Objective To summarize the MRI findings of spinal paraganglioma,in order to improve the diagnostic accuracy of imaging. Methods The MRI findings of 6 patients with spinal paraganglioma were retrospectively reviewed.All cases were proved by pathology.Results All 6 cases of spinal paraganglioma were located in lumbar spinal canal.There were serpentine vessels shade observed above the tumor in 5 cases.Two cases with smaller size of lesions exhibited as homogeneous signal intensity with homogenous enhancement. The other 4 cases with larger size of tumors exhibited as heterogeneous signal intensity because of intratumoral cystic change,hem-orrhage and hemosiderin deposit at the margin of the tumor.Conclusion Serpentine vessels above the tumor can be seen in spinal paragangliomas.Intratumoral cystic change and hemorrhage,hemosiderin deposit at the margin of the tumor are the MRI character-istics of spinal paraganglioma.

Objective To discuss the clinical effect of weight loss training and oral intake of mefformin on obese women with polycystic ovary syndrome.Methods 60 cases of obese women with polycystic ovary syndrome in Nan'an District Maternal and Child Health Hospital were studied.They were divided into 2 groups,30 cases in each group.The control group received simple weight loss training and the observation group received weight loss training combined with the oral administration of metformin.The clinical data of the 60 cases were retrospectively analyzed and the clinical efficacy and safety of different treatment methods were evaluated.Results After treatment,two groups of patients have been effectively improved.16 cases(53.3％)in the control group and 29 cases(96.7％)in the observation group resumed normal menstruation,and the differences had statistical significance.Fasting blood sugar(FBS),BMI,testosterone and luteinizing hormone levels of the two groups had significant improvement after treatment,in addition,the improvement of these indicator were more obvious in the observation group than those in the control group,and the difference had statistical significance.The difference of FBS,BMI,testosterone and luteinizing hormone levels had statistical significance between before and after treatment(P =0.003 7,0.001 2,0.002 0 and 0.002 4,respectively).Conclusion The combination therapy of weight loss training and oral intake of metformin is effective in treating obese women with polycystic ovary syndrome.It is the main method in treating obese women with polycystic ovary syndrome.

Etiquette education is an essential part of modern nursing quality education.In order to improve the general quality of the nursing students by etiquette education,the nursing teachers can infiltrate the essence of etiquette education into education reform,by theory teaching,demonstration, portrayal training,scenario training,and so on.

AIM:To explore the histopathological classification and incidence of orbital space-occupying lesions in children in order to provide references for the diagnosis of orbital space-occupying lesions in children.
METHODS:A total of 290 paediatric patients with orbital space - occupying lesions diagnosed by pathological examinations at the Second Hospital of Tianjin Medical University from January 1998 to December 2012 were retrospectively reviewed.
RESULTS:In 290 paediatric patients with orbital space-occupying lesions, venous hemangioma was the most common (58 cases,20. 0%), the other commons were as follows: hemangio lymphangioma, dermid cyst, neurofibroma, optic nerve glioma, rhabdomyo sarcoma and so on. Capillary hemangioma, venous hemangioma, optic nerve glioma had the predominant age incidence. On the other hand, optic nerve glioma, venous hemangioma, rhabdomyosarcoma had the predominant sex incidence.
CONCLUSION: The majority of paediatric patients with orbital space - occupying lesions are congenital and embryonic lesions, the most common of which is venous hemangioma. Some lesions had the predominant age and sex incidence.

