Objective To review the prenatal ultrasonographic evaluation on fetal midline facial defects of holoprosencephaly. Methods Twenty-four facial malformations of 14 cases with alobar/semilobar holoprosencephaly from August 2000 through April 2004 were reviewed to determine and classify the associated facial abnormalities detected with prenatal sonography. Results There were 24 facial abnormalities in 14 cases with alobar/semilobar holoprosencephaly. Facial abnormalities were present in all cases and were detected in 22 ( 91.7%) of 24 facial malformations on prenatal sonography. One or more extrafacial anomalies were present in 8 ( 57.1%) of 14 fetuses. Conclusions Prenatal sonographic evaluation of midline facial defect may allow more definitive diagnosis of alobar or semilobar holoprosencephaly.

Objective To observe the respiratory system adverse drug reaction ( AREs) in obese patients in anesthesia recovery incidence and treatment outcome .Methods This was a control prospective trial .Study was con-ducted on 27 cases of obesity and the same amount of normal with body mass index (BMI)<30(control group).The sex distribution ,age and the type of operation and operation was similar between the two groups .The hospitalization rate of AREs in PACU was observed .Descriptive analysis on the variables ,use Mann-Whitney U,compared with chi square test and Fisher exact test of variables .The relationship between variables and AREs was studied by using uni-variate and multivariate Logistic retrospective analysis .Results Obese patients with the STOP-Bang≥3 ( 89% vs 11%,P<0.001)occur more frequently,obese patients had a lower rate of underwent high risk operations (7% vs 41%,P=0.005) and big operation (4% v s15%,P=0.008).Obesity in PACU patients were more susceptible to getting AREs(33% vs 7%,P<0.018).Multivariate analysis indicated that obesity and residual muscle relaxation effect was the independent risk factors of AREs .Obese patients in PACU had a longer periods of time treatment (120min vs 84min,P<0.001).Conclusion Obesity is an independent risk factor for PACU in patients with AREs . Obese patients in PACU were treated time more longer .

Objective To explore the clinical characteristics and prognosis of apical hypertrophic cardiomy -opathy (AHCM).Methods A retrospective analysis was performed on the clinical data of 34 patients with AHCM, the clinical characteristic , ECG, imageology data and the cardiovascular morbidity were counted and analyzed . Results There was no specificity on the clinical characteristics of the patients with AHCM ,the high voltage of the left ventricular and the huge inverted T wave of the left precordial leads came into the characteristic change for the ECG,there were 21 patients of the total 34 patients were made a definite diagnosis after examined by the ultrasonic cardiogram,13 patients of them were made a definite diagnosis after examined by MRI .During the following-up,there were 4 patients occurred angiocardiopathy (the morbidity was 11.8%).The thickness of apex,apex cordis and poste-rior wall of the left ventricle examined during the last follow-up had significant differences compared with that during the first diagnosis(t=-3.73,-3.908,all P<0.05).The left ventricular ejection fraction ,interventricular septal thickness,left ventricular end diastolic diameter and thickness of the posterior wall of left ventricle had no significant differences compared with that during the first diagnosis (t =1.762,1.662, -1.857,2.015,all P >0.05). Conclusion AHCM has the benign prognosis effect , but the clinical misdiagnosis rate is high , clinicians should enhance their understanding level on the disease ,the characteristic ECG change ,ultrasonic cardiogram and MRI check can help to make a definite diagnosis .

