Objective To study the abnormal findings and metabolic alterations of the brain in chronic hepatic disease with MRI and 1H magnetic resonance spectroscopy (1H-MRS) for better understanding the clinical significance of pallidal hyperintensity and the role in the diagnosis and treatment of hepatic encephalopathy (HE) . Methods Brain MRI and 1H-MRS examination were performed in 50 patients with chronic hepatic disease and 20 healthy volunteers. The pallidus index (PI) was calculated and the height of resonance peaks of Glx was measured. The correlation between PI and Child/Pugh classification, and the association between blood ammonia and the spectroscopic alterations were studied. Pre-and post-therapeutic comparative study was also conducted in 5 cases with chronic HE. Results PI was gradually increased from healthy volunteers to patients with chronic hepatitis and liver cirrhosis (1.01?0.04, 1.06?0.09, and 1.18?0.09), and the differences in PI value among them were significant (F=22.294, P

Objective To develop a noninvasive diagnostic model comprising of transabdominal ultrasonography and serum markers for assessing esophageal varices in liver cirrhosis.Methods Totally 230 liver cirrhosis patients were randomly allocated to either an estimation group(161 cases)or a validation group(69 cases).Gastroscope was performed and whether esophageal varices existed or not was assessed in every patient.Seventeen common ultrasonographic and serum markers were analyzed initially in the estimation group to derive a predictive model.The model created was then assessed with ROC analysis.It was also applied to the validation group to test its accuracy.Results Among seventeen variables associated with esophageal varices selected by univariate analysis,splenic thickness,diameter of portal vein,prothrombin time were indentified by multivariate Logistic regression analysis as independent risk factors of varices.A varices index constructed from the above three markers was established.In ROC analysis,the AUC was 0.853(0.764,0.942)for predicting existence of varices using the optimal cutoff score 6.3.The diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 81.2%,85.7%,92.35%,68.21%,82.77% respectively.For the validation group,the AUC and diagnostic accuracy were 0.889(0.814,0.965)and 82.86% respectively.Conclusion A noninvasive model consisting of splenic thickness,diameter of portal vein and prothrombin time is helpful in predicting existence of esophageal varices in cirrhosis.

Objective To investigate the clinical outcome of modified large decompressive craniectomy in treatment of severe traumatic brain injury combined with acute subdural hematoma. Methods A retrospective analysis was carried out to compare the clinical outcome of large decompressive craniectomy (treatment group) for 81 patients with severe traumatic brain injury combined with acute subdural hematoma from July 2007 to June 2010 and that of standard large trauma decompressive craniectomy (control group) for 65 patients with same injuries from July 2004 to June 2007. Results According to the Glasgow outcome scale at the end of month 6 after injury, there were 21 patients (GCS 5 points) with good recovery, 19 (GCS4 points) with moderate deficit, 24 (GCS 3 points) with severe deficit, five (GCS 2 points) under persistent vegetative status and 12 (GCS 1 points) deaths in the treatment group,with good prognosis rate (good recovery and moderate deficit) of 49% (P ＜ 0.05) and poor prognosis rate of 51%. However, only 21 patients got favorable outcome, including 12 patients (GCS 5 points)with good recovery and nine (GCS 4 points) with moderate deficit; 44 patients got unfavorable outcome (68%), including 22 patients (GCS 3 points) with severe deficit, three (GCS 2 points) under persistent vegetative status and 19 (GCS 1 points) deaths in the control group (P ＜0.05). Furthermore, the incidences of delayed intracranial hematomas and subdural collection of fluid in the treatment group were significantly lower than those in the control group (P ＜ 0.05). Conclusion Modified large decompressive craniectomy can significantly improve the outcome and reduce complications of patients with severe traumatic brain injury combined with acute subdural hematoma.

To promote clinical medical students' personal harmonious development,we have established the new problem-based teaching mode and reform the evaluation system in clinical teaching of obstetrics and gynecology and have obtained more satisfied teaching result.

To meet the need of cultivating the high-quality medical personnel,we have ad-justed and reformed the content of the "Clerkship" teaching in obstetrics and gynecology and conducted the survey and research among teaching philosophy,training mode and management mechanism,and have obtained more satisfactory teaching result.

Objective To analyze the computed tomography (CT)characteristics of splenic lymphangioma and the association be-tween CT findings and pathological results.Methods The CT characteristics and pathological findings of 9 patients with splenic lym-phangioma were retrospectively analyzed.Results There were 8 cavernous lymphangioma and 1 cystic lymphangioma.Of the 9 ca-ses,it revealed that the percentage of blood vessel elements ranging from 5% to 50% via microscope.CT found 2 cases were with single lymphangioma,3 with multiple lesions,exhibiting as round or round-like mass;4 cases were found with diffuse lymphangio-ma and different size of cystic masses distributed across spleen.Five of the 9 cases who were with single or multiple lymphangioma showed circular and thin line-like cyst wall,while the remaining 4 cases showed latticed cyst wall in CT characteristics.The content in the cysts were with uneven density in all the 9 cases with CT value ranging from 10 to 40 HU,3 of which combined with sand-like calcification.Enhancement scanning found two characteristics:(a)cyst wall and separation were mildly enhanced,especially in the delayed phase;(b)the content in the cyst presents anomalous small patchy and mild enhancement.The enhancement of the content in the cyst did not change as the increasing of blood vessel composition.Conclusion CT examination will help the diagnosis of splenic lymphangioma and is of significance in informing clinical treatment.

