Two hundred and forty patients with primary hypertension in Weifang Community were randomly sampled as contract group and another 240 hypertensive patients were sampled as control group.Patients in contract group signed service contract with general practitioners (GPs),who provided individualized service for hypertension management.Patients in control group receive conventional outpatient service for hypertension management.The clinical data of patients before and one year after contracted services were documented and compared with those in control group.The results showed that in contract group the average systolic pressure decreased from 134.60 mm Hg (1 mm Hg =0.133 kPa) to 130.62 mm Hg (P =0.000),reaching-the-target-BP rate increased from 56.3％ to 85.5％ (P =0.000),serum total cholesterol and triglyceride decreased significantly one year after receiving contracted services (P =0.000) ; while these indicators were not significantly changed in control group (all P ＞ 0.05).The results indicate that the contracted services of GPs can improve the effectiveness of hypertension management in community.

Acute liver failure (ALF) in children is severe syndrome with varied etiology and a rapid deterioration of liver function which results in coagulopathy abnormality and encephalopathy.ALF in children often carries a high morbidity and mortality.Laboratory tests is helpful for diagnosis and severity assessment of ALF in children and is useful for predicting survival or need for liver transplantation.The objective of this article is to introduce the values of laboratory tests in clinical diagnosis,prognosis and timing for transplantation of ALF in children.

Lysophosphatidic acid is a intermediary metabolite in lipid metabolism, mainly produced from activated platelets. It may cause the apoptosis of hippocampal neurons, abnormal phosphorylation of tau protein and increased permeability of the tight junction of endothelial cells, which is closely correlated with pathological changes of ischemic cerebrovascular diseases, Alzheimer's disease and vascular dementia. It is shown that lysophosphatidic acid may induce the opening of the blood-brain barrier under pathological conditions, and enters central nervous system through the blood-brain barrier, and causes different effects of pathological changes by acting on various cells.

Objective To quantitatively measure the perfusion parameters of placenta in different stage of pregnant rats using contrast-enhanced ultrasonography (CEUS) with contrast pulsed sequencing (CPS), and to analyze the relationship between perfusion parameters and changes of placental vascular bed. Methods Sixty healthy pregnant rats in according to the requirements of the experiment was divided into three groups: 15 days, 17 days and 20 days of gestation with 20 animals in each group. One blous injection of SonoVue (Sonovue 1.0 ml/kg) via a tail vein was administered to each rat, and the time-intensity curves (TIC) of placenta and uterine muscle wall were drawn with ACQ using CPS technique with MI 0.20, and the perfusion parameters were calculated. Then 4 μm vertical placenta sections were cut and stained with hematoxylin and eosin. Surface area densities of placental maternal blood space was measured with image analysis software. Results The peak intensity (PI) of 17 days and 20 days was higher than that of 15 days pregnant rats (P＜0.05). There was no difference in PI between 17 days and 20 days (P＞0.05), and nor of arrivel time (AT) and time-to-peak (TTP) (P＞0.05) among the three groups. There was significant difference of surface area densities of placental maternal blood space among the three groups (P＜0.05). PI was positively correlated to the surface area densites of placenta (P＜0.05). Conclusion There is close relationship between peak intensity and area densities of placental maternal blood space. CPS technique can sensitivly detect changes of the placenta vascular bed in different stage of pregnant rats.

Objective To compare the clinical eficiency of gemcitabine plus oxliplatin and gemeitabine alone for advanced pancreatic cancer.Methods The histologic or cytologic confirmed 60 cases of pancreatic cancer were randomly divided into control Gemcitabine plus oxaliplatin group(GEMOX)with gemcitabine alone group(GEM)treatment,each 30 Cases.Results 54 patients were enrolled.The general remission rates(CR+PR)were 68.0 % in GEMOX group and 37.9 %in GEM group respectively.There was significant statistical diference between two group(P

Objective To demonstrate the cause of visual loss (VL) caused by pituitary adenomas (PAs),through retrospective study on the magnetic resonance imaging (MRI) radiological materials of patients with PAs.Methods Forty eight patients with PAs were selected,who received surgical treatment at our Hospital.Their medical records and MRI radiological films were reviewed.The relationship between the characteristics of PAs and the visual deterioration were analyzed.Neuro-ophthalmological findings were elevated with the relationship between the tumor and the supraelinoidal segment (C2 segment) of the internal carotid artery(ICA).Resuits On the coronal MR images,C2 segments of 28 sides(29.2%) were involved by the tumors whose value of VL in the ipsilateral eyes averaged 0.80±0.20 (range from 0.40 to 1.00).In the rest 68 sides (70.8%) without C2 segments involved,the valHe of VL in the correspondent eyes averaged 0.30±0.30 (range from 0.00 to 1.00).The difference was statistically significant (P<0.05).Conclusions If the C2 segment of ICA is invaded,the worse visual acuity would appear.which might be due to the markedly involved chiasmal arteries.

