With a low incidence and a non-specific clinical manifestation, medial medulary infarction (MMI) can often be misdiagnosed or missed diagnosis. Magnetic resonance imaging(MRI) played a major role in diagnosing the MMI. This article reviews the epidemiology, etiology, pathogenesis, clinical and imaging manifestations, diagnosis and differential diagnosis, and prognosis of MMI.

Objective To investigate relationship between urinary iodine level and thyroid diseases in Liaocheng city.Methods Level of serum TSH,FT3,FT4,TPOAb,TGAb and urinary iodine in thyroid disease group and normal control group was detected respectively.Results The median concentration of urinary iodine in normal control group in Liaocheng was 108μg/L.The median urinary iodine level in patients with thyroid dysfunction and thyroid nodal diseases was higher than that in normal control group(P<0.01).In patients with thyroid dysfunction and thyroid nodal diseases,the concentration of urinary iodine Was above 300μg/L and distribution frequency Was much higher than that in control group(P<0.01).There was no correlation between urinary iodine and thyroid function or thyroid nodule(P>0.05).Conclusions Iodine uptake in Liaocheng is sufficient.Additional uptake of iodine increases the incidence of thyroid diseases.Urine iodine detection helps to guide iodine supplementation in individual.

Objective To explore the treatment of laterognathism of the mandible.Methods Nineteen cases of laterognathism of the mandible were treated by Lefort Ⅰ osteotomy,sagittal split ramus osteotomy,genioplasty,anterior mandibular subapical osteotomy and prosthesis implantation,respectively,and their efficacy was evaluated and clinical experience summarized.Results The nineteen cases were followed up for average 12 months after the treatments and all the patients were satisfied with the surgical effects.All osteotomy lines healed well and there were no complications,such as root damage or neurotrosis.Conclusions The orthognathic procedure for laterognathism of the mandible should be selected according to the types and locations of asymmetry deformities.Anterior mandibular subapical osteotomy combined with mandibular cosmetic surgery for slight laterognathism of the mandible could achieve satisfactory results.

Objective To investigate the predictive value of plasma lipoprotein phospholipase A2 (Lp -PLA2 )and D -dimer in patients with hypertension complicated with stroke.Methods 70 hypertensive patients with stroke were selected as A group,72 patients with simple hypertension were selected as B group,and 71 healthy sub-jects were selected as C group.The light transmitting method was used to detect serum Lp -PLA2 ,and immunoturbi-dimetry was used to detect plasma D -dimer.The clinical value of the two joint detection and single detection in prediction of hypertension complicated with stroke was analyzed.Results The plasma Lp -PLA2 and D -dimer levels of A group were (471.88 ±181.49)ng/mL,(982.54 ±373.28)μg/mL,which were higher than those of B group[(195.17 ±34.74)ng/mL,(263.57 ±29.70)μg/mL]and C group[(122.94 ±46.25)ng/mL,(96.44 ± 8.49)μg/mL](F =189.7,171.1,all P =0.000).The plasma Lp -PLA2 level of A group was positively correlated with D -dimer(r =0.692,P <0.01).The plasma D -dimer >252g/mL forecast hypertension stroke risk sensitivity was 83.3% and specificity was 98.6%,the plasma Lp -PLA2 >176.36ng/mL forecast hypertension stroke risk sen-sitivity was 92.9% and specificity was 83.1%,and the combined prediction of hypertension stroke risk sensitivity was 87.6%,specificity was 93.5%.Conclusion The plasma levels of Lp -PLA2 and D -dimer are significantly increased in hypertensive patients with stroke,and the combined detection of the two indicators can improve the prediction of stroke risk in patients with hypertension.

Objective To study the influencing factors of the competing sentences test in normal-hearing adults, in order to provide references for the preparation of the competing sentences test with children and the development of the diagnostic tools of the central auditory processing disorders.Methods According to the three kinds of test tables of semantic competition, sentence constituent competition and phonetic competition for the competing sentences test, the 2×3×3 factors mixed experimental design were used to test the 48 normal-hearing adults(forty-six right-handed adults and two left-handed adults) with the competing sentences test.The correct rate was obtained and the influencing factors were analyzed.Results ①The average correct rate of the Competing Sentences Test for the forty-six right-handed normal-hearing adults was 94.98%,and for the two left-handed normal-hearing adults was 96.12%.②The right-handed subjects'' right ear accuracy rate was significantly higher than that of the left ear(P<0.01),while the accuracy rate of the left ear was obviously higher than the right ear with left-handed subjects.③The effects of genders on the results of the competing sentences test was not significant(P>0.05)with the right-handed subjects.④For the results of three types sentences,the correct rate of semantic competition was the highest, the second was the sentence constituent competition and phonetic competition was the lowest with the right-handed subjects.Conclusion No gender factors were found to affect the results of the competing sentences test among adults.The normal-hearing right-handed adults have the right ear advantage in the competing sentences test, prompting us to become concerned about the choice of the ear sides.Different competition types of sentences will have a greater impact on the difficulty of the competing sentences test, so we should pay more attention to this in the preparation of competitive sentences test tables.

