Gastrointestinal bleeding is a common acute and critical illness that may result in hemorrhagic shock.In conventional concept, sufficient blood transfusion to ensure volume resuscitation was necessary for this emergency condition.With the propose and application of restrictive transfusion strategy in clinical practice, the new concept has been applied in patients with gastrointestinal bleeding.Restrictive transfusion strategy could maintain the perfusion of vital organs with a minimized blood transfusion, and avoiding the coagulopathy and acidosis caused by massive transfusion.This article reviewed the advances in study on gastrointestinal bleeding and restrictive transfusion strategy.

Objective To evaluate whether dynamic contrast enhanced-MRI (DCE-MRI) can help clinicians in differentiating malignant tumors from benign lesions and in predicting and correlating the histologic grade for breast cancer patients.Methods DCE-MRI from 98 patients (with histopathological confirmation) in our department were retrospectively analyzed.In the first dynamic phase,the hot and cold spot ROIs were selected as the regions with maximum and minimum Slopein,respectively.The kinetic characteristics (including hot spot,cold spot,and heterogeneous characteristics) and morphologic features were evaluated.The ROC curve analysis was used to test the diagnostic power of all DCE-MRI parameters (inflow slope,Slopein ; washout slope; inflow slope ratio; washout slope ratio; time-signal intensity curve shape; rim enhancement; internal homogeneity) for differentiating malignant tumors from benign breast lesions.Joncheere-Terpstra test was adopted to analyze the kinetic data.Categorical data were analyzed by using the Fisher test.Results Hot spot Slopein might have the biggest area (0.620) under the ROC curve (but not significant) among all the different MRI parameters(P ＞ 0.05).Its sensitivity,specificity,positive predictive value,negative predictive value were 63.2％ (55/87) and 72.7％ (8/11),respectively.The cold spot parameter Slopein(P =0.025),heterogeneity parameter ratio-in (P =0.031),and internal homogeneity (P =0.032) showed a significant correlation with histologic grade.The median and quartile of cold spot Slopein in pathologic Ⅰ,Ⅱ,and Ⅲ were 6.1 × 10-3,5.4 × 10-3 and 1.4 × 10-3,respectively;inflow slope ratio:6.6,9.8 and 17.6 ; pathologic Ⅰ,Ⅱ,and Ⅲ showed 2,1,and 0 patients with homogeneity enhancement,respectively ; intermediate enhancement:5,12,and 2 patients,respectively;heterogeneity enhancement:2,6,and 8 patients.Conclusions The DCE-MRI is a potential tool in helping clinicians to predict the histologic grading in breast cancers.Parameter hot spot Slopein might help differentiae malignant tumors from the benign counterpart.

Background and purpose:Medulloblastoma(MB),which is a primitive neuroectodermal tumor(PNET),is the most common malignant brain tumor of childhood.The mean age at diagnosis is 6 years.Due to the tremendous improvements in techniques of radiotherapy and chemotherapy,the 5-year overall survival(OS) is increased to 70% now,compared with 20% in the 1970s.Factors which include local relapse,whether or not there has occurred metastases before resection,residual tumor and age etc.are mostly considered to have significant effects on prognosis.We studied the effects and side effects of the three dimensional conformal radiation therapy(3D-CRT) for the children with medulloblastoma,and summarized the reasons of failure of the therapy.Methods:From August 2001 to August 2007,34 children with medulloblastoma were treated in our hospital.Among all the patients(3-16 years,mean age was 9.5 years) there were 16 cases in high-risk group,and 18 cases in low-risk group.All of them underwent total or subtotal resection before radiation therapy.Patients were not given radiotherapy and chemotherapy before surgery.The interval between surgery and radiotherapy was less than 3 weeks.The 3D-CRT was done for all the patients with the same techniques:30 Gy to the whole cranialspinal axis followed by a boost of 20-25 Gy to the posterior fossa,witha median fraction dose of 180 cGy.Chemotherapy was given according to the protocol which consisted of lomustine,cisplatinum and vincristine after radiotherapy,but the patients were not given intrathecal chemotherapy.Blood counts and chemistries and renal and hepatic evaluations were performed regularly before every course.Results:5-year OS and 5-year event free survival(EFS) were 71% and 62% respectively.The mean follow-up was 36.5 months.The 5-year OS of the high risk group and low risk group were 88.9% and 50.0% respectively.There was significant difference between them(P=0.01).13 patients were failures.Of all failure patients,3 had recurrence in the region of the cribriform plate.The complete remission was 70.5%,and the partial remission was 14%.If metastases were found before surgery,the 5-year OS was 12.5%(1/8),and if the residual tumor was more than 1.5 cm3,the 5-year OS was 0%(0/5).Whether or not the metastases were found before surgery,and the presence of residual tumor,both had significant impacts on the prognosis of the children with medulloblastoma(P

