Objective To describe the MRI findings in patients with Acquired hepatiocerbral Degeneration(AHCD) and evaluate the role of MRI in dignosis of AHCD. Methods 26 patients with chornic hepatic failure under went brain MRI scan. Eight of these patients had abdominal MR digital subtract angiography(MRDSA) examnation. 25 patients had plasma ammonia levels test two weeks after MR exmnation. Results 22 patients had abnormal MRI findings, T 1WI demonstrated incresed signal in the globus pallidus (22/26), putmen (4/26), mesencephalon surrounding red nucleus(15/26),and in the anterior pituitary (12/26). While T 2WI demonstraied no corresponding alteration in signal intensity. Eight patients which had MRDSA showed obvious portal systemic shunts. There was positive correlation between plasam ammonia level and abnormal signal( r = 0.521 6, P

Hepatic eosinophilic granuloma is a rare benign liver lesion,which results from granuloma formation due to chronic inflammation.Two patients were admitted to the Yantaishan Hospital and Yuhuangding Hospital from July 2008 to April 2012,respectively.The results of laboratory examination showed the elevation of peripheral blood eosinophils,and ultrasound examinations revealed low-echo masses in the liver and no blood flow was detected.The results of computed tomography showed hypoattenuation lesions with well-demarcated boundary.After intravenous administration of contrast angent,the lesions demostrated delayed heterogeneous enhancement with internal grid.The results of magnetic resonance imaging of 1 patient showed the lesion had slight hyper-intensity to the surrounding liver parenchyma on T1-weighted images,and slight high signal with low signal separation strip inside on fat-suppressed T2-weighted images.An obvious high signal was detected in diffusion weighted imaging.Familiarity with the imaging characteristics and combination of the elevation of peripheral eosinophil can help surgeons to make a suggestive diagnosis.

Analyzing and discriminating incorrect cases is a good method in medical statistics teaching,which can not only help students review the knowledge they have learned but also guide their self-learning.Teachers can start teaching based on the reverse thinking,propose incorrect cases with moderate difficulty and in accordance with the reality and arouse students' creativity through introducing the incorrect cases,reviewing the incorrect cases and conducting group discussion.

Objective To explore the indexes change of coagulation and fibrinolysis in APL with ATRA and As2O3.Methods Treatment group 18 eases were undeaaked ATRA 20-30 mg/d until relieved completely.0.1%arsenic trioxide 10 ml with 5%glucose 500 ml for 28 days.Normal control 10 cases were undertaked ATRA 45～60 mg/d until relieved completely.Results The CR rate of treatment group was higher than control group(P＜0.05),the patients of control group showed different reactions such as thirsty mouth,rationale acid syndrome.2 cases reacted strongly and the treatment had to be interrupted,the patients of treatment group had little reaction,but liver function were badly hurt and liver-protection treatment was needed.Fbg,D-dimer recovery time is 7 days,21 days in treatment group,14 days,21 days in control group.Conclusion CR rate is high and has little side effect,and indexes change of coagulation and fibrinolysis were recovered quickly,it has great significance to take D-dimer as early diagnose and observe the indexes change during the treatment.

