Objective To explore the value of transcranial Doppler ultrasonography (TCD) on diagnosing the cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH). Methods TCD was used to detect and monitor the cerebral blood flow status to estimate CVS following SAH in 30 cases, then the results of TCD were analyzed by combining with clinical manifestation and SAH severity on CT. Results 17 patients (56.7%) had the evidence of CVS confirmed by TCD, 10 of them were nonsymptomatic and 7 were symptomatic. The incidences of CVS in patients with Fisher grade Ⅲ and Ⅳ were more higher than gradeⅠandⅡ(P

0.05).②The ophthalmic artery showed a significant increase in Vs and PI,RI 1 week postoperatively(P 0.05).Conclusions Two horizontal rectus muscle operations do cause significant hemodynamic changes in the ophthalmic artery 1 week postoperatively,but these changes in the ophthalmic artery revive normal 1 month postoperatively.

Objective [WT5”BZ] To evaluate the surgical treatment of insulinomas in the head and neck of the pancreas. [WT5”HZ]Methods [WT5”BZ] Data of 43 patients with insulinomas located in the head and neck of the pancreas during the past 16 years in PUMC Hospital were analyzed retrospectively.[WT5”HZ] Results [WT5”BZ] The average age of patients was 37 years old with an average preoperative history of 2 7 years. The preoperative accuracy of PTPC, DSA, B ultrasound, CT and MRI were 89 5%,72 5%,22 4%,25 3% and 66 7% respectively. The accuracy of intraoperative palpation was 97 8%. Enucleation of tumors was usually applied, and distal pancreatectomy or Roux en Y pancreaticojejunostomy were performed in 7 cases. The incidence of postoperative pancreatic leakage was 32 6%.[WT5”HZ] Conclusions [WT5”BZ] Selection of operation methods depends on the relationship of tumor with pancreatic duct and bile duct. Intraoperative monitoring of blood glucose is an essential mean to verify the complete resection of tumors. [WT5”HZ]

Objective To analyze the oral glucose tolerance test (OGTT) curve characteristics in Chinese women with gestational diabetes mellitus (GDM) or gestational impaired glucose test (GIGT) and to evaluate whether omission of the third-hour plasma glucose measurement of the OGTT could alter the sensitivity of the diagnosis on GDM,and whether there is a close relationship between plasma glucose values of 50 g glucose challenge test (50 g GCT) or OGTT and insulin therapy. Methods A retrospective analysis on medical records of 647 cases with GDM from January 1,1989 to December 31,2002 and 233 cases with GIGT were performed. Among 647 cases of GDM,535 were diagnosed by 75g OGTT. All OGTT (535 with GDM and 233 with GIGT) results were evaluated. Results There were 112 cases of GDM diagnosed by elevated fasting plasma glucose without OGTT performed. Of 535 cases of GDM diagnosed by OGTT,49.2% (263/535) women were with fasting plasma glucose value ≥5.8 mmol/L;90.1% (482/535) women with 1hr plasma glucose values ≥ 10. 6 mmol/L;64.7% (359/535) were with 2 hr plasma glucose levels ≥9.2 mmol/L. There were only 114 cases (21.3%) with abnormal 3 hr plasma glucose levels among 535 women with OGTT,and when 3 hr plasma glucose reached cutoff value,49.1% the other three values of OGTT were abnormal and 34.2% with the other two values of OGTT. Among 233 women with GIGT,only 4 cases with the abnormal 3 hr plasma glucose. We also investigate use of the glucose values for the first 2 hours of OGTT only missed 19 cases of GDM,still discriminated 516 cases. Omission of the third -hour glucose tolerance test value only resulted in failure to diagnose 2.9%(19/647) of GDM cases and 1.72%(4/233) of GIGT cases in Chinese women. Plasma glucose levels ≥11.2 mmol/L following 50 GCT were highly associated with GDM necessitating insulin therapy (75.4%). An elevated fasting plasma glucose level was also associated with insulin therapy (59.7%).Conclusion Omission of the third -hour glucose tolerance test value still yielded a higher sensitivity of 97.1%(628/647) of GDM cases and 98.2%(229/233) of GIGT cases in Chinese women. It is practicable to omit 3-hour post -glucose ingestion value of the OGTT in Chinese women. Plasma glucose levels ≥11.2mmol/L following 50g GCT indicated 75.4% cases of GDM necessitating insulin therapy.

