Objective To summarize the MRI findings of spinal paraganglioma,in order to improve the diagnostic accuracy of imaging. Methods The MRI findings of 6 patients with spinal paraganglioma were retrospectively reviewed.All cases were proved by pathology.Results All 6 cases of spinal paraganglioma were located in lumbar spinal canal.There were serpentine vessels shade observed above the tumor in 5 cases.Two cases with smaller size of lesions exhibited as homogeneous signal intensity with homogenous enhancement. The other 4 cases with larger size of tumors exhibited as heterogeneous signal intensity because of intratumoral cystic change,hem-orrhage and hemosiderin deposit at the margin of the tumor.Conclusion Serpentine vessels above the tumor can be seen in spinal paragangliomas.Intratumoral cystic change and hemorrhage,hemosiderin deposit at the margin of the tumor are the MRI character-istics of spinal paraganglioma.

Objective To discuss the clinical effect of weight loss training and oral intake of mefformin on obese women with polycystic ovary syndrome.Methods 60 cases of obese women with polycystic ovary syndrome in Nan'an District Maternal and Child Health Hospital were studied.They were divided into 2 groups,30 cases in each group.The control group received simple weight loss training and the observation group received weight loss training combined with the oral administration of metformin.The clinical data of the 60 cases were retrospectively analyzed and the clinical efficacy and safety of different treatment methods were evaluated.Results After treatment,two groups of patients have been effectively improved.16 cases(53.3％)in the control group and 29 cases(96.7％)in the observation group resumed normal menstruation,and the differences had statistical significance.Fasting blood sugar(FBS),BMI,testosterone and luteinizing hormone levels of the two groups had significant improvement after treatment,in addition,the improvement of these indicator were more obvious in the observation group than those in the control group,and the difference had statistical significance.The difference of FBS,BMI,testosterone and luteinizing hormone levels had statistical significance between before and after treatment(P =0.003 7,0.001 2,0.002 0 and 0.002 4,respectively).Conclusion The combination therapy of weight loss training and oral intake of metformin is effective in treating obese women with polycystic ovary syndrome.It is the main method in treating obese women with polycystic ovary syndrome.

Etiquette education is an essential part of modern nursing quality education.In order to improve the general quality of the nursing students by etiquette education,the nursing teachers can infiltrate the essence of etiquette education into education reform,by theory teaching,demonstration, portrayal training,scenario training,and so on.

AIM:To explore the histopathological classification and incidence of orbital space-occupying lesions in children in order to provide references for the diagnosis of orbital space-occupying lesions in children.
METHODS:A total of 290 paediatric patients with orbital space - occupying lesions diagnosed by pathological examinations at the Second Hospital of Tianjin Medical University from January 1998 to December 2012 were retrospectively reviewed.
RESULTS:In 290 paediatric patients with orbital space-occupying lesions, venous hemangioma was the most common (58 cases,20. 0%), the other commons were as follows: hemangio lymphangioma, dermid cyst, neurofibroma, optic nerve glioma, rhabdomyo sarcoma and so on. Capillary hemangioma, venous hemangioma, optic nerve glioma had the predominant age incidence. On the other hand, optic nerve glioma, venous hemangioma, rhabdomyosarcoma had the predominant sex incidence.
CONCLUSION: The majority of paediatric patients with orbital space - occupying lesions are congenital and embryonic lesions, the most common of which is venous hemangioma. Some lesions had the predominant age and sex incidence.

