BACKGROUND: There are obvious neuropsychological changes after stroke besides the damage of cognitive function, and the symptoms of depression and anxiety which are also very conspicuous.OBJECTIVE: To investigate the related characteristics of neuropsychological changes after stroke by means of neuropsychological methods.DESIGN: A case-control study.SETTING: Department of Psychology, the Third Hospital of Daqing; Department of Neurology, the Second Affiliated Hospital of Harbin Medical University.PARTICIPANTS: Sixty stroke inpatients (33 males and 27 female)aged from 42 to 75 years old with an average of (59.3±8.8) years old were selected from the Department of Neurology, the Second Affiliated Hospital of Harbin Medical University between October 2001 and June 2002. Totally 49 cases had cerebral infarction and 11 cases had cerebral hemorrhage; 31 cases had single focus and 29 cases had multiple focuses (including 2 focuses or more); 20 cases had lesion in left hemisphere,21 cases had lesion in right hemisphere and 19 cases had bilateral lesions. The lesion was at temporal lobe in 6 cases, at occipital lobe in 2 cases, at frontoparietal temporal lobe in 15 cases, at internal capsule in 4 cases, at basal nuclei in 19 cases, at lateral ventricle in 4 cases, at thalam us in 4 cases, at cerebellum in 1 case and at multiple sites in 5 cases. The focal size was ＜ 15 mm in 33 cases and ≥ 15 mm in 27 cases. Sixty residents (33 males and 27 females) aged 42to 75 years with an average of (58.7±7.9) years old were selected simultaneously from the communities and suburbs of Harbin city as the controls and they all had no cerebral and organic lesion, mental disorder, severe somatic diseases and family history of mental disease.INTERVENTIONS: The poststroke mental status of the patients at stable recovery period was assessed with symptom checklist-90 (SCL-90, consisted of 90 items and 9 symptoms, scored by 5 grades of 0 to 4, including 0 as never, 1 as mild, 2 as moderate, 3 as a little severe and 4 as severe;Hamilton depression scale (HAMD, consisted of 24 items, including 11 somatic symptoms scored by 0 to 2 grades and 13 mental symptoms scored by 0 to 4 grades; the total score ＞ 24 points was taken as severe depression, 17 to 24 as moderate depression, 7 to 16 as mild depression, ＜ 7 as no depression), self-rating depressive scale (SDS, consists of 20 items, evaluated according to the occurrence frequency of the symptom, and classified into 4 grades; the score was 1, 2, 3 and 4 points for the forward scored questions, but 4, 3, 2 and 1 point for the backward scored questions; the highest total score was 80 points; the depressive severity=accumulative scores of each item/80×100, the depressive index ranged 25 to 100, the index ＜ 0.5 was taken as no depression, 0.5 to 0.59 as mild depression,0.6 to 0.69 as moderate depression, ＞ 0.7 as severe depression) and selfrating anxiety scale (SAS, consisted of 20 items, scored by 4 grades, mainly evaluated according to the occurrencefrequency of the symptoms. The forward scores were 1, 2, 3 and 4 points, and the backward scores were 4,3, 2 and 1 point; the total score multiplied by 1.25, and then the integer was taken as the standard score, the lower the better, and the delimitative value was 50. The total score of anxiety ＜ 50 points was taken as normal,50 to 60 as mild anxiety, 61 to 70 as moderate anxiety, ＞ 70 as severe anxiety). According to the different characters of disease, the patients with moderate depression and above were given suitable psychotherapy and psychiatric drugs for 4 weeks as a course.of the 4 scales between stroke patients with different lesion natures, foin the patients accompanied by depression. RESULTS: All the 60 stroke patients and 60 eases in the control group were involved in the analysis and SAS between the stroke group and control group: All the total scores were higher in the stroke group than in the control group [(131.45 ±18.89), (94.25 ±9.08) points; (18.73 ±6.54), (8.60 ±2.39)points; (56.49±11.85), (41.63±9.91) points: (40.08±6.55), (28.72±1.84)the 4 scales between stroke patients with different lesion natures, focal sites and focal sizes: In the stroke group, the total scores were higher in the patients with lesion in left hemisphere, cortical lesion, multiple focuses and large focal size (≥ 15 mm) than in those with lesion in right hemisphere, subcortical lesion, single focus and small focal size (＜ 15 mm)(t=1.92 to 4.31, P ＜ 0.05), but the scores were almost the same between the patients with cerebral infarction and those with cerebral hemorrhage accompanied by depression before and after treatment: 21 patients had moderate depressive symptoms and above, and their total scores of SCL90, HAMD, SDS and SAS were obviously higher than those in the control group (t=7.45 to 13.75, 9.83 to 21.20, P ＜ 0.01).CONCLUSION: The poststroke neuropsychological changes are more obvious, and the changes are associated with the lesion location, focal size and focal site, but have no close correlation with the lesion nature.After psychological interventions, the depressive emotion is markedly ameliorated in the patients with obvious depressive symptoms and it is then indicated that poststroke patients should be given psychological interventions.

