A 43-year-old man was diagnosed as massive left occipital lobe hemorrhage with the hematoma expanded into the entire ventricular system. On admission, he was in deep coma with clinical signs of brain herniation and a Glasgow Coma Scale (GCS) score of 4. Vascular malformations were highly suspected since he was young with no history of hypertension. Considering the life-threatening situation, open craniotomy and hematoma evacuation was proposed as the first therapeutic option, but this was refused by his family members for non-medical reasons. In order to save his life, stereotactic aspiration was suggested again and was accepted. UK at an aggressive dosage of 50 000 IU was administered during and after the surgical procedure for 5 days. One month later, this patient gained an excellent recovery with a Glasgow Outcome Scale (GOS) score of 5.

Objective:To investigate the changes of macular region structure before and after operation in patients with macular epiretinal membrane,and its relationship with the visual function of patients.Methods:The clinical data of 60 patients with macular epiretinal membrane (60 eyes) in our hospital from February 2014 to August 2016 were retrospectively analyzed.All patients were examined with optical coherence tomography (OCT) examination,and observed the changes ofmacula central fovea and retinal each azimuth thickness,and the best corrected visual acuity (BCVA) was recorded before and after operation,and the correlations of them were analysised.Results:The visual acuity was improved in 53 patients (53 eyes) after operation,accounting for 88.33％,and the visual acuity was unchanged in 7 patients (7 eyes),accounting for 11.67％.The preoperative BCVA of patients was (0.18± 0.07),and it was (0.38± 0.12) at 3 months after operation,which was significantly higher than before operation (P＜0.05).Postoperative macular central thickness,inner side of the inner ring thickness,nasal side of the inner ring thickness,above the inner ring thickness,below the inner ring thickness,outer ringtemporal side thickness,external ring nasal side thickness,above the outer ring thickness,below the outer ring thickness in patients compared with the preoperative were significantly lower,the difference was statistically significant (P＜0.05).The Pearson correlation analysis showed that preoperative macular central thickness,preoperative inner side of the inner ring thickness,preoperative outer ring temporal side thickness,the difference of macular fovea thickness before and after operation,the difference of the medial temporal before and after operationwas,the difference of outer ring temporal side before and after operation were negatively correlated with postoperative BCVA (P＜0.05).Conclusion:Vitrectomy can significantly reduce macular retinal thickness in patients with macular epiretinal membrane,and it can improve the visual function of patients,and the shape ofmacular region before operation had some influence on postoperative visual acuity.

The idea of moral heath deserves our attention and consideration.Moral health contains deep humanistic meaning and value pursuit.The aim for college education includes instructing the students to think about the basic questions for life and humanity.Education for moral health is necessary for achieving moral health and we have so much work to do.

The erythropoietin(EPO) system was used to study the molecular mechanisms associated with the induction of hypoxia responsive genes and from these investigations the hypoxia-inducible factors (HIFs) was identified as a key transcriptional hypoxic regulator of EPO. Subsequent research has now found that a large number of other hypoxia-inducible genes are also induced by HIF under hypoxic conditions. The HIF transcriptional complex is a heterodimer consisting of an alpha subunit and a beta subunit. Recently, two oxygen sensor, oxygen-dependent prolyl and asparaginyl hydroxylation were found,and it is the first time that the oxygen sensor had been described for higher organisms. This review focused on the structure and functions of HIF and the regulation of HIF proteins by hypoxia and oxygen sensors.