Objective To compare the effects of hypertonic saline,acetic acid and acetic acid-hypertonic saline(AAHS) solution on the ablated volume produced by hepatic radiofrequency ablation(RFA) in rabbits in vivo,and to determine the optimal synergist for radiofrequency ablation.Methods Thirty big-ear white rabbits were equally divided into group A(RFA alone),group B(RFA with 36% NaCl injection),group C(RFA with 50% acetic acid injection),group D(RFA with 50% AAHS injection),group E(50% AAHS injection alone),and group F(36% NaCl injection alone),with five rabbits in each group.Follow-up exam with CT scanning was made.The experimental rabbits were sacrificed by stages.The livers were collected and fixed in 10% formalin.Both the longitudinal and transverse diameter of the necrosis lesion produced by radiofrequency ablation were measured,the results were compared among groups.Results The difference in the lowest impedance value between group A and other groups was statistically significant(P 0.997).The persistent time of group A was significantly shorter than that of both group B and group D(P

Objective To discussion the efficacy and safety of single channel and double chinese -made biliary stent in high biliary malignant hilar obstructive jaundice .Methods We reviewed the clinical data of 24 malignant hilar obstructive jaundice patients treated with single channel and double chinese -made biliary stent from October 2012 to December 2013 retrospectively.Of which 9 cases(study group)were used for single channel and double stenttreatment,and 15 cases(control group)were treated by the bilateral channel;We compared the number of intraoperative percutaneous puncture hepatic duct , radiation exposure doses , operation time , drainage effectiveness and complication rates in the two groups .Results The average number of percutaneous puncture hepatic duct in the study group was 1.44 ±0.53 times,which was significantly lower than the control group (3.73 ±0.70 times).The fluoroscopy time and radiation exposure dose of study group was 1152.22 ±335.61 s and 653.22 ±207.02 mGy,which was slightly less than the control group (1236.93 ±463.43 s and 727.00 ±348.52 mGy),the difference was not statistically significant (P=0.638;P=0.572).Liver function was tested after 4 W, the drainage effectiveness of study group and the control group were 88.9%(eight-nineths),86.7%(thirteen-fifteenths),the difference was not statistically significant .One case occurred bile leakage in the study group ,2 pa-tients with hemobilia in control group ,both groups showed no serious complication .Conclusion The single chan-nel and double chinese -made biliary stent to treat high biliary malignant hilar obstructive jaundice is minimally injured and effective ,which can be selectively applied to treat patients with hepatic hilum malignant obstructive jaundice .

[ Objective ] To investigate the mechanism of Jianxin Pinglu Pill (JPP) in counteracting arrhythmia. [Methods] Ninety rats were randomized into 3 groups: model (normal saline), high-dose JPP (1.6 g/kg) and low-dose JPP (0.8g/kg) . The treatment lasted 7 days. Rat models with myocardial ischemia /repermsion were established by blocking left coronary artery. Ⅱ lead of electrocardiogram was recorded, connexin 43 (Cx 43) was detected by immunohistochemical assay. The effect of JPP on incidence of arrhythmia, death rate and the expression of connexin 43 in the myocardium was observed. [Results] JPP could decrease the incidence of arrhythmia and death rate obviously and enhance the expression of connexin 43 in myocardium. [ Conclusion ] JPP can counteract the damage of myocardial ischemia /reperfusion to enhance Cx 43 expression, and this is one of its possible mechanism.

