Objective To discuss the value of enlargement of geniculate fossa of facial nerve canal in the diagnosis of facial nerve canal fracture.Methods Thirty patients with facial nerve canal fracture underwent axial and coronal CT scan.The correlation between the fracture and the enlargement of geniculate fossa of facial nerve canal was analyzed.The ability of showing the fracture and enlargement of geniculate fossa of facial nerve canal in axial and coronal imaging were compared.Results Fracture of geniculate fossa of facial nerve canal was found in the operation in 30 patients,while the fracture was detected in CT in 18 patients.Enlargement of geniculate ganglion of facial nerve was detected in 30 patients in the operation,while the enlargement of fossa was found in CT in 28 cases.Enlargement and fracture of geniculate fossa of facial nerve canal were both detected in CT images in 18 patients.Only the enlargement of geniculate fossa of facial nerve canal was shown in 12 patients in CT.Conclusion Enlargement of geniculate fossa of facial nerve canal was a useful finding in the diagnosis of fracture of geniculate fossa in patients with facial paralysis,even no fracture line was shown on CT images.

Objective To study the effect of three different kinds of intervenient measures for TB control on the disease burden of TB patients. Method The estimating method of disability adjusted life years(DALY) as recommended by the WHO was used to assess the disease burden of TB patients. Result The average disease burden of new and retreated TB patients covered by the international TB program(ITP) was the lightest, with the loss of 0.31 DALY and 0.62 DALY respectively; the average disease burden of new and retreated TB patients covered by the national TB program(NTP) was intermediate, with the loss of 0.42 DALY and 0.59 DALY respectively; and the average disease burden of new and retreated TB patients from areas using conventional TB therapy(CTT) was the heaviest, with the loss of 0.61 DALY and 0.91 DALY respectively. From a social perspective, the average yearly loss of DALY per thousand TB patients in the ITP, NTP and CTT areas was respectively 16.42, 33.6 and 37.36, with the loss in the NTP areas being 2.05 times as much as that in the ITP areas and the loss in the CTT areas being 2.28 times as much as that in the NTP areas. Conclusion ITP was far superior to NTP and CTT in reducing the disease burden of TB patients, achieving better results both from the perspective of TB patients and the society.

Objective To study the effect of different intervenient measures for TB control on disease financial burden. Method A survey was conducted of the expenses incurred on 1 700 new and retreated TB patients from areas covered by the World Bank project, the Ministry of Public Health project, and non project areas where intervenient measures were also taken. The method of economic estimation was used to explore the disease financial burden carried by the patients families and society. Result The average family disease financial burden is as follows: 1 735 yuan for a new case and 2 755.99 yuan for a retreated case in the international TB program(ITP); 2 669.27 yuan for a new case and 3 530.17 yuan for a retreated case in the national TB program(NTP); and 6 787.02 yuan for a new case and 7 276.10 yuan for a retreated case in the non project areas using conventional TB therapy(CTT). The average social disease financial burden is as follows: 4 735.55 yuan in ITP; 6 471.91 yuan in NTP; and 10 919.96 yuan in CTT. Conclusion The disease financial burden was the lowest in ITP, highest in CTT, and intermediate in NTP.

Objective To study the cost effectiveness, cost utility and cost benefit of three programs for TB control, viz. the World Bank TB project, the Ministry of Public Health TB project and measures taken by non project areas. Method A survey was conducted in TB prevention and treatment institutions in 17 counties of 6 provinces with regard to the course of disease, expenditure for treatment and financial burden of 1 700 new and retreated TB patients. Result The World Bank project, wherein the strategies of directly observed treatment and short course chemotherapy were adopted, proved to be a low input and high output program with low capitalized cost and significant effectiveness, utility and benefit. Suggestion A new round of TB control projects ought to be started so as to achieve the sustainable development of TB prevention and treatment programs and to achieve the goals of the nation in this aspect.