Objective To discuss the clinical value of three dimensional proton MR spectroscopic imaging( 3D 1HMRSI) in the detection of transition zone(TZ) prorate cancer and evaluate the feasibility of 3D 1HMRSI for determining the aggressiveness of TZ cancer by analyzing its metabolic characteristics.Methods The 3D 1HMRSI data of sixty patients suspected TZ cancer in conventional MR examinations were retrospectively analyzed.The values of (Cho + Cre)/Cit of TZ cancer and benign prostatic hyperplasia (BPH) voxels were recorded and compared using independent sample t' test,and the area under the ROC curve was used to evaluate the diagnostic accuracy.Based on Gleason scores,TZ cancer voxels were divided into three groups,including low-risk ( Gleason score ＜ 7 ),intermediate-risk ( Gleason score =7 ) and highrisk (Gleason score ＞ 7).The values of (Cho + Cre)/Cit were compared among the three groups using Kruskal-Wallis test.The correlation of the value of (Cho + Cre)/Cit and Gleason score was analyzed using rank correlation analysis.Results Among the 60 patients,histopathology confirmed TZ cancer in 25 patients and BPH in 35 patients.The inversion of Cho and Cit peak value with increased ( Cho + Cre)/Cit was detected in 160 out of 177 TZ cancer voxels.Most spectral curves of the 517 BPH voxels were similar with that of normal peripheral zone on 1HMRSI.The mean values of ( Cho + Cre)/Cit of TZ cancer and BPH voxels were 2.17 ± 1.29 and 0.77 ± 0.20,respectively,with significant difference between them( t' =14.38,P ＜ 0.01).Using (Cho + Cre)/Cit for distinguishing TZ cancer,the area under ROC curve was 0.985 (P ＜ 0.01).With the cut-off point 1.08,the sensitivity,specificity and accuracy of TZ cancer diagnosis was 92.7％,94.2％ and 93.8％,respectively.The number of low-risk,intermediate-risk and high-risk TZ cancer voxels were 57,64 and 56 respectively,and the mean values of ( Cho + Cre)/Cit of the three groups were 1.43 ( 1.16-1.87 ),1.66 ( 1.43-2.36 ) and 2.32 ( 1.86-3.30 ) respectively,with significant difference among them ( x2 =36.282,P ＜ 0.01).The value of ( Cho + Cre )/Cit of TZ cancer increased with the increasing of Gleason score with positive correlation ( r =0.555,P ＜ 0.01).Conclusions TZ caner has a different metabolic profile from BPH.The value of ( Cho + Cre)/Cit on 3D 1HMRSI could provide useful information for early detection and differentiation TZ cancer from BPH.Besides these,( Cho +Cre)/Cit is also a valuable imaging marker to evaluate the aggressiveness of TZ cancer.

OBJECTIVETo discuss the curative effect of traditional treatment and combination therapy for senile hip fracture.

METHODSUsing prospective methods to choose 300 cases of elderly patients with hip fractures from February 2011 to December 2012, which were randomly divided into comprehensive treatment group and conventional treatment group. After screening, 148 case were in comprehensive treatment group,including 62 males and 86 females with an average age of (78.76 +/- 7.32) years old ranging from 60 to 88; 45 cases were intertrochanteric fracture of femur, 103 cases were fracture of neck of femur; Singh index > or = IV in 74 cases, < IV in 74 cases;preoperative Harris score was 39.90 +/- 2.28. There were 146 cases in conventional treatment group,including 60 males and 86 females with an average age of (80.00 +/- 7.06) years old ranging from 66 to 96; 50 cases were intertrochanteric fracture of femur, 96 cases were fracture of neck of femur; Singh index > or = IV in 75 cases, < IV in 71 cases; preoperative Harris score was 40.10 +/- 2.81. Preoperative general situation,leaving bed time and hospital stay, the incidence of postoperative 12 weeks Singh index > or = IV and DPD/Cr value, Harris score at 12 months after operation and the incidence of fracture again of two groups were observed and compared.

