With the improvement of radiation therapy technology and the comprehensive treatment of malignant tumors,the survival time of patients with malignant tumors is gradually extended.In recent years,carotid stenosis and cerebrovascular disease complications after radiation therapy have received increasing attention.Existing studies have shown that carotid stenosis after radiation therapy is not only associated with atherosclerosis,it is likely to be an independent vascular lesion.This article reviews the correlation between head,neck and cerebral ischemic events,characteristics and mechanisms of vascular injury after radiation therapy,as well as the risk factors for carotid stenosis,clinical manifestations,and diagnosis and treatment methods after radiation therapy.

Objective To investigate the clinical application prospect of water exchange colonoscopy.Methods A total of 300 outpatients who underwent unsedated colonoscopy were randomized to the WEC group (n =150)or the AIC group(n =150).The maximum pain score, insertion time, the cecal intubation rate and the polyp detection rate were reported by an assistant during the insertion phase and at the end of colonoscopy.Results The maximum abdominal pain scores were 1.77 ± 1.29 in the WEC group and 2.84 ± 1.55 in the AIC group with significant difference (P =0.000).The intubation time of WEC was longer than that of AIC (11.91 ± 3.58 VS 8.03 ± 3.19 ,P =0.000)with no significant difference.There was no significant difference in the cecal access rate between the two groups(97.3％ VS 94.0％ ,P =0.157).The polyp detection of WEC was higher than that of AIC (16.7％ VS 10.0％, P =0.089).In the post abdominal operation subject of colonoscopy procedure, WEC had higher rate of cecal intubation than AIC ,the maximum abdominal pain score were 2.25 ± 1.63 in the WEC group,lower than 3.48 ± 1.45 in the AIC group.Conclusion Water exchange colonoscopy can alleviate patients' abdominal pain symptoms, but with longer insertion time.There are no significant difference in the cecal access rate and the polyp detection rate between two groups.For difficult colonoscopy, water exchange colonoscopy is helpful to increase the rate of cecal intubation.

Objective To investigate the major risk factors for posterior circulation stroke and the clinical and imaging features of posterior circulation stroke patients with diabetes.Methods The patients with acute cerebral infarction were enrolled.The clinical data of patients with posterior circulation and anterior circulation stroke were compared.The patients with posterior circulation stroke were further divided into either a diabetic group or a non-diabetic group,and the vascular risk factors and imaging features of both groups were compared.The patients with posterior circulation stroke were divided into proximal segment,middle segment and distal segment and mixed groups according to the distribution of vascular lesions.The correlations between diabetes and each group and the imaging features were analyzed.Results A total of 328 patients with posterior circulation stroke (male 194,the diabetic group 108) and 336 patients with anterior circulation stroke (male 214,the diabetes group 59)were enrolled.The proportions of patients with diabetes (32.9％ vs.21.7％ ; x2 =10.501,P =0.001),hyperlipidemia (60.1％ vs.47.9％ ;x2 =9.852,P =0.002),previous stroke or transient ischemic attack (TIA) (29.0％ vs.22.0％ ;x2 =4.213,P =0.040) in the posterior circulation ischemic stroke group were significantly higher than those in the anterior circulation ischemic stroke group,and the proportion of smoking patients was significantly lower than that in the anterior circulation ischemic stroke group (18.3％ vs.26.2％ ; x2 =5.977,P =0.014).The levels of total cholesterol (4.72 ±1.07 mmol/L vs.4.56 ± 0.98 mmol/L; t =2.079,P =0.038),triglycerides (1.54 ± 1.07 mmol/L vs.1.33±0.71 mmol/L; t=3.085,P=0.002) and low-density lipoprotein cholesterol (2.91±0.90 mmol/L vs.2.75 ±0.80 mmol/L; t =2.373,P =0.018) were significantly higher than those in the anterior circulation ischemic stroke group,and the level of high-density lipoprotein cholesterol was significantly lower than that in the anterior circulation ischemic stroke group (1.13 ± 0.31 mmol/L vs.1.18 ±0.32 mmol/L; t =2.045,P=0.041).Multivariate logistic regression analysis showed that diabetes (odds ratio [OR] 1.560,95％ confidence interval [CI] 1.086-2.239; P =0.016) and previous stroke or TIA history (OR 1.455,95％ CI 1.013-2.090; P =0.042) were the independent risk factors for posterior circulation ischemic stroke.In patients with posterior circulation ischemic stroke,the patient's proportions of hyperllpidemia (66.7％ vs.55.5％ ;x2 =5.069,P =0.024) and drinking (13.0％ vs.4.5％;x2 =7.568,P=0.006) in the diabetic group (n =108) were significantly higher than those in the non-diabetic group (n =220); the proportion of atrial fibrillation patients was significantly lower than that in the non-diabetic group (3.7％ vs.11.4％ ;x2 =5.274,P =0.022).The levels of triglycerides (1.70 ± 0.93 rnmol/L vs.1.45 ± 1.11 mmol/L; t =1.989,P =0.048),fasting glucose (8.46 ± 2.96) mmol/L vs.5.30± 0.96 mmol/L; t=10.706,P=0.000) and glycosylated hemoglobin (8.36％ ± 1.94％ vs.6.07％ ± 0.55％ ; t =10.576,P =0.000) in the diabetic group were significantly higher than those in the non-diabetic group.The proportion of patients with large artery atherosclerosis stroke in the diabetic group was significantly higher than that in the non-diabetic group (73.1％ vs.60.0％; x2=5.457,P=0.019); the proportion of the patients with cardioembolism was significantly lower than that of the non-diabetic group (2.8％ vs.9.1％;x2 =4.428,P =0.035).The proportion of patients with posterior circulation middle segment infarction in the diabetic group was significantly higher than that of the non-diabetic group (49.1％ vs.31.4％ ;x2 =9.726,P =0.002).The proportions of the patients with brainstem infarction (60.2％ vs.48.2％ ;x2 =4.182,P =0.041) and single brainstem infarction (55.6％ vs.30.5％ ;x2 =19.235,P =0.000) in the diabetic group were significantly higher than those in the non-diabetic group.In patients with single brainstem infarction,the proportions of the patients with pontine infarction (43.5％ vs.25.9％ ;x2 =10.374,P =0.001) and medulla oblongata infarction (7.4％ vs.1.8％ ; P =0.023) in the diabetic group were significantly higher than those in the non-diabetic group.Conclusions Diabetes and previous stroke or TIA history are the independent risk factor for posterior circulation stroke.Diabetes is closely associated with brainstem infarction,and it is more likely to result in pontine infarction.

