Objective To compare the impact of nimodipine combined with mannitol and mannitol only on the neurologic impairment score,cerebral hemodynamic parameters and clinical efficacy of hypertensive cerebral hemorrhage in acute phase.Methods 68 patients with hypertensive cerebral hemorrhage in acute phase were selected,and they were randomly divided into control group (34 cases) and study group(34 cases) by digital table method.The control group was treated with mannitol only,while the study group was treated with nimodipine combined with marmitol.The clinical efficacy,hematoma volume,area of cerebral edema,cerebral hemodynamic parameters,neurologic impairment score,Barthel score of the two grou.ps were compared,and the adverse drug reaction of the study group was observed.Results The total effective rate (82.4％ vs.94.1％) and efficiency rate (44.1％ vs.61.8％) of the two groups had statistically significant differences (x2 =5.688,4.956,all P ＜ 0.05).The neurologic impairment score [post-treatment of the control group (10.2 ± 9.3) points vs.pre-treatment (14.9 ± 11.6) points,t =4.607,P ＜ 0.05;post-treatment of the study group (6.0 ± 4.7) points vs.pre-treatment (14.4 ± 10.8) points,t =8.379,P ＜0.05],area of cerebral edema[post-treatment of the control group (3.7 ± 0.6) cm2 vs.pre-treatment (4.8 ±0.9) cm2,t =5.262,P ＜ 0.05;post-treatment of the study group (2.2 ± 0.8) points vs.pre-treatment (5.1 ±1.2) points,t =9.193,P ＜ 0.05],hematoma volume [post-treatment of the control group (12.5 ± 7.4) mL vs.pre treatment (18.9 ± 7.1) mL,t =6.033,P ＜ 0.05;post-treatment of the study group (8.6 ± 8.2) points vs.pre treatment (18.4 ± 7.3) points,t =10.437,P ＜ 0.05] and Barthel score [post-treatment of the control group (73.6 ±40.4) points vs.pre-treatment (32.8 ± 27.1) mL,t =7.827,P ＜ 0.05;post-treatment of the study group (85.6 ±46.8) points vs.pre-treatment (36.7 ± 28.6) points,t =10.966,P ＜ 0.05] of the two groups had statistically significant differences.The neurologic impairment score of the study group after treatment was much lower than that of the control group [(6.0 ± 4.7) points vs.(10.2 ± 9.3) points,t =3.955,P ＜ 0.05].There were statistically significant differences between after and before treatment of the control group in critical pressure [(9.3 ± 2.2)kPa vs.(9.6 ± 2.1) kPa,t =5.046,P ＜ 0.05],peripheral resistance [(1 788.2 ± 209.4) kPa · s-1 · mL-1 vs.(1 659.2 ±219.3)kPa·s-1 · mL-1,t =6.146,P＜0.05]and mean blood flow velocity[(6.4 ±1.1) mL/s vs.(7.9±1.2) mL/s,t =6.266,P ＜ 0.05].The cerebral hemodynamic parameters of the study group after treatment had statistical differences compared with before treatment in critical pressure [(8.9 ± 2.3) kPa vs.(8.2 ± 1.1) kPa,t =5.292,P ＜ 0.05],peripheral resistance [(1 794.3 ± 188.6) kPa · s-1 · mL-1 vs.(1 469.5 ± 161.8) kPa · s-1mL-1,t =4.693,P ＜ 0.05],mean blood flow velocity [(6.4 ± 1.3) mL/s vs.(8.6 ± 1.5) mL/s,t =4.069,P ＜0.05],mean blood flow volume [(13.3 ± 3.0) cm/s vs.(14.5 ± 3.3) cm/s,t =5.633,P ＜ 0.05].There were statistically significant differences between the two groups in critical pressure,peripheral resistance,mean blood flow velocity,mean blood flow volume (t =4.664,4.563,5.532,5.327,all P ＜ 0.05).There were 4 cases of facial flushing,2 cases of pulsatile headache,3 cases of blood pressure drop,and the symptoms were gradually relieved after slowing down.Conclusion In the acute phase of hypertensive cerebral hemorrhage,nimodipine can reduce the scope of hematoma in a timely manner,significantly improve the efficacy and the quality of life of patients,it is worthy of clinical pronotion.

