Objective To Observe the effects of treating primary trigeminal neuralgia with modified Shaoyao-Gancao decoction and carbamazepine. Methods 76 patients with primary trigeminal neuralgia were randomly divided into a treatment group and a control group, 38 patients in each. The treatment group was treated with modified Shaoyao-Gancao decoction and carbamazepine; and the control group was treated with carbamazepine only. Clinical curative effect, pain improvements and adverse reactions were observed after the treatment and 6 week follow-up. Results The total effective rate was 89.3%and 75.5%in the treatment group and the control group respectively, the difference was statistically significant(P=0.043). The onset frequency, duration, degree of pain were all improved in both groups after the treatment and 6 week follow-up[treatment group after the treatment is (0.54±0.78), (2.15±1.73), (1.58±1.26), 6 week follow-up is (0.24±0.63), (1.36±1.03),0.86±1.95);control group after the treatment is (1.98±1.68), (3.96±1.49), (3.02±1.45), 6 week follow-up is (1.06±1.78), (1.97±1.69), (2.13±1.54), P<0.05],and the treatment group was better than the control group(P=0.040 and 0.039 respectively). Conclusion Modified Shaoyao-Gancao decoction combined carbamazepine has good clinical curative effect in treating primary trigeminal neuralgia.

WHO has issued three editions of pathologic classification of bladder urothelial carcinoma in 1973,1999 and 2004.The 1973 version classification had been widely and the longest applied.However,WHO 2004 classification had been prevalent in past years.There were two issues in the applications of WHO 2004 classification.On one hand,there were some difficulties in quick grading in a given case.On the other hand,there were some misunderstandings in the conversion of different WHO classification.In this article,the changes of different pathologic classification of bladder urothelial carcinoma were reviewed and the outline of different pathologic classification was generalized.The criterion of all the systems was cell anaplasia.In WHO 1973 version classification,the definition of the various grades was vague.It was relatively precise in WHO 1999 classification.However,the grading of Ⅰ,Ⅱ and Ⅲ in WHO 1999 classification still remained confusions.The major changes in WHO 2004 classification was that this system divided urothelial carcinoma into low-and high-grade,which may solve the heterogenesis of grade Ⅱ in the other two classifications.

Objective To study the effect of knee joint replacement on the elderly patients with osteoarthritis and the influence on the quality of life.Methods This study selected 68 patients(72 knees)with knee joint replacement, followed up for three months,with the aid of HSS scoring method,the function of knee joint and the change of quality of life before and after operation were compared.Results Compared with preoperation,the symptoms of pain[(25.1 ± 1.8)points vs.(13.1 ±1.9)points],activity[(13.1 ±1.3)points vs.(8.1 ±1.5 )points],functional recovery [(23.1 ±1.4)points vs.(9.1 ±3.9)points],muscle strength[(7.9 ±1.7)points vs.(2.1 ±1.3)points]and stability[(8.1 ±1.9)points vs.(4.1 ±2.9)points]were significantly improved after 3 months of operation,the differences were statistically significant(t =7.23,5.75,8.96,6.82,9.71,all P <0.05).Evaluation of the quality of life of the patients after the end of the follow -up period,the scores were significantly improved compared with the preoperation,the scores were increased,the differences were statistically significant(t =5.43,4.48,4.87,3.96, 2.57,2.79,all P <0.05).Conclusion The knee joint replacement can achieve the goal of effective treatment of senile osteoarthritis and can significantly improve the quality of life of the patients and patients'satisfaction.

Objective To explore the job tasks and qualifications of midwives in China for the next five years.Methods Anonymous surveys were sent by email to 80 professionals to learn the job tasks and qualifications of midwives in China using the Delphi method.The recipients include senior midwives, nursing administrators and nursing educators,senior obstetricians and gynecology department chiefs,as well as health administrators.Results Learnt in the survey were the qualifications and job tasks of professional midwives in China for the next five years.The system concludes 77 job tasks of midwives, among which 31 items are supposed to be completed independently.Conclusion China should develop the midwife system as soon as possible,strengthen the midwife training and education,develop the midwife access system and the corresponding laws and regulations for midwives,standardize midwife management,clear the midwife qualifications and job tasks,formulate normative midwife promotion system,and realize the midwifery scientific management.

Total 786 cases of acute uncomplicated appendicitis(UCAA) were included for analysis.All the cases were given antibiotics as a main treatment.Clinical cure rate and the number of cases requiring surgery were observed.Patients with conservative treatment were followed up and the recurrence was observed.Logistic regression was applied to analyze the risk factors of recurrence.Among 786 cases,774 (98.5％) were treated conservatively and achieved clinical cure;68 cases (9.0％) had recurrence during follow-up,the median time to recurrence was 11 months (1-33 months).Logistic regression analysis showed that age(OR =1.124,95％ CI:1.067-3.790,x2 =2.767,P =0.041) and appendix bezoar (OR =1.649,95％ CI:1.281-4.055,x2 =3.935,P =0.027) were independent risk factors for recurrence.Non-operative treatment for acute uncomplicated appendicitis shows a good short and long term effects.Surgical excision may be a better choice for the patients with high risks of recurrence.

