Objective To discuss the treatment effect of doctor-nurse cooperation in multi-plane operation of obstructive sleep apnea hypopnea syndrome.Methods 73 patients with multi-planar surgery due to OSAHS were divided into the observation group (38 cases) and the control group(35 cases) in our department from January 2008 to December 2012.Health care was strengthened throughout the course of treatment in the observation group and traditional treatment and care were adopted in the control group.Short-term and long-term efficacy,intraoperative and postoperative complications were compared between two groups.Results The operation of short-term effective rate was 100％,and significant differences were found in the long-term efficacy between the two groups.There were significant differences in nasal bleeding during surgery,one-time intubation success rate and the significances were found in postoperative pain,extubation time,lung infection and soft palate regurgitation between two groups.Conclusions The implementation of the multi-plane surgery for patients with OSAHS can effectively improve the short-term efficacy of the patients throughout the course of treatment.Strengthening doctor-nurse cooperation effectively improve the patients' long-term efficacy,reducing the patients' intraoperative and postoperative complications.

Objective To explore the value of peak systolic displacement of mitral annulus in evaluating left ventricular systolic function by speckle tracking imaging(STI).Methods The study population consisted of 96 subjects. The apical four-chamber view and two-chamber view were obtained and the systolic displacements of mitral annulus were measured at lateral, spetum, anterior and inferior mitral annulus (MADlat, MADsep, MADant, MADinf).The systolic displacements of mitral annulus midpoint (MADmid) and its ratio to the length of left ventricle at end-diastole(MADmid%) were calculated.Left ventricular ejection fraction(LVEF) was measured by three-dimensional echocardiography.The correlation of these displacements parameter with LVEF was analyzed.Results ① There was no significant difference among MADsep, MADlat, MADant, MADinf and MADmid(P>0.05).②There was significant correlation between LVEF and these parameters (P <0.01) ,and MADmid and MADmid% showed an excellent correlation with LVEF (r = 0.87 and 0.89 respectively, P<0.01).③The cut-off value of MADmid for LVEF>50% was 8.9 mm with a sensitivity of 95% and a specificity of 80% while the cut off value of MADmid% for LVEF>50% was 10.9% with a sensitivity of 95% and a specificity of 85%.Conclusions Displacement of mitral annulus by STI showed an excellent correlation with LVEF, and it may be a new promising method for routine evaluation of left ventricular systolic function with its high feasibility, simplicity and accuracy.

Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae,and substantially harms human health and socioeconomic development.Due to inappropriate treatment and the presence of drug resistance genes in patients,antibiotic resistance has emerged in Neisseria gonorrhoeae,such as resistance to penicillin,tetracycline,ciprofloxacin,or other antibiotics.Currently,extended-spectrum cephalosporins (ESCs) are the first-line treatment of gonococcal infection.With the wide use of ESCs,the sensitivity of Neisseria gonorrhoeae to ESCs has been decreasing gradually,and there have been reports on cases of treatment failure in clinical practice.In order to control gonorrhea and deal with drug resistance in Neisseria gonorrhoeae,combined therapy,alternative therapy and new drugs have been developed in clinic.

Objective To investigate the correlation between the serum thyroid-stimulating hormone levels and the outcomes in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke were enrolled prospectively.The general clinical data,vascular risk factors,and biochemical indexes including thyroid hormones were collected.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of baseline neurologic deficit.The modified Rankin Scale (mRS) was used to evaluate the neurological outcomes at day 90 after onset.The mRS 0-2 was defined as good outcome.Multivariate logistic regression analysis was used to identify the independent influencing factors of the poor outcomes in patients with acute ischemic stroke.Results A total of 140 patients with acute ischemic stroke were enrolled,including 95 men (67.86％) and 45 women (32.14％),aged 35-94 years old.Thirteen patients (9.29％)had subclinical hyperthyroidism and 17 (12.14％) had subclinical hypothyroidism.Ninety-eight patients (70.00％) had good outcome and 42 (30.00％) had poor outcome.The proportions of male (x2 =4.717,P =0.047) and small arterial occlusive stroke (x2 =5.564,P =0.018),as well as uric acid (t =2.602,P =0.010),FT3 (t =2.406,P=0.017),and TSH (t =2.302,P =0.023) in the good outcome group were significantly higher than those in the poor group (P =0.001);age (t =-3.489,P=0.001),fasting blood glucose (Z =-2.178,P =0.031),and baseline NIHSS score (t =-8.009,P ＜ 0.001) were significantly lower than those of poor outcome group.The proportion of patients with TSH in the first quartile (＜0.805 mU/L) in the good outcome group was significantly lower than that in the poor outcome group (17.35％ vs.42.86％;x2 =10.204,P =0.003,and that in the fourth quartile (＞ 2.476 mU/L) was significantly higher than the poor outcome group (30.61％ vs.11.90％;x2=5.488,P=0.002).Multivariate logistic regression analysis showed that after adjusting various confounding factors,the higher baseline NIHSS score was an independent risk factor for poor outcome at day 90 after onset (odds ratio,1.690,95％ confilence interval 1.317-2.168;P＜ 0.001),while the higher baseline TSH level was associated with good outcome (odds ratio,0.520,95％ confidence interval 0.408-0.867;P=0.007).Conclusions The higher serum TSH level was independently associated with good neurological outcome at day 90 after onset in patients with acute ischemic stroke.

