). The ratios of NAA/Cho and Cho/Cr were significantly different between low-grade gliomas and demyelinating diseases (P < 0.05), while the ratio of NAA/Cr was not significantly different (P > 0.05)., Conclusions: The ratio of NAA/Cho and Cho/Cr is remarkably different between low-grade gliomas and demyelinating diseases. It can a useful indicator for differential diagnosis of these two diseases by 1H-MRS.

Background and Purpose: The higher relaxivity of gadobenate dimeglumine compared with gadodiamide is potentially advantageous for contrast-enhanced brain MR imaging. This study intraindividually compared 0.1-mmol/kg doses of these agents for qualitative and quantitative lesion enhancement., Materials and Methods: Adult patients with suggested or known brain lesions underwent 2 identical MR imaging examinations at 1.5T, one with gadobenate dimeglumine and the other with gadodiamide. The agents were administered in randomized order separated by 3-14 days. Imaging sequences and postinjection acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images qualitatively for diagnostic information (lesion extent, delineation, morphology, enhancement, and global preference) and quantitatively for contrast-to-noise ratio (CNR)., Results: One hundred thirteen of 138 enrolled patients successfully underwent both examinations. Final diagnoses were intra-axial tumor, metastasis, extra-axial tumor, or other (47, 27, 18, and 21 subjects, respectively). Readers 1, 2, and 3 demonstrated global preference for gadobenate dimeglumine in 63 (55.8%), 77 (68.1%), and 73 (64.6%) patients, respectively, compared with 3, 2, and 3 patients for gadodiamide (P < .0001, all readers). Highly significant (P < .0001, all readers) preference for gadobenate dimeglumine was demonstrated for all qualitative end points and for CNR (increases of 23.3%-34.7% and 42.4%-48.9% [spin-echo and gradient-refocused echo sequences, respectively] for gadobenate dimeglumine compared with gadodiamide). Inter-reader agreement was good for all evaluations (kappa = 0.47-0.69). Significant preference for gadobenate dimeglumine was demonstrated for all lesion subgroup analyses., Conclusion: Significantly greater diagnostic information and lesion enhancement are achieved on brain MR imaging with 0.1-mmol/kg gadobenate dimeglumine compared with gadodiamide at an equivalent dose.

Background: Regions prone to atherosclerosis, such as bends and bifurcations, tend to exhibit a certain degree of non-planarity or curvature, and these geometric features are known to strongly influence local flow patterns. Recently, computational fluid dynamics (CFD) has been used as a means of enhancing understanding of the mechanisms involved in atherosclerotic plaque formation and development., Purpose: To analyze flow patterns and hemodynamic distribution in stenotic carotid bifurcation in vivo by combining CFD with magnetic resonance angiography (MRA)., Material and Methods: Twenty-one patients with carotid atherosclerosis proved by digital subtraction angiography (DSA) and/or Doppler ultrasound underwent contrast-enhanced MR angiography of the carotid bifurcation by a 3.0T MR scanner. Hemodynamic variables and flow patterns of the carotid bifurcation were calculated and visualized by combining vascular imaging postprocessing with CFD., Results: In mild stenotic cases, there was much more streamlined flow in the bulbs, with reduced or disappeared areas of weakly turbulent flow. Also, the corresponding areas of low wall shear stress (WSS) were reduced or even disappeared. As the extent of stenosis increased, stronger blood jets formed at the portion of narrowing, and more prominent eddy flows and slow back flows were noted in the lee of the stenosis. Regions of elevated WSS were predicted at the portion of stenosis and in the path of the downstream jet. Areas of low WSS were predicted on the leeward side of the stenosis, corresponding with the location of slowly turbulent flows., Conclusion: CFD combined with MRA can simulate flow patterns and calculate hemodynamic variables in stenotic carotid bifurcations as well as normal ones. It provides a new method to investigate the relationship of vascular geometry and flow condition with atherosclerotic pathological changes.

Purpose: To investigate the potential value of magnetic resonance elastography (MRE) in evaluating the consistency of brain tumors., Material and Methods: Six patients with known solid brain tumor underwent brain MRE studies. Consistency of brain tumors was evaluated at surgery. Correspondence of MRE evaluation with operative result was studied., Results: The elasticity of tumors in six patients evaluated by MRE agreed with the tumor consistency given by the operative results., Conclusion: MRE could be used as an imaging technique for noninvasive assessment of the consistency of brain tumor in vivo.

Objective: To study the mechanisms of Tongxia Huayu Decoction (a Chinese herbal decoction for purgation and removing blood stasis) in prognostic improvement for severe acute pancreatitis by early intervention on pancreatic microcirculatory disturbance., Methods: Fifty-three patients with severe acute pancreatitis were divided randomly into treatment group (n=28) and control group (n=25). Tongxia Huayu Decoction was given to the patients in treatment group in addition to the normal treatment in control group for one week. The clinical symptoms and signs, hemodiastase, urinary amylase, C-reactive protein (CRP) and endothelin (ET) of the patients in the two groups before and after treatment were observed and detected., Results: The total response rate of the treatment group was 98.4%, while that of the control group was 80%, with significant difference between them (P<0.05). There was no significant difference of the contents of hemodiastase, urinary amylase, CRP and ET between the two groups before treatment, while they were significantly decreased after treatment (P<0.01) with more obvious change in treatment group (P<0.01)., Conclusion: Tongxia Huayu Decoction brings satisfied therapeutic effect on severe acute pancreatitis. The mechanisms may associate with its reducing function on ET releasing so as to inhibit the pancreatic microcirculatory disturbance and acinar cell injury induced by ET.