Objective To investigate the morphology,size and density characteristics of adult normal thyroid and to establish the normal reference range of thyroid.Methods 317 patients without thyroid disease underwent head and neck computed tomography angiography (CTA)examination from Jun.2011 to Jun.2012 in the First Affiliated Hospital of Chongqing Medical University.Their data were analyzed.The thyroid morphology including the outside angle,width,thickness,isthmus was observed and measured.Plain scan and arterial phase CT values of thyroid gland were measured.The age and sex of patients were recorded.The left and right lobe on the thyroid dimension and density were investigated,and the index 95％ normal reference range was calculated.Results ① Morphology:normal thyroid glands were butterfly-shaped on the axis,accounting for 95.9％(304/317),and absence of thyroid gland isthmus accounted for 4.1％(13/317).② There was no significant difference for the thyroid lateral angle between the lobes and sexes(P＞0.05).There was significant difference between age groups(P=0.00).The 95％ reference range:the outside angle was 111.7°± 31.6° in patients younger than 60 years old,and 101.3°± 36.7° in patients of or older than 60 years old.③ The dimensions of the right lobe were longer than those of the left.The dimensions of the lobes in males were longer than those in females.There was no statistical difference among decades(P＞ 0.05).There was no significant difference in the thickness of thyroid isthmus between genders and among different age groups (P＞ 0.05).95％ reference range of the thickness of thyroid isthmus was 1.1-7.3 mm.④ There was statistical difference for the plain scan and enhanced CT values between lobes and sexes and among age groups (P＜0.05).95％ reference range needed to be separately formulated between the lobes,sex and age＜30 years and ≥30 years.Conclusion Studying the morphology,size and density characteristics of adult normal thyroids can help to establish normal thyroid imaging anatomical data in this region,and provide reference basis for imaging diagnosis of thyroid disease.

Objective To describe the changes of thrombosed venous sinus on MRI after administration of contrast material and evaluate the sensitivity and specificity of thread-like enhancement around sinus to diagnose thrombosis in the corresponding sinus.Methods Patients with cerebral venous sinus thrombosis (CVST) admitted to our department from January 2005 to December 2014 and undergone a MRI scan with administration of contrast material were included in this study.The enhancement features of venous sinus were studied in the plane parallel to the interested sinus.The features of enhancement were classified as peripheral thread-like enhancement, partial enhancement and complete enhancement.The proportion of these three type of enhancement in thrombosed sinuses and normal sinuses were described and compared.The sensitivity and specificity of peripheral thread-like enhancement to diagnose thrombosis in corresponding sinus were calculated.The proportion of each type of enhancement was also described and compared in acute (≤ 7 d), subacute (8-30 d) and chronic (≥ 31 d) stage after onset of symptoms.Results Peripheral thread-like enhancement, partial enhancement and complete enhancement were all found in both thrombosed and normal sinuses.There was a significant difference of enhancement features between normal and thrombosed sinus in superior sagittal sinus (100％ (30/30) vs 60％ (27/45), x2 =13.789, P =0.001), left trans verse sinus, and right sigrnoid sinus.The sensitivity and specificity of peripheral thread-like enhancement to diagnose thrombosis in the corresponding sinus were 10.5％-44.4％ and 53.3％-76.7％ respectively.There was no significant difference of contrast features at different stage after onset.Conclusion The value of peripheral thread-like enhancement to diagnose CVST is limited because of low sensitivity and specificity.