RESULTSIn comprehensive treatment group 140 patients were followed up for 12 to 18 months with an anverage of 14.80 +/- 1.85. In conventional treatment group 132 patients were followed up for 12 to 14 months with an average of 12.75 +/- 0.79. There were no significant differences in age, gender, the classification of fracture, preoperative Harris hip score, preoperative Singh index > or = IV level and DPD/Cr value between the two groups (P > 0.05). Comprehensive treatment group had shorter leaving bed time and hospital stay, smaller postoperative 12 weeks DPD/Cr value and higher postoperative Harris score, higher incidence of postoperative 12 weeks Singh index > or = IV level, lower incidence of fracture again than conventional treatment group, there was statistically significant difference between two groups (P < 0.05).

CONCLUSIONFor the anti-osteoporosis effect, the comprehensive treatment group has more advantage than traditional treatment group in elderly hip fracture, which can further improve the elderly hip fracture treatment and provide the reference of evidence-based medicine cooperate with rehabilitation department.

Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Hip Fractures ; surgery ; Humans ; Incidence ; Length of Stay ; Male ; Postoperative Complications ; epidemiology ; Prospective Studies

Background and purpose:Cancer-related pain is one of the most important symptoms of patients with advanced cancer. Chemotherapy sometimes induces peripheral neuropathy and pain. These symptoms seriously affect patients’ quality of life. Cancer pain assessment is now achieved by the subjective scales of patients, but lacking objective measurement. In this study, we used the neurotic electrophysiological method by way of PainVision system (PV system) to evaluate cancer pain quantitatively to detect and analyze degree of chemotherapy-induced neuropathy. Methods:We obtained numerical rating scale (NRS) scores from patients receiving analgesics and calculated the PainRatio from PV system at the same time. Then we analyzed the relationship between NRS and PainRatio scores. We detected current perception threshold (CPT) levels of patients receiving chemotherapy to ifnd the correlation between chemotherapy and CPT level, and attempt to evaluate chemotherapy-induced neuropathy.Results:PainRatio scores were linearly associated with NRS scores (Pearson correlation coeffcient=0.849,P<0.001). Patients with neuropathy symptoms got higher CPTs. However, no statistically signiifcant difference was observed between patients treated with oxaliplatin, paclitaxel and other agents.Conclusion:PainVision system can be used in cancer pain assessment quan-titatively, and be helpful in cancer pain assessment objectively. Patients with deifned neuropathy showed higher CPTs, indicating the potential clinical value of PV system in detecting and evaluating chemotherapy-induced neuropathy.

Objective To study the maternal blood glucose management of gestational diabetes mellitus during the labor and relationship of maternal blood glucose in labor and neonatal blood sugar. Methods A prospective study on maternal blood glucose monitoring and control during labor was carried in 40 pregnant women with abnormal glucose metabolism. We adjusted maternal blood glucose by low-dosage constant insulin drop during labor. Results Maternal blood glucose in labor arranged between 3.8 ～ 11.2 mmol/L,and low-dosage constant insulin drop was used in 17 cases (42.5%). The neonatal blood glucose was (4.0?1.5)mmol/L following delivery and (3.9?1.0)mmol/L at 24-hour postpartum. There were 2 cases with neonatal hypoglycemia. The neonatal blood glucose of the rest 23 cases was (4.2?1.5)mmol/L,and (3.9?1.0)mmol/L at 24-hour postpartum,and 1 case with neonatal hypoglycemia. There was no the difference of the blood glucose level of newborns between mothers with abnormal glucose metabolism and the normal pregnant women. Conclusion It is necessary to monitor and control the blood glucose level by low dose constant insulin during labor in pregnant women with abnormal glucose metabolism.

Objective To explore the relationship between dipeptidyl peptidaseⅡ(DPPⅡ) and the pathogenesis of congenital cataract.Methods Eighty SCR rats with congenital cataract were randomly divided into four groups:8,10,12 and 14 weeks groups(n=20).Normal Wistar rats at each age were used as control groups.Immunohistochemical experiments using the streptavidin-biotin immunoper-oxidase method were used to observe the immunoreactivity changes of DPPⅡ in lens in SCR rats at different time(8,10,12,14 weeks).Results The immunoreactivities of DPPⅡ in the lens epithelial cells and fibres of cataractous lenses of all ages were higher than those in control groups.At the 12th and 14th week,immunoreactive staining of DPPⅡwas found to extend into the perinuclear region.Conclusion The immunoreactivity of DPPⅡ is enhanced in cataractous rat lenses.DPPⅡ may be participated in the proteolytic modification of lens proteins during cataractogenesis.