Purpose：To determine the treatments and prognostic predictors of malignant melanoma of the head and neck. Methods：Surgical treatment and outcome was analyzed for 28 patients with malignant melanoma of the head and neck at department of the head and neck of our hospital (1984-1994). Results：23 patients underwent local excised as the first treatment, and local recurrence was demonstrated in 8 (34.8%). Margin of resection of primary melanoma was divided into narrow excision (≤2 cm) and wide excision (＞2 cm), and 5-year survival was 58% and 40%(P＜0.01). According to surgical methods, 5-year survival of WE, WE/END and WE/TLND were 80%, 80% and 39%. Conclusions：An excision with 2 cm margin is safe procedure for primary tumor of malignant melanoma of the head and neck. Neck dissection may not be practiced until neck lymph node is positive. Neck dissections differ from the positions of the primary tumors, and the flaps must be raised preferably superficial to the platysma.

Objective　The conditional hierarchical clustering for 1-dimensional(1-d) ordinal data was discussed.Methods　Because the individuals are ordered in 1-d,the conditional matrix was constructed with all elements in the second-diagonal are 1 and the others are 0.Distance matrix of individuals defined by some particular definition.Then the conditional-distance matrix was made for the hierarchical clustering by connecting the conditional matrix and distance matrix.This method was called 1-dimentsional conditional hierarchical clustering.An example was illustrated by this method and a Monte Carol study showed that method was feasible and robust.Results　Compared with the least-squares partition,this method is easy to understand,easy to practice and easy to compute.It also can give us a stable result.Conclusion　Because of the austere theory,the simple thought and the convenient application,it's a good method for the 1-d ordinal data.

Objective:The short term results of laparoscopic radical hysterectomy and pelvic lymph nodes dissection for early uterine malignancy were investigated.Methods:70 patients with eady malignant uterine tumor who underwent a laparoscopic radical hysterectomy and pelvic lymph nodes dissection(TLRH+LPL)were retrospectively reviewed.At the samt time,48 patients were recruited to be the control group who had laparotomy radical hysterectomy and pelvic lymph nodes dissection(ARH+APL).Intraoperative and postoperative situations and complications between these two groups were analyzed.Results:70 patients underwent laparoscopic operation,but two cases changed to laparotomy(transfer rate 2.9%).The mean operation time,blood loss,number of dissected pelvic lymph nodes and postoperative temperature recovery time of TLRH+LPL group was significantly different from ARH+APL group(P<0.01),while there were no difference between these two groups on bladder function recovery time and occurance of postoperative complications.Conclusions:TLRH+LPL has the same feasibility and safety with ARH+APL,less invasive to the tissue,thus offers a good option of microinvasive therapy for female malignant tumor.

Department ofPediatrics,the Maternal and Child Health Hospital ofHuzhou,Huzhou,Zhejiang 313000,China(Shen ZZ)Objective To observe the effect of phentolamine in the treatment of severe hand foot and mouth disease with acute pulmonary edema.Methods 90 children with severe hand foot and mouth disease and acute pul-monary edema from January 2014 to December 2015 in our hospital were selected as the research subjects.All the children were randomly divided into 45 case of the observation group and 45 case of the control group.They were given conventional drug therapy and positive pressure ventilation,the control group was given milrinone,5μg/kg,the obser-vation group was given phentolamine,5μg/kg.The myocardial enzymes and cardiac troponin were detected before intervention and after 72h intervention,the blood gases index and ventilator parameter were analyzed,and the time of ventilator support and hospital stay were compared.Results (1)The CK -MB,CK,troponin of the observation group and the control group after treatment were (17.52 ±1.33)U /L and (28.23 ±3.89)U /L,(120.42 ±6.21)U /L and (150.86 ±8.67)U /L,(0.46 ±0.07)μg/L and (0.96 ±0.06)μg/L,which were significantly higher than before treatment (t =5.024 and 8.455,9.353 and 14.757,6.356 and 9.505,all P <0.01),but the CK -MB,CK,troponin of the observation group after treatment were significantly lower than the control group (t =5.601,7.426,5.829,all P <0.01 ).(2)The PaO2 and PaCO2 of the intervention group and the control group after 72h intervention were (80.24 ±14.35)mmHg and (62.30 ±5.68)mmHg,(39.38 ±6.08)mmHg and (46.10 ±3.42)mmHg respectively, which were significantly improved than before treatment,the differences were statistically significant (t =11.352 and 7.204,7.827 and 5.287,all P <0.01),there were statistically significant differences between the two groups after the intervention (t =7.426,5.829,all P <0.01).The FiO2 ,PIP,PEEP of the two groups after treatment were significantly lower than before treatment,the differences were statistically significant (t =8.446 and 6.905,9.705 and 7.832, 8.605 and 6.889,all P <0.01),there were statistically significant differences between the two groups after the inter-vention (t =3.461,5.165,4.532,P <0.05 or P <0.01).(3)The time of mechanical ventilation and hospitalization in the observation group and the control group were (3.42 ±1.61)d and (5.06 ±2.15)d,(15.40 ±3.62)d and (18.62 ±3.81)d,the differences were statistically significant(t =3.513,3.734,all P <0.05).Conclusion Phent-olamine has better effect than milrinone in the treatment of severe hand foot and mouth disease with acute pulmonary edema,it can control the disease progression and improve clinical outcomes and has better clinical value.

