Forty cases of unilateral low- frequency sensorineural hearing loss(LFSNHL) were analysed. The symptoms included tinnitus(87.5% ), deafness(75% ), vertigo(35%) and ear fullness(25% ). Audiome-try showed LFSNHL in all cases. The threshold difference between low frequencies and high frequencies was 26. 32 dB. The cause of LFSNHL, the relation between tinnitus, LFSNHL and endolymphatic hydrops were discussed. We hope that the diagnosis of LFSNHL should be standardized.

Objective: To explore therapeutic effect of carvedilol combined valsartan on chronic heart failure (CHF), and its influence on cardiac function and level of high sensitive C reactive protein (hsCRP).Methods: A total of 78 CHF patients, who were treated in our hospital from Jul 2011 to Jul 2015, were selected.According to therapeutic method, they were divided into valsartan group (n=38, received valsartan based on routine treatment) and combined treatment group (n=40, received carvedilol based on valsartan group).Therapeutic effect, cardiac function, serum hsCRP level and quality of life (QOL) score before and after treatment were observed and compared between two groups.Results: Total effective rate of combined treatment group was significantly higher than that of valsartan group (92.50% vs.71.05%), P=0.022.Compared with before treatment, there were significant reductions in heart rate, cardiothoracic ratio (C/T), left ventricular end-diastolic dimension (LVEDd) and serum hsCRP level, and significant rise in left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), emotional index, health index and life satisfaction score in both groups after treatment except C/T of valsartan group, P<0.01 all;compared with valsartan group after treatment, there were significant reductions in heart rate [(124.39±10.07) beats/min vs.(101.18±8.72) beats/min], C/T [(0.63±0.15) vs.(0.53±0.12)], LVEDd [(43.32±4.02)mm vs.(40.38±3.76)mm] and serum hsCRP level [(32.12±3.99) pg/ml vs.(10.29±2.08) pg/ml], and significant rise in LVEF [(45.59±9.99)% vs.(59.97±10.02)%], LVFS [(24.58±5.67)% vs.(31.89±6.68)%], scores of emotional index [(70.20±10.02) scores vs.(86.58±12.28) scores], health index [(73.36±8.08) scores vs.(85.58±11.01) scores] and life satisfaction [(74.34±8.39) scores vs.(88.12±13.35) scores] in combined treatment group,P<0.05 or <0.01.Conclusion: Carvedilol combined valsartan possesses significant therapeutic effect on chronic heart failure.It can significantly reduce hsCRP level, improve cardiac function and quality of life in these patients, which is worth extending.

Objective To explore the clinical manifestation of stroke caused by central nervous system vasculitis (CNSV). Methods 49 patients who suffered from stroke by CNSV were reviewed retrospectively. Results Among the 49 patients, 5 were intracerebral hemorrhage, 15 were ventricular hemorrhage, 7 were subarachnoid hemorrhage and 22 were cerebral infarction; the mean of age was (26.0±12.7) years old. Conclusion The clinical manifestation of stroke caused by CNSV is variform, and usually happens in young age. CNSV should be considered as the cause of stroke in adolescent.

Objective To explore the change of perioperative serum alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) in patients with primary liver cancer undertaken transcatbeter arterial chemoembolization (TACE).Methods One hundred and two patients with primary liver cancer were performed with TACE treatment.The levels of AFP and CEA after treatment 3 d,1 week,3 weeks were detected and compared.Results The levels of AFP after treatment 3 d and 1 week were higher than that before treatment,but there was no significant difference [(549 ±30),(530 ±30) μg/L vs. (527 ±40) μg/L] (P ＞ 0.05).After treatment 3 weeks,the levels of AFP significantly decreased than that before treatment [ (351 ± 20) μ g/L vs.(527 ± 40) μ g/L ] (P ＜ 0.05 ).The levels of CEA after treatment 3 d,1 week,3 weeks were significantly lower than that before treatment [(410 ± 15),(350 ± 20),(200 ± 10) μg/L vs.(570 ±22) μ g/L] (P ＜0.05).After treatment 3 weeks,the levels of AFP and CEA achieved normal.Conclusions TACE in treatment for primary liver cancer can achieve better therapeutic effect,significantly improve the symptoms,decrease the levels of AFP and CEA.To control the indication and contraindication,perform TACE in time can decrease mortality,improve prognosis,and is valuable in clinic.