Objective To explore the dosimetry of simplified intensity modulated radiotherapy (sIMRT)in the spinal component of craniospinal irradiation(CSI)compared with conventional plan(3D-CRT).Methods Five previously treated patients were adopted to generate 3D-CRT,3-and 5-field slMRT plans.The prescribed dose was 36 Gy to the planning target volume(PTV)in 20 fractions.The dose distributions of target volume and normal tissues,and homogeneity index(HI)were ananlyzed using the dose volume histogram.The total monitor units(MUs)were also analyzed to compare the delivery time indirectly.Results For 3D-CRT plans,the region of the neighbouring fields only received 70％ of the prescribed dose,and the maximum dose delivered in the normal tissues was increased to approximately 140％ of the prescribed dose.The homogeneity index(HI)of 3-and 5-field sIMRT were 0.09 ± 0.01 and 0.08 ±0.01,respectively,superior to that of 3D-CRT(0.18 ± 0.02,t=7.80,7.65,P＜0.05).The values of V10 for the heart of 3-and 5-field sIMRT were(8.4 ± 1.9)％ and(8.4 ± 2.0)％,respectively,lower than that of 3D-CRT((36.0 ± 6.0)％(t=13.3,13.0,P＜0.05).V20 for the thyroid gland were (12.4±1.5)％ and(12.4±1.6)％,respectively,lower than(69.4±5.7)％ of 3D-CRT(t=26.3,26.4,P＜0.05).V20 for the larynx were(17.2 ± 1.2)％ and(17.9 ± 1.5)％,respectively,lower than that of 3D-CRT[(89.4±7.0)％(t=25.5,26.5,P＜0.05)].V30for the NTwas(4.4±1.4)％,(4.9± 1.9)％,lower than that of 3 D-CRT[(31.9 ± 6.1)％(t=8.5,10.1,P＜0.05)].The averaged values of total MUs for 3-and 5-field sIMRT were 1100 ± 177 and 1160 ±204,respectively,higher than that of 3D-CRT(640 ± 151).Conclusions Compared with the 3D-CRT CSI technique,3-and 5-field sIMRT have better dose distribution and can improve target dose uniformity and protect the organs at risk.

Objective To compare two verification tools for intensity modulated radiotherapy (IM-RT) and to investigate the feasibility of a new three dimensitional verification tool. Methods Five patients receiving IMRT were randomly chosen for the quality assurance plans with MapCHECK Model 1175 (SunNu-clear, Melbourne, FL,USA) and Delta4(ScandiDos, Sweden) by using Philips Pinnacle 8.0D treatment planning system. Dose verification was measured with the Varian Clinical 23EX LA. Results The overall average percentages of pass points in DD2% DTA2 mm, DD3% DTA3 mm and DD4% DTA4 mm were 84.7%, 97. 1% and 99.3% with MapCHECK Model 1175, 86.2%, 98.2% and 99.6% with Delta4 re-spectively. The differences were statisticically significant (t = 3.94, P = 0.003 ; t = 3.17, P = 0.011 ; t = 3.05 ,P =0.014,respectively). The gantry angle was changed to zero degree with MapCHECK, but not with Delta. The effects were embodied with Delta, such as the gravity on leaf position accuracy of MLC, the treat-ment table on dose distribution and the earth magnetism on dose system. Conclusion Delta4 is an ideal verification tool for intensity modulated radiotherapy.