BACKGROUND: There have been some prospective, randomized, controlled studies regarding the feasibility and safety of laparoscopic gastrectomy for gastric cancer, but controversy exists.OBJECTIVE: To systemically assess the feasibility and safety of laparoscopic gastrectomy for gastric cancer.METHODS: A computer-based online research of prospective, randomized, controlled studies addressing laparoscopic gastrectomy versus open gastrectomy published between January 1994 and December 2009 was performed in PubMed, Ovid Medline, Web of Knowledge, EMbase, Chinese Journal Full-text Database and Wanfang Database. Meta analysis of acquired data was performed through the use of RevMan 5.0 software. The inverse variance method was used to test the significance of continous data, while the Mantel-Haenszel method was used for dichotomous data. The chi-square test was used for evaluation of data heterogeneity. Homogenous data was calculated using the fixed effect model, and heterogeneous data was calculated using freedom model. Statistical data was expressed as 95% confidence interval. Funnel plot was used for sensitivity analysis to show potential publication bias.RESULTS AND CONCLUSION: Five papers that corresponded to inclusion criteria were included in this study. Among 326 cases included, 164 underwent laparoscopic gastrectomy and 162 received open gastrectomy. Meta analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy (both P ＜ 0.01), but for early-stage gastric cancer, laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay (P ＜ 0.01). But there was no significant difference in terms of time to resumption of oral intake, postoperative complications,postoperative morbidity rate, and tumor recurrence. Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node. The five papers adopted two different modes to remove lymph nodes, so subgroup analysis was also used. Results showed that for D1 lymph node dissection, laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy. All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.

The paper describes the short and medium term (within 2 to 5 years) priorities that any region in China right now faces in working out and implementing its regional health planning, viz. the coordinated development strategy of medicine and health, medical security and social economy. The authors hold that to achieve the coordinated growth of the health cause and society, it is imperative to overcome in the short run logically related obstacles in four aspects: ineffective solution to the apparent problems followed with interest by both the social and health sectors and lack of effective operating conditions accompanying medical insurance reform, both resulting in the lack of a driving force in the reform within hospitals; difficulty in achieving breakthroughts in the development of the health cause; and the probability of a regional health planning becoming a mere formality because of the above factors. In addition, the fact that reform of medical and health institutions in their setup and ownership of property rights lags behind macroscopic social economic reform obscures the explanation of and solution to the above problems. Based on the research results, the paper sets forth the priorities in short and medium term planning.

Objective To study the clinical characteristics in young women with breast cancer.Methods Clinical data on 71 young breast cancer cases (under 35 years) out of a total 810 female cases during a period of 20 years were retrospectively analyzed. Result Delayed medical consultation was more often seen in young patients(56?4)?d vs (35?3)?d; u=2.33; P

Objective To investigate the main technical points of detachable balloon in management of traumatic carotid-cavernous fistulas (TCCF) and evaluate objectively the clinical outcome.Methods A total of 59 patients with TCCF were treated with detachable balloons,which involved 64 embolization procedures.Follow-up ranged from 3 months to 2 years. Results Forty-eight patients with TCCF (81％) were successfully occluded with patency of internal carotid artery.The rest 11 patients were obstructed in both the fistula and the internal carotid artery.Recurrent TCCF was found within three days after embolization in five patients (with a recurrence rate of 8％ ) who underwent further embolization,of whom one patient went blind after the procedtre and the eyesight showed no recovery even after another embolization with balloon for successful occlusion of the fistula; one patient presented with intracerebral hematoma at day 3 postoperatively and underwent emergency embolization again to occlude the internal carotid artery and fistula,with slight paralysis of the left limb. Conclusions Embolization of TCCF with detachable balloon is a reliable treatment,which is characterized by slight injury and high safety.However,the disease' s development should be strictly observed after the treatment.In the case of recurrence of symptoms,brain angiography and CT scanning should be rechecked timely and emergency treatment should be performed.

Objective To explore the CT and MR imaging findings of acinic cell carcinoma (ACC)in salivary gland and enhance the diagnosis of this rare disease.Methods The CT and MR imaging characteristics of 20 patients (7 males and 13 females,median age 44 years old) with pathologically proved ACC were retrospectively reviewed.CT and MR images were evaluated in relation to the following: location,size,morphology,margin,CT density/MR signal intensity and enhancement pattern.Results Twelve lesions were located in parotid gland,two lesions in maxillary Sinus,and one lesion in submandibular,parapharyngeal,infratemporal fossa,buccal,nasal cavity,and hard palate respectively.The size of lesions were 0.7～5.8 cm.Sixteen lesions less than 3 cm in size demonstrated round or oval round masses with well defined margin.Four lesions more than 3 cm in size demonstrated irregular masses with unclear margin.Among them,bony destruction of the wall of the maxillary sinus was noted in 3 cases,and the preauricular skin was invaded in 1 case.The densities (signal intensity) were homogeneous in 6 cases and heterogeneous in 14 cases.Lesions were slightly low density in 11 case and isodensity in 3 cases on CT plain scan.Lesions were homogeneous isointense in 2 cases and heterogeneous isointense in 4 cases on T1WI,heterogeneous hyperintense in all cases on T2WI.On post contrast images,lesions demonstrated remarkable enhancement in 14 cases,moderate enhancement in 2 cases and mild enhancement in 3 cases.Conclusions The imaging characteristic of ACC were nonspecific.CT and MR could accurately detect the extent of tumor involvement and was helpful to provide more comprehensive information for the strategy of clinic therapy.