A variety of views and approaches were found in the appraisal and judgments of the people's courts in various provinces and cities,on medical disputes involving absence of a hand or foot of newborns,which result in different or event contradictory court decisions.This study made an analysis of the characteristics,nature,and classification of such cases as well as countermeasures of medical institutions,with recommendations on rational and appropriate handling of such cases,for the purposes of legitimate rights maintenance of both doctors and patients,and promotion of mutual understanding between the two parities,and establishment of a harmonious doctor-patient relationship.

Objective To observe the neurotoxicity of epidural different dose of dexmedetomi-dine in combination with 0.75% bupivacaine.Methods Twenty-five rabbits weight 2-3 kg without gender tendency and equipped with an epidural lumbar catheter were allocated randomly to five groups with 5 cases each.The control group (group C)received injections of 1.5 ml normal saline,0.75%bupivacaine 1.5 ml plus normal saline 0.5 ml in group B,and the other treatment groups received in-jections of 0.75% bupivacaine 1 ml plus dexmedetomidine 0.1 μg/kg (group D1 ), 0.75%bupivacaine 1 ml plus dexmedetomidine 0.2 μg/kg (group D2 )or 0.75% bupivacaine 1 ml plus dexmedetomidine 0.4 μg/kg (group D3),in the same volume of 1.5 ml.After successive 3-day epi-dural administration of the drugs and a 3-day observation,the rabbits were killed and the spinal cord was examined under optical and electron microscope.Results Serious damages of neuron were found in 1 animal from group D2 and 2 from group D3 under optical microscope.There was unclear bounda-ries between gray and white matter.Some nerve cells appeared necrosis in the grey matter of spinal cord and the number of nerve cells was decreased.Some reversible changes were found in all groups under electron microscope.Conclusion Epidural administration of dexmedetomidine can induce spinal cord and spinal nerves injury dose-dependently,and the motor function can recuperated completely.

