Objective To investigate the analysis of collateral circulation in patients with acute symptomatic internal carotid artery occlusion (ICAO)and its clinical significance. Methods Seventy-two consecutive patients with symptomatic ICAO diagnosed by digital subtraction angiography (DSA)were enrolled retrospectively. The American Society of Intervention and Treatment Neuroradiology / Society of Interventional Radiology (ASITN/ SIR)scores were used to evaluate the collateral circulation in the region of ICAO,and the collateral circulation of the patients with different causes,different clinical manifestations, and different types of infarcts were compared. Results Of the 72 patients with ICAO,61(84. 7%)had atherosclerotic occlusion,8(11. 1%)had cervical dissection,and 3 (4. 2%)had cardioembolism;55 patients (76. 4%)had cerebral infarction and 17(23. 6%)had transient ischemic attack. There were no significant differences in the ASITN/ SIR scores among the different causes (P > 0. 05). The ASITN/ SIR scores in patients with cerebral infarction and transient ischemic attack were 2. 64 ± 0. 80 and 3. 29 ± 0. 69 respectively. There was significant difference (P < 0. 05). In patients with cerebral infarction,the ASITN/SIR scores in patients with internal watershed infarction and regional cerebral infarction only were 2. 43 ± 0. 68 and 2. 36 ±0. 51 respectively,they were lower than the patients with only external watershed infarction only and/ or cerebral infarction in cortical territory (3. 42 ±0. 90,P <0. 05). Conclusion Atherosclerotic occlusion is the most common cause of ICAO. ASITN / SIR scores may reflect the conditions of collateral circulation in patients with ICAO. The occurrence of internal watershed infarction and regional infarction indicates the collateral circulation is poor,and need for further therapeutic intervention.

6 cm AVMs(57.1%)were much higher than that with 0.05).Seizure was found in forty-three patients.After embolization the seizure in 20 patients disappeared,11 patients had been improved greatly.The total effective power was 72.1%.Conclusions The size and location of AVM is significantly associated with the onset of seizure.The number of feeding artery has no relation with the seizure.Endovascular embolization for the AVMs has got better cure effect.

Objective To study the expression and transcription of PKC? in renal tissue of streptozotocin-induced diabetic rats. Methods Hyperglycemia was induced with streptozotocin(55 mg/kg) in Sprague-Dawley rats. After 5 weeks, the expression of PKC? protein and mRNA was measured by immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. Results In diabetic animals, the expression of PKC? was greatly enhanced especially in the proximal tubules and the glomeruler mesangial areas with upregulating of the membrane-associated PKC?. RT-PCR analysis showed that mRNA level of PKC? increased by 1.67 folds in diabetic rats as compared with the normal ones. Conclusion The expression of PKC? protein and mRNA is upregulated in early diabetic nephropathy, which suggests an interaction between PKC? and the pathogenesis of diabetic nephropathy.

Objective To explore the feasibility of minimally invasive video-assisted thyroidectomy (M IVAT). Methods Clinical data of 8 consecutive patients with ben ign thyroid nodules treated by MIVAT in this hospital from September 2002 to Sep tember 2004 were retrospectively reviewed. Results All the pro cedures were successfully completed. The operative time was 90~150 min (mean, 12 0 min), and the hemorrhage volume, 10~30 ml (mean, 20 ml). No complications happ ened and no conversions to open surgery were needed. All the patients were compl etely recovered and discharged from hospital 3~4 days after the surgery. Follow- up checkups for 6~12 months (mean, 9 months) in the 8 patients found normally he aled wounds and no paraesthesia. Conclusions MIVAT is safe and effective, with excellent cosmetic outcomes.

The quality and quantity of published SCI papers written by the Third Military Medical University from 2010 to 2012 were analyzed to provide information for the scientific research administration.The problems of assessment with SCI was discussed.At last,suggestions were proposed to improve scientific research administration,innovation ability and scientific and technological level.

Objective To compare the efficacy of intra?articular dexmedetomidine or morphine mixed with ropivacaine for postoperative analgesia after arthroscopic knee surgery?Methods Sixty ASA physical status I or II patients scheduled for elective arthroscopic knee surgery were randomly assigned into 3 equal groups using a random number table?The group R received 0?25% ropivacaine, and the group RD received 1 μg/kg dexmedetomidine and 0?25% ropivacaine,and the group RM received 2 mg morphine and 0?25% ropivacaine intraarticularly in a total volume of 20 ml?Visual analogue scales( VAS) scores when the patients actively flexed the operated knee to 90° were recorded at 2, 4, 8, 12, 18 and 24 h after surgery?The analgesic duration and consumption of fentanyl at 24 h after surgery were recorded?The complications such as bradycardia,hypotension, nausea,vomit,cutaneous pruritus and uroschesis were followed up?Results At 8 and 12 h after surgery,VAS scores were significantly lower in group RD ( ( 3?23 ± 0?45 ) points, ( 3?18 ± 0?47 ) points ) and RM ( ( 3?20 ±0?46) points,(3?13±0?45) points) than in group R((4?01±0?74) points,(3?93±0?71) points),and at 18 and 24 h after surgery,they were significantly higher in group R((3?85±0?62) points,(3?72±0?57) points) and RD((3?83±0?57) points,(3?71±0?55) points) than in group RM((3?07±0?43) points,(3?02±0?41) points),and there was significant difference(F between groups=124?65,P=0?021,F inner grouP=11?65,P=0?004,F across groups=67?65,P=0?024)?The analgesic duration was significantly different in three groups (F=45?78,P<0?001),and in group RD((668?3±133?4) min) and RM((1 412?8±275?67) min) was significantly longer than in group R(402?3±81?5) min,P<0?05),and the group RM was longer than the group RD( P<0?05)?The consumption of fentanyl at 24 h after surgery was significantly different in three groups ( F=34?47,P<0?001),and it was significantly lower in group RD((32?6±7?3) μg) and RM((12?8±3?7) μg) than in group R((151?3±28?5) μg,P<0?05),and the group RM was lower than the group RD(P<0?05)?No significant side effects were found?Conclusion Intra?articular dexmedetomidine or morphine all can improve the efficacy of ropivacaine for postoperative analgesia after arthroscopic knee surgery,while morphine is superior to dexmedetomidine.