Objective To ummarized the clinical characteristics of lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,so to improve the physician's treatment ability by summary the clinical feature of lactic acidosis combined with hypoglycemic coma,diabetic ketosis and hyperkalemia.Methods Analyzed the clinical characteristics and disease development of one case with lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,and reviewed literature.Results The patient had hypoglycemia and acidosis at the same time due to taking phenformin and glibenclamide.After 2 days,the patient was better through correcting acidosis,intravenous fluid therapy,lowering blood potassium and controlling blood glucose.Conclusion Because acidosis caused the potassium transfer from intracellular to extracellular,the latter leads to hyperpotassemia,lactic acidosis caused by phenformin should be treated with intravenous fluid therapy,correcting acidosis.

Objective To study the expression of chemokine receptor 5 (CCR5) in breast cancer and metastatic axillary nodes and the frequency of polymorphism CCR5-△32,and its effect on breast cancer metastasis.Methods Specimens were collected from Aug.2008 to Jun.2009 in Department of Breast and Thyroid Surgery,Liaocheng People's Hospital.The relative expression quantity of CCR5 mRNA was detected by real-time fluorescence quantitative PCR (RT-PCR),and polymorphism CCR5-△32 was tested by DNA electrophoresis.The data was processed by SPSS software.Results 1.The relative expression quantity of CCR5 mRNA was significantly higher in breast cancer tissues than in paracarcinoma tissues(P ＜ 0.01)and breast fibroadenoma tissues (P ＜ 0.05).The difference of relative expression quantity of CCR5 mRNA had statistical significance between breast cancer tissues in stage Ⅱ and Ⅲ(P ＜ 0.05 ),but not between breast fibroadenoma tissues and paracarcinoma tissues(P ＞0.05).2.The relative expression quantity of CCR5 mRNA was significantly higher in metastatic axillary nodes than in nonmetastatic nodes (P ＜ 0.05 ).3.Polymorphism CCR5-△32 wasn't found in any specimen.4.The relative expression of CCR5 mRNA had connection with breast oncogene C-erbB-2 and whether there was axillary lymph node metastasis,but no connection with other immunological and biochemical indicators.Conclusions CCR5 mRNA is significantly higher expressed in breast cancer and metastatic axillary nodes.The interaction between CCR5 and its ligands promotes the progress of breast cancer and axillary lymph node metastasis.CCR5 can be taken as a molecular indicator to predict axillary lymph node metastasis in breast cancer and provides new targert for clinical therapy.

Objective To investigate the effects of endogenous estrogen on blood glucose level,serum insulin level,and plasma total antioxidant capacity in streptozotocin-induced diabetic female mice,and to explore possible protective effects of estrogen on pancreatic islet cells.Methods Female mice were randomly according to body weight divided into four groups:( 1 ) Sham( Sham operation and vehicle administration) ; ( 2 ) Ovx( ovariectomy and vebicle administration ) ; ( 3 ) Sham + STZ ( Sham operation and STZ administration ) ; and ( 4 ) Ovx + STZ ( ovariectomy and STZ administration).The diabetic mice were induced by intraperitoneal injection of streptozotocin (STZ,50 mg/kg ).Blood glucose levels were measured once a week.Results The blood glucose level and malondialdehyde of Ovx group were higher than that in Sham group,while total anti-oxidant capacity ( T-AOC ) was lower than those in Sham group.the blood glucose level and MDA of Ovx+ STZ group were higher than those in Sham +STZ group,while T-AOC and serum insulin level were lower than those in Sham + STZ group.Conclusions Endogenous estrogen may have some protective effects on pancreatic islet function from streptozotocin-induced diabetes mellitus in female mice.

The clinical manifestation of vertebrobasilar dolichectasia (VBD) changes with the different degree of expansion and extension,including ischemic stroke,transient ischemic attack,hemorrhagic stroke,cerebral nerve and brainstem compression symptoms,and hydrocephalus.At present,the diagnosis of VBD mainly relies on CT,MRI multimodal imaging,and there are more complete diagnostic criteria.Because of the low incidence of VBD,the analysis of its clinical characteristics is helpful for early detection and early treatment in clinical practice,so as to improve the prognosis of patients.

Objective To explore rationale and clinical application of simplified modified radical thyroideetomy for differentiated thyroid carcinoma.Methods From Jan.2007 to Jun.2010,349 cases of differentiated thyroid carcinoma received simplified operative procedure based on standard modified radical thyroidectomy.The simplified procedure took a low small collar incision(about 10-12 cm).In separating upper and lower skin flaps,subcutaneous tissues covering posterior triangle of neck and posterior edge of sternoeleidomastoid muscle were spared to protect sensory nerves.Subtotal thyroidectomy Was performed to resect the affected lobe,isthmus,and the majority of opposite lobe without considering the size of primary tumor or whether metastasis to the neck lymph nodes happened.Soft tissues of the mainly metastatic areas(Ⅱ a、Ⅲ、Ⅳ、Ⅴb)were cleared.The accessory nerve was not exposed routinely to avoid stimulation.Lymph nodes metastasis in different areas was recorded respectively.Complications in different operative modes were compared.Results Compared with standard modified radical thyroidectomy,the simplified mode had shorter scar-and no limit of neck mobility.Because of muscles and nerves pemervation,movement dysfunction and abnormal sensation of neck and shoulder decreased obviously.The operation duration was shortened.Cervical lymph node status Was evaluated,which provided basis for prognosis judgment and comprehensive treatment.Conclusions The simplified modified radical procedure has the benefit of decreased trauma while maintains the similar recurrence rate compared to modified radical thyroidectomy.It improvs the life quality of patients.This procedure fits the principle of functional radical neck dissection better.