China ; Hepatitis, Autoimmune ; diagnosis ; therapy ; Humans

Doing a good job of guarding against medical risks can effectively improve medical safety and reduce waste of medical resources. In recent years, marked results have been attained in the US in studies on the use of FMEA, a prospective quality analysis tool, to minimize medical risks. Similar studies, though not many, have been made in some other countries, such as Italy and Australia. No reports, however, have been published at home on studies in this field. The paper gives an account of the use and theoretical studies of FMEA in medical risk management in the US, illustrates cases wherein it was used to lower risks in prescribing drugs to patients and ensure the safe use of hospital software and hardware, and puts forward issues that shouldn't be ignored in using FMEA so as to arouse the attention of domestic hospital management departments.

Renal cell carcinoma (RCC) accounts for approximately 2% of all malignancies. The incidence of RCC has increased by 2% per year for the past 65 years. Over the past two decades, with the widespread use of imaging methods, the frequency of incidental detection of RCC has increased. Surgery is an important therapeutic method for renal cell carcinoma. Originally, nephron-sparing surgery was indicated only for those treated with radical nephrectomy which would render the patients functionally anephric and requiring dialysis. These settings include RCC in a solitary kidney, RCC in one kidney with contralateral inadequate renal fuction, and bilateral synchronous RCC. However, nephron-sparing surgery has been used increasingly in patients with T_(1a) and T_(1b) renal tumors (i.e. up to 7 cm in the greatest dimension) and a normal contralateral kidney, with equivalent outcomes to radical nephrectomy. Compared with radical nephrectomy, nephron-sparing surgery can increase patient survival and reduce the risk of cardiovascular events. However, nephron-sparing surgery has not been widely used yet because most surgeons are confused of its safety, indication, resection range and complications.

Objective To study the relationship of Nesfatin -1,RBP4 with gestational diabetes mellitus (GDM)and macrosomia,and its clinical significance.Methods 40 patients with GDM were selected as the study subjects,15 cases of newborn children were huge (huge child group),25 cases of neonatal were normal children (normal weight children group).40 cases of normal glucose metabolism (NGT)patients at the same period were selected as the control group.Nesfatin -1,RBP4 levels in maternal blood and umbilical blood were detected by ELISA.Results In the huge child group,the Nesfatin -1 levels in maternal blood and umbilical cord blood were positively correlated (r =0.389,P =0.042),the RBP4 levels in maternal blood and umbilical cord blood were positively correlated(r =0.402,P =0.037).In the huge child group,the Nesfatin -1 levels in maternal blood and blood glucose levels were negatively correlated (r =-0.416,P =0.012),the RBP4 levels in maternal blood and blood glucose levels were positively correlated(r =-0.391,P =0.022).Conclusion Nesfatin -1,RBP4 in GDM and maternal blood and umbilical cord blood of huge children have abnormal expression,and Nesfatin -1,RBP4 levels are closely related to the incidence of GDMand huge children,and Nesfatin -1,RBP4 are important morbidity factors of GDMand huge children.

Objective:To explore relationship amongpersonality,family interpersonal dynamics and college students'adaption.Methods:Adaption to college was assessed with the Symptom Checklist 90 (SCL-90)in internet when 1850 freshman selected conveniently from a university in Shanghai (Students with single factor score of SCL-90 equal or greater than 2.5 belonged to the positive group,while the other students with single factor score of SCL-90 all less than 2.5 belonged to the negative group).At the same time,they were evaluated with the Cattell's 16 Personality Factor(16PF)to evaluate their characteristics and Multi-Interpersonal Dynamics Questionnaire for Un-dergraduates (MIDQ-U)for undergraduate students to assess family interpersonal dynamics.Results:The scores of anxiety of 16PFwere higherin the positive groupwith 50 students than in the negative group[(7.2 ±1.4)vs.(4.6 ± 1.9),P <0.001 ],while the scores of extroversion,serenity and alertness of 16PF were lower in the positive groupthan inthe negativegroup.In the SCL-90 positive group,the MIDQ-Uscores of indifference and submissivenesswere higher[(17.3 ±6.0)vs.(14.9 ±4.2),(11.5 ±3.2)vs.(10.3 ±3.1);P <0.001]and the scores of indepen-dencewere lower than that in the positive group[(18.7 ±3.0)vs.(19.8 ±3.4),P =0.02].Path graphanalysiss-howed that anxiety and extroversionpartly predicted freshmen's adaption directly(β=0.57 --0.01 )and partly worked through indifference(β=0.031 --0.004),while decisivenesscompletely functioned through indifference with the coefficient of 0.008.Anxiety had part mediating effect between indifference and freshmen's adaption(β=0.008).In the other three factors,anxietyplayedcompletemediatingrole.Conclusion:Personalities and family inter-personal dynamics may affect each other,then mutually predictstudents'adaption to college.

Objective:To establish the technique for T lymphocytes inducted and differentiated by using human hematopoietic stem/progenitor cells ex vivo and to provide a technological platform for studying T cells biological characteristics and cellular immune.Methods:Human CD34-positive cells were isolated from umbilical cord blood by using a high-gradient magnetic cell sorting system(MACS) and CD34+ cells were seeded on human fetal thymic stromal monolayer system.Liquid culture system contains hematopoietic cytokines(FL+IL-12+IL-7+IL-2) and 20% human AB serum.Non-adhension cells were obtained after 7?14?28?35?42 days of culture respectively to analysis T cells phenotype by FACS using T cells specific monoclonal antibody.T cells morphology were also studied.Results:After 2 weeks of culture CD4+CD8+ immature T lymphocytes wre about 0 3%～13 3% and the peak value is 16 6%～26 5% at 4～5 weeks of culture.CD4-CD8+ and CD4+CD8- T cells that coexpressed CD3 cells increased at 26 5%～64 9% and 11 6%～38 9% after 6 weeks of culture.Wright staining shows that the mature T cells harvested after mitogenic stimulation have the presence of large cells with lymphoblast morphology.Conclusion:Human umbilical cord blood CD34+ cells could be differentiated into T lymphocytes by the culture conditions of human fetal thymic stromal monolayer system and the cytokine combination of FL+IL-12+IL-7+IL-2,and the T cells can be stimulated by IL-2+PHA.