Objective To investigate the effects of sevoflurane preconditioning on autophagy after traumatic brain injury (TBI) in rats and the role of C-Jun N-terminal kinase (JNK) signaling pathway.Methods Sixty adult male Sprague-Dawley rats,weighing 220-250 g,were randomly divided into 4 groups (n =15 each) using a random number table:sham operation group (group S),group TBI,TBI + sevoflurane preconditioning group (group TBI + Sevo) and TBI + sevoflurane preconditioning + JNK inhibitor SP600125 group (group TBI + Sev + SP).TBI models were established using Feeney' s method.In TBI + Sev and TBI + Sev + SP groups,the rats inhaled 2.4％ sevoflurane for 30 min once a day for 4 concecutive days,and TBI was produced at 24 h after the end of sevoflurane preconditioning.In TBI + Sev + SP group,SP600125 (6 mg/kg) was injected intrapetitoneally at 30 min after TBI.Five rats were chosen at day 1,3,and 7 after TBI,and neurological deficit score (NDS) was measured.The rats were then sacrificed and brains were removed to measure brain water content,expression of LC3 lⅡ and Beclin-1 mRNA (using PCR),and expression of LC3 Ⅱ,Beclin-1,JNK and phosphorylated JNK (p-JNK) (by Western blot).Results Compared with group S,brain water content and NDS were significantly increased,and the expression of LC3 Ⅱ and Beclin-1 protein and mRNA,JNK,and p-JNK was up-regulated in the other three groups.Brain water content and NDS were significantly decreased,and the expression of LC3 Ⅱ and Beclin-1 protein and mRNA,JNK,and p-JNK was down-regulated in TBI + Sev and TBI + Sev + SP groups as compared with group TBI,and in TBI + Sev + SP group as compared with TBI + Sev group.Conclusion The mechanism by which sevoflurane preconditioning mitigates TBI is related to inhibiton of activation of JNK signaling pathway and decreased autophagy in rats.

AIM: To explore the therapeutic effect of malleolus radialis implantation with vascularized periosteal flap for disunion of carpal navicular fracture, and investigate the characteristics of tissue implantation. METHODS: Thirty-two patients with disunion in carpal navicular fracture were selected from Jiangyin People's Hospital from January 2000 to January 2006, with the informed consents of all the patients. They were treated with implantation of malleolus radialis with vascularized periosteal flap, fixed with plaster cast for 8-10 weeks. Therapeutic effect was evaluated as: ①excellent: normal activity of carpal joints, without soreness sense, fracture line disappeared by X ray;②fine: uncomfortable activity of carpal joints, with slight limitations, fracture line disappeared by X ray. RESULTS: ①All 32 cases of the disunion in carpal navicular fracture were synostosis displayed by X ray.②There were 23 cases followed up for 3-12 months, 7 cases for 13-24 months, and 2 cases for 25-36 months. Carpal joints function achieved the standard of the uninjured side, without pain or affection on daily life.③The therapeutic effect was excellent in 22 cases, fine in 10 cases, and good rate was 100%. CONCLUSION: Implantation of malleolus radialis with vascularized periosteal flap is an effective way to treat the disunion of carpal navicular fracture.

This article elaborated the connotation of public hospital medical insurance payment system and the importance of reform,summarizing and analyzing the practical exploration of promoting medical insurance payment system reform in the localities.Then it moved on to introduce new progress of medical insurance payment system reform abroad and the emerging mode of medical insurance payment, such as pay for performance,payment by results,and bundled payment.In the end,the authors put forward policy suggestions to improve medical insurance payment system at public hospitals in China, namely to build a modern healthcare payment system in line with the needs of medical service system.Such a system should be guided by comprehensive performance,restrained by cost budgeting, based on a diversified payment mode,and supported by information technology.In addition,it should have scientific payment standard and modern governance mechanism,and keep interactive development with commercial health insurance.

Objective To explore the role of improved cranioplasty plus ventriculoperitoneal shunt in early treatment of hydrocephalus secondary to decompressive craniectomy for patients with severe craniocerebral injury. Methods A retrospective study was performed on 45 patients complicated by hydrocephalus after decompressive craniectomy for severe craniocerebral injury treated with early stage improved cranioplasty plus ventriculoperitoneal shunt from January 2006 to December 2010.Then,the clinical data,complications and outcomes were summarized. Results All operations were carried out 38-80 days after injury.The postoperative complications were distal obstruction of ventriculoperitoneal shunt in two patients and intracranial infection in one.The clinical symptoms were obviously improved in 36 patients (80％) and the cerebral ventricle was diminished in 34 (76％) one month postoperatively.The Glasgow Outcome Scale (GOS) at discharge was good in eight patients,moderate disability in 19,severe disability in 13 and prolonged coma in five,where better recovery (good recovery and moderate disability) in 27 patients (60％) showed significant improvement compared with preoperation ( x2 =23.47,P ＜0.01 ). Conclusion Early cranioplasty plus ventriculoperitoneal shunt is an effective and safe method for treatment of the complicated hydrocephalus after decompressive craniectomy for severe craniocerebral injury.