Twelve cases of adrenocorticotropic hormone-independent macronodular adrenocortical hyperplasia were retrospectively reviewed.All cases had physical signs and biochemical evidence of Cushing syndrome. Urinary free cortisone(UFC)levels were not suppressed by high dose and low dose dexanethasone suppression tests,and plasma adrenocorticotropic hormone levels were low in all patients.CT scan showed bilateral enlarged adrenal glands in all cases,and histopathologic examination confirmed bilateral adrenal macronodular hyperplasia. The follow-up revealed that 4 patients had a normal blood pressure 8y after bilateral adrenalectomy. In 8 cases the blood pressure was rebound 3y after single side adrenalectomy,6 of whom had medical treatment; 2 of whom had contralateral adrenalectomy and the blood pressure returned to normal afterwards.There was no Nelson syndrome in all cases.

OBJECTIVE: Radiculopathy is a common disease in orthopedics,clinically manifested chiefly by pains in the regions innervated by the spinal nerve involved. Since the etiology is complex,either surgical or non-surgical interventions can be adopted accordingly. This study reviewed recent relevant reports to explore the etiology and therapy of radiculopathy.DATA SOURCES: A computer-based search were carried out in Medline database for related articles published between January 1999 and August 2004 using the key words of "nervi spinales,pain,therapy" with language of the text limited to English. A computer-based search of Chinese periodical database,Wanfang Digital Database was also conducted for articles published in Chinese between January 1999 and December 2004 with the same searching words in Chinese language.STUDY SELECTION: Original studies of the etiology,pathogenesis and treatment of radiculopathy.DATA EXTRACTION: Totally 22 articles related to the etiology,pathogenesis,surgical treatment,minimal invasive and interventional treatment,as well as non-surgical treatment for radiculopathy were collected.DATA SYNTHESIS: Cervical,lumbar and back pains are the most common clinical manifestations of radiculopathy,induced by mechanical compression and chemical stimulation due to different etiologies. In clinical practice,surgeries or alternative non-surgical treatment can be adopted according to the etiology,the choice of which depends on,therefore,a thorough knowledge of the etiology and therapy of radiculopathy.CONCLUSION: The key for achieving favorable outcome of the patients with radiculopathy lies in correct recognition of the etiology and proper therapeutic decisions.

Objective In order to summarize the common characters of medical education , this research Compared curricula and educational reformation of different counties .The common characters of international medical educa-tion are useful to China's current medical education reformation .Methods This research used method of compara-tive education study to compare the medical education of the U .S, the U.K and Japan.Results Although the medical education program length is different in the 3 countries, they all recognize medical education as professional education .So they all adopt muti-method to test candidates .The curriculum frameworks of medical education pro-gram of 3 countries are different , but the curriculum organization , teaching methodologies , assessment methods are similar.They all have complete quality control system .As the medical education reformation , about half of medical schools in the U .K and Japan have implemented graduate entered medical education program .Conclusions Al-though medical education program length is different in the U .S, the U.K and Japan, they do share some charac-ters.These common characters are useful to medical education reformation and quality control in China .

Angiogenesis and invasion are two remarkable features of spongioblastoma,which lead to the failure of clinical treatment.With the development of the glioma（s） molecular biology mechanism in the realm of angiogenesis,some anti-angiogenesis drugs have got a positive therapeutic efficacy in the clinical trials,such as bevacizumab.However,it is reported that these drugs maybe also enhance the invasion and migration ability of glioma cells in the process of anti-angiogenesis therapy.Matrix metalloproteinases,hypoxia induced factor-1 and the inositol-requiring enzyme-1 maybe have some correlations with the change of the invasion and migration,but the molecular biological mechanism needs further research.

This article was aimed to study the pharmacokinetics of mussaenoside in rats. Gardenoside was used as the internal standard in the content determination of mussaenoside in rat plasma with HPLC. The chromatographic conditions were Diamonsil C18 (2) column (150 mm í 4.6 mm, 5 μm), mobile phase of methanol:0.5% glacial acetic acid (30:70), flow amount of 1.0 ml/min, detection wavelength at 238 nm, column temperature at 30℃. Compartment model fitting of average plasma concentration in rats - time data had been conducted after mussaenoside was given to mice through single intravenous injection with the help of DAS 2.0 pharmacokinetics intelligence analysis software. The results showed that the plasma concentration using 2-comparment model intravenous injection calculation method, which corresponded well to that of actually measured (weighting of 1), was proved superior to other models. The distribution half-life time (t1/2α) was 9.892 min and the elimination half-life time (t1/2β) was 55.384 min. It was concluded that the established method was convenient, accurate and stable, which can be used for the study on phar-macokinetics of mussaenoside. Mussaenoside was distributed rapidly in the body of rats. The main process of mus-saenoside in the body of rats was elimination. The metabolic rate was at moderate speed.