Objective　To investigate the change of epithelium growth factor(EGF), tumor necrosis factor (TNF), superoxide dismutese(SOD) and hemorrheology (HL) in patients with diabetic retinopathy.Methods　EGF、TNF、SOD levels and HL changes have been measured in 30 NIDDM patients with retinopathy (DR group), 29 NIDDM patients without retinopathy (NDR group), and 29 patients with senile cataract and without diabetes as control (C group). Results　The mean levels of EGF、TNF and blood viscosity were significantly higher in both DR and NDR group than those in C group; the mean levels of SOD was significantly lower in both DR and NDR group than that in C group. The EGF、TNF and blood viscosity was significantly higher in proliferative type DR than in background DR; The SOD was significantly lower in proliferative type DR than in background DR.Conclusion　The development of diabetic retinopathy is related to the increase of EGF、TNF、blood viscosity and decrease of serum SOD.

This article reviewed characteristics of geriatric traumatic spinal cord injury, including incidence, causes and clinical features, as well as definition, differenciation, special management and treatment strategy for geriatric traumatic spine and spinal cord injury.

ObjectiveTo investigate the characteristics of patients with flaccid paralysis after high spinal cord injury. Methods1014 cases with traumatic spinal cord injury were investigated. The patients with flaccid paralysis after high spinal cord injury (spinal fractures above the level of T10) were analyzed. Results6 patients were ananlyzed, including 5 males and 1 female, mean of age was (42±12). The neurological injury involved C7 to T8, and the fractures involved T3 to T10. 3 cases had the neurological deterioration upward at least 3 spinal segments after operation compared with the fractures. One case accomplicated with severe pain in the chest had the subacute progressive ascending myelopathy up to C7 level. MRI showed extensive atrophy of thoracic spinal cord 6 months later in 5 cases. ConclusionThe incidence of flaccid paralysis after high spinal cord injury was rare. It presents the extensive thoracic spinal cord atrophy, and the causes and mechanisms are not clear.

The outcome of spinal cord injury is related to many factors, such as mechanism and severity of injury, and differences of individual. The standard of clinical trial plays a very important role in the reliability of the research. especially the inclusion and exclusion criterias, ethical issues, treatment standardization, informed consent and other issues. The effect of these factors on the clinical trial of spinal cord injury was summarized in this article. The inclusion and exclusion criterias to control the consistency should be developed based on the specific research content. Informed consent for clinical trial is also necessary, especially to the clinical trials with uncertainly benefits and risks, as well as the standardization of the operation procedures and rehabilitation treatment.

Objective To investigate the mechanism of pulmonary fibrosis induced by paraquat (PQ),and the effect of Xuebijing injection in treatment of PQ poisoning.Methods Seventy-two male Wistar rats were randomly divided into control group,PQ poisoning group,and Xuebijing intervention group,with 24 rats in each group.Pulmonary fibrosis was induced by single garage at the dosage of 50 mg/kg of PQ,while 1 mL of distilled water was given by gavage in control group.Xuebijing injection at the dosage of 4 mL/kg were given intraperitoneally at 30 minutes after exposure to PQ in Xuebijing group,and it was repeated every 12 hours; same amount of physiological saline was given intraperitoneally in PQ group and control group.The experiment lasted for 14 days.Six rats in each group were sacrificed on 1,3,7,14 days,respectively,after insult,and 30 minutes after the last intervention.The lung tissues were harvested,the changes in pathology in lung tissue and the degree of pulmonary fibrosis were observed with optical microscope with hematoxylin-eosin (HE) staining and Masson stain.The ultrastructure changes in lung tissues were observed with transmission electron microscopic,and the content of hydroxyproline (HYP) in the lung tissue was determined by alkaline hydrolysis.The expression of mitochondrial fusion protein 2 (Mfn2) was determined by Western Blot.Results ① HE staining:in PQ group,inflammation was most marked on the 3rd day.On the 7th day,exudates in the alveoli started to be organized,and hypertrophic fibroblasts were seen to secrete slim collagen fibers,and fibrosis could be seen in alveoli.On the 14th day,intensive hyperplasia of fibroblasts could be observed,and the alveolar structure was destroyed and collapsed,with deposition of collagen deposited with formation of pulmonary fibrosis.At the same time,pathologic changes were milder in Xuebijing group than those in PQ group.② Masson staining:the degree of inflammation in alveoli and pulmonary fibrosis were less marked in Xuebijing group than those of PQ group on the 14th day.③ Under the transmission electron microscopy,it was found that the mitochondria of lung tissue cells was relatively less in number on the 14th day in PQ group,and the majority of them underwent degeneration,swelling and damage.Basement membrane became folded,alvcoli were collapsed,and fibrosis was obvious.These changes were less serious in Xuebijing group.④ Content of HYP (μg/g):contents of HYP in lung tissues on the 3rd day in PQ group and Xuebijing group were significantly higher than those in control group (743.3 ± 50.2,718.1 ± 34.0 vs.665.8± 6.6,both P＜0.05),it then increased gradually,but the contents of HYP in Xuebijing group were significantly lower on the 7th day and 14th day than those in PQ group (790.5 ± 23.8 vs.876.7 ± 42.0,812.9 ± 72.3 vs.931.3 ± 33.0,both P＜0.05).⑤ Expression of Mfn2:the expression of Mfn2 in control group was relatively lower.The expression of Mfn2 in PQ group was increased gradually under stress,but its rate was low.The expression of Mfn2 (A value) in Xuebijing group was significantly higher than that in PQ group on the 1st day (0.731 ±0.035 vs.0.618 ±0.029,P＜0.05),and it was elevated steadily,reaching the peak on the 7th day (0.732 ± 0.037 vs.0.669 ± 0.034,P＜0.05),but it was lower than that of PQ group on the 14th day (0.708 ± 0.034 vs.0.765 ± 0.041,P＜0.05).Conclusions Xuebijing reduces lung inflammatory reaction and pulmonary fibrosis as a result of PQ poisoning.The mechanism is that Xnebijing regulates and increases expression of Mfn2 in lung tissue.