Objective To investigate the effect of sevoflurane preconditioning on the expression of Toll-like receptor 4(TLR4) during myocardial ischemia reperfusion(IR) in rats.Methods Thirty male SD rats weighing 250-300 g were randomly divided into 3 groups (n=10 each):sham operation group (S group) , IR group and sevoflurane preconditioning group(SP group).Myocardial ischemia was produced by temporary ligation of anterior descending branch of left coronary artery for 30 min followed by 2 h reperfusion. In SP group, the animals inhaled 2.5% sevoflurane for 30 min followed by 15 min washout before ischemia. The rats were sacrificed at 2 h of reperfusion, hearts removed and myocardial tissues obtained for microscopic examination.The expression of TLR4, NF-κB and TNF-α was detected using Western blot. Results The expression of TLR4, NF-κB and TNF-α was significantly up-regulated in IR and SP groups compared with group S (P＜0.05).The expression of TLR4, NF-κB and TNF-α was significantly down-regulated in group SP compared with group IR (P＜0.05).The myocardial injury was attenuated in group SP.Conclusion Sevoflurane preconditioning can attenuate myocardial IR injury by inhibiting the up-regulation of TLR4 expression and reducing the inflammatory response.

Objective To explore the role of hemoglobin (Hb) level in mortality and morbidity of chronic kidney disease (CKD)patients,aiming to give some evidence for therapy of anemia.Methods Randomized,clinical trials (RCTs) were identified by searching Medline,Embase and the Cochrane library.All the analyses were performed using the Revman software available free from the Cochrane collaboration.Results Twenty-three trials involving 10 204 patients were identified.Overall,the high Hb target was associated with increased risk of all-cause mortality (RR=1.10,95％ CI 1.00 to 1.21),hypertension (RR=1.40,95％ CI 1.12 to 1.75),stroke and hospitalization (RR=1.07,95％ CI 1.00 to 1.14) compared with low Hb target (P＜0.05).No significant difference was found in the risks of non-fatal mycardial infarction (RR=1.13,95％ CI 0.79 to 1.62) and renal replacement therapy (RR =1.00,95％ CI 0.85 to 1.18).Conclusions Targeting low Hb target is beneficial to CKD patients based on reduced risk of hypertension,hospitalization,stroke and all-cause mortality.However,no significant difference is found in non-fatal mycardial infarction and renal replacement therapy.

Objective To evaluate the efficacy and safety of rabeprazole sodium injection in the treatment of non-esophageal variceal upper gastrointestinal bleeding in comparison with the positive control,omeprazole.Methods From January 2010 to January 2011,231 patients with non-esophageal variceal upper gastrointestinal bleeding from 20 hospitals were divided into rabeprazole group and omeprazole group in this multicenter,randomized,blind,parallel-group,positive drug controlled clinical trial.Hemostasis rate in 72 hours was the primary endpoint.Hemostasis rate in 120 hours,time to hemostasis,blood transfusion volume and the rate of switching treatments were the secondary endpoint.And safety was also analyzed.Chi square test and Wilcoxon rank sum test were performed for statistical analysis.Results At 72 hours after treatment,the hemostasis rates of rabeprazole group and omeprazole group were 98.20％(109/111)and 98.25％(112/114), respectively, and the difference was not statistically significant (P＞0.05).The 95％ confidence interval (CI) of the rate difference between the two group was-3.50 ％ to 3.40 ％.The result of non-inferiority test indicated that the lower limit of the 95％CI of the rate difference between the two groups was-2.95％ (U=5.652,P＜0.01),and rabeprazole group was not inferior to omeprazole group.At 12 hours after treatment,the hemostatic rates of rabeprazole group and omeprazole group were 63.06％(70/111) and 53.51％(61/114),respectively,and there was no statistically significant difference (P＞0.05).At 120 hours after treatment,the hemostasis rates of rabeprazole group and omeprazole group were 99.10 ％ (110/111) and 98.25 ％ (112 /114),and there was no statistically significant difference (P＞0.05).The median time of hemostasis of two groups was 24 hours.During the treatment,there were two cases and seven cases of rabeprazole group and omeprazole group received blood transfusions,respectively;there were 0.90％ (1/111) and 2.63 ％ (3/114) patients switched to other treatment,and no statistically significant difference was found (P＞0.05).The rates of adverse event of rabeprazole group and omeprazole group were 11.61％ (13/112) and 5.26％ (6/114),respectively.The rates of adverse reaction were 6.25％ (7/112) and 4.39％ (5/114),respectively.The differences in the rates of adverse event and adverse reaction between two groups were not statistically significant(both P＞0.05).Conclusion Rabeprazole sodium injection is an effective and safe drug in the treatment of non-esophageal variceal upper gastrointestinal bleeding.

