Expression of FGF-2 and IGF-1 in diabetic rats with fracture

Objective:To observe the change of fibroblast growth factor-2(FGF-2),insulin-like growth factor-1(IGF—1)in serum and bone callus after fracture in diabetic rats,and to explore molecular biological mechanism of healing of diabetic fracture.Methods:Thirty male SD rats were designed into normal(n=13)and control(n=!5)groups randomly.Venous blood was extracted on the 1st,2nd,4th,6th,8th week after surgery.It was certificated and the serum was obtained.Left lower extremity was observed by X-ray.Bone callus at broken ends was observed under light microscope.Expressions of FGF-2 and 1GF-1 in tissue were detected by immunohistochemistry method,and ELISA was used to detect expression of FGF-2 and IGF-I in serum.Results:The results showed a significant increase in the density and area of newly formed bone in the distraction gaps of normal rats compared to control rats.Increased cell proliferation was also found in the distraction gaps of normal rats versus control rats.There was significant difference in serum levels of FGF-2 and IGF-1 between two groups.Conclusions:The decrease of FGF-2 and IGF-1 both in the serum and in the fracture region is one of the reasons for bad bone healing or delayed union in rats'fracture with diabetes.There are some synergistic effects possibly between FGF-2 and ICF-I.

MRI and diffusion tensor imaging in assessing correlation of activation of cortical motor function and manifestations of corticospinal tract with muscle strength in patients with ischemic stroke

BACKGROUND： Ischemic stroke is often followed by the abnormalities of neurons and corticospinal tract, which can lead to corresponding clinical symptoms and signs. Recently, with the continuous perfection of high-field MRI instrument, it becomes possible to assess and investigate the cortical function and structural reconstruction following stroke by using MRI and diffusion tensor imaging （DTI）. OBJECTIVE： To observe the cortical motor function and changes of corticospinal tracts by using MRI and DTI in the patients with ischemic stroke at acute period, compare with the normal subjects, and assess the damage of corticospinal tract and muscle strength.DESIGN ： A case-control observation.SETTING： Department of Medical Imaging, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS ： Nine inpatients （5 males and 4 females） with injury of motor function induced by acute ischemic stroke were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between August and December in 2005, they aged 16-87 years with an average of 51 years old, and those with obvious conscious disturbances and severe cognitive disorders were excluded. At the same time, nine healthy right-handed physical examinees matched by age and gender with the patients were also selected, and they all had no nervous disease, epilepsy, mental diseases, cerebrovascular abnormalities and injury history, etc. All the subjects were informed with the detected items and agreed to participate in. METHODS： All the 9 patients with ischemic stroke at acute period and 9 healthy subjects were examined with MRI and DTI.① A block-based design was used in the MRI, the passive finger-to-finger exercise was used as the stimulative task, and the static condition was taken as the baseline task. The GE 1.5T MRI system was used, all the data were processed after off-line, and analyzed with the SPM2 software, the association between the activated area and local anatomy of brain was observed. ② The DTI image was processed with the dTV.Ⅱ.R1 software part of the anisotropic image and color anisotropic image were shown, and the three-dimensional white matter image of bilateral corticospinal tracts of the patients were reconstructed. ③ The muscle strength of the affected hand of the stroke patients was judged with the Brunnstorm standard. MAIN OUTCOME MEASURES： The manifestations of MRI, DTI and corticospinal tracts of the 9 stroke patients were mainly observed. RESULTS： All the 9 stroke patients and 9 healthy subjects were involved in the analysis of results. ① Results of MRI examination： The handed exercise of the healthy subjects mainly activated contralateral sensorimotor cortex, posterior parietal cortex and bilateral supplementary motor areas. For the exercise of ipsilateral hand of 7 stroke patients, contralateral sensorimotor cortex was weakly activated, but ipsilateral posterial parietal cortex was obviously activated, and the activation of cerebrum was observed in 3 of them. For the other two patients, bilateral sensorimotor cortexes were activated during the exercise of ipsilateral hand, and the ipsilateral activated area was greater than the controlateral one. The exercise of contralateral hand activated contralateral sensorimotor cortex, posterior parietal cortex and contralateral supplementary motor area, and no obvious ipsilateral activated area was observed.② Results of DTI examination： The anisotropic values of the infarcted area were obviously lower than those of the contralateral part （t=4.570, P 〈 0.01）. the anisotropic value of the infarcted area were obviously was obviously correlated with bilateral muscle strength （t=0.888, P 〈 0.05）. ③ Results of the examination for corticospinal tracts： The reconstruction of bilateral corticospinal tracts, contralateral anatomic form were generally identical with those of normal subjects, the consistency of each continuous form from anterior central gyrus downward to internal capsule to bridge of varolius and bulbus medullae. Because of the involvement of infarcted area to different extent, ipsilateral corticospinal tract was manifested by the interruption of succession and loss of consistency of anatomic structural form. The severity for the injury of corticospinal tract was markedly correlated with the muscle strength of the ipsilateral hand （r=0.888, P 〈 0.05）. CONCLUSION ： ① The MRI manifestations of stroke patients during the exercise of affected hand are different from those of normal subjects, suggesting that there is compensation and reconstruction of brain function.② DTI examination is good for the judgement of the correlation between the damaged severity of infarction and muscle strength.③The damaged severity of corticospinal tracts is correlated with muscle strength, and it can be used to judge the prognosis of rehabilitative treatment.