The evaluation systems for chronic venous insufficiency of lower extremities play a very important role in standardizing the diagnosis and evaluating the curative effect in patients with the disease. This paper gives an introduction to the CEAP classification system, VSS evaluation system and chronic venous insufficiency questionnaire.

Objective To explore the effect and safety of transcranial approach for spheno-orhital meningioma. Design Retro- spective case series. Participants Thirty-two patients being operated with transcranial approach. Twenty-four cases were meningothelial meningiomas, 3 cases were fibrous meningiomas, 1 case was psammomatous meningioma, 2 cases were atypital meningiomas, 2 case were malignant meningiomas. Methods All patients underwent frontal-temporal craniotomy, the involved sphenoid wing bone and peri- orbit were removed to prevent recurrence. The superior orbital fissure and optic canal were decompressed, the dural and periorbital de- feet were repaired by autogenous temporal fascia or artificial dura. Main Outcome Measures Preoperative and postoperative exoph- thalmus and eyeball movement, the extent of tumor resection, the ratio of recurrence. Results The extent of tumor resection: 8 cases were Simpson gradeⅡ, 20 cases Simpson gradeⅢ, 4 cases Simpson grade IV. After surgery, proptosis were improved in all patients, ophthalmoplegia was found in 6 eases. There was no operation-related death or other significant complication. Tumor recurred in 6 cas- es. Conclusions Adequate exposure of the tumor and bony decompression of the cranial nerves can result from transcranial approach, all the involved bone should be removed in order to prevent recurrence. This approach is relatively safe and the ptoptosis are improved significantly. Complete surgical resection is difficult because of the involvement of the orbital apex, superior orbital fissure and cav- ernous sinus.

A description of the concept,origin and development,and key contents of the system safety theory,and an analysis of the presence and future of China's medical safety management,holding that such a theory enjoys a promising perspective in medical safety managemenL Medical safety management needs to follow such a theory as fl guideline,and its principles to set system safety objectives,and to determine the scope of the safety system_By building a comprehensive feedback mechanism,clarifying the responsibility borders and advocating a safety culture,medical safety management can be significantly upgraded.

Objective To explore the relationship between vascular lesions and benign paroxysmal positional vertigo in the elderly.Methods 74 patients aged 60 years and over with benign paroxysmal positional vertigo in Huanhu Hospital and 80 subjects without vertigo history in the medical examination center of the same hospital were randomly divided into the case group and the control group,respectively.The carotid intima-media thickness (CIMT) and plaque in the carotid artery were detected using high-resolution color duplex ultrasound for evaluating large vascular lesions.At the same time,T1WI,T2WI and diffusion weighted imaging (DWI) were performed with high-field 3.0 T MRI scanner as the detection index of small vascular lesions to compare the difference in severity of lacunar infarction,leukoaraiosis and micro hemorrhage between the two groups.Both indexes were used together to compare the overall difference in the intracranial and extracranial vascular lesions between the two groups.Results Between the case group and the control group,there were significant differences in the CIMT [(0.96±0.21) mm vs.(0.84±0.26) mm,t=3.136,P＜0.05],the detection rate of plaque (89.2％ vs.72.5％,x2 =5.803,P＜0.05),the number of lacunar infarction [(3.48± 1.67) vs.(2.34± 2.06),t=1.994,P＜0.05] and the score of white matter [(4.77±2.15) vs.(3.95±2.04),t=2.430,P＜0.05].There was no significant difference in the positive detection rate of the cerebral microbleeds in the case group and control group (22.9％ vs.17.5％,x2=0.4264,P＞0.05).Conclusions There is a relationship between the benign paroxysmal positional vertigo and intracranial or extracranial vascular lesions in the elderly.Vascular factor may play an important role in the pathogenesis of benign paroxysmal positional vertigo.Not only the atherosclerosis of large and small arteries but also the microcirculation disturbance may be partly attributed to the benign paroxysmal positional vertigo in the elderly.