Objective To find out factors affecting physicians' prescribing conduct so as to get rid of the negative effects and reduce medical costs. Methods Analyses were conducted by reviewing relevant literature published at home and abroad. Results Factors affecting physicians' prescribing conduct include: the medical security system, the hospital compensation mechanism, the requisitioning party, pharmaceuticals per se, and promotion of sales. Conclusion To get rid of the negative effects of physicians' prescribing conduct, it is necessary to rationalize the hospital compensation mechanism, strengthen the control of drug examination, approval, purchase and sale, and provide physicians with accurate pharmaceutical information.

Humans ; Hyperparathyroidism, Secondary ; diagnosis ; Monitoring, Intraoperative ; Parathyroid Hormone ; blood ; Parathyroidectomy

Objective To evaluate the anatomic morphology of submandibular fossa. Methods Cone-beam computed tomography (CBCT) was used to analyze the anatomic morphology of submandibular fossa. Implants of various dimensions were virtually placed into the mandibular 1st and 2nd molar region. Spatial relationships among submandibular fossa , mandibular canal and implant were analyzed. Results The depth of the submandibular fossa was (1.0 ± 0.61)mm in the 1st molar region and (1.5 ± 0.61)mm in the 2nd molar region. There were no significant statistical difference in genders, sides, and tooth loss. The length of the implants was (19.7 ± 3.75)mm (d = 4 mm) and (18.6 ± 3.73)mm (d = 5 mm) in the 1st molar region and (16.2 ± 3.46) mm (d = 4 mm) and (15.2 ± 3.09)mm (d = 5 mm) in the 2nd molar region in patiens with teeth and lingual perforation; the length of the implants was (17.1 ± 3.77)mm (d = 4 mm) and (15.6 ± 3.85)mm (d = 5 mm), and (14.2 ± 4.05)mm (d = 4 mm) and (13.2 ± 4.27)mm (d = 5 mm) in patients with tooth loss, respectively. Conclusions Determination of spatial relationships among submandibular fossa , mandibular canal and implants by using CBCT has important significance in guiding dental implant surgery.

Objective To study the clinical characteristics,microsurgical methods and results of treatment of the purely intrinsic third ventricular craniopharyngioma. Methods Eight cases of craniopharyngiomas located purely in intrinsic third ventricula which were treated microsurgically were analyzed retrospectively.Their clinical manifestations,endocrinal examination,CT and MRI images,choice of operactive approaches and post-operative complications were studied.Results Total tumor removals were achieved in 7 cases.and subtatol tumor removal in 1 case.Temporary central diabetes insipidus occurred in 5 cases,and perloperative water and elecctrolyte imbalance in 6 cases. No patient died in this series. Conclusion According to clinical characteristic of purely intrinsic third ventricular craniopharyngioma, microsurgical technique is a safe and effective method for treatment by a resonable surgical approaches.

Objective To evaluate the usefulness of diffusion-weighted MR combined with routine T2 WI in finding the possible residual foci in uterine cervical cancers after radical chemo-radiation therapy.Methods This was a retrospective study including 25 consecutive cervical cancer patients who received hysterectomy after radical chemo-radiation therapy.All of them underwent MR examinations post-chemoradiation and just before operation.Images of T2 WI alone and those of T2 WI combining DWI were evaluated respectively by 2 senior radiologists,in order to decide whether there were residual tumors.ADC values were also measured.Taking the post-operation pathological results as the gold standard,the accuracies,sensitivities and specificities of T2 WI alone,T2 WI combining DWI,and ADC values were all calculated.Results In those 25 patients,9 were found with foci of residual cancer in operative pathology,while no cancer cells were found in the other 1 6 patients.The accuracy,sensitivity and specificity in finding the positive residual cancer using T2 WI alone were 56.0%,77.8% and 43.8%,comparing with 72.0%,66.7% and 75.0% in T2 WI combining DWI.The accuracy and specificity increased with statistical significance after combining DWI (P =0.01 6 for accuracy,P =0.031 for specificity),while the sensitivity decreased but did not reach statistically significant level (P =0.099).No difference in ADC values was found.Conclusion DWI can be used as a supplementary sequence in finding the existence of residual tumors of cervical cancer after radical chemo-radiation therapy.Routine T2 WI combing DWI increased the specificity and accuracy,but still facing the risk of decreasing sensitivity.