Changes in brain function and anatomical structure following treatment of hyperbaric oxygen for visual pathway abnormalities in 16 cases Evaluation of functional magnetic resonance imaging combined with diffusion tensor imaging

BACKGROUND： There is a growing research focus on the combination of blood oxygenation level dependent functional magnetic resonance imaging （BOLD-fMRI） and diffusion tensor imaging （DTI） to evaluate visual cortical function and structural changes in the cerebrum, as well as morphological changes to the white matter fiber tracks, after visual pathway lesions. However, the combined application of BOLD-fMRI and DTI in treating of visual pathway abnormalities still requires further studies. OBJECTIVE： To observe and evaluate the effects of hyperbaric oxygen on visual pathway abnormalities, and to evaluate the characteristics of cerebral function and anatomic structural changes by using BOLD-fMRI combined with DTI technique. DESIGN： Case contrast observation. SETTING： Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS： Sixteen patients （9 males and 7 females, 15-77 years old） with lateral or bilateral visual disorder induced by visual pathway lesions were selected from the Department of Neurology, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January 2006 to May 2007. These patients comprised the lesion group. Measures of interventional therapy： hyperbaric oxygen of two normal atmospheres for three courses （10 d/course） and routine internal medicine treatment. In addition, 12 healthy subjects of similar sex and age to the lesion group were regarded as the control group. The control group underwent routine ophthalmological and ocular fundus examinations; diagnostic results were normal. The experiment received confirmed consent from the local ethic committee, and all patients provided informed consent. METHODS： BOLD-fMRI and DTI manifestations in the lesion group were observed before and after hyperbaric oxygen intervention, and the results were compared with the control group. The subjects were positioned on their back, and BOLD-fMRI images were collected with the following GRE EPI sequence： TR = 2 000 ms, TE = 40 ms, layer thickness = 5 mm, and 20-layer successive scanning to cover the whole brain. While, DTI images were collected with SE EPI sequence of single excitation： TR=10 000 ms, TE = 112 ms, layer thickness = 4 mm, layer spacing = 0.5 mm, and a 30-layer successive scanning, matrix = 128×128. A diffusion gradient was applied at 13 directions, and one layer without diffusion weighted imaging was collected at b =1 000 s/mm^2. Numbers of activated voxels in cortical-activated regions, and fractional anisotropy in bilateral cerebral optical radiation regions, were calculated. Displacement, continuity, and destruction of fibrous tracts were analyzed. MAIN OUTCOME MEASURES： Results of BOLD-fMRI and DTI examinations. RESULTS： All 16 patients and 12 controls were included in the final analysis. ① Numbers of activated voxels through the use of BOLD-fMRI： prior to hyperbaric oxygen therapy, the number of activated voxels in the bilateral cortex of occipital lobe were significantly less in the lesion group than in the control group （t =3.23, P 〈 0.01）. In addition, the number of activated voxels significantly increased after treatment compared to before treatment （t = 2.46, P 〈 0.05）. ② Fractional anisotropy in optical radiation regions of bilateral cerebrum： fractional anisotropy in the lesion group was significantly less than the control group （t =2.89, P 〈 0.05）. In addition, fractional anisotropy after treatment was significantly higher than before treatment （t = 2.48, P 〈 0.05）. Moreover, fractional anisotropy of optical neuropathy was significantly higher in 6 patients in the lesion group than the occipital lobe optical central lesion （t = 2.35, P 〈 0.05）. CONCLUSION： BOLD-fMRI combined with DTI can indicate the occurrence, development, and therapeutic course of action for optical pathway lesions. The results acquired from these methods can provide information for function and structure, which can provide reliable verification in the treatment of cerebral function.