Objective To characterize the clinical manifestations, laboratory findings of patients with occult sys?temic malignant neoplasms, whose initial manifestation presented as multiple acute cerebral infarcts including coagula?tion function,radiological imaging and microembolic signals (MES) detection by transcranial Doppler sonography (TCD) and to explore the possible underlying mechanisms. Methods All clinical records, laboratory hematological tests includ?ing hypercoagulable states measured by D-dimer levels, brain MRI including DWI, and TCD monitoring MES, the treat?ment and prognosis were retrospectively reviewed in 12 patients with multiple acute cerebral infarcts as the first manifes?tation of occult systemic malignancy. Results The clinical manifestations presented as localized neurological dysfunction, e.g. hemiparesis, aphasia, hemiparesthesia, dysarthria, vertigo and seizures, etc. DWI revealed multiple disseminated acute cerebral infarcts in multiple arterial territories such as the bilateral anterior or anterior plus posterior cerebral circu?lation in all patients. Eleven of 12 patients tested had elevated D-dimer. TCD detected MES in 5 of 7 patients. There were 12 patients diagnosed with occult systemic malignancy including 5 lung cancer, 3 pancreatic cancer, 1 gastric can?cer, 1 colon cancer, 1 endometrial adenocarcinoma and 1 metastatic poorly differentiated mucinous adenocarcinoma with unknown primary. Ten patients already had remote metastasis at diagnosis. The prognosis was usually poor and there were 7 cases with ischemic stroke recurrence, 4 cases with acute myocardial infarction, 3 cases died during hospitaliza?tion. Conclusions When patients present with multiple disseminated acute cerebral infarcts involving multiple arterial territories as initial manifestation, the underlying occult systemic malignancy should be considered. Hypercoagulopathy and MES might provide the clues to the diagnosis.

Objective To investigate the clinical features and TCD-detected microembolic signals in patients with hypercoagulability related multiple acute cerebral infarcts within non-single arterial territories, and to explore the possi?ble underlying mechanisms. Methods A retrospective review was conducted on all clinical, laboratory, radiological and TCD monitoring records from patients with hypercoagulability related multiple acute cerebral infarcts within non-single arterial territories, who admitted to the neurology department in our hospital. Results The data from twenty-two cases were finally included in this study. All patients presented with acute-onset localized neurological dysfunction, e.g. hemi?paresis, aphasia, hemiparesthesia, dysarthria, hemianopsia and cortical blindness. Their hypercoagulability related diseas?es included 10 cases of systemic malignancy, 5 moderate to severe hyperhomocystynemia (HCY>50μmol/L), 2 nephrot?ic syndrome, 2 antiphospholipid syndrome, 1 ulcerative colitis, 1 polycythemia vera,1 paroxysmal nocturnal hemoglobin?uria. In 18 cases, the hypercoagulability related diseases were diagnosed after their initial stroke onset. DWI showed mul?tiple disseminated acute cerebral infarcts in non-single arterial territories involving bilateral anterior or anterior plus pos?terior cerebral circulation simultaneously. Foci involved lobar cortex/subcortex of cerebral hemisphere in 22 cases, deep cerebral hemisphere in 12 cases, cerebellum foci in 10 cases,brainstem foci in 2 cases. TCD revealed microembolic sig? nals in ten of 22 patients monitored. Conclusions Patients with multiple acute cerebral infarcts involving non-single arte?rial territories, should be screened for hypercoagulability as in that hypercoagulability and microembolism might be in?volved in the etiology of cerebral infarction.

The patient is a young woman,manifested as orthostatic hypotension and gastrointestinal motility disorders in acute onset.The physical examination and laboratory test suggested disorders of wide range of autonomic neuropathy.The levels of serum antinuclear antibody and SSA antibody were elevated.The biopsy of lip gland suggested Sjogren's syndrome.Nerve biopsy showed loss of a large number of unmyelinated nerve fibers.After the treatment of intravenous gamma globulin and glucocorticoid and symptomatic treatment,the symptoms of orthostatic hypotension were significantly relieved,but the gastrointestinal motility was not significantly improved.