It is well known that the tumor mainly transfers through the lymphatic vessels of the tumor .The current studies main-ly focus on the mechanism of metastasis , hoping to uncover the lymph node metastasis through investigating generation of lymphatic ves -sels and remodeling of tumor lymphatic vessels .Lymph node metastasis is directly related to and prognosis and the quality of life of cancer patients , and how to block the corresponding signaling pathways to prevent tumor lymphangiogenesis becomes the research fo -cus.This paper reviews the lymphangiogenesis and lymphatic vessel remodeling .

Objective: To deeply investigate the influential factors of mental health in medical students by structural equation modeling.Methods: 480 medical students were tested with SCL-90,adolescent self-rating life events check list and simplified coping style questionnaire,then theoretical model were established and confirmed for the relationships of life events,satisfaction degree with their profession,coping styles and mental health.Results: Study stress,human relations,satisfaction degree towards their profession and coping styles closely correlated with mental health status,and the structural equation modeling fitted the data very well,GFI and AGFI were both larger than 0.90.Conclusion: Use of structural equation modeling has more advantages than the traditional statistical methods,but it should combine with professional knowledge when it is used.

OBJECTIVE:To study the postoperative use of anti-infectives inpatients undergoing liver transplantation and its rationality.METHODS:50 inpatients who had undergone liver transplantation were randomly collected from center of organ transplantation for the analysis of the use of anti-infective agents within 1 month after operation in respect of utilization frequency(cases/times),duration of medication,drug utilization index(DUI) as well the conformity between drug combination and etiology so as to derive the rationality of drug use.RESULTS:Among the top 10 anti-infectives in terms of utilization frequency in patients undergone liver transplantation,9 had their DUI less than 1,and 1 had its DUI above 1.The perioperative application rate of anti-infective agents was 100%.In terms of drug combination,2 cases(4%) used one kind of anti-infectives,17(34%) two kinds,21(42%) tree kinds,10(20%) four kinds concomitantly.CONCLUSION:The doses and the proportion of anti-infectives used in combination for inpatients undergoing liver transplantation were on the high side,which should be controlled urgently.

Objective To observe the feasibility of phase-rectified signal averaging applied for the evaluation of automatic nervous system activity in general anesthesia.Methods Forty-seven fe-males and 63 males aged 18-65 years,ASA falling into category Ⅰ or Ⅱ,scheduled for oral maxillo-facial surgery under general anesthesia were selected.The heart rate variability(HRV)signal was re-corded by Powerlab throughout the operation,and then it was sectioned into three segments with 5 minutes:pre-anesthesia(T0 ),means the waking state before the operation;intra-anesthesia(T1 ),the period of operation in 25-30 min;post-anesthesia(T2 ),the consciousness recovery state in the end of the operation.All indicators of HRV analysis was calculated in the time domain.SpO 2 ,MAP and BIS were recorded synchronously in the three periods.Results Compared with T0 ,DC, RMSSD, SDNN,SD1,SD2,logTP,logLF,logHF were significantly lower at T1 and T2 (P <0.05).In con-trast to T1 ,HR,MAP and BIS were significantly higher at T2 (P <0.05 ),DC,RMSSD,SDNN, SD1,SD2,logTP,logLF,logHF were significantly increased at T2 (P <0.05 ).There was positive relation between DC and RMSSD,SD1,logHF (r =0.905,0.909,0.932,respectively,P <0.01). Conclusion As 5 min-DC could indicate the character of PRSA,especially its specificity in showing vagus nerves activities,it is feasible that DC is used to observe the autonomic nerve activity intra op-eration.

Objective:Observing the therapeutic effectiveness of Erhuangwendan Decoction and Yiqiyangyinningxin Decoction treating acute viral myocarditis.Methods: 344 cases were distributed into the therapeutic group(258cases) and the control group (86 cases). The treapeutic group were first given Erhuangwendan Decoction one packet per day, then Yiqiyangyinningxin Decoction one packet per day after acute attack. The control group were only given myocardial nutrient. All were given 3～6 months. We observed the symptoms,signs ang EKG of the two groups. Results: The effective rate of the therapeutic group was 40% after 3 months. And it was 84% after 6 months. The effective rate of the control group was 15% after 3 months. And it was 34.8% after 6 months. The two groups have obvious difference( P

Objective To study the relationships between serum matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metal]oproteinase-2 (TIMP-2) with bone metabolic markers and bone mineral density (BMD) in postmenopausal Chinese women.Methods In this study,192 postmenopausal Chinese females aged 48-65 were selected.Serum MMP-2,TIMP-2,bone alkaline phosphatase (BAP),osteocalcin,bone cross-linked C-telopeptides of typeⅠcollagen (CTx) and urine bone cross-linked N-telopeptides of typeⅠcollagen (NTx) were measured by ELISA.And the ratio of MMP-2/TIMP-2 was calculated.BMD was measured by dual energy X- ray abserptiometry.According to the criteria of WHO,these women were assigned to 3 groups : the normal,the low BMD and the osteoporosis groups.Results (1) Serum MMP-2 level was significantly higher in postmenopausal women with osteoporosis (1388?121)?g/L than that in age-matched normal controls (1126?141)?g/L (P0.05).(2) Notable negative relations were found between MMP-2,ratio of MMP-2/TIMP-2 with BMD of lumbar spine and Ward's triangle,serum BAP and osteocalcin (all P0.05).(3) In osteoporosis women,notable negative correlations between MMP-2,ratio of MMP-2/TIMP-2 with BMD of lumbar spine,femoral neck and Ward's triangle,serum BAP and osteocalcin were found (all P