Observation of activation status of motor-related cortex of patients with acute ischemic stroke through functional magnetic resonance imaging

BACKGROUND： About more than three fourth of patients with stroke have motor dysfunction at different degrees, especially hand motor dysfunction. Functional magnetic resonance imaging （fMRI） provides very reliable visible evidence for studying central mechanism of motor dysfunction after stroke, and has guiding and applicable value for clinical therapy. OBJECTIVE： To observe the activation of motor-related cortex of patients with acute ischemic stroke with functional magnetic resonance imaging, and analyze the relationship between brain function reconstruction and motor restoration after stroke. DESIGN ： A contrast observation SETTING： Medical Imaging Center, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS ： Nine patients with acute ischemic stroke who suffered from motor dysfunction and received the treatment in the Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between August and December 2005 were recruited, serving as experimental group. The involved patients including 5 male and 4 female, aged 16 to 87 years, all met the diagnostic criteria of cerebrovascular disease revised by The Fourth National Conference on Cerebrovascular Disease, mainly presenting paralysis in clinic, and underwent fMRI. Another 9 right handed persons matched in age and gender who simultaneously received healthy body examination were recruited, serving as control group. All the subjects were informed of the detected items. METHODS ： ①Muscular strength of patients of the experimental group was evaluated according to Brunnstrom grading muscular strength （Grade Ⅰ -Ⅳ）. ②Passive finger to finger motion was used as the mission （alternate style of quiescence, left hand motion and quiescence, nght hand motion was repeated 3 times, serving as 1 sequence, 20 s per block and 20 s time interval. The whole process of scanning was 260 s）, and subjects of 2 groups were given Bold-fMRI examination with GEl .5T double gradient 16-channel magnetic resonance imaging system. All the data were given off-line management, and fMRI was treated with SPM2 softwere. The activation of passive finger-to-finger motion-related cortex of subjects in 2 groups was observed. ③ Results of fMRI of subjects in 2 groups were compared. The size of activation region of brain and signal intensity were measured and unilateral index was calculated. The data of activation region of cerebral hemisphere of different sides at finger motion were given statistical analysis of unilateral index. Differences among unilateral indexes at hand motion were compared between intact and affected hands of patients in experimental group. The relationship between unilateral index and muscular strength of affected hands at affected hand motion in patients of the experimental group was performed Spearman correlation analysis. MAIN OUTCOME MEASURES： ① The activation of motion-related cortex passive finger-to-finger motion between handedness and non-handedness was detected with functional magnetic resonance imaging of subjects in 2 groups. ②Relationship between unilateral index and muscular strength of subjects of experimental group at affected hand motion. RESULTS： Nine patients with ischemic stroke and 9 controls all participated in the final result analysis. ① Passive fMRI detection results between handedness and non-handedness of controls： Right-handed finger-to-finger motion of subjects of control group mainly activated contralateral sensonmotor cortex, and left-handed finger-to-finger motion not only activated above-mentioned brain region, but also activated supplementary motor area （SMA） of contralateral brain region; ②In the experimental group, sensorimotor cortex of contralateral hemisphere was activated at affected hand motion, and homolateral posterior parietal cortex （PPC）was also obviously activated. Bilateral sensonmotor cortex was activated at affected hand motion in 2 patients, and homolateral activation area was larger than contralateral one. At intact hand motion, contralateral sensorimotor cortex was activated, but no obvious homolateral activation area was found. ③ Correlation of unilateral index with muscular strength： Passive finger-to-finger fMRI （ between affected and intact hands of subjects of experimental group： Unilateral index at passive single finger motion of affected and intact hand of subjects of experimental group was -0.018±0.01 and 0.319±0.187, respectively, with significant difference （t=4.059, P 〈 0.01 ）. Unilateral index was significantly positively correlated with the muscular strength of affected hand at affected hand motion（r=0.834, P 〈 0.05）.CONCLUSION ： ①fMRI can objectively shows different activation states of motor cortex between patients with ischemic stroke and healthy controls, and brain functional compensation and recombination exist. Both primary sensorimotor cortex and SMA of bilateral hemispheres participant in affected hand motion, at the same time, parietal lobe and cortex of intact side also obviously participant in the affected hand motion. ②Correlation analysis of unilateral index and muscular strength of affected hand performed through fMRI can be used as an effective means to investigate the relationship between motion rehabilitation and brain functional recombination after stroke.