Objective: To evaluate the reliability and validity of the Chinese version of the Questionnaire of Executive Functioning (QEF) among elementary school students aged 7-12 years. Methods: A total of 841 elementary school students from four primary schools in the Pearl River Delta (Guangzhou), eastern Guangdong area (Jieyang), northern Guangdong area (Shaoguan), and western Guangdong area (Maoming) were selected for item analysis by using a stratified whole group sampling method in September 2022. A total of 377 elementary school students from the four elementary schools were selected for testing the structural validity and reliability, and 87 subjects from an elementary school in Guangzhou were selected at 15-day intervals for assessing test retest reliability test. Results: The questionnaire had good discrimination, and the correlation between the items and the total score ranged from 0.22 to 0.46 ( P <0.01). Exploratory factor analysis showed a cumulative variance contribution rate of 56.68%, with item loadings ranging from 0.41 to 0.74. Confirmatory factor analysis showed a good model fit ( χ 2/ df =3.048, CFI=0.988, TLI= 0.980 , RMSEA=0.058, SRMR =0.009). The overall Cronbach s α , split half reliability and test retest reliability of the questionnaire were 0.72 , 0.76, 0.79, respectively. Conclusion The Chinese version of the Questionnaire of Executive Functioning has good reliability and validity, and it is suitable for application to the self assessment of executive function among elementary school students.

China has entered the task stage of comprehensive medical insurance payment reform, but there are problems restricting the development of innovative medical technology in the reform of diagnosis-related groups(DRG) payment system. The author introduced the international definition and scope of innovative medical technology, and summarized the preconditions and payment policy of short-term payment of innovative medical technology under the DRG payment system; And put forward suggestions in line with China′s actual situation, including clarifying the definition of innovative medical technology, setting access conditions for additional payment or actual payment, setting up special transition funds for high-value innovative drugs, clarifying the payment amount of innovative medical technology, and formulating payment strategies for innovative medical technology.

Objective To compare the effectiveness and safety of ultramini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized (about 1-2 cm) renal lower caliceal calculi.Methods From March 2015 to December 2016,patients in our hospital scheduled for surgery due to renal lower caliceal calculi with the greatest diameter of 10-22 mm were prospectively analyzed.Patients were randomized into two groups according to the random number table.Group UMP's operational channel was only F14 and the nephroscope's diameter was 1 mm.200 μm holmium laser lithotripsy was used to break the stones which was rushed out by eddy cuurent.In Group RIRS,all patients needed placing a F6 double J stent preoperatively for two weeks.A flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by 200 μm holmium laser lithotripsy through the WOLF flexible ureteroscope.The intraoperative and postoperative datas including stone-free status and the complications were compared.Results 100 patients were enrolled in the study 50 patients in Group UMP,28 were male and 22 were female,mean age was 43.4 ± 7.9 years old.Mean stone size was 14.5 ±3.0 mm(range 10-22 mm).Among them,18 cases were complicated with mild and moderate hydronephrosis.The other 50 cases were allocated to Group RIRS,including 31 males and 19 females.Their mean age was 44.5 ± 8.3 years old and mean stone size was 13.7 ± 3.1 mm (range 10-21 mm).Among them,16 cases were complicated with mild and moderate hydronephrosis.No statistically significant difference were seen between the two groups (P ＞ 0.05).After three months' follow-up,one-time stone free rate(SFR) of UMP group was 94.0％ (47/50),which was significantly more superior than the 72.0％ (36/50) of the RIRS group(P ＜ 0.05).The intraoperative decrease in hemoglobin were (7.8 ± 3.3) g/L vs.(3.1 ± 3.4) g/L,and operating time(26.5 ± 6.1) min vs.(43.3 ± 6.3) min.Significant differences were also seen between the two groups(P ＜0.05).There was more blood loss and less operating time in the group of UMP.The hospital stay,delayed hemorrhage and postoperative fever between the UMP and RIRS groups were (4.3±1.3)d vs.(3.24 ± 1.21)d,8.0％ (4/50)vs.0(0/50),16.0％ (8/50)vs.12.0％ (6/50) respectively.No significant differences were seen (P ＞ 0.05).Conclusions Both UMP and RIRS procedures are effective and safe in the treatment of moderate-sized renal lower caliceal calculi.Compared with RIRS,UMP may be more effective and has less operating time,however wtih more intraoperative blood loss.