Purpose: To study the application of magnetic resonance elastography (MRE) in the human brain., Material and Methods: An external force actuator was developed, which produced propagating shear waves in brain tissue. A modified phase-contrast gradient-echo sequence was developed. The propagating shear waves within the brain were directly imaged. The wave images were processed to obtain the elasticity image. Shear waves at 100 Hz, 150 Hz, and 200 Hz were applied., Results: The propagating shear waves in the brain were visualized on wave images. The elasticity image revealed the difference in tissue elasticity between gray and white matter of the brain., Conclusion: MRE could be an imaging technique for assessing the elasticity of brain tissue.

Elasticity is an important physical property of human tissues. There is a tremendous difference in elasticity between normal and pathological tissues. Noninvasive evaluation of the elasticity of human tissues would be valuable for clinical practice. Magnetic resonance elastography (MRE) is a recently developed noninvasive imaging technique that can directly visualize and quantitatively measure tissue elasticity. This article reviewed the MRE technique and its current status.

Objective: To explore the role of preoperative blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) and diffusion tensor tractography (DTT) to identify the relationship between motor cortical area, pyramidal tracts with brain gliomas in neurosurgical treatment of intraoperative electrical stimulation for gliomas involving motor areas at 3T., Methods: Twenty-eight patients with brain gliomas involving motor areas were included. They underwent MRI examination, which included conventional T1WI, T2WI, BOLD-fMRI of bilateral hands movement paradigm and diffusion tensor imaging (DTI). The data of BOLD-fMRI and DTI were transferred to the workstation (Leonardo syngo 2003A, Siemens) and analyzed. Activation mapping of hands movement, fractional Anisotropy (FA) Color and three dimensional pyramidal tracts were produced. The relationship between motor cortical area, pyramidal tracts and brain gliomas was demonstrated, which was used to optimize the pre-surgical planning. With guidance of the result of BOLD-fMRI and DTT, all patients received microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations. The brain lesions were removed as far as possible in the case of eloquent areas and sub-cortical important white matters preservation. The preoperative and postoperative KPS of all patients were operated to evaluate the state of patients., Results: BOLD-fMRI, DTI were performed successfully in 28 patients. The relationship between the primary motor cortex, premotor area, supplementary motor area, pyramidal tracts and brain gliomas localized by preoperative fMRI and DTI. Under anaesthesia retaining consciousness, the primary motor area was monitored by the method of direct electrical stimulations with the guidance of preoperative BOLD-fMRI. There was good correlation between preoperative fMRI and intraoperative cortical stimulation. Furthermore, the preoperative mappings and DTT could make up for the un-monitored motor areas and pyramidal tracts during operative cortical stimulation. Comparing the preoperative KPS, the postoperative KPS was advanced., Conclusions: BOLD-fMRI and DTT could non-invasively localize the relationship between brain motor cortex, pyramidal tracts and brain gliomas in vivo to optimize the surgical planning, guide the microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations and remove brain tumors as far as possible in the case of eloquent areas and sub-cortical important white matters preservation.

Objective: To analyze the impact of hematoma location and vascular territory on the clinical symptoms and signs, neuroimaging findings, and clinical prognosis of striatocapsular hemorrhage., Methods: The data of 181 cases of striatocapsular hemorrhage, 124 males and 57 females, aged 28 - 89, including medical history, symptoms, and signs were analyzed. On the basis of hematoma locations and arterial territories, the striatocapsular hemorrhage was divided into six types: anterior type (with the blood supply from Heubner's artery), middle type (with the blood supply from medial lenticulostriate artery), posteromedial type (with the blood supply from anterior choroidal artery), posterolateral type (with the blood supply from posteromedial branches of lateral lenticulostriate artery), lateral type (with the blood supply from the most of lateral branches of lenticulostriate artery), and massive type (with the hematoma occupying the whole or greater part of striatocapsular region). The short-term clinical outcome and prognosis were evaluated by Modified Rankin Scale (MRS). The relationship between the type and outcome was analyzed., Results: There were 22 cases of anterior type, accounting for 12.15%, of which 68.18% showed an excellent outcome (MRS = 0 - 2) and only 1 case died. There were 12 cases of middle type, accounting for 6.63%, of which 6 cases (50%) showed a poor outcome (MRS = 5) but without dead case. There were 19 cases of posteromedial type (10.50%), of which 52.63% had excellent outcome (MRS = 0 - 2) without dead case. There were 19 cases of posterolateral type (18.78%), of which 76.47% were with poor outcome (MRS = 5) and 17.65% died. Accounting for 39.23%, lateral type was the most common condition, of which 38.03% patients had a poor outcome (MRS = 5) and 8.45% cases died. The incidence rate of massive type was also high (12.71%), of which 47.82% showed a poor outcome (MRS = 5) and 47.83% cases died., Conclusion: Hematoma location and vascular territory are the determinating factors of prognosis of striatocapsular hemorrhage. The six-type classification system provides a simple and reliable means to predict the clinical outcomes and to guide therapeutic options of striatocapsular hemorrhage.