Evaluation of corticospinal tract injury with three-dimensional diffusion tensor tract in patients with acute cerebral infarction

BACKGROUND:Three-dimensional diffusion tensor tract(DTT)is the newest imaging to describe the structure of white matter fiber in three-dimensions,it has great significance in dividing the concrete anatomic site of gray and white matter lesions,displaying the correlation with fibrous band and judging clinical prognosis,which is incomparable by other imagings.OBJECTIVE:To observe the conditions of corticospinal tract(CST)in acute cerebral ischemic stroke patients,and analyze the relationship between motor function and the severity of CST injury.DESIGN:A case-control observation.SETTING:Department of Medical Imaging,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS:Fifteen patients with acute cerebral infarction were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February to December in 2005.They all suffered from acute attack and motor disorder of hemiplegic limbs to different extent,and were conformed by CT or MRI.There were 9 males and 6 females,aging 16-87 years old,the median age was 51.7 years,and all were right handed.Fifteen right-handed normal subjects,who were matched by age and sex with the patients in the cerebral infarction group,were selected from the relatives of patients and physicians of the Imaging Department as the control group.All the subjects were informed and agreed with the study.METHODS:The patients with acute cerebral infarction and subjects in the control group received MR diffusion tensor imaging(DTI)with GE 1.5 T nuclear magnetic resonance system,fiber tracking with the software of dTV-Ⅱ.Fractional anisotropy(FA)maps and three-dimensional tractography of bilateral CST of all patients were created.Displacement,continuity and destroy of fibrous bands were observed.At the same time,muscle strength of ipsilateral hand of patients with cerebral infarction was measured with Brunnstrom standard.The correlation between the severity of CST injury and the muscle strength of ipsilateral hand was analyzed with spearman correlation analysis.MAIN OUTCOME MEASURES:①FA values in the infarcted sites and those in the contralateral corresponding sites of patients with cerebral infarction;②CST manifestations in the patients with cerebral infarction and the control group.RESULTS:All the 30 testees were involved in the analysis of results.①The FA values in infarcted sites of white matter were significantly lower than those in the contralateral ones(t=4.570,P<0.001).②In the control group,bilateral CST were reconstructed,they originated from precentral gyrus,went downwards to internal capsule,and extended to pontine and medulla oblongata,each fiber had good uniformity in continuous form.In the patients with cerebral infarction,the forms of contralateral CST were consistent with those in the control group with good continuity.Due to the involvement by the infarcted site to different extents,the ipsilateral CST manifested as continuous interruption and loss of uniformity in anatomic structure and form.The CST involvements were divided into three grades:integrated CST for grade 1(n=2);integrated CST but compressed or displaced for grade 2(n=5);interrupted CST for grade 3(n=8).③The severity of CST injury was obviously correlated with the muscle strength of the ipsilateral hand(r=0.888,P<0.05).CONCLUSION:①CST is injured to different extents in patients with acute cerebral infarction,and the severity of injury is associated with muscle strength.It is indicated that it can be used to judge the prognosis of rehabilitative treatment.②DTT can directly display the status of pyramidal tract more three-dimensionally.