BACKGROUND: Neuroglioma is easy to recur, the focus of infection in which is rich in new vessels. Different expression of vascular endothelial growth factor (VEGF) may be related with the pathologic changes and recurrence of tumor.OBJECTIVE: To analyze the characteristics of VEGF expression in recurrent brain glioma.DESIGN: Control test.SETTLNG: Department of Neurosurgery, West China Hospital of Sichuan University.PARTICIPANTS: Forty-four (22 pairs) samples of neurogliocytoma before and after the recurrence with complete clinical data were collected from143 paraffin embedded samples, which were obtained from the operation between June 1996 and June 2001 in West China Hospital and pathologically proved to be brain gliomas. Samples were collected separately from the first operation and first recurrence, in which 8 cases belonged to grade Ⅰ of Kernohan scale, 10 were grade Ⅱ , 14 were grade Ⅲ and 12 were grade Ⅳ. The enrolled samples were divided into two groups: primary group and recurrent group with 22 cases in each group.METHODS: The immunohistochemiscal method was adopted. First antibody was goat-anti-human VEGF (mono-antibody), and second antibody was rabbit-anti-goat with the working concentration of 1:50. The phosphate buffered solution (PBS) was taken as negative control for staining instead of first antibody. The protein expression of VEGF in brain gliomas of 44 cases before and after the recurrence were detected and the cross-check analysis was conducted by combing with pathologic grades. ① The buff grains in intracytoplasm were positive signals. ②MPLAS-500 media mix chromatic pathologic imaging and literal analytical system were used to detect the PU (positive unit) value and number of tumor cells.③95% were the critical value of PU value, and the positive cell rates were calculated respectively. ④Routine hematoxylin-eosin stain was used for pathologic grades (Kernohan). MAIN OUTCOME MEASURES: ① PU value and the intensity of VEGF expression in brain glioma samples before and after the recurrence. ②The pathologic grades of brain gliomas before and after the recurrence. RESULTS: ①The expression of VEGF in primary and recurrent groups of brain glioma: the primary group was 21.927 3±6.607 and the recurrent group was 33.054 5±6.684. ② Pathologic grades: In 8 cases of primary grade Ⅰ gliomas, there were 2 cases of grade Ⅱ in recurrence, 5 cases of grade Ⅲ in recurrence, 1 case of grade Ⅳ in recurrence. In 6 cases of primary grade Ⅱ gliomas, there were 2 cases of grade Ⅱ in recurrence, 1case of grade Ⅲ in recurrence, 3 cases of grade Ⅳ in recurrence. In 6eases of primary grade Ⅲ .gliomas, 2 cases of grade Ⅲ in recurrence, 4cases of grade Ⅳ in recurrence. In 2 cases of primary grade Ⅳ gliomas,there were 2 cases of grade Ⅳ in recurrence. ③ Differences in PU value of VEGF protein expressions and pathologic grades of brain glioma samples before and after recurrence in self-compared detection were remarkable (P＜0.05).CONCLUSION: The expression of VEGF in recurrent glioma is higher than primary glioma, and there is a worsening tendency in recurrent tumor and the high-expression of VEGF in glioma plays an important role in the recurrence.

Objective To analyze the space-time characteristics of hand-foot-mouth disease (HFMD) in Shijiazhuang by using geographic information system (GIS).Methods The data of HFMD during 2009 to 2011 in Shijiazhuang were collected and GIS database was created.Special map was drawn by PHGIS software to analyze the space-time characteristics of HFMD in Shijiazhuang.Results The epidemic situation of HFMD in Shijiazhuang appeared sporadic with local centralization.The attack ranked alternately rise year after year and high epidemic areas were geographically complimentary.Overall epidemic levels tend dropping from 2009 to 2011 and there were differences among areas.The high-attack areas of HFMD changed over time.Conclusions GIS can provide direct-viewing of the space-time characteristics of HFMD and further understand the prevalence of HFMD,which could help to provide the scientific basis of HFMD control in Shijiazhuang.

0.05).However,50.0% of T1 patients with TNBCs had lymph node metastasis,which was much higher than the other 2 groups.The recurrence rate in TNBC,non-TNBC or Her-2 positive patients were 57.1%,40.5% and 44.2%,respectively.The triple negative group had higher tumor recurrence rate than the other two groups(P=0.03).The overall 3 year survival rate of the TNBC group was 58.9%,which was much lower than the other two groups(76.4% for the luminal a and b group and 74.8% for the Her-2 positive group(P=0.04).Conclusion:The TNBCs was higher in premenopausal patients well as a higher lymph nodes metastasis rate with small tumor size.Moreover,three years recurrence and mortality rates in this group is higher than the non-TNBC groups.