Objective To explore the value of high frequency and color doppler ultrasonography on diagnosis of deep venous thrombus in lower extremitiy.Method 32 cases with lower extremitiy deep venous thrombi diagnosed by angiography were further examined by CDFI,36 healthy cases were randomly selected as the normal group (NOR).Results High frequency and CDFI displayed the venous image in normal lower limbs rapidly and clearly as well as the echographic features of different shapes and types of the obstructed vessels.Conclusion High frequency and CDFI as a non-invasive and realtime method is better than angiography in diagnosis of the disease.

Objective To compare the efficacy of ureteroscopic lithotripsy ( URL) combined with occlusion devices and mini-invasive percutaneous nephrolithotomy ( MPCNL) in the treatment of upper incarcerated ureteral stones. Methods A total of 89 patients with unilateral upper ureteral calculi were enrolled from April 2011 to July 2013, 42 of which were treated with MPCNL and 47 of which were treated by rigid ureteroscopic lithotripsy combined with occlusion devices. Resuts There were no significant differences in the success rate of primary lithotripsy (97.6% vs.95.7%, χ2 =0.000, P=1.000).No marked differences were detected in the stone clearance rate (97.5% vs.95.6%, χ2 =0.000, P=1.000), complication rate (7.1% vs.8.5%, χ2 =0.000, P=1.000) and operation time [(80.2 ±11.9) min vs.(65.1 ±10.9) min, t =6.248, P=0.000] between the two groups.The hospitalization time in the URL group was (3.5 ±1.5) d, which was obviously shorter than that in the MPCNL group , in which it was (7.3 ±1.5) d(t=11.931, P=0.000). Conclusion URL combined with occlusion devices can obtain satisfactory results as well as MPCNL in the treatment of upper ureteral calculi by proper case selection and careful operation performance .

The clinical data of 21 cases of adrenal ganglioneuroma treated in our hospital from July 1988 to August 2008 were reviewed. The clinical manifestations were: lower back uncomfortableness (9 cases), paroxysmal dizziness (4 cases), central obesity ( 1 case) and 7 cases were discovered incidentally.Five cases were diagnosed pre-operationally and remaining 16 cases were diagnosed post-operationally by pathology. All patients completely recovered after surgery except one, who still had dizziness with high blood pressure. Ultrasonography, CT and MRI examinations are the main diagnostic methods for adrenal ganglioneuroma, and it is confirmed by histopathology, surgical removal of the tumor is the main therapy for the disease.

Objective To investigate reasonable method of deciding internal target volume (ITV) by comparing physical phantom volumes (including moving volume) with reconstruction volumes of spiral CT scanning.Methods The various-volume wax blocks which were labeled No.1-9 were made and put on the respiratory motion simulator.The range of motion was set 2.5 cm and frequency 18 beats/min.All blocks were scanned 10 times continuously and imported into the Eclipse TPS.All blocks volumes were calculated and then compared with the true physical volumes and paired t-test.Results The reconstruction volumes of 1-9 blocks were bigger than their stationary volumes (121.77 cm3 vs.103.14 cm3,P =0.038),but significantly smaller than their moving volumes (121.77 cm3 vs.161.75 cm3,P =0.045).The results can be gotten in different volume block scanning.The relative deviation of reconstruction volumes and the moving volumes tends to increase as the stationary physical volume decreases.Conclusions As to moving targets,conventional spiral CT scanning speed is too fast to collect all volume information of targets.So the one-time-scanning volume does not represent the ITV.

Low levels of hepatitis B virus(HBV) DNA,viral mutation leading to failure of hepatitis B surface antigen(HBsAg) detection and peripheral blood monouclear cells(PMBC) infected by HBV are the main reasons for occult hepatitis B virus infection(OBI).The host's immune state and HCV infection,schistosoma infection and long-time drinking also play parts in OBI.Until now,there were no uniform way to detect OBI and the standards to judge detection results varied in different studies.Formulating the uniform standards to detect OBI is very necessary to compare the different studies.And further studies were also needed to classify the molecular form about OBI and their relative frequency.