Objective　To compare the predictive value of Glasgow coma scale (GCS), revised trauma score (RTS) and acute phsiology and chronic health evaluation (APACHEⅡ) system on head injury prognosis, and selectscoring systems apt to predicting prognosis of the head injury. 　Methods　The data of 116 case of head injury were reviewed. The correlation between the score of GCS, RTS, or APACHEⅡ and the patients' prognosis was determined by Spearman rank relation test on admission. Then, the logistic regression analysis was administered, in which GOS I～Ⅲ in half year were regarded as risk event. The independent predictive varieties were determined from following varieties: GCS, systolic pressure, respiratory rate, age, and chronic health condition. 　Results　GCS, RTS and APACHEⅡ were significantly related with the prognosis (r=0.660,0.676 and -0.578, respectively). GCS and age were independent predictive indexes. 　Conclusions　RTS system doesn't show the superiority to GCS system. The predictive accuracy may improve if GCS system is appropriately combined with APACHEⅡ system.

Objective To investigate the treatment effect of gamma knife radiosurgery for hypothalamic hamartomas. Methods Gamma knife radiosurgery was performed in 9 patients with gelastic seizures. Collimator helmets (4 and 8 mm) were used and a radiosurgery plan was designed to cover 90% of the hamartoma at the 40%~55% isodose curve with the center dose of 28~40 Gy and the margin dose of 12~18 Gy. The clinical outcome was evaluated with the Tan’s scale. Results No complications due to gamma knife radiosurgery occurred. A follow-up from 24 to 54 months showed effectiveness in 7 patients, disappearance of seizure in 1 patient, rare occurrence in 3 patients, significantly reduced occurrence in 2 patients, improvement in seizure control in 1 patient, but ineffectiveness in 2 patients. Conclusion As an approach to the treatment of hypothalamic hamartomas, gamma knife is a safe and cost-effective therapy with rare side effects for hypothalamic harmatomas.

Objective To investigate the clinical effect of using uninterrupted vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis in treating frontal sinusitis after craniotomy.Methods The clinical data in 31 cases of frontal sinusitis after craniotomy in our hospital from January 2006 to December 2014 were retrospectively analyzed.Seventeen cases adopted simple debridement and drainage treatment and 14 cases were treated with continuous vacuum sealing drainage combined with routine debridement treatment.Postoperative follow up lasted over 1 year.Results In simple debridement and drainage,12 cases were cured,the other 5 cases recurred after operation,and the cure rate was 70.6 ％.But in the continuous vacuum sealing drainage combined with routine debridement treatment,14 cases were cured,no case recurred after operation,and the cure rate was 100％.Therefore,the cure rate of continuous vacuum sealing drainage treatment combined with routine debridement was higher than that of simple debridement and drainage treatment(P＜0.05).Conclusion Adopting vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis can promote the infection focus clearance and wound healing,and increases the cure rate.

ObjectiveTo evaluate the impacts of pereutaneous nephrolithotomy (PCNL) on perioperative renal hemodynamics.MethodsThe hemodynamics of operated renal arteries of 30 patients who underwent unilateral PCNL with single pole access were observed 1 day before and 5-7 days after operation with CDFI.Parameters were analyzed statistically.ResultsAfter operation,resistance index (RI) of renal arteries decreased (P＜0.05).The diastolic flow statistically increased at main renal artery (MRA) of renal hilus,interlobar renal artery and interlobular renal artery (all P＜0.05).After PCNL,in serious hydronephrosis patients,RI decreased (P＜0.05) at segmental renal artery (SRA) and interlobar artery,end-diastolic flow velocity (Vmin) increased at interlobar renal artery (P＜0.05).In moderate hydronephrosis patients,RI decreased at all renal arteries (P＜0.05) after PCNL,Vmin increased at MRA and interlobular renal artery (P＜0.05).In minor hydronephrosis patients,RI decreased at MRA and SRA,Vmin increased at SRA.In patients without hydronephrosis,RI changeed like serious hydronephrosis patients.ConclusionAfter PCNL,ipsilateral renal perfusion improves,renal diastolic flow increases and RI decreases.CDFI can be used to observe the blood perfusion of kidney,and provide quantitative information of renal hemodynamics.

Objective To analyse the therapeutic outcome of cavernous sinus meningiomas by gamma knife radiosurgery. Methods Retrospective analysis was conducted of 37 patients with cavernous sinus meningiomas. The median maximum diameter was 2.6 cm (1.4～3.2 cm) with the median dose to the tumor margin of 15.7Gy(8～22 Gy), the isodose curve to the tumor margin of 40%～60% and the target numbers of 1～9. The radiosurgical dose to the optic nerve and brain stem was not more than 10 Gy and 15 Gy, respectively. Results After an average follow up of 22.6 months(ranging 4～43 months), unchanged symptoms were found in 22 cases(59.5%), alleviated in 12 cases(32.4%) and complications of optic and trigeminal nerve in 3 cases(8.1%). By MR image analysis, unchanged size was found in 18 cases(48.6%), smaller size in 15 cases(40.5%) and larger size in 4 cases(10 8%). One factor analysis of variance revealed that tumor recurrence was associated with marginal dosage(

