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.

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

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 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.

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Objective To evaluate the efficacy of percutaneous CT guided interstitial 125Ⅰ seeds implantation treatment for refractory pelvic malignant tumors and discuss the procedure of technique.Methods Twenty-three patients with refractory pelvic malignant tumors(25 lesions,diameter 3.5-7.0 cm,mean 4.5 cm) showing failure response to full chemotherapy and/or radical radiotherapy after tumors resection were undergone percutaneous CT guided intratumoral 125Ⅰseed implantation.Treatment plan system(TPS)was used to design the distribution and number of 125Ⅰ seeds according to matched peripheral dose(MPD)1-3 days before the procedure.Of which 6 cases received combined internal iliac arterial infusion chemotherapy before or after the 125Ⅰ seed implantation procedure.Results 9 ～ 75(mean 27)125Ⅰ seeds were implanted into a single tumor at first time including 6 patients with intraarterial chemotherapy for 14 cycles(mean 2.3 cycles),showed relief of clinical pain symptoms in 16 of 23 cases,72 h ～ 4 w after the seeds implantation;with the an effective rate of 69.6%.Follow up for 2-34 months(median,21 months),CT or MRI performed 2 months after the seeds implantation showed no CR,but PR in 18 cases,SD in 4 cases,and PD in 1 case,with overall response rate of 78%(18/23),and no serious complication.In addition,20 cases survived,with the longest one of 34 months and the other 3 died.Conclusions Intratumoral 125Ⅰ seeds implantation under CT guidance for pelvic refractory malignant tumors is safe,minimally invasive,and effective.

Aim To investigate the myocardial hypertrophy,the expression of transforming growth factor ?1(TGF-?1),Smad3 and Smad7 proteins in spontaneous hypertensive rats(SHR)and the effects of benazepril and candesartan.Methods SHRs of 12 weeks old were given benazepril and candesartan for 12 weeks.The tail arterial pressure was measured every two weeks.At 12 th weekend,cardiac configuration,heart mass index,area of cadiocytes,concertrations of AngⅡin plasma and myocardium,expressions of TGF-?1、Smad3 and Smad7 proteins were measured respectively.Results The arterial pressure,wall thickness,heart mass index,area of cardiocytes and the expressions of TGF-?1,Smad3 proteins increased in SHRs but were attenuated after the treatment of benazepril or candesartan.After the combined treatment,the synergistic effect could be observed.The levels of cardiac tissue and plasma AngⅡwere reduced.The expressions of Smad 7 were up-regulated after the treatment of benazepril or candesartan,while they were stable after the combined use.Conclusion There is a synergistic effect of attenuating myocardial hypertrophy in SHRs by combined use of benazepril and candesartan.It may be related to the regulation of Ang Ⅱ,decreasing the expressions of TGF-?1 and Smad3.