Objective To observe the effect and toxicity of oxaliplatin plus 5-Fu and CF (FOLFOX) vs irinteean plus 5-Fu and CF (FOLFIRI) in patients with advanced/metastatic colorectal cancer. Methods 67 patients with histologicaly confirmed advanced/metastatic colorectal cancer were non-randomized to enter the study. Patients for FOLFOX: oxaliplatin 85 mg/m2 iv 2 h d1.CF 200 mg/m2 iv 2 h followed by 5-Fu 250 mg iv bolus and 5-Fu 600 mg/m2 iv 22 h d1,2 were given, every 2 weeks as one cycle. FOLFIRI: irinotecan 150 mg/m2 iv d1. CF, 5-Fu do so. Efficacy was evaluated at 4 cycles. Results For 39 patients to FOLFOX and 37 patients to FOLFRI, the objective response rate (CR+PR) was 41.0 % vs 35.1%. The median time to progression was 5.2 months vs. 5.8 months in the FOLFOX and FOLFIRI arm. The median survival time was 13.2 months vs. 14.0 months in the FOLFOX and FOLFIRI arm respectively. The clinical benefit rate was 71.8 % vs 78.4 % in the FOLFOX and FOLFIRI ann respectively. There was no significantly differences between two arms (P>0.05). The most frequently observed toxicity reaction was hematological toxicity nausea/vomiting and neurn-sensory toxicity in FOLFOX arm, and hematological toxicity and diarrhea in FOLFIRI arm. FOLFIRI arm had a remarkably higher incidence rate of grade 3 diarrhea than FOLFOX arm(P<0.025). Conclusion FOLFOX and FOLFIRI arm provid high effective and well tolerable treatment for advanced/ metastatic colorectal cancer.

Objective To assess clinicopathological features and prognosis of patients with combined hepatocellular and cholangiocarcinoma (cHCC-CC). Methods Clinicopathological and follow-up data of 115 cHCC-CC patients confirmed pathologically in Liver Cancer Institute of Fudan University from 1995 to 2007 were analyzed. Kaplan-Meier method was used to calculate 1-,3- and 5-year survival rates and tumor-free survival rates. Survival curves were analyzed using the log-rank test. The factors that impacted the prognosis of cHCC-CC were estimated. Results In 115 cases, one was Allen's type A, one was Allen's type B, and the other 113 were Allen's type C. Being with male in predominance, most of the cHCC-CC patients had liver cirrhosis background. They presented with elevated AFP or CA19-9, vascular invasion, resembling hepatocellular carcinoma(HCC)as well as lymph nodes metastasis. One-, 3-, 5-year survival rates of 115 patients were 68. 1%, 38. 1% and 33.6%, respectively, with median survival time of 13.0 months. Whereas the 1-, 3-, 5-year survival rates in radical resected patients were 78.4 % ,44.4 % and 44.4 % ,respectively, with median survival time of 16.0 months. Tumor free survival time at 1-, 3- and 5-year was 57.8 %, 12.6 % and 0.0 %,respectively,with median recurrent time of 10.0 months. One-, 3-, 5-year survival rates of 10 nonsurgical patients were 10/10,10/10 and 0/10,respectively, with median survival time of 5.3 months.TNM stage was independent factor for prognosis of the patients after resection. Whereas the lymph nodes involvement was independent factor for the tumor free survival time of radical resected patients.Conclusions Although clinicopathological characteristics of cHCC-CC are more similar to those of HCC, the prognosis of cHCC-CC is more unfavorable than that of HCC. TNM stage is an independent determinant of long time outcome for patients after resection.