Objective: To compare the clinical efficacy of open surgery, peritoneal laparoscopic excision and retroperitoneal laparoscopic excision for adrenal pheochromocytoma. Methods. We retrospectively ana-lyzed the clinical data of 54 patients with adrenal pheochro-mocytoma (27 males and 27 females). Patients' age ranged from 19 to 71. The diameter of tumors ranged from 1.5 to 7.0 cm. Fifty patients had symptoms of hypertension and their course of disease ranged from 2 months to 15 years. None of the patients had inva-sion and metastasis in surrounding organs. According to modus operandi, the patients were divided into 3 groups. The 20 patients in group A underwent open surgery, the 16 patients in group B underwent peritoneal laparoscopic excision, and the 18 patients in group C underwent retroperitoneal laparoscopic excision. The surgical duration, volume of blood loss, severe blood pressure fluctuation, recovery time of intestinal function,postoperative hospital stay, and decrease of blood pressure were compared among the three groups. The re-sults were statistically analyzed. Results: All surgeries were successful, with no complications. All specimens were proved pheochromocytoma. The mean surgical duration was 120.60±18.18 min in group A, 105.13±17.46 min in group B, and 102.22±16.01 min in group C. The volume of blood loss was 146.50±36.20 mL in group A, 116.56±37.32mL in group B, and 120.28±33.80mL in group C. Twelve cases in group A, 5 cases in group B and 5 cases in group C had blood pressure fluctuation. The recovery time of intestinal function was 2.40±0.79 d in group A, 1.75±0.45 d in group B, and 1.58±0.49 d in group C. The postoperative hospital stay was 11.15±1.87 d in group A, 5.94±0.85 d in group B, and 5.94±0.80 d in group C. There was statistical signifi-cance between group A VS group B and group C (P<0.05). There was no statistical significance between group B and group C. There were 18, 15 and 17 cases in group A, B and C who had postoperative decrease of blood pressure, with no statistical difference among the three groups (P>0.05). All cases were followed up for 9 months to 6 years, with no recurrence. Conclusion: Peritoneal laparoscopic excision and retroperitoneal laparoscopic excision can be considered as the preferred choice for adrenal pheochromocytoma, with mini-mal invasion, fast recovery, and satisfactory safety.

Through all times and around the world,those who discipline themselves with high ethical standards can be regarded as truly noble men successfully taking advantage of moral authority of the people.Books on the art of war in ancient China raised a couple of ethical requirements for those superior military officers and governors.If officers want to affect his men′s mental state and generate the army′s spirit of combat effectiveness,they must assume a certain degree of ethical responsibility.Also,active share of ethical responsibility calls to take the initiative to develop a sense of ethical responsibility.Furthermore,to develop a sense of ethical responsibility calls for the building of ethical self-consciousness to participate in the training of ethical responsibility.However,the participation of ethical building consciousness can not be separated from the ethical sense of responsibility.In conclusion,each part of the three links,complementing each other,can not be biased and separated.

Objective To evaluate the characteristics of echocardiogram in senile degenerative heart valvular disease. Methods The cardiac structure and functional changes of the 166 cases of senile degenerative heart valvular diseases were studed with HP5500(USA) and En Visor color doppler(Philips). Results Simple aortic valve calcification was found in 93 cases(56.0%); simple mitral calcification, 18 cases(10.8%);aortic valve calcification combining mitral calcification, 55 cases,(33.1%);enlarged left atrium 116 cases(69.9%);left ventricular diastolic dysfunction 142 cases(85.5%).Within 136 cases of cardiac valve dysfunction, there was aortic valvular regurgitation in 70 cases(42.2%),stenosis of aortic valve in 23 cases(13.9%),mitral regurgitation in 20 cases(12.2%),mitral stenosis in 8 cases(4.8%),aortic valvular regurgitation combining stenosis in 10 cases(6.0%),mitral regurgitation combining stenosis in 5 cases(3.0%). The highest morbidity in valvular dysfunction was aortic valvular regurgitation(42.2%),the second was aortic valve stenosis(13.9%),the lowest morbidity was mitral stenosis combining insufficiency(3.0%). Enlarged left atrium was in 116 cases(69.9%). Conclusions The senile degenerative heart valvular disease have no specific clinical manifestation. With increasing age,the proportion of complex valve calcification is increased, and the highest is the aortic insufficiency in valvular dysfunction. The proportion of enlarged left atrium is also increased.

Objective To investigate the analgesic effect of epidural labor analgesia with contin-uous background infusion and its impact on obstetric outcome.Methods This was a retrospective co-hort study.In the two months of march 2014 and march 201 5,503 nulliparas women who had re-ceived epidural analgesia for labor were enrolled and assigned to two different study groups according to their analgesic protocol.Two hundred and fifty-eight nulliparas in group C received only patient-controlled analgesia while two hundred and forty-five nulliparas in group P received patient-controlled analgesia with continuous background infusion.The basic and perinatal data of all enrolled nulliparas women were collected and analyzed to compare the analgesic effect and the impact on obstetric risk of two different analgesic protocol.Results The NRS pain score during the second labor stage was lower in group P [3 (3-4)scores vs.5 (4-5)scores](P <0.001).The second stage prolonged [50 (29-82) min vs.38 (24-62)min](P =0.001)and intrapartum hemorrhage increased [200 (100-250)ml vs. 1 50 (100-200)ml](P =0.003)in group P.There were no significant differences between the two groups with regard to the delivery mode (P =0.656)and the morbidity of postpartum hemorrhage (9.8% vs.10.9%,P =0.697).Analgesic protocol with background infusion was not associated with postpartum hemorrhage,instrumental delivery risk and cesarean risk.Conclusion Epidural labor an-algesia with continuous background infusion provided more effective analgesia in nulliparas,without additional obstetric risk.