ObjectiveTo explore the characteristic CT features of benign and malignant submandibular gland lesions.Methods CT scans of 75 cases of submandibular gland lesions verified pathologically after surgery were analyzed retrospectively,including 38 cases of pleomorphic adenoma,22 cases of malignant tumors,11 cases of chronic submaxillaritis,2 cases of myoepithelioma,1 case of neurilemoma and 1 case of hemangioma.Results ( 1 ) All 38 cases of submandibular gland pleomorphic adenoma only occupied a part of submandibnlar gland.Thirty five lesions were on the edge of submandibular gland.The edge of 33 lesions were smooth and the density of 30 lesions were even.Thirty three lesions were slightly or moderately enhanced and 10 lesions showed “target sign” on enhanced CT.( 2 ) There were 22 cases of submandibular gland malignant tumors.Three lesions of lymphoma located at the edge of submandibular gland with smooth edge and even density,and showed mild to moderate enhancement.The remaining 19 lesions showed rough edge and uneven density.Eighteen of the 19 lesions showed ill-defined boundary,2 of the 18 lesions invaded most of submandibular gland and 16 of the 18 lesions invaded the whole submandibular gland.Seventeen lesions were unevenly enhanced,thickened,cirvilinear vessels were seen in 12 of the 17 lesions.Nine cases were accompanied with swollen lymph nodes ( minor diameter greater than 1.0 cm) in neck.(3)There were 11 cases of chronic submaxillaritis,which showed enlargement of the whole submandibular gland with relative smooth edge and relative clear boundary.Most of lesions were moderately and evenly enhanced.Six cases were companied with submandibular duct lithiasis and dilatation.All of 11 cases were accompanied with lymph node enlargement in neck.(4) Two cases of myoepithelioma demonstrated irregular ring enhancement on CT;one case of neurilemoma showed obvious cystic changes and slight enhancement on the edge;1 case of hemangioma showed multiple phleboliths and prolonged contrast enhancement.ConclusionsMost of submandibular gland benign and malignant lesions show some degree of characteristic CT findings.It is relatively difficult to discriminate between lymphoma and submandibular gland pleomorphic adenoma.

Objective To study the value and clinical significance of diffusion tensor imaging(DTI)in differentiating high-grade astrocytomas and solitary metastatic tumors of brain.Methods 16 patients with intracranial solitary metastasis and 25 patients with high-grade astrocytoma confirmed pathologically were examined with MR DTI.Mean diffusivity(MD)and fractional anisotropy(FA)were measured in the regions of interest(ROI)of peritumor and cerebral parenchyma of the normal side on DTL Fiber tractography was reconstructed and the encountered patterns of tumor-related alteration to cerebral white matter were observed.Results The peritumor were all depicted as hyperintense or isointense signals on DTI.The FA values were 0.227±0.05 and 0.169±0.07 in the peritumor of high-grade astrocytoma and metastasis respectively,which was of significant difference(P＜0.05).Furthermore,fiber tractography could display the course of white matter tracts in three-dimensional space.Conclusion DTI may be help to differential diagnosis of solitary metastasis and high-grade astrocytoma in clinical practice.

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Objective To study the relation between thyroid nodule and urine iodine and to provide a scientific basis for etiological research of thyroid nodule.Methods 178 cases of thyroid nodule were detected urine iodine concentration (μg/L) by As ( Ⅱ ) 2Ce4 + catalytic spectrophotometry.160 normal people were set as control group.Data of the 2 groups and the correlative clinical information were analyzed.Results The median urine iodine concentration was 116.2 μg/L for the 178 cases of thyroid nodule,217.2 μg/L for the control group.Among the 178 cases,the median urine iodine concentration was 125.6 μg/L for the 92 cases with nodule size ＞ 10 mm and 136.4 μg/L for the 86 cases with nodule size ＜ 10 mm.The difference of urine iodine had no statistical significance between the thyroid nodule group and the control group.There was no correlation between urine iodine and the size of thyroid nodule as well as sex.Conclusions No correlation is found between urine iodine and thyroid nodule.Patients with thyroid nodule,no matter male or female,don't have to restrict iodine intake excessively.