Objective To investigate the changes of zinc in maternal plasma and MMP-9,collagen Ⅳ levels in serum and matrix metalloproteinases-9 (MMP-9) level in amniotic fluid in patients with premature rupture of membranes at term(TPROM).Methods Thirty cases who were diagnosed as PROM at term during Nov.2012 to Mar.2013 were enrolled as case group,and 30 cases delivered during the same time without PROM were enrolled as control group.Maternal blood and ammiotic fluid were collected from all the cases.The level of zinc in maternal plasma was measured by atomic absorption method and the levels of MMP-9 in serum and amniotic fluid were detected by enzyme linked immunosorbent assay(ELISA),while the level of collagen Ⅳ in serum was measured by up-conversion luminescence method.The relationship among them was analyzed.Results Compared to control group,there were statistically significant difference between TPROM and control groups in terms of the level of zinc,collagen Ⅳ,MMP-9 in serum and MMP-9 in amniotic fluid (zinc:(109.10 ± 16.07) μmol/L vs.(90.54 ± 10.99) μmol/L; t =-5.22,P ＜ 0.001 ; collagen Ⅳ:(56.86 ±41.26) μg/L vs.(88.61 ±44.87) μg/L;t =2.852,P =0.006;MMP-9 in serum:(1 463.25 ±483.6) μg/L vs.(1 196.9 ± 357.43) μg/L,t =-2.426,P =0.018 ; MMP-9 in amniotic fluid:(125.48 ± 67.18) μg/L vs.(72.64 ± 60.74) μg/L,t =-2.873,P =0.006).Zinc level in maternal plasma and collagen Ⅳ in serum had a negative relationship in TPROM (r =-0.261,P =0.044).Zinc level in maternal plasma and MMP-9 level in serum had a positive relationship in TPROM (r =0.274,P =0.034).MMP-9 levels in serum and amniotic fluid had a positive relationship in TPROM (r =0.264,P =0.047).There were no significant relationship between zinc level in maternal plasma,MMP-9 level in amniotic fluid,collagen Ⅳ and MMP-9 levels in serum,collagen Ⅳ in serum and MMP-9 in amniotic fluid (r =0.215,-0.172,-0.172 ; P ＞ 0.05).Conclusion The level of zinc in maternal plasma and increase of MMP-9 in serum and amniotic fluid of women and decrease of the level of collagen Ⅳ in serum are related to the occurrence of TPROM.

Objective To investigate the application effect of evidence-based nursing and individual nurs-ing in pregnancy patients with lupus nephritis. Methods Sixty-five patients were randomly divided into control group and observation group. They were treated with routine care and evidence-based nursing respectively. The complications, pregnancy outcome and satisfaction of patients were compared between the two groups. Results There were not significant difference in renal failure , pregnancy induced hypertension , ecalampsia , heart failure , HELLP syndrome and other complications between observation group and normal group (P > 0.05). The pregnan-cy outcome had no significant difference between two groups (P > 0.05). In observation group, the health score was significantly higher than that of control group(P < 0.05). The mental health score in control group was sig-nificantly higher than that of observation group (P < 0.05). There werenot significant difference in social health and overall health score between the two groups (P > 0.05). Conclusion The application of evidence-based nursing and individual nursing in pregnancy patients with LN not only reduce the incidence of complications , but also reduce the chance of premature birth, stillbirth. And it could improve the cognition on the nursing work of this disease and the satisfaction of patients. But individual nursing is better in improving the patient′s mental health, while the evidence-based nursing is better in improving the health status.

Objective To investigate the effect of recombinant human growth hormone (rhGH) action on pregnancy rate of polycystic ovarian syndrome(PCOS).Methods The PCOS who were client in our hospital in February-August,2012 were investigated.The rhGH group (41 cases) were that all patients took rhGH at the same time ovulation.The control group (41 cases) were no medication group.The two groups had sex action after ovulation.Ovulation rate,pregnancy rate and endometrial score of the two groups were compared.Results Ovulation rate of rhGH group was 90.2％ (37/41),the control group was 68.2％ (28/41),the difference was statistically significant (x2 =3.459,P =0.036).Clinical pregnancy rate of RhGH group was 32.7％ (12/37),the control group was 25.0％ (7/28).The difference was statistics significance (x2 =4.319,P =0.032).Endometrial score of rhGH group was (14.96 ± 2.18),the control group was (12.77 ± 2.60) points,the difference between groups was statistically significant (t =-3.356,P =0.032).Conclusion Giving rhGH ovulation cycle specification can promote ovulation PCOS patients and improve the adverse factors affecting pregnancy,improving the pregnancy rate.

Objective To evaluate the efficacy and adverse effects of thalidomide plus melphalan and VAD regimen in the treatment of multiple myeloma(MM). Methods 24 patients in the treatment group were treated with thalidomide plus melphalan and VAD regimen. Two continuous treatment were considered valuable. Observational content included results of serum myeloma protein; liver and renal function; protein-uria of 24-hours; bone marrow and peripheral blood and soon. The side reactions were recorded. The clinical efficacy evaluation was divided into complete response(CR), partial respouse(PR), none response(NR). Results 13 cases in the treatment group achieved CR, 6 cases achieved PR, 5 cases no change, 19 cases achieved overall response. Conclusion The prominent clinical efficacy was achieved with thalidomide plus melphalan and VAD regimen in multiple myeloma. The clinical manifestation was improved significantly.