Objective To explore the role of hemoglobin (Hb) level in mortality and morbidity of chronic kidney disease (CKD)patients,aiming to give some evidence for therapy of anemia.Methods Randomized,clinical trials (RCTs) were identified by searching Medline,Embase and the Cochrane library.All the analyses were performed using the Revman software available free from the Cochrane collaboration.Results Twenty-three trials involving 10 204 patients were identified.Overall,the high Hb target was associated with increased risk of all-cause mortality (RR=1.10,95％ CI 1.00 to 1.21),hypertension (RR=1.40,95％ CI 1.12 to 1.75),stroke and hospitalization (RR=1.07,95％ CI 1.00 to 1.14) compared with low Hb target (P＜0.05).No significant difference was found in the risks of non-fatal mycardial infarction (RR=1.13,95％ CI 0.79 to 1.62) and renal replacement therapy (RR =1.00,95％ CI 0.85 to 1.18).Conclusions Targeting low Hb target is beneficial to CKD patients based on reduced risk of hypertension,hospitalization,stroke and all-cause mortality.However,no significant difference is found in non-fatal mycardial infarction and renal replacement therapy.

BACKGROUND: Some studies have demonstrated that the degradation of extracellular matrix (ECM), which matrix metalloproteinases (MMPs) participates in, plays a key step in the corneal neovascularization (CNV). Tissue factor pathway inhibitor 2 (TFPI-2), a new type serine proteinase inhibitor found recently, can effectively inhibit the activity of MMPs. Whether TFPI-2 gene transfection can influence CNV is unclear.OBJECTIVE: To investigate the effect of TFPI-2 gene transfection on CNV.DESIGN: Randomized controlled experiment.SETTING: Laboratory for Department of Surgery, Wuhan Union Hospital; Central Laboratory, the Affiliated Third Hospital of Sun Yat-sen University.MATERIALS: This study was carried out in the laboratory for Department of Surgery of Wuhan Union Hospital and State Central Laboratory of the Third Hospital Affiliated to Sun Yat-sen University between June 2004 and March 2006. Sixty healthy purebred adult New Zealand rabbits of either gender, weighing 2.5 to 3.0 kg, were involved. Preoperatively, no obvious anterior segment ocular lesion was found by slit-lamp examination. pBos-Cite-neo/TFPl-2 was kindly gifted by Dr. Zhong Ren (Department of Hematology, Union Hospital). Peroxydase blocking agent, nonimmune goat serum,mouse anti-human MMP-1, 2 and 3 monoclonal antibodies, biotin labeled goat-anti-mouse IgG second antibody (Santa cruz Company) were used in this study.METHODS: Experimental intervention: Experimental rabbit models of CNV were created in each group by silver nitrate cautery. Then, the rabbit models were randomized into 3 groups and 20 rabbits for each group. Different reagents were subconjunctivally injected via many points in each group: saline in the group Ⅰ, empty vector in the group Ⅱ, plasmid encoding TFPI-2 in the group Ⅲ. Experimental evaluation: CNV growth was observed under the slit-lamp biomicroscope.The expression of TFPI-2 in each rabbit model was detected by reverse transcription-polymerase chain reaction (RT-PCR) method 2 weeks after modeling; the expression of MMPs in corneal tissue was detected by immunohistochemical method at 3,5,7,9 and 14 days after modeling.TFPI-2 gene expression was significantly higher in the group Ⅲ than in the group Ⅱ and group Ⅰ (P ＜ 0.01); The MMP-1, 2, 3 expressions in the corneal tissue were significantly lower in the group Ⅲ than in the group Ⅱ and group Ⅰ,respectively, especially MMP-1, 3.