Objective To investigate the drug induced liver injure(DILI)associated with Chinese herbal medicine and herbal related food supplements.Methods From 1982 to 2005.8.9 consecutive pa- tients were diagnosed as DILI based on their medication history,clinical manifestation,liver function and other laboratory tests.The final retrospection confirmatory diagnosis was made according to the interna- tional scoring system for DILI.Results The 82 DILI patients(28 men,54 females,age ranging from 16 to 81 years old)accounted for 2.2% of hospitalized patients with liver dysfunction.Among those patients with DILI,30.5% was caused by weight reducing drugs or food supplements,12.2% by drugs of derma tology,8.5% by drugs for cardiovascular disease,8.5% by drugs of rheumatology,7.3% by drugs of gynecology,6.1% by drugs for liver disease,6.1% by blood-lipids modulators,3.7% by drugs for thy- roid disease,3.7% by drugs for hyperplasia of mammary glands and 13.4 % by the others.The duration of medication was from 6 clays to 6 months and the incubation period was from 6 days to 3 months.DILI could be classified as acute hepatocellular injury(36.59%),acute cholestasis(39.02%)and mixtures (24.39%).About 10% patients were accompanied by allergic manifestations.All patients recovered rap- idly after stopping the relevant medicine.Conclusion Chinese herbal medicine and herbal related food supplements are a common cause of DILI in China.The awareness and monitoring improving DILI during herbs treatment is a critical issue in daily practice.

The clinical data and routine biochemical parameters of 64 maintenance hemodialysis (MHD)patients and 20 controls were analyzed in the study.Serum cystatin C levels were detected by latex particle enhalice inununo-turbidimetry:and the cardial structure and function were assessed by echocardiography.As MHD time extended,the levels of semm cystatin C increased gradually,accompanied with high incidence of left ventricular hypertrophy(LVH).The LVH-positive patients had higher systolic blood pressure and left veHtricular mass index,and had higher serum cystatin C than tllose in LVH-negative patients.The serum cystatin C levels were positively correlated with left yentricular mass index(r=0.633,P<0.01)and systolic blood pressure(r:0.397,P<0.01).The results suggest that serum cystatin levels may be an influencing factor for long-term cardiacvascular complication in MHD patients.

Objective To explore the application and clinical effect of bipolar hemiarthroplasty with bipolar prosthesis on unstable intertrochanteric fracture in the elderly patients.Methods The study involved 53 patients aged over 75 years with intertrochanteric fracture treated with bipolar hemiarthroplasty in our hospital from April 2003 to January 2010.According to Evans-Jensen classification,there were 24 patients with type Ⅲ fractures,eight with type Ⅳ and 11 with type Ⅴ.Osteoporosis degree was at Singh degree Ⅰ in 13 patients,degreeⅡ in 18,degree Ⅲ in 12 and degree Ⅳ in 10.Most patients underwent operation within three days after injury.Results The operation duration was(75 ±10)min,with intraoperative blood loss of(350 ± 68)ml.Three patients were lost to follow-up after discharge and one patient was died of respiratory failure caused by chronic bronchitis five months after operation.Forty-nine patients were followed up for 12-93 months(mean 38 months),which showed no joint dislocation,or loosening,subsidence or rupture of the prosthesis.According to the Harris score of hip joint,the result at final follow-up was excellent in 29 patients,good in 13 and fair in seven,with excellence rate of 86％.Conclusions Bipolar hemiarthroplasty is an effective treatment for osteoporotic and unstable intertrochanteric fractures in the elderly patients.However,as the complemented therapeutic method of proximal femoral nail antirotation(PFNA),bipolar hemiarthroplasty has severe secondary trauma and its indications must be strictly mastered.

Objective To develop a scale to measure three representative real relationships of undergraduates (parent-child relationship,collegemate relationship and teacher-student relationship) and test its validity and reliability(multi-interpersonal dynamics questionnaire for undergraduates,MIDQ-U).Methods A total of 1 310 students were conveniently sampled as respondents to analyze validity and reliability indexes.Result Three relationships share four factors for interpersonal dynamic characteristics:closeness,indifference,independence and submissiveness.The revised MIDQ-U composed of 26 items to separately measure characteristics of three relationships both separately and together.The factor loading of items in parent-child relationship scale were 0.41-0.73 and 50.71％ of the variances could be explained,while eollegemate relationship 0.41-0.72 and 51.81％ explained,teacher-student relationship 0.42-0.76 and 49.58％ explained.The model in 4 factors(x2/df =2.59,CFI =0.85) fitted the data with well construct validity.The Cronbach α coefficients were 0.847 in parent-child relationship scale,0.865 in collegemate relationship scale and 0.836 in teacher-student relationship scale.The test-retest reliabilities were 0.867,0.786 and 0.746.Conclusions The MIDQ-U has satisfactory validity aud reliability.It can be used to measure one of the three relationships separately,and also as an evaluation tool to compare and correlate multiple interpersonal dynamics.