Objective To alanyze the imaging features of brain in systemic NHL.Methods CT and MRI of brain in 8 cases of systemicNHL proved pathologically were performed.Imaging findings of brain were analysed and by comparison with that in 73 cases of brainmetastases with marked enhancement after contrast administration.Results 13 lesions in 8 cases were found by CT,the findings on contrast-enhanced CT included:①Ten lesions showed low density with obscure border;②Three nodular lesions showed high density(including 2 homogeneously and 1 ring-like enhanced nodules).All lesions showed neither ventricle enlargement nor occupying effects.Those enhanced showed no edema around the nodules.Of the 4 cases with MRI,low T_1 signal and high T_2 signal with no change after contrast administrationwere seen in 3 cases.One showed ring-like enhancement with no edema around.While 89% of the 73 brain metastatic cases showeddifferent extent of edema.Conclusion The imaging findings in some of the lesions in this study are different from that described before in literatures.In comparison with other metastases,the marked-enhanced nodules with no edema were found to be a specialty of secondary NHL in brain in our cases.

Objective To investigate the feasibility of ADC values that derived from MR DWI with multiple b values in reflecting the amplitude of enhancement and degree of differentiation in cervical squamous cell carcinomas on 3.0T MR scanner.Methods DWI and multiple phase contrast enhanced MRI images of 31 patients with pathologically diagnosed cervical squamous cell carcinomas were retrospectively analyzed.All ADC values in different b values and the amplitude of signal intensity enhancement were measured in various areas of tumors.Correlations of differences of ADCs in high and low b values with early and late enhancement,and the relationship of ADC and differences of ADCs with pathologically tumor differentiation grades were analyzed.Results ADC value in high and low enhanced areas of cervical cancer was inversely related with different b values.Differences of ADCs between low b value (200 s/mm2) and high b values (800,1 000,1 200,1 400 s/mm2) had weak positive correlation with early enhancement (r=0.315-0.339,all P＜0.05).While b=800 s/mm2 and 1 000 s/mm2,ADCs in highly enhanced areas of tumor were significantly lower in well-differentiated cancer lesions compared with those of poorly differentiated cancer lesions.There was no statistically significant of ADC value in other b values,and also of differences of ADCs in all b values in different differentiation foci (all P＞0.05).No differences were found in ADC values under other b values in various degree of differentiation foci,nor in differences of ADCs in all b values (all P＞0.05).Conclusion Combination of multiple b values of DWI may have the potential to reflect blood supply and tumor differentiation grades in cervical squamous cell carcinomas,while low b value of 200 s/mm2 and high b values of 800 s/mm2 and 1 000 s/mm2 will be the preferable choice on 3.0T MR scanner.