Objective To explore the influence of self-concealment level on patients'quality of life and clinical curative effect for curing refractory chronic prostatitis(RCP)by high-intensity focused ultrasound(HIFU). Methods Patients of RCP who meet the diagnostic criteria were assessed with the Self-Concealment Scale(SCS), TDL's table of self-assessing quality of life and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI).The patients whose SCS score were above the average score plus a standard deviation were taken as the high SCS group,and whose SCS Score were below the average score minus a standard deviation were taken as the low SCS group.The scores for CPSI and TDLs table of self-assessing quality of life and the clinical curative effect of the two groups were determined before and after the treatment by HIFU, respectively.Results The SCS score(35.75±10.34) of the RCP patients before HIFU treatment was significantly higher than the norm for male college students(29.20±8.73)(t=4.26,P<0.01).Two and six weeks after the HIFU application,the CPSI of both the high and the low SCS group decreased significantly(P<0.01),and the CPSI of the low SCS group de-creased more greatly than that of the high SCS group(P<0.01).The scores for TDL Life Quality Scale of low SCS group were significantly higher before and after two and six weeks'HIFU treatment than that of high self-concealment group(P<0.01).The TDL quality of life scale score of thelow SCS group increased respectively after two and six weeks'HIFU treatment (P<0.01),while for the high SCS group,this score increased only after six weeks' HIFU treatment(P<0.05).Six weeks after HIFU treatment,the clinical curative effect for the low SCS group was, observably better than that for high self-concealment(P<0.05).The SCS scores was significantly positive with CPSI scores(P<0.01),and significantly negative with the scores of TDL Life Quality Scale (P<0.01).Conclusion The symptom abatement,quality of life and clinical curative effect the RCP patients with a high self-concealment level were respectively worse after the HIFU treatment than that for whom with a low self-concealment level.

Objective To investigate the effects of virtual reality prism adaptation on visuospatial neglect in stroke patients.Methods Thirty stroke patients with visuospatial neglect were studied.The subjects were divided into atreatment group and a control group.The subjects in the treatment group were treated with virtual reality prism adaptation and routine rehabilitation interventions for 2 weeks,while those in the control group were treated with routine rehabilitation interventions only.All the patients performed a battery of spatial attention tests including line bisection,letter cancellation,clock drawing and the Attention Network Test at the beginning and after 2 weeks of treatment.Results The virtual reality prism adaptation training had significant positive effects on all the measures of visuospatial neglect.Pair-wise comparisons confirmed significant differences between the treatment and control groups after 2 weeks of treatment with regard to all of the measures.Conclusions Virtual reality prism adaptation treatzment combined with routine rehabilitation can be more effective than conventional measures alone in improving the visuospatial performance of stroke survivors.

Objective To investigate the changes of compliance in large arteries and carotid artery intima-media thickness(IMT)in patients with metabolic syndrome.Methods There were 64 patients with metabolic syndrome and 56 age-matched control subjects.Their carotid-femoral pulse wave velocities(C-FPWV)were measured by the Complior SP and their carotid artery IMT were detected by B-mode ultrasound.At the same time their height,weight,waist circumstance,hip girth,blood pressure,blood glucose,blood lipid,BMI and waist to hip ratio(WHR)were measured.Results Compared with the control,the patients with metabolic syndrome had higher C-FPWV(P

Objective To explore the role of left frontoparietal pathway in controlling spatial attentional function. Methods 60 healthy, right-handed humans (30 males and 30 females) aged 18~22 years were recruited. They were divided into frontal group (n=30) and parietal group (n=30) in accordance with sex for either the left dorsolateral prefrontal cortex or the left posterior parietal cortex stimuli study, respectively. They were measured with the Attention Network Test following the continuous theta burst stimulation to the left frontoparietal pathway. Results During the Attention Network Test, the efficiencies of alerting network improved in participants after both the left dorsolateral prefrontal cortex and left posterior parietal cortex stimuli. However, the efficiency of orienting network was deficit after the left dorsolateral prefrontal cortex stimuli. Conclusion Inhibition of the left frontoparietal pathway may improve the alerting function of spatial attention network.