Correlation between muscular strength and basal nuclei ischemic/hemorrhagic stroke-induced corticospinal tract injury,as detected by diffusion tensor imaging and tractography

BACKGROUND： Conventional neuroimaging diagnosis does not assist with the monitoring or evaluation of basal nuclei ischemic and hemorrhagic stroke, or motor functional recovery. Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography have all been used to observe features of cerebral white matter fibrous structures. In addition, diffusion tensor tractography is the only non-invasive imaging method to display the corticospinal tract in vivo. OBJECTIVE： To evaluate the impairment degree of corticospinal tract induced by basal nuclei ischemic and hemorrhagic stroke through the use of magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography, and to analyze the correlation to muscular strength. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the Department of Medical Imaging, Neurology and Neurosurgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between November 2002 and June 2008. PARTICIPANTS： A total of 15 patients with acute or subacute cerebral ischemic stroke and nine with hemorrhagic stroke in the basal nuclei were selected. METHODS： Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography results and data were analyzed. Fractional anisotropy and directionally encoded color maps were obtained. Three-dimensional tractography of bilateral corticospinal tract was created, and corticospinal tract integrity was graded. Fractional anisotropy of infarct region and corresponding contralateral normal regions were measured, and hematoma volume in hemorrhagic stroke patients was determined. Hand motor function ability was evaluated using Brunstorm criteria. MAIN OUTCOME MEASURES： Fractional anisotropy of infarct region and corresponding contralateral normal regions; hematoma volume in hemorrhagic stroke patients; correlation between muscular strength and corticospinal tract impairment degree in ischemic stroke and hemorrhagic stroke patients before and after treatment. RESULTS： In ischemic stroke patients, the fractional anisotropy value was significantly lower in the infarct area of white matter than in the normal hemisphere （P 〈 0.01）. The impairment degree of corticospinal tract negatively correlated with muscular strength of the corresponding hand （r = -0.97 P 〈 0.01）. The hematoma volume of hemorrhagic stroke patients significantly negatively correlated with Spearman test results for muscular strength of the corresponding hand （r = -0.88, P 〈 0.01）. CONCLUSION： Corticospinal tract impairment severity negatively correlated with muscular strength and motor functional recovery, which suggested that diffusion tensor imaging and diffusion tensor tractography could be used to evaluate corticospinal tract motor function.

Clinical Study on the Treatment of Knee Osteoarthritis of Shen(肾)-Sui(髓) Insufficiency Syndrome Type by Electroacupuncture

Objective： To study the clinical efficacy of electroacupuncture （EA） on treating knee osteoarthritis （KOA） of Shen （肾）-Sui （（肾） insufficiency （SSI） syndrome type. Methods： A total of 245 patients （279 knees） of KOA-SSI were randomly assigned to two groups by lottery： 141 knees in the treatment group and 138 knees in the control group. The treatment group was managed with EA at the dominant points of Neixiyan （Ex-LE4） and Waixiyan （Ex-LE5） as well as the conjugate points of Xuanzhong （GB39） and Taixi （KI3） for 30 min, once a day, with 15 days as one course; 2 courses were applied with a 5-day interval in between. The control group was treated with intra-articular injection of 2 mL hyaluronic acid into the affected joint every 7 days for 5 times in total. The clinical effects on the patients in different stages were observed, and their symptom scores of knee and contents of cytokines, including interleukin-1 （IL-1）, interleukin-6 （IL-6）, tumor necrosis factor- α （TNF- α）, prostaglandin E2, （PGE2α） and matrix metalloproteinases-3 （MMP-3）, in the knee joint fluid were measured before and after treatment. Results： The study was completed in 235 patients （263 knees）; four patients （7 knees） in the treatment group and six patients （9 knees） in the control group dropped out. Comparison of therapeutic effects （excellent and effective rates） between the two groups showed insignificant differences （P〉0.05）. Symptom scores of knee and contents of cytokines in the knee fluid after treatment were lowered significantly in the patients of stage Ⅰ -Ⅲ in both groups （P〈0.05 or P〈0.01）. However, the lowering of the total symptom score of knee in the patients of stage Ⅲ in the treatment group was more significant （P〈0.05）. Conclusions： EA could effectively alleviate the clinical symptoms in KOA patients of stage m, showing an effect superior to that of hyaluronic acid. EA also shows action in suppressing the secretion of IL-1, IL-6, TNF-α, PGE2α and MMP-3 in the knee fluid.