Objective To observe the neural protective subsidiary effect of Wenyang Yiqi method on patients with severe traumatic brain injury under mild hypothermia therapy.Methods A prospective study was conducted in which 53 patients with severe traumatic brain injury treated by mild hypothermia were randomly divided into control group (26 cases) and observation group (27 cases). All the patients in the two groups received conventional western treatment combined with mild hypothermia therapy. In the observation group, additionally was given the representative drug of Wenyang Yiqi method, Shenfu injection 100 mL mixed into 5% glucose 500 mL intravenous drip once a day. At the end of mild hypothermia, the Shenfu injection was stopped. After treatment, the changes of intracranial pressure (ICP) on 1 (the day the treatment began), 2, 3, 4, 5, 6 and 7 days and the indexes levels, including S-100B, lactate dehydrogenase (LDH) and creatinkinase (CK) in the cranial spinal fluid (CSF) before treatment and 2, 4, 6 days after treament (CSF) were observed. The Glasgow coma score (GCS) before treament and 3, 5, 7, 14, 28 days after treament, and Glasgow outcome scale (GOS) on 28 days and 3 months after treatment were recorded, and the incidences of complications were calculated at the end of therapy.Results After treatment with the prolongation of therapeutic time, the levels of ICP were gradually increased in two groups and reached the peak values on the 4th day, then beganto fall, and on the 5th day it was significantly lower in observation group than that in control group [ICP (mmHg, 1 mmHg = 0.133 kPa): 16.11±1.23 vs. 18.73±1.42], persisting the same situation to the 7th day (14.17±0.80 vs. 16.94±1.00,P < 0.05). The levels of S-100 B in the two groups were progressively decreased after the treatment, on the 2nd day it was significantly lower in observation group than that in control group (μg/L: 1.21±0.43 vs. 1.86±0.57, P < 0.05), also persisting to the 6th day (0.40±0.09 vs. 0.94±0.15,P < 0.05); the levels of LDH and CK reached the peak values on the 2nd day, then began to fall, they were significantly lower in the observation group than those in the control group on the 4th day [LDH (U/L): 63.43±12.21 vs. 80.11±14.34, CK (U/L): 52.41±14.14 vs. 88.37±12.21, bothP < 0.05], and on the 6th day still there were statistically significant differences between the two groups. The GCS before treatment showed no statistically significant difference between the two groups (P > 0.05); after treatment, the GCS score of the two groups was progressively improved, and on the 14th day the score in the observation group began significantly higher than that in the control group (11.74±1.24 vs. 9.41±2.11,P < 0.05), persisting the same situation to the 28th day (12.68±2.51 vs. 10.67±1.99,P < 0.05). On the 28th day after treatment, the GOS showed no statistically significant difference between the two groups (2.35±0.16 vs. 2.43±0.22,P > 0.05), but the score in the observation group was significantly higher than that in the control group after treatment for 3 months (4.11±0.38 vs. 3.72±0.41, P < 0.05). The incidences of complications in the observation group were significantly lower than those in the control group [respiratory failure: 25.9% (7/27) vs. 50.0% (13/26), shock: 18.5% (5/27) vs. 53.8% (14/26), acute pulmonary edema: 14.8% (4/27) vs. 30.8% (8/26), stress ulcer: 22.2% (6/27) vs. 57.7% (15/26), hypoproteinemia: 40.7% (11/27) vs. 73.1% (19/26), allP < 0.05].Conclusion Wenyang Yiqi method has the subsidiary neural protective effect on patients with severe traumatic brain injury treated by mild hypothermia, and can improve their outcome.

Objective To investigate the effect of growth differentiation factor 5(GDF-5)on expression of gap junctional protein,connexin 43,during ehondrogenic differentiation of bone marrow sternal cells(BMSCs)in vitro.Methods BMSCs were isolated from mouse bone marrow and cultured in vitro.The cells in passage 3 were chosen to be induced into chondrogenic differentiation.After induction for 72 hours,TypeⅡcollagen protein was examined by immunocytochemistry and the sulfate glycosaminoglycan was measured by Alcian blue staining.With induction for 24,48 and 72 hours,the proliferation effects of BMSCs were investigated by MTT assay;connexin 43 mRNA and protein were examined by RT-PCR,western blotting and immunocytochemistry respectively at different time points during induction.Results According to MTT assay,GDF-5 had no effect on the proliferation of BMSCs at different time points of induction;RT-PCR,western blotting and immunocytochemistry showed that GDF-5 could promote expressions of connexin 43 mRNA and protein at different times during induction.After 72 hours of induction,immunocytochemistry showed expression of TypeⅡcollagen protein,and AIcian blue staining of proteo- glycan revealed deposition of typical cartilage extracellular matrix.Conclusion GDF-5 can enhance chondrogenic differentiation of mouse BMSCs in vitro by up-regulating the expression of gap junctional protein,connexin 43.

·α-crystallin is the predominant structural protein in the lens.lt is a member of small heat shock proteins ( sHSPs) which has the common functions of HSPs.lt also has anti-apoptotic activity etc.Recently, it has been proved to combine with the cellular membrane of retinal ganglion cells ( RGCs ) to enhance the survival of RGCs and the regeneration of axons, thereby partly restore visual function.But we haven’t come to a unified conclusion of the mechanism.This review is focused on structure and functions of α-crystallin, the protection function and mechanism of α-crystallin towards RGCs after the optic nerve injury.