OBJECTIVE:To provide reference for implementing relevant policies and measures,and promote rational drug use. METHODS:The cognition(questionnaire)and application(prescription spot checks)about antibiotics and glucocorticoids by 191 rural doctors from 14 township hospitals and 18 health room in area A,B and C(representing the economically developed areas, moderately developed areas and undeveloped areas)were investigated,and the results were statistically analyzed. RESULTS:Total-ly 382 questionnaires were sent out(191 for antibiotics and 191 for glucocorticoids),and 382 were effectively received with effec-tive recovery of 100%;and 2 300 prescriptions were checked. Results of questionnaire showed,there were still some misunder-standings and blindness among the rural doctors'cognition and application about antibiotics and glucocorticoids,the usage of β-lac-tam was not fully grasped,part of the empirical use of antibiotics and drug treatment was still not entirely clear,more than 40%had no clear ideas about the classification and contraindications of hormones,and more than half of them didn't know the Glucocor-ticoids Clinical Practice Guidelines;results of prescription spot checks showed,there were regional differences about the proportion of antibiotics and glucocorticoids,area A had the highest proportion among 3 areas,accounting for 60.9% and 18.9%,respective-ly. And area C showed highest proportion about unreasonable prescriptions,accounting for 22.5%. CONCLUSIONS:The cognition and reasonable use of rural doctors for antibiotics and glucocorticoids still needs to be strengthened. It is suggested to take effective measures,formulate and implement the corresponding supervision system,strengthen antibiotics and glucocorticoids knowledge training for rural doctors and fully implement the the principles of rational drug use to improve the rational drug use.

Objective To investigate the effect of early early enteral nutrition combined with parenteral nutrition support on postoperative gastrointestinal function,nutritional status and liver function of patients with obstructive jaundice.Methods Sixty-two patients with obstructive jaundice of hepatobiliary who were treated in the General Surgery Department of the Affiliated Hospital of North China University of Science and Technology from July 2013 to July 2014 were randomly divided into the control group and the observation group,31 cases in each group.The control group were treated with simple parenteral nutrition,and were injected by central venous catheter at the first day after operation,with the injection tiem of 12-15 h and continuous infusion of 7 d or more.The observation group were received enteral nutrition combined with parenteral nutrition,parenteral nutrition was given first,and the preparation method of the nutrient solution was identical with that of the control group;and then slowly dropped 250 ml physiological saline into the jejunum nutrition tube at the second day,dropped into the enteral nutrition liquid at the third day with the initial dose of 300 to 500 ml per day,slowly dropped in the speed of 20-30 ml/h.Results The first exhaust time,first defecation time and hospitalization time in the observation group were (41.37±6.85) h,(46.85±7.13) h and (12.79±3.76) d,significantly shorter than those in the control group ((57.21 ± 9.23) h,(61.43 ± 10.62) h and (16.94 ± 4.33) d;t =7.67,6.35,4.03;P＜O.05),daily hospitalization expenses was (1637.65± 138.24)yuan,significantly less than that in the control group((2121.42±112.38)yuan;t=15.12;P＜0.05).The serum albumin berofe and after the operation in the control group and observation group were (28.73±3.24) g/L and (29.21±3.31) g/L,(36.85±4.05) g/L and (47.21±4.13) g/L,respectively.The serum pre albumin berofe and after the operation in the control group and observation group were (162.81±31.27) g/L and (163.14±30.56) g/L,(248.95±58.62) g/L and(324.24±61.34) g/L,respectively.There was no difference before operation between the two groups (P＞0.05),while the serum protein levels were significantly increased in observation group than the control group (P＜0.01).There were no difference in ALT,total bilirubin and direct bilirubin levels between the two groups before operation (P ＞ 0.05),after treatment,the levels of ALT,total bilirubin and direct bilirubin in the observation group were significantly higher than those in the control group(P＜0.01).The patients in the two groups recovered well,and no serious adverse reactions occurred.Conclusion Early enteral and parenteral nutrition support in patients with obstructive jaundice has better effect and safety in the clinical treatment.