To meet the challenge of the clinical teaching,the"Regulations on the Management of Clinical Teaching Practice in Medical Education"has been made and implemented, which establish the definitude responsibilities,rights and profit relations among doctors,students and the patients. Related organizations and persons should fully realize its normative significance,implementation obstacles and deepen the study of clinical teaching research,thus facilitating the enhancement of the teaching effect,and building a harmonious triangular relationship among the concerned parties.

Objective To explore the CT and MR imaging features of nodular fasciitis(NF), which will in return improve the standard and quality of diagnosis. Methods CT (n = 4) and MRI (n = 5) findings of pathologically proved nodular fasciitis in 9 patients were retrospectively analyzed. Results Of 9 NF, 5 were located in the lower extremities, 2 in the abdominal wall, and the others in the acoustic duct. The resected tumor size vary from 1.1 to 9. 5 cm in the largest diameter and mean (3.7±0.3) cm. All lesions appeared as a discrete solid mass on imaging. The CT value of lesions was similar to muscle. MR imaging manifested as a hypo to isointense lesion on T_1WI and hyperintense signal intensity on T_2WI. There was homogeneous or heterogeneous moderate to significant enhancement in the lesions. Conclusion CT and MRI can provide helpful information for the clinical and differential diagnosis of NF.

Objective: To compare the efifcacy and safety of sirolimus-eluting stent (SES) and everolimus-eluting stent (EES) for treating the patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 400 NSTE-ACS patients treated in Jining Medical College Hospital from 2013-09 to 2014-09 were studied. According to different stents, the patients were divided into 2 groups: SES group,n=220 and EES group,n=180. A prospective follow-up study was conducted for 1.5 years to compare the incidence rate of major adverse cardiovascular events (MACE). The patients were further stratiifed by GRACE scores as Low risk group (score<109), Medium risk group (score 109-140) and High risk group (score>140). MACE free survival was studied by Kaplan-Meier curve and analyzed by Long-rank test, predictive value of GRACE for 1.5 year MACE incidence rate was examined. Results: There were 355/400 (89%) patients completed (16.7 ± 5.7) months of follow-up study including 205 in SES group and 150 in EES group. MACE occurrence rates were similar between SES group and EES group (16.10% vs 18.0%), P>0.05. By GRACE score stratiifcation, MACE rates in High risk SES group were higher than High risk EES group (48.00%vs 16.00%),P<0.05; while they were similar between Medium risk groups (14.49% vs 28.00%) and Low risk groups (9.11% vs 12.86%), allP>0.05. ROC curve indicated that the predictive value of GRACE score for 1.5 year MACE incidence was for AUC=0.762, 95% CI (1.026-1.050),P<0.001. Conclusion: Implanting of EES would be more beneifcial for NSTE-ACS patients with high GRACE risk; GRACE score has the better predictive value for their long-term prognosis.

Objective To explore the meaning of midkine (MK) levels in serum in different development stage of acute leukemia,and to explore the relationship between MK and WT1.Methods The levels of the MK in serum of 86 cases of acute leukemia and 30 cases of normal people were detected by ELISA.Real-time quantitative PCR (RQ-PCR) method was used to determine the expression of WT1 at mRNA level in 15 AML patients.Results The MK level in serum in the new diagnosed group was higher than that in the complete remission group and the normal control group [7.52 (5.44,10.55) ng/ml vs 3.52 (1.56,5.20) ng/ml vs 2.44 (1.89,3.12) ng/ml].There' s no statistical difference between midkine level in new diagnosed acute B cell leukemia (B-ALL) group and acute myeloid leukemia (AML) group [7.88 (5.78,15.78) ng/ml vs 6.25 (4.59,16.33) ng/ml].The clear correlation was found between the level of serum MK and quantities of marrow WT1 gene (r =0.529,P =0.043).Conclusions The level of MK in serum of acute leukemia patients is increased at the time of new diagnosis and decreased at complete remission.ELISA may be a way to measure the status of AL.The location of MK gene is adjacent to WT1 gene and MK' s clinical significance is similar to WT1' s,furthermore,there is a clear correlation between MK in serum and WT1 of marrow in quantities.

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