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.

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.

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

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: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.

BACKGROUND: Basic fibroblast growth factor (BFGF) widely in human tissue participates in trauma repair of various tissues and is one of wound healing factors in the body. OBJECTIVE: To summarize the progress of BFGF in the fracture healing. RETRIEVAL STRATEGY: A computer-based online search of Pubmed Database was undertaken to identify the relevant articles on BFGF in the fracture healing published from January 2000 to December 2007 with the Keywords of "fibroblast growth factor 2 (basic fibroblast growth factor), fracture healing, regulation, signal transduction" in English. At the same time, Chinese relevant articles were searched in China Journal Full-text Database (CJFD) and Wanfang Database published between January 2000 and December 2007 with the same key words in Chinese. Exclusive criteria included articles with repetitive research and non-original study. LITERATURE EVALUATION: A total of 33 articles were collected about the distribution (3 articles), biological characteristics (3 articles) and the effect on the healing of bone fracture (27 articles) of BFGF. DATA SYNTHESIS: Bone healing is the process of regeneration after bone injury and the process of bone formation. BFGF can promote the cell migration by its chemotaxis and accelerate the healing by aggregating mesenchymal stem cells, macrophage and fibroblasts towards trauma region. Present animal studies on BFGF are deep and reports on clinical application are a few. Thus, the effect of BFGF is available. BGFG can affect bone formation by adjusting cell prolifeation and differentiation and changing the synthesis of cell products. BGFG not only can promote the bone growth, but also enhance the adhesion of osteoblasts and scaffold. CONCLUSION: The distribution and biological characteristics of BGFG have been recognized primarily. The further study on modulatory mechanism in the fracture healing of BFGF is carrying through. The bone restoration compounded by BFGF and its carriers is in the experiment and needs to be studied further.

To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy (TLRH) for the treatment of uterine malignancies, we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009. Data collected included operative time, estimated blood loss, lymph node count, time for the recovery of normal temperature and time to resumption of normal bladder function, intraoperative and postoperative complications. The procedure was completed laparoscopically in 108 patients. Two patients were converted to laparotomy due to common iliac vein injury. The mean overall operative time was 200.6+/-38.6 min; the mean operative blood loss was 280.5+/-128.3 mL; he mean number of pelvic lymph nodes that were resected wa26. 0+/-5.8. The time for recovery of normal temperature and the normal bladder function after the operation was 5.8+/-2.9 d and 15.2+/-4.3 d. There were 2 (1.8%) common iliac vein injuries during the operation and 10 (9.1%) bladder retentions post operation. It was concluded that TLRH is feasible, minimally invasive and provides promise for the treatment of uterine malignancies.

Objective To explore the related factors that affect the incidence of uterine fibroids to provide a theoretical basis for the clinical diagnosis and prevention.Methods Based on the clinical data selected from June 2014 to July 2016 in pathology of our hospital,159 cases of patients were confirmed with uterine fibroids,a comparative study was employed and the single factor test and the logistic regression analysis were both used to analyze the related risk factors that affecting the incidence of uterine fibroids.Results There were all significant level (P ＜ 0.05) between case and control groups in 40 years to 50 years,the number of abortions (≥2) as well as gynecological diseases,which were the independent factors for the incidence of uterine fibroids.In the present,the regression coefficients of former two factors were 0.186 (P ＜ O.05),and 0.584 (P ＜ 0.05),respectively.The corresponding regression coefficients of breast hyperplasia,vaginitis,cervicitis,endometritis and pelvic inflammatory disease,and other gynecological diseases and gynecological diseases were 0.221 (P ＜ 0.05),O.363 (P ＜ 0.05),O.539 (P ＜ 0.05),0.361 (P ＜ 0.05),and 0338 (P ＜ 0.05),respectively.It suggests that these were independent factors affecting the incidence of uterine fibroids.Conclusions The more the increasing age and the number of abortions,kinds of gynecological diseases infected will increase the risk of patients suffering from uterine fibroids.