Background and Object: Percutaneous coronary intervention (PCI) on ostial lesions in coronary arteries associated with higher procedural difficulty and complication morbility. It has been technically difficult because it should be done with precise stent placement in ostium and absence of side branch compromise. The Szabo technique consists of side branch wiring through most proximal stent strut as well as main branch wiring through stent lumen. The side branch wire or anchor wire prevents stent advancement beyond ostial segment and makes possible the accurate stent implantation in ostium. The purpose of this study is to evaluate the safety, feasibility and success rate of Szabo technique by analysing technical, angiographic and IVUS (Intravascular Ultrasonography) findings. Methods: The data of 39 PCIs in 39 patients with a significant lesion at a coronary artery ostium which was treated percutaneously using Szabo technique were retrospectively analysed. The technically successful procedure was defined as there was neither stent loss nor second guide wire pull back during stent advancement. A successful procedure from angiographic point of view was defined as a precise stent implantation at ostium without side branch compromise. Successful procedure from IVUS point of view was defined as accurate stent placement in ostium without proximal protrusion and without any stent uncovered area. A total of 39 patients was with 28 males and 11 females. They aged from 43 to 79 years with a mean age of （65±12）years. The 6F and 7F guiding catheter were used in 35 (89.7%) and 4 (10.3%) patients separately. The access was radial in 31 (79.5%) and femoral in 8 (20.5%) patients. The culprit vessel was left anterior descending (LAD) in 26(66.7%), right coronary artery (RCA) 5 (12.8%), circumflex-obtuse marginal (LCX-OM) 3(7.7%), and posterior descending (PDA) 5(12.8%). IVUS was performed through culprit vessel in 30 (76.9%) and was also done in side branch in 9 (23.1%) patients after stent implantation. Results The procedure was technically successful in 36 (92.3%) patients. All technically successful patients had angiographic success (100%). IVUS examination of culprit vessel showed accurate stent placement in ostium 29 (96.7%) and slight stent proximal protrusion in 1(3.3%) patients. No serious complication occured. Conclusions This study shows that Szabo technique is safe and feasible for PCI in ostial coronary artery lesions with a high angiographic success rate，its deserved to spread.

Objective To investigate the factor that related to neoplasm from the clinicopathologic character of gallbladder polyps, and identify the reciprocal effectiveness of these factors. Method Three hundred and forty-seven patients who were underwent operation with gallbladder polypoid lesions were reviewed. Results Logistic regression analysis showed, only 5 parameters were significant for the prediction of neoplastic lesions, including age of the patient (P =0.015), the number of polyps (P=0.018), the maximal diameter (P=0.000), echo property (P=0.000), as well as the position of polyps (P=0.030),of which the maximal diameter was the best one to predict the neoplasm polyps. Further analysis with HOC curve showed that 0.925 cm, the diameter of polyps, was the critical point to calculate the polyp was neoplasm or not. Conclusions Age of the patient , the number of polyps , the maximaldiameter, the position of polyps, and echo property are independent factors in predicting gallbladder neoplastic lesions. The size of the polyps is the most significant one among the factors to predict gallbladder neoplasm with its critical point of 0.925 cm.

Fast track surgery(FTS)is an idea and theory which has widely used in the surgical operations,through the whole treatment of patient' s surgery. A series of positive measures has been adopted, FTS has ameliorated the velocity of the rehabilitation and prognosis after operation, and improved the quality of life and the therapeutic effect. We reviewed the new concept and the application prospect of FTS in the gastrointestinal surgery in this article.

Myeloid-derived suppressor cells are a heterogeneous population of early myeloid progenitors,immature granulocytes,macrophages,and dendritic cells at different stages of differentiation.These cells have the capacity to suppress both the innate immunity response mediated by the cytotoxic natural killer cells and natural killer T cells,and the adaptive immune response mediated by CD4+ and CD8+ T cells.In addition,myeloid-derived suppressor cells have close links with macrophages,dendritic cells,regulate T cells and so on,and also play an important role in the process of tumor progression.

This paper discussed on the importance of management system of paperless electronic medical record and pointed out that we would encountered lots of problems during the construction of paperless electronic medical record management system including authenticity,legal effect,similarity,safety,mistakes and missing of medical records.This paper analyzed these problems and proposed corresponding countermeasures including developing safety management system,whole-process monitoring of medical record quality,enhancing archive management,developing backup and recovery mechanisms,improving secrecy and authorization system,promoting borrowing management,performing copy system,strengthening electronic signature management,implementing unique number management and enhancing overall quality of personnel

The A/G polymorphism of cytotoxic T lymphocyte associated antiger 4(CTLA-4) was determined by PCR-RFLP in 120 patients with recurrent Graves′ disease (GD), including 85 cases with early relapses within 3 years and 35 cases with relapses more than 3 years after withdrawal of antithyroid medication.66 initial GD patients and 100 healthy controls were included in the present study.The results suggest that A/G polymorphism of CTLA-4 was associated not only with GD, but also with early relapes after withdrawal of antithyroid medication.

Double main teaching model can be applied in the teaching of pharmacology. To be spe-cific,for complex and difficult theory,we applied 'transmission-acceptancee' teaching method while for simple and easy theory,we used 'discovery' teaching method. Compared with the traditional teaching mod-el, double main teaching model improved teaching results and enhanced students' enthusiasm for learn-ing,their autonomous learning ability and cooperative ability. On the other hand,there still existed some prob-lems. We should keep on making great efforts to achieve better teaching results.