Objectives To investigate the causes of short stature in Turner syndrome (TS). Methods 86 patients were di-agnosed with TS by karyotypes from 2004 to 2013. According to the deletion types of the X chromosome short arm, growth hor-mone (GH), insulin-like growth factor-1 (IGF-1) and thyroid function, the TS patients were divided into different groups and com-parison was made among groups. Results Ht SDS in three groups with different extent of the deletion of the X chromosome short arm were (-4.39±1.08), (-3.26±1.25) and (-2.84±0.15) (P<0.05). The proportion of growth hormone deifciency (GHD) in the three groups were 62.5%, 38.9%and 0%(P<0.05). Ht SDS in groups with different degree of IGF-1 level were (-4.37±1.10), (-3.82±1.07) and (-3.25±0.91) (P<0.05). There was no signiifcant difference of Ht SDS between hypothyroidism patients with and without GHD (P>0.05). Conclusions The deletion of X chromosome short arm may cause the short stature in TS. The GH-IGF-1 axis in TS is impaired, but GHD is not related to short stature in TS.

Objective To study the applied value of diffusion weighted imaging-DWIBS(diffusion weighted imaging with background suppression) in detecting the body tumour.Methods 10 healthy volunteers and 20 patients with histologically proven tumour were examined by diffusion Weighted MR with different techniques of background/fat body signal suppression.STIR-EPI sequence and spin echo-echo planar imaging(SE-EPI) sequence with chemical shift selective(CHESS) pulse were compared in terms of their degree of fat suppression.The diffusion weighted imaging features of control group and patients with tumour were observed and the values of ADC were measured.Results Fat suppression with STIR-EPI sequence in neck,chest,spine and extremity was well and SE-EPI with CHESS pulse in chest,abdomen,pelvic was satisfying.Signal to noise ratio(SNR) wss higher in SE-EPI with CHESS than that in STIR.The glands,spleen,peripheral nerves,lymph nodes and so forth could be showed by DWIBS in control group.85% malignant lesions were well visualized and appeared as high signal intensity and lower signal intensity in similar PET imaging,but the lesions only in 3 patients are not well visualized including pancreas cancer(1 case),rectum cancer(1 case),prostate cancer(1 case).PET scan was performed in 3 patients and well corresponded with diffusion weighted imaging in 2 cases,the other one was not visualized on diffusion weighted imaging.The highest ADC of malignant tumors was(1.58?2.06)?10-3mm2/s,the lowest ADC of malignant tumors was(0.88?0.74)?10-3mm2/s,the mean values of ADC of malignant tumors was(1.34?0.79)?10-3mm2/s.Conclusion DWIBS is a new method of diffusion-weighted MR,it has high spatial resolution,high contrast to noise ratio(CNR) and high SNR. This technique can be used as a powerful screening tool for tumour and evaluating the pathological lesions by measuring the values of ADC.

Brain natriuretic peptide (BNP) is one of the most sensitive and specific laboratory indicators during cardiac dysfunction.N-Terminal pro-brain natriuretic peptide (NT-proBNP) is the N-terminal precursor of BNP.The functions of both are not consistent,but its physicochemical properties are superior to BNP.Now it has been widely used in the diagnosis and treatment monitoring of cardiovascular diseases.In the field of stroke,the testing and application of BNP,especially NT-proBNP is less.This article reviews the roles of NT-proBNP in cardio-cerebrovascular diseases,especially in ischemic cerebrovascular disease.

Objective To analyze the clinical characteristic s of an infant with congenital lipoid adrenal hyperplasia (CLAH),and to sequence the acute regulatory protein (steroid acute regulatory,StAR) gene of the infant patient and her pedigree.Methods Physical examination,laboratory tests,and imaging examination of the 11-month-old patient with CLAH were collected.DNA was extracted from blood samples of the patient and her parents.The 7 exons of StAR gene were amplified by PCR and then sequenced.Results Dark skin,girl vulva,and one each 1.0 cm×1.0 cm palpable lump in inguinal area bilaterally were observed.The adrenocorticotropic hormone (ACTH) was 253 pg/ml,cortisol was 27.6 nmol/L at 8 am,17-hydroxyprogesterone was 3 nmol/L.Uhrasound showed that sign of testicular ultrasonography existed in bilateral inguinal regions.Karyotype analysis showed 46,XY.Sequencing of PCR amplified fragments showed that there were two heterozygous mutations c.229C ＞ T,p (Gln77X) and C.659A＞G,p (His220Arg) of StAR gene in this patient.By rectifying the disturbance of electrolyte,and treating with hydrocortisone and 9α fludrocortisone,etc,the patient has been stable so far.Conclusion The patient presents typical clinical manifestations.Two heterozygous mutations including c.229C ＞T,p (Gln77X) from maternal and C.659A＞G,p (His220Arg) from paternal of StAR gene were detected.Wherein the c.659A＞G,p.(His220Arg) as a novel point mutation of StAR gene,has not been reported so far.