BACKGROUND:Cuscuta chinensis is a mature seed of Cuscutachinensis Lam., can warm kidney. Previous studies demonstrated that kidney compound composed of Cuscuta chinensis could apparently inhibit bone loss and improve bone density.
OBJECTIVE:To explore the influence of flavonoids from Cuscuta chinensis on bone mineral density of femur, 1,25(OH)2D3 levels of serum and kidney, the expression of smal intestine CaBp-D9K mRNA in model rats with ovariectomized osteoporosis.
METHODS:A total of 72 Sprague-Dawley female rats were equal y and randomly divided into six groups (n=12):sham surgery group, model group, vitamin D3 group and low-, moderate-and high-dose flavonoids groups. The sham surgery group only received sham operation and the other five groups were ovariectomized respectively. One week after ovariectomy, the rats were given flavonoids from low-, moderate-and high-dose Cuscuta chinensis and vitamin D3 (2 mg/kg) by intragastric administration for 3 consecutive months. Blood was obtained from the abdominal aorta. Serum was isolated. The kidney was obtained. Enzyme linked immunosorbent assay was used to determine 1,25(OH)2D3 contents of renal and serum. Rats were sacrificed at the end of experiment. The thighbone was taken out to determine bone mineral density. The second lumbar vertebra was taken out to measure the expression of lumbar vertebra and renal vitamin D receptor mRNA using real-time fluorescent reverse transcription-polymerase chain reaction. The smal intestine was taken out to measure the expression of smal intestine CaBp-D9K mRNA using real-time fluorescent reverse transcription-polymerase chain reaction.
RESULTS AND CONCLUSION:Compared with the sham operation group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA significantly decreased in model group, and the expression of smal intestine CaBp-D9K mRNA significantly decreased in model group. Compared with the model group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney, and the expression of the second lumbar vertebra vitamin D receptor mRNA, and the expression of smal intestine CaBp-D9K mRNA were increased in moderate-and high-dose flavonoids groups and vitamin D3 group. Results indicated that flavonoids from Cuscuta chinensis could significantly raise bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA and the expression of smal intestine CaBp-D9K mRNA, accelerate intestinal calcium absorption and osteoblast activity, and reinforce quality of the bone.

Objective To explore the effect of individualized chemotherapy plans which was designed depend on secific genetic characters in patients with advanced cancer.Methods The surgery or biopsy specimen samples from 25 patients with advanced recurrent tumors (study group) were analyzed.Different gene mRNA expressions were detected by PCR and sequencing.According to detection results,the most appropriate chemotherapy would be applied on 25 cases patients of study group.The chemotherapy from traditional experience and evidence-based medical evidence were applied for 20 cases patients of control group.The difference of RR and disease control rate (DCR) between two groups were compared.Results The DCR and RR were 84 ％ (21/25) and 44 ％ (11/25) in study group,35 ％ (7/20) and 15 ％ (3/20) in control group.The DCR and RR in study group were significantly higher than those in control group (P ＜ 0.01).Conclusion Individualized chemotherapy could improve the efficient and prolong the survival period of the patients with advanced recurrent tumors.

Objective To analyze the current situation of domestic research on fetal surgery by the method of literature measurement, and analyze the development trend.Methods The key words of ‘fetal surgery’or ‘fetal surgery’were searched respectively as the theme, keyword and Title Retrieval in CHKD Database,Wanfang Data knowledge service platform (Wanfang Data),VIP Chinese Journal database (CQVIP)and Chinese biomedical literature database (CBM).Results The result showed that the literature of fetal surgery increased obvi-ously by NoteExpress,especially after 2013.Some hot words of literature about fetal surgery included prenatal diagnosis,ultrasound,fetal sur-gery,prognosis and complications.The major authors’units located in Guangdong,Liaoning,Shanghai,Zhejiang,Sichuan and other regions. The affiliated Shengjing Hospital of China Medical University,Maternal and Child health Hospital of Foshan City in Guangdong Province,the First Affiliated Hospital of Zhongshan University were as the main research institutions.The literatures were classified by the subject of the ob-stetrics and gynecology,surgery,clinical medicine,pediatrics,oncology,the two accounted for more than 50%.The distribution of journals published this type of literature were more broad,and the content was more dispersed.Conclusion The development of the fetus is still in the early stage of development,which need for more accurate positioning and development of the fund to support its development.

Objective To study the pathogenesis of lower limb motor disorder in vascular parkinsonism(VP)using diffusion tensor image(DTI). Methods A case?control study was performed in a cohort of 16 VP patients and 32 PD patients. Patients were all recruited from the first affiliated hospital of China Medical University from Dec. 2011 to Dec. 2012. The lower limb motor function of those patients was assessed using measurement scales. All patients received magnetic resonance image(MRI)and diffusion tensor image(DTI). Results Patients in VP group showed more seri?ous movement disorders such as freezing of gait(gait ignition failure)than these in PD group,and the movement disorders of their lower limbs prog?ress more rapidly in VP group than the PD group. Movement disorders of their lower limbs in VP group were related to fibers in bilateral frontal lobes (P=0.008). Movement disorder of their lower limbs in PD group were related to fibers in substantia nigra(P=0.030). There are statistically signifi?cant differences in both the FA values of substantia nigra,bilateral frontal lobes and the ADC values of frontal lobes,and the pars compacta and pars reticulata of substantia nigra between these two groups(all P<0.05). Conclusion Movement disorders of bilateral lower limbs are more seriously manifested in VP patients than in PD patients. The onset movement dysfunction of bilateral lower limbs is closely related to fibers in the frontal lobe.