Aged ; Cryptococcosis ; microbiology ; pathology ; surgery ; Cryptococcus neoformans ; isolation & purification ; Follow-Up Studies ; Humans ; Laryngeal Diseases ; microbiology ; pathology ; surgery ; Male

Objective To compare the early and delayed tracheostomy in patients treated with prolonged mechanical ventilation in respects of mortality.incidence of nosocomial pneunonia and length of ICU stay.Methods Randomized controlled trials(RCTs)and quasi-randomized controlled trials(quasi-RCTs)were performed by searching throush the Ovide MEDLINE(1996-2006.7),EMBASE(1980-2006.7),Cochrane Database(Issue 2,2006),Chinese Cochrane Centre Database and CBMdisc(1978-2006.7).The published and unpublished data and their references were searched.All RCTs and quasi-RCT of tracheostomy for critically ill patients treated withprolonged mechanical ventilation were included.Data were collected and evaluated by two reviewers independently and separately.RevMan version 4.2 software was used for data analysis.Results Two hundred and eighty-six patients from 4 RCTs and 106 cases from one quasi-RCT were taken for meta analysis.The meta-analysis showed that the early tracheostomy could reduce mortality(OR 0.69,95%CI 0.51,0.95),significantly shorten the duration of mechanical ventilation(WMD-8.49,95%CI-15.32,-1.66)and shorten the length of ICU stay as well(WMD-15.33,95%CI-24.58,-6.08)in patients treated with prolonged mechanical ventilation.but the incidence of nosocemial pneumonia was not different between two sorts of patients(OR 0.91,95%CI 0.70,1.18).Conclusions In case of prolonged mechanical ventilation,the tracheostomy performed at earlier stage may decrease the mortality,and shorten the duration of mechanical ventilation and the length of ICU stay.but cannot reduce the incidence of nosocomial pneumonia.

Cerebral vasospasm is the main reasons of cerebral infarction and delayed ischemic neurological deficit in patients with spontaneous subarachnoid hemorrhage. At present, the research of cerebral vasospasm is relatively focused on the spasmogens in bloody cerebro-spinal fluid. This article reviews the mechanisms of cerebral vasospasm induced by the major spasmogens in the bloody cerebrospinal fluid after subarachnoid hemorrhage.

Breast Neoplasms ; pathology ; surgery ; Carcinoma, Ductal, Breast ; pathology ; surgery ; Cryoultramicrotomy ; Cytodiagnosis ; methods ; Female ; Histocytological Preparation Techniques ; methods ; Humans ; Intraoperative Care ; methods ; Precancerous Conditions ; pathology ; surgery

The resident match system established in 1952.And since then almost all of the senior medical students and international students have applied a position of resident training in this national system.They seek a respective resident program and hospital for training while the hospital hires students they preferred.The match procedure includes submitting application,interview of selected candidates,submitting rank-order list of both parties,centralizing matching service by computer and announcement of the results in Match Day.This is a relatively stan-dardized,rational and fair system which we can learn something from.

Objective To investigate the degree of vascular damage in patients with hypertension in various stages with transcranial Doppler (TCD), so as to provide references for the prevention and treatment of obstructive cerebral vascular disease. Methods TCD was adopted to examine bilateral anterior cerebral arteries (ACA), terminal internal carotid arteries (TICA), vertebral arteries (VA) and basal arteries (BA) in patients with hypertension (n=176) and normotensive individuals as control group (n=60). The hemodynamic data of two groups were analyzed statistically. Results In patients with stage Ⅰ hypertension, the blood stream velocity was increased in all intracranial vessels, especially in MCM and TICA. In patients with stage Ⅱ and Ⅲ hypertension, the elevation of blood pressure was followed by the decrease of blood stream velocity, especially in MCA, TICA and BA. The rate of abnormality as detected by TCD was 90 and 96 in patients with stage Ⅱ and Ⅲof hypertension, respectively. Conclusions The abnormal findings of cerebral vessels as detected by TCD seem to coincide with the clinical characters of stroke. TCD findings may be used as an early forewarning index of obstructive cerebral disease.

Objective To evaluate the value of MRI in diagnosing the bucket handle tear (BHT) of the knee meniscus.Methods Eighty four knees which underwent both MRI and arthroscopy (AS) examinations were analyzed. Results of AS were used as golden standard to evaluate the results of MRI. The evaluating criteria included primary reports, central displaced fragments of meniscus (CDFM), double posterior cruciate ligament sign (DPCLS) and the absent bow tie sign (ABTS). Results For MRI diagnosing BHT, the sensitivity and specificity of primary reports were 43% and 87%, respectively; the sensitivity and specificity of CDFM were 72% and 87%, respectively; the sensitivity and specificity of the DPCLF were 31% and 97%, respectively; and the sensitivity and specificity of the ABTS were 71% and 69%, respectively.Conclusions When MRI was applied to diagnose BHT, the CDFM had higher sensitivity and specificity, while the ABTS had higher sensitivity and lower specificity. The DPCLF had the highest specificity and the lowest sensitivity.

Child ; Humans ; Kidney ; pathology ; Lymphoma, T-Cell, Cutaneous ; pathology ; Male ; Skin Neoplasms ; pathology

The relation between the critical radius and the particle size distribution for generalized Ostwald type ripening processes whereby the mass transfer coefficient is modelled by a power law was derived. The critical radius is determined by the growth rate, the mass transfer coefficient and the mass balance, and is independent of whether the limiting stationary growth regime has been obtained.
Computer Simulation ; Crystallization ; methods ; Macromolecular Substances ; analysis ; chemistry ; Models, Chemical ; Models, Molecular ; Molecular Conformation ; Particle Size

Objective To analyze the clinical features and image manifestations of hepatic inflammatory myofibro-blastie tumor( HIMT), and to investigate the optimal management of this disease. Methods From January 2000 to January 2007, clinical data with HIMT verified by pathology were retrospectively analyzed. Results Eight patients 5 men, 3 women were included in the analysis. The mean age was 41.3 years. All eases did not have a history of previous hepatitis and liver cirrhosis, and 6 with no typical clinical symptoms. Hepatic functions, serum levels of AFP, CEA, CA199 in these patients were all within the normal ranges. Preoperative imaging by ultrasonography and computed tomography(CT) were not indicative of HIMT. Morphologic features by CT scan were summarized: at nonenhanced CT, the masses appeared as low density lesions. At contrast enhanced CT, the masses exhibited mod-erate intensification in the solitary areas, and the intensification peak appeared during the period of artery. During the period of portal vein and delayed scan, the masses showed low to moderate intensification in the solitary areas, in which the degree of intensification was a little lower than that in peripheral liver parenchyma. Gross specimens showed single solid masses, 3～12 cm, without classic envelope. All the patients underwent surgery whereas no incidence of perioperative death. Diagnosis of HIMT was confirmed by pathology of surgical specimens. Condusion Although typical presentation and the diagnostic workup are still lacking for HIMT, CT is helpful in diagnosing HIMT as well as combined with clinical findings. Surgical management would be likely the optimal treatment of this disease.