Radon, an established lung carcinogen, remains the single most important environmental radiation exposure. Yet, an excess of lung cancer from breathing radon in homes has not been consistently demonstrated in studies conducted to date. To address several major problems that have hindered previous studies of lung cancer and radon in homes, we have embarked upon a lung cancer case-control study in Gansu Province, China, where a substantial proportion of the population live in underground dwellings. In this paper, we report on results of a pilot study in which radon measurements were made for 3 days in the summer in 40 homes under normal occupancy conditions using short-term E-PERM detectors and for 6 months from February through August in 49 homes using long-term alpha-track detectors. Useable E-PERM data were obtained from 38 homes and useable alpha-track data from 47 homes. For both types of detectors, measurements were approximately log-normally distributed. Arithmetic and geometric means were 233 and 185 Bq m-3 (range 74-1,590 Bq m-3) for E-PERM measurements and 165 and 158 Bq m-3 (range 74-592 Bq m-3) for alpha-track measurements, respectively; 68% of E-PERM measured homes and 55% of alpha-track measured homes exceeded 148 Bq m-3. Alpha-track measurements made at the entry, middle, and rear areas of the underground dwellings did not differ significantly (arithmetic means of 168, 162, and 165 Bq m-3 with standard deviations 63, 73, and 48, respectively), which suggests that air circulation may be minimal. The underground dwellings measured in the pilot study had high radon levels and the underground dwellers may provide an excellent population for studying indoor radon and risk of lung cancer.

This case demonstrated the classic gross pathologic, CT, and MR appearances of epidermoid tumors. The imaging features and differential diagnosis are summarized.

Intracranial vessels were evaluated in 600 patients with IADSA. Among them, 100 cases were studied with both conventional angiography and IADSA. The advantages of IADSA are: (1) Good image quality; (2) Examination time shortened; (3) Very useful for interventional neuroradiology, hence it can replace conventional cerebral angiography for preoperative evaluation in most cases.

The MRI findings of 6 small acoustic neuromas proved by surgery and pathology were analyzed in detail and compared with CT air cisternography. The MRI features of small acoustic neuromas include that small lesions produce thickening of the nerve or partial or entire filling of the internal auditory canal. In T1-weighted images, the tumor is of higher signal intensity than CSF, but is the same as the brain in T 2-weighted images, the tumor is brighter than the brain. MRI makes possible the diagnosis of small acoustic neuromas without subjecting the patients to invasive procedures or exposing them to X-radiation. Comparing MRI with CT air cisternography, we conclude that MRI is more convenient than CT and causes no postoperative complications.

CT findings of 17 patients with neuron migration anomalies, 5 with lissencephaly, 6 with schizencephaly and 6 with heterotopic gray matter were reviewed. Migratory anomalies are congenital malformations caused by insult to the neurons during the time of migration. CT is effective in detecting these malformations.

Organochlorine pesticides in cerumen were used as a biological marker to monitor the exposure of organochlorine pesticides in the human body. The amount of sample used was about 10 mg. The order of magnitude of HCH (hexachlorocyclohexane) isomer content in cerumen was beta greater than alpha greater than gamma greater than delta; for DDT, the order was p,p'-DDE greater than p,p'-DDT. There was little o,p'-DDT and p,p'-DDD. The contents of beta-HCH and p,p'-DDE in cerumen were highly significantly correlated with those in adipose tissue of the same individuals. Approximately 3800 cerumen samples collected from 35- to 54-year-old healthy adults in the general populations of 35 counties were analyzed for HCH and DDT. The accumulation levels of beta-HCH had a geographical character with obvious gradient differences, and the levels were higher in males than in females. The accumulation levels of beta-HCH in the populations studied were highly significantly correlated with the mortality rates from liver cancer, colon/rectum cancer, and lung cancer in males as well as colon/rectum cancer in females (P less than 0.01), suggesting that the effect of HCH on the above cancers should be studied further.

11 patients with angiographically occult intracranial vascular malformations proved by surgery and pathology were studied by magnetic resonance imaging (MRI). The chief MRI findings were: On T1-weighted imaging, there was a homogeneous or heterogeneous hyperintensity or isointensity signal at the centre of the lesion with a surrounding rim of hypointensity signal; On T2-weighted imaging, there was a hyperintensity signal at the centre and hypointensity signal at the peripheral region. Differential diagnosis between hemorrhagic tumor and occult vascular malformation lies in that the latter has no edema and is often single. comparing with CT, the size of occult vascular malformation on MRI was equal to that on CT.