Objective To explore the relationship of phosphatase and tensin homology deleted on chromosome ten ( PTEN ) expression with the positioning of AMPA recepter subunit GluR2 in hippocampal neuron after stretch injury. Methods The primary rat hippocampal neuron from neonate rats were cultured and the model of stretch injury established. Western blot and TUNEL staining were used to detect PTEN expression and the positioning of AMPA receptor subunit GluR2 in rat hippocampal neuron at different time intervals after stretch injury. Results The PTEN expression was increased obviously after stretch injury, while the expressions of AMPA receptors GluR1, GluR2 and GluR3 showed no evident differences at every time point. However, AMPA receptor subunit GluR2 located at cytomembrane was down-regulated obviously after stretch injury. Conclusion The intracellular PTEN expression and the expression of AMPA receptor subunit GluR2 located at cytomembrane are on the contrary, indicating that PTEN phosphatase may participate in the transport and reintegration process of AMPA receptor subunit GluR2 located at cytomembrane.

Objective To analyze the correlation of hypersensitive C-reactive protein(hs-CRP),homocysteine(Hcy) and D-dimer(D-D) with pathological change degree of coronary heart disease(CHD),and to investigate the diagnostic specificity and sensitivity of joint detection in CHD.Methods A total of 100 cases of CHD patients(experimental group) and 100 healthy subjects(control group) were enrolled,.Patients of the experimental group were divided into four groups on the basis of complications,including simple CHD group(32 cases),amalgamating hypertension group(46 cases),amalgamating diabetes group(9 cases),amalgamating hypertension diabetes group(13cases).The levels of hs-CRP,Hcy and D-D in the five groups were detected and analyzed.Results The levels of hs-CRP,Hcy and D-D in the experimental group were all higher than the control group(P<0.05).Logistic regression confirmed that three indexes were the independent risk factors for CHD.Each indicator has a certain clinical significance to the diagnosis and treatment of CHD but the value of Hcy could be better.Joint detection of hs-CRP and Hcy could be an ideal combination of detection,and the three joint detection might not be suitable for early diagnosis and treatment of CHD.The levels of hs-CRP and D-D in simple CHD group,amalgamating hypertension group,amalgamating hypertension diabetes group were all higher than amalgamating diabetes group(P<0.05).Conclusion hs-CRP,Hcy and D-D could be the independent risk factors of CHD,and joint detection might be with important clinical value for diagnosis of CHD.

Objective To investigate the clinical features,diagnosis and therapy of adrenal incidentalomas. Methods The data of 66 cases of adrenal incidentalomas were retrospectively analyzed. Results The accuracy rates of localization detected by B-Ultrasound,CT scan and MRI were 84.3%,100% and 100% respectively. The accuracy rates of qualitative diagnosis by B-Ultrasound, CT scan and MRI were 30.0%,75.5% and 79.2% respectively. There were 60 cases underwent operation and the postoperative pathological examination confirmed that there were 31 cases of adrenal cortical adenoma, 6 cases adrenal cyst, 5 myelolipoma, 5 pheochromocytoma, 3 adrenal cortical carcinoma, 3 metastatic carcinoma, 3 ganglioneuroma, 1 adrenal neurilemmoma, 1 adrenal hematoma, and 1 nodular hyperplasia of adrenal cortex. Conclusions Ultrasonography is the first choice of scanning adrenal incidentaloma. However the CT scan and MRI are satisfactory in localization of the tumour. The qualitative diagnosis of adrenal incidentaloma will depend on the diameter, imaging features of tumors, the age of patients, and endocrine examination.

Alzheimer's disease (AD) is a central neurodegenerative disease with still unclear pathogenesis. Recent studies have shown that axonal transport dysfuction of mitochondria may contribute to AD progression. Normal mitochondrial axonal transport mainly involves microtubules, molecular motors and connexins, while AD early pathological changes can damage mitochondrial axonal transport by interfering with these proteins: accumulated β-amyloid (Aβ) impairs the function of molecular motors; abnormally modified Tau protein reduces microtubule stability; mutant presenilin-1 (PS1) can induce phosphorylation of some related proteins by activating glycogen synthase kinase-3β (GSK-3β); all these processes can damage mitochondrial axonal transport, leading to synaptic dysfunction. This review aims to clarify the possible mechanisms of axonal transport dysfuction of mitochondria in AD and provides new ideas for AD treatment.

The existing doctor-patient communication pattern often falls prey to insufficient informed consent and even medical disputes. In the patient centered perspective, Zhejiang Provincial People′s Hospital explored a new communication mode centering on patients. Based on diagnosis-related groups catalogues and high-frequency surgeries catalogues of the departments, multimedia technology was called into play to produce dubbed PPTs and videos that were easy to understand, standardized and homogeneous, which were embedded into medical records system. Following observation of the PPT or video, patients could directly sign an informed consent on the computer. This practice not only deepens patient′s understanding and achieves homogeneous level of the communication, but also elevates doctor′s work efficiency, contributing to building a harmonious doctor-patient relationship.