Objective The report was focused on polycystic ovary syndrome(PCOS) in female adolescents related to homosexual precocious puberty,and the new awareness of its influence on long-term health of homosexual precocious girls.Methods A girl with idiopathic central precocious puberty (ICPP) but diagnosed as PCOS in adolescence was reported and the data were reviewed.Results A girl was diagnosed as ICPP when she was near 8 years old with obesity,but without hyperinsulinemia,then she received the treatment of a 3.75 mg dose gonadotropin hormone analogues (GnRHa) every 28 days.Her gonads development was under control while her growth was arrested.Growth hormone(GH) injection started at 13 months.She stopped all medications when finished GH and GnRHa treatment for 12 months and 25 months.She went to see doctors again because of no menarche after discontinuing medication for nearly 2 years.She appeared obese and acne,hirsutism,athanens negricans and purple purple striae on the skin.Hyperinsulinemia and hypertestosterone were demonstrated.Pelvic B ultrasonography showed polycystic ovary,and she was diagnosed as PCOS.She was ordered to lose weight and to take metformin.And adrenocorticotropic hormone stimulating test was done,and B ultrasonography again ruled out atypical congenital adrenal hyperplasia and tumor of adrenal gland.She got her menarche 1 month later.Twelve months after the PCOS diagnosis and treatment,she had 4 menses,her insulin level decreased,glucose tolerance and her serum testosterone level turned normal.At the same time,the form of ovarian and follicular was significantly reduced.After taking mefformin for 20 months,her height and weight did not change,her menstrual was regular every 35-40 days,each time lasting about 7 days.She was followed up.We also reviewed literatures and learnt that precocious puberty might not be a benign situation and it might have an intrinsic relation to obesity,precocious puberty and PCOS.It might be the cofactors for causing PP and PCOS that accessed luteinizing hormone(LH) secretion and disorder of hypothalamus pituitary gonad(HPG) axis except obesity with hyperinsulinemia.Reported pubertas praecox in childhood developed to PCOS at 30％ with high prevalence of obesity.GnRHa suppressive therapy might relate to PCOS and had disputation for improving final height.There were fewer investigations on adolescent PCOS,and no consensus guideline on it in China.Conclusions Girls with ICPP may develop to PCOS some time later.The clinical features of the reported girl and the knowledge from literatures support the hypothesis that inner relationship between the CPP and the PCOS.The LH high secretion and disorder of HPG axis may be the causes of them; LH treatment on suppressing obesity should be cautious during treatment.The benefit and risk from GnRHa treatment should be evaluated thoroughly.Further clinical research should be conducted on adolescent PCOS.