Objective To expatiate the ultrasonographical and pathological manifestations of breasts with juvenile macromastia.Methods Four patients with juvenile macromastia were examined by high frequency ultrasonography.The sonographical and pathological images were observed and reported.Results The sonographical characteristics of the breasts with juvenile macromastia were similar: the anatomical structures of the breasts were obscure,which were characterized by cystic formation,reticular structure,patched hypoechoic or hyperechoic regions and distorted gland structure.One patient had fibroadenoma and dermatic erythema.The results of pathological examination showed marked cystic proliferation of glands accompanied with ductal epithelial hyperplasia,irregular ductal distribution,no lobules formation or proliferation of fat tissue,fibrocyte and fibroblast.Conclusions The abnormalities of juvenile macromastia may not only be the huge volume,but also may include abnormal ultrasonographical and pathological manifestations,awaiting more follow-up studies.

Objective To study the value of ultrasonographic diagnosis of galactostasis in lactation.MethodsPatients in lactation and post-lactation were examined by color Doppler ultrasonography.Combined puncture,operation and pathology,the imaging features of different stage were summarized.Results The type of galactostasis included ductal ectasia,galactocele,infection and consolidation.The ultrasonographic examination with imaging features can determine the diagnosis and judge the type and the course of disease.Conclusions Ultrasonography is a first choice in diagnosing galactostasis in lactation.

Objective To evaluate the efficacy of preoperative femoral nerve block on preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.Methods Sixty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 65-75 yr,scheduled for elective total knee arthroplasty,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group Ⅰ),preoperative femoral nerve block group (group Ⅱ) and postoperative femoral nerve block group (group Ⅲ).Single-injection femoral nerve block was performed with 0.375％ ropivacaine 20 ml injected around the nerve under thc guidance of ultrasound immediately before induction of anesthesia and at the end of surgery in Ⅱ and Ⅲ groups,respectively.Patient-controlled intravenous analgesia (PCIA) with sufentanil (background infusion 2 ml/h,bolus dose 2 ml,lockout interval 15 min) was used until 2 days after surgery,and VAS score was maintained ≤ 3.When VAS score＞3,flurbiprofen axetil 50 mg was injected intravenously as rescue medication.The consumption of sufentanil per hour,requirement for rescue medication,and development of adverse reactions were recorded within 24 h after surgery.Sufentanil-sparing degree was calculated.Results Compared with group Ⅰ,the consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly decreased within 24 h after surgery in Ⅱ and Ⅲ groups.The consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in group Ⅱ than in group Ⅲ.The consumption of sufentanil per hour was decreased by 35％ in group Ⅱ as compared with group Ⅰ,and decreased by 18％ in group Ⅱ as compared with group Ⅲ.Conclusion Preoperative femoral nerve block can provide good preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.

Objective To analyze the clinical feature and pathological characteristics of oral submucous fibrosis (OSF) coexisted with oral leukoplakia (OLK) or oral lichen planus (OLP),and summarize both the common and each clinical and pathological characteristics of two kinds of diseases.Methods The clinical and pathological data of 74 patients with OSF coexisted with OLK and 57patients with OSF coexisted with OLP were retrospectively reviewed.Results Most of patients with OSF coexisted with OLK or OLP were mainly young and middle-aged male patients,and all had the habit of eating betel quid chewing.Most of them had the habit of smoking and alcohol drinking; while their limitation of mouth opening were not obvious.Patients coexisted with unilateral OLK or OLP all had a unilateral mastication of chewing betel nut;the prevalence rate of erosive OLP was lower in the patients with OSF coexisted OLP than that of OLP patients never chew betel nut.The pathology of both OSF coexisted with OLK or OLP was with the respective characteristics of OLK or OLP on the basis of OSF,and the epithelium was thickened more than atrophic.No relationship was found between the degree of epithelial hyperplasia and the severity of fibrosis in patients with OSF coexisted with OLK.Conclusions OSF coexisted with OLK and OSF coexisted with OLP were the occurrence of OLK or OLP on the basis of OSF,which were not a simple superposition of two diseases,but combination with their own characteristics of OSF coexisted with OLK or OLP.