Objective To investigate the cellular viability and mitochondrial reactive oxygen species (ROS) production of the Müller cells under high glucose condition,and explore the protection role of the 5,6-dihydrocyclopenta-1,2-dithiole-3-thione (CPDT) on Müller cells.Methods Müller cells from Sprague Dawley rats were divided into 5 groups randomly,including 25 mmol/L normal glucose group (group A) and 65 mmol/L high glucose group (group B).High glucose group with 45,60,70 μmol/L CPDT and cultured them 72 hour was set as group C,D and E.Water soluble tetrazolium salt (WST)-8 was used to measure the cellular viability.Flow cytometry was used to measure the active oxygen and apoptosis index.The expression of nuclear factor erythroid 2-related factor 2 (Nrf2),hemeoxygenase-1 (HO-1),Bcl-2 and Bax protein were measured by Western blot.Results Compared with group A,the WST-8 showed that the viability of Müller cells apparently decreased in group B (t=39.59,P＜0.05).Compared with the group B,the viability of Müller cells had changes in group C (t=0.97,P＞0.05),but recovered in group D and E (t=-4.17,-7.52;P＜0.05).Compared with group A,the FCM showed that the mitochondrial ROS levels was higher in group B (t=-30.99,P＜0.05).Compared with group B,the mitochondrial ROS levels were decreased in group D (t=27.68,P＜0.05).Compared with group A,Bax,Nrf2 and HO-1 increased (t=-11.03,-63.17,-11.44;P＜0.05),while the bcl-2 decreased in group B (t=7.861,P＜0.05).Compared with the group B,Nrf2,HO-1 and Bax decreased (t=15.11,26.59,6.27;P＜0.05),while the bcl-2 increased in group D (t=-6.53,P＜0.05).Conclusions Under the high glucose,CPDT may reduce the mitochondrial ROS levels and the expression of Nrf2,HO-1 and Bax protein of Müller cells.It may inhibit apoptosis through activating the Nrf2/HO-1 pathway and balancing of level of Bcl-2 protein and mitochondrial ROS.

Objective To evaluate the effects of inhalation sevoflurane in the early ischemia and reperfusion on pulmonary inflammatory response in patients undergoing cardiac surgery with extracorporeal circulation (ECC). Methods Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into 2 groups (20 patients in each group): control group and sevoflurane group. In sevoflurane group, 2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked, and also before and after the ascending aorta was opened. Paitents in control group didn′t inhale sevoflurane. Time was defined as the followings: after anesthesia and before skin incision (T0), immediately before ECC (T1), immediately after ECC (T2), 2 h after ECC (T3), 6 h after ECC (T4) and 24 h after ECC (T5). At T0, T2, T3, T5, the radial artery blood was obtained to detect the levels of plasma tumor necrosis factor-α(TNF-α), interleukin-8(IL-8) and soluble intercellular adhesion molecule-1(sICAM-1). At T1, T2, the pulmonary artery and pulmonary vein blood was obtained to detect the neutrophil count and calculate the differences between the vein and artery. At T0, T2, T3, T4, T5, the arterial blood gas was detected and differences of alveoli-arterial oxygen pres [P(A- a)O2], oxygenation index (OI), static compliance (Cst) were calculated. Results The levels of plasma TNF-α, IL-8 and sICAM-1 were higher at T2, T3, T5 than those at T0 in two groups (P<0.05). The levels of plasma TNF-α, IL-8 and sICAM-1 were decreased in sevoflurane group at T2 and T3, compared with those in control group (P<0.05). The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were higher at T2 than those at T0 in two groups (P<0.05). The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were decreased in sevoflurane group at T2 compared with those of control group (P<0.05). The level of P(A- a)O2 was higher at T2, T3, T4 and T5 than that at T0 in two groups (P<0.05). The level of OI was decreased at T2, T3, T4 and T5 compared with that at T0 in two groups (P<0.05). The level of Cst was decreased at T2, T3 and T4 compared with that at T0 in two groups (P<0.05). The level of P(A-a)O2 was decreased in sevoflurane group at T2, T3 and T4 compared with that in control group (P<0.05). The levels of OI and Cst were higher in sevoflurane group at T2, T3 and T4 compared with those in control group (P<0.05). Conclusions Severe pulmonary inflammation often occurs during cardiac surgery with ECC, and it can be relieved by inhalation of sevoflurane in the early ischemia and reperfusion.

Objective To investigate the relationship of alcohol exposure during pregnancy and non-compaction cardiomyopathy (NCC) in offspring mice.Methods Pregnant mice of ED3.5-ED18.5 were given 56％ alcohol by gavage at a dose of 5 mL/kg.The ED19.5 mice were sacrificed,and the heart of the fetal mice was harvested.Transmission electron microscopy (filaments,mitochondria and sarcoplasmic reticulum) and HE staining were used to verify the changes of structure and ultrastructure of the obtained myocardial tissues.Echocardiography was used to evaluate the cardiac function and ventricular myometrium of the offspring mice after growing up.Results Alcohol exposure during pregnancy caused the disorganized and dissolved myofilaments in the fetal mice.Some offspring mice (31.25％,5/16) had NCC.The ratio of non-compacted myocardium to compact myocardium at the end of systole (N/C) was 2.49 ± 0.6 in the offspring mice of the alcohol exposure group,significantly higher than that in the control offspring mice (0.62 ± 0.23,t =10.397,P =0.000).The volume of heart was decreased in the offspring mice of the alcohol exposure group while the left ventricule was enlarged.Echocardiography showed cardiac dysfunction and thickened ventricular septal/left ventricular posterior walls in the grown-up mice of the exposure group.Conclusion Large dose of alcohol exposure during pregnancy cause trabeculations and non-compaction in ventricular myocardium,and it might be one of causers for NCC in the offspring.