AIM To investgate the changes in the expression of CREB and p-CREB in the cortex of ethanol dependent rats. On other hand, the effects of fluoxetine on these changes were also studied. METHODS Ethanol was administered in drinking water at the concentration of 6% V/V, for 28 d. The expression of CREB and p-CREB in the rat cortex were measured by immunohistochemistry methods. RESULTS It was found that chronic ethanol treatment and its withdrawal did not modify the expression of CREB in the rat cortex. However, the levels of p-CREB in the frontal and piriform cortex of rats were significantly decreased during ethanol withdrawal, and respectively decreased 57.28%?55.84% compared to control rats at 24 h after ethanol withdrawal. When fluoxetine (ip, 10 mg?kg -1) were administried concurrently with ethanol, it can significantly dampen alcohol withdrawal symptoms and antagonize the down-regulation of the phosphorylation of CREB in the frontal and piriform cortex of rats at 24 h after ethanol withdrawal, the expression of p-CREB protein respectively increased 292 58%,128 44% compared with rats intaking ethanol. CONCLUSION CREB may be one of the substance of the signal transduction process for ethanol dependence. Fluoxetine can reverse the decreased p-CREB levels in rat cortex induced by ethanol withdrawal, which may be the part reason of fluoxetine dampening alcohol withdrawal symptoms.

Through all times and around the world,those who discipline themselves with high ethical standards can be regarded as truly noble men successfully taking advantage of moral authority of the people.Books on the art of war in ancient China raised a couple of ethical requirements for those superior military officers and governors.If officers want to affect his men′s mental state and generate the army′s spirit of combat effectiveness,they must assume a certain degree of ethical responsibility.Also,active share of ethical responsibility calls to take the initiative to develop a sense of ethical responsibility.Furthermore,to develop a sense of ethical responsibility calls for the building of ethical self-consciousness to participate in the training of ethical responsibility.However,the participation of ethical building consciousness can not be separated from the ethical sense of responsibility.In conclusion,each part of the three links,complementing each other,can not be biased and separated.

Objective To evaluate the characteristics of echocardiogram in senile degenerative heart valvular disease. Methods The cardiac structure and functional changes of the 166 cases of senile degenerative heart valvular diseases were studed with HP5500(USA) and En Visor color doppler(Philips). Results Simple aortic valve calcification was found in 93 cases(56.0%); simple mitral calcification, 18 cases(10.8%);aortic valve calcification combining mitral calcification, 55 cases,(33.1%);enlarged left atrium 116 cases(69.9%);left ventricular diastolic dysfunction 142 cases(85.5%).Within 136 cases of cardiac valve dysfunction, there was aortic valvular regurgitation in 70 cases(42.2%),stenosis of aortic valve in 23 cases(13.9%),mitral regurgitation in 20 cases(12.2%),mitral stenosis in 8 cases(4.8%),aortic valvular regurgitation combining stenosis in 10 cases(6.0%),mitral regurgitation combining stenosis in 5 cases(3.0%). The highest morbidity in valvular dysfunction was aortic valvular regurgitation(42.2%),the second was aortic valve stenosis(13.9%),the lowest morbidity was mitral stenosis combining insufficiency(3.0%). Enlarged left atrium was in 116 cases(69.9%). Conclusions The senile degenerative heart valvular disease have no specific clinical manifestation. With increasing age,the proportion of complex valve calcification is increased, and the highest is the aortic insufficiency in valvular dysfunction. The proportion of enlarged left atrium is also increased.