Objective To study a new method of minimally invasive balloon kyphoplasty (PKP)for treatment of chronic osteoporotic vertebral compression fractures. Methods The study involved 27 patients with chronic osteoporotic vertebral compression fractures treated with PKP in our hospital from February 2007 to February 2009. There were 11 males and 16 females, at mean age of 72.4 years (range 55-86 years). The history of chronic osteoporotic vertebral compression fractures ranged 3-17 months (mean 7.6 months). The pathological changes were determined at one stage in 25 patients and at two stage in two. According to the Genant classification, there were 10 patients (11 vertebrae) at grade two and 17 patients (18 vertebrae) at grade three. Before operation, the visual analog scale (VAS) score was average 8.3, the ratio of compression height of the anterior vertebral body to the posterior vertebral body was 39% by X-ray measurement and the kyphosis angle was average 15.60°. All patients received PKP under local anesthesia. Results Patients were followed up for average 11.2 months, which showed that all the patients achieved significant pain relief and ambulation at days 3 or 4 after operation. Cardiorespiratory function was significantly improved, with no reoccurrence of pain or severe complications found.After operation, the VAS score was average 2.8, ratio of compression height of the anterior vertebral body to the posterior vertebral body was average 47.6% and the kyphosis angle was average 15.60°. Conclusions Minimally invasive PKP can achieve rapid relief of pain, help early ambulation, decrease various complications resulting from long-term confinement to bed and improve cardiorespiratory function for elderly patients with chronic osteoporotic vertebral compression fractures of the vertebral body mainly with pain but without nerve injury.

Objective To evaluate the perfusion parameters in different zone of placenta using CPS,to research placental blood perfusion of different zone. Methods A total of 60 pregnant rats were divided into 3groups, 15 day,17 day and 20 day of gestation with 20 animals in each group,the placenta was divided into the central zone and marginal zone. SonoVue was injected by tail vein of rat using CPS, the time-intensity curves of the central zone and marginal zone were drawn and perfusion paramcters were calculate by software ACQ and Sonoliver. Surface area densities of different zone of placental maternal blood space was measured with histoligical method,and using immunohistochemical marked the placenta vascular. Results Arrivel time(AT) and time-to-peak(TTP) of placenta central zone was earlier than marginal zone,the peak intensity(PI) of the central zone was higher than that of the marginal zone ( P ＜ 0.05). There was significant difference between the central zone and marginal zone of surface area densities of placental maternal blood space ( P ＜0.05). PI of the central zone and marginal zone and the surface area densites of placenta was positively correlated ( P ＜0.05). The placental blood vessels was not expressed by factor Ⅷ.Laminin in the placental basement membrane expression of 20 day of gestation was not continuous or missing. Conclusions The surface area densities of central zone and marginal zone was different. CPS technique can be sensitive to detect changes of the placenta vascular bed in different zone.

In recent years, there has been a comprehensive reform of higher medical education in the Medicine School of Wuhan University. According to the need for reform, the teaching of neurology has to be changed from the traditional form to a new form, and be integrated into the clinical pathophysiology and therapeutics (CPPT) courses. Currently neurology in CPPT takes the form of theoretical lectures, case discussions, combined with practical lessons to observe sections under the microscope and clinical practice, for the cultivation of students'!self-learning ability and clinical thinking. In the commissioning process, it exposes some problems in teaching process due to the characteristics of the course in neurology. For example, the knowledge of neuroanatomy is insufficient and review lessons relatively too short, and the teaching effect may be worse due to the fact that teachers have busy clinic work. In addition, students participate in case discussions with less enthusiasm. To solve these problems, we take some measures to promote teaching reform in neurology, such as increasing the review hours of neuroanatomy section in the CPPT neurology, training a group of specialized medical teachers to enrich and stabilize teacher team, adjusting the content and form of discussion class to improve students'!interest and participation, and increasing assistant jobs by the student to assist discussion teaching.

OBJECTIVE To investigate ?-lactamase coding genes and oprD2 gene in multidrug-resistant Pseudomonas aeruginosa isolated.METHODS Polymerase chain reaction(PCR) was used to detect various ?-lactamase coding genes including TEM,SHV,OXA,PER,GES,IMP,VIM,plasmid type AmpC ?-lactamase DHA,MIR and oprD2 in 20 strains of P.aeruginosa.RESULTS The detection rate of ?-lactamase coding genes plasmid type AmpC,VIM,TEM,SHV,OXA and IMP were 15%,5%,15%,10%,10% and 5%,respectively,the loss rate of oprD2 was 25%,but PER and GES genes were negative.CONCLUSIONS The study indicated that the P.aeruginosa is carrying genes of DHA,TEM,SHV,OXA,VIM,IMP and being lost oprD2 gene,the latter is the essential resistance mechanism of P.aeruginosa to beta-lactam antibiotics in local area.