To approach the criminal characteristics and responsibility of murder committed by psychotics.Case control study between psychotic(74 cases)and non psychotic(77 cases)were studied.The murders committed by psychotics were characterized with the abruptness,overt and cruelty.The symptom of delusion(47 2%)and auditory hallucination(31 1%)contribute the major causes of committing murder.Murderer with schizophrenia rank the first,while who with the manic depressive psychosis rank the second(14 8%).The criminal characteristic and intent of murder are the basis for assessment of criminal responsibility.

This work observed on isolated perfused rat hearts, that 10~(-9)mol/L endothelin (ET) induced myocardial contracture, decrease of heart function and coronary flow, intramyocardial Ca~(2+) accumulation and Mg~(2+) loss and etc. These cardiac action of ET were obviously more prominent when Mg~(2+) in the perfusion fluid was lowered to 0.12 mmol/L, and were significantly alIeviated when Mg~(2+) content was increased to 4.8mmol/L (normal plasma Mg~(2+) content is about 1.2 mmol/L). The mechanism of the Mg~(2+) effect on the cardiac action of ET may be related to its inhibition of Ca~(2+) influx into the myocytes. These results suggested that without magnesium defficiency, suitable replenishment of Mg~(2+) probably have practical clinical significance in the prevention and therapy of myocardial injury occurred during diseases with elevated circulatory ET level.

Objective To evaluate the clinical value of computed tomography (CT) examination in the etiologic diagnosis of small bowel obstruction.Methods From January 2010 to September 2013,a total of 237 patients with small bowel obstruction confirmed by operation were enrolled.The clinical data of all patients were collected.The diagnostic value of color Doppler ultrasound and abdominal CT examination were compared in estimating site of obstruction,etiology of obstruction and strangulation obstruction.Chi square test was performed for count data comparison.Results Among 237 patients with small bowel obstruction,there were 121 patients with data of both color Doppler ultrasound and abdominal CT examination.After operation,it was comfirmed that the accurate diagnosis rates of abdominal CT scan in the site of obstruction,the etiology of obstruction and strangulation obstruction were 75.2 ％ (91/121),66.1％ (80/121) and 87.2％ (41/47),respectively,and which were higher than those of abdominal color ultrasound (44.6％,54/121; 30.6％,37/121 and 42.6％,20/47).The differences were statistically significant (x2 =23.555,30.595 and 20.593,all P＜0.01).Conclusion The accurate diagnosis rates of abdominal CT scan in estimating the site of obstruction,the etiology of obstruction and strangulation obstruction were higher than those of color Doppler ultrasound,especially with obvious advantage in judging the etiology of obstruction.

BACKGROUND:Immunologic injury is a main pathogenesis of chronic rejection,and it is related to multiple immunological associated-gene polymorphism,in particular,transforming growth factor-β1 gene polymorphism.Recently,there are a lot of researching results of the relationship between TGF-β1 gene polymorphism and chronic rejection.OBJECTIVE:To study the relationship between TGF-β1 genotypes and the chronic renal allograft rejection in recipients and donors.DESIGN:Prospective case analysis.SETTING:Department of Urinary Surgery,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA;General Organ Transplantation Center.PARTICWANTS:A total of 144 recipients and 65 out of 114 donors(another 30 cases did not have the blood preparation)were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from Jane 2000 to May 2001.The surgical program was approved by the local ethics committee.METHODS:The TGF-β1 genotypes were detected in 144 recipients before renal transplantation and 65 out of 114 donors by sequence-specific primer polymerase chain reaction.The follow-up lasted for 5 years in recipients after surgery to survey chronic renal allografi rejection;furthermore,the effects of genotypes of recipients,genotypes of donors,and the genotype combination on transplanted renal function were analyzed.MAIN OUTCOME MEASURES:(1)Inciderce of chronic renal allograft reiection in recipients and donors with difierent TGF-β1 genotypes;(2)incidence of chronic renal allograft rejection in recipients and donors with TGF-β1 genotype combination.RESULTS:(1)Incidence of chronic renal allograft rejection in recipients with high-secretory TGF-β1 genotype was significantly higher than that in those with moderate-secretory or low-secretory TGF-β1 genotypes(x2=10.091,P<0.01).There were no significant differences in chronic renal allograft rejection among donors with different TGF-β1 genotypes(x2=0.002,P>0.05).(2)Chronic renal allograft rejection occurred in the recipients with high-secretory TGF-β1 genotype,whose donors also had high-secretory TGF-β1 genotype,and the incidence of chronic renal allograft rejection was significantly higher than that in other recipients with TGF-β1 genotype combination(x2=4.352,P<0.05).While the incidence of chronic renal allograft rejection in the recipients with moderate-secretory and low-secretory TGF-β1 genotypes,whose donors also had moderate-secretory and low-secretory TGF-β1 genotypes was significantly lower than that in other recipients with TGF-β1 genotype combination (x2=4.134,P<0.05).CONCLUSION:The TGF-β1 gene polymorphism is detected in the recipients and donors before renal transplantation to benefit for along-term prognostic factor for chronic renal allograft ejection and an ideal genotype combination between recipients and donors.

Objective To evaluate the killing efficacy of chlorine-releasing agents (CRAs) with different concentrations on multidrug-resistant Acinetobacter baumannii.Methods Totally 30 clinical strains of multidrug-resistant Acinetobacter baumannii were collected from November 2008 to December 2009.Killing efficacy of CRAs on these strains was evaluated by quantitative suspension test.The one-way analysis of variance was performed.Results The log values of killing to 30 strains of multidrug-resistant Acinetobacter baumannii were all ≥5.00,when the bacteria were exposed to available chlorine concentrations 400 mg/L of CRAs for 10 min,600 mg/L for 10 min,800 mg/L for 3 min and 1000 mg/L for 1 min,respectively.And effective rates were all 100％. Furthermore,there were significant differences among different available chlorine concentrations exposed for the same time ( except 10 min) ( F =72.72,64.79 and 32.33,P =0.00),and among different exposure time in the same available chlorine concentration ( except 1000 mg/L) ( F =110.42,20.41 and 3.20,P=0.00,0.00 and 0.03).Conclusion Satisfactory killing efficacy of CRAs to multidrug-resistant Acinetobacter baumannii can be achieved with available chlorine concentration 500 mg/L to 1000 mg/L and exposure time 10 min to 30 min.

Objective To investigate the clinical results of combined TIPSS and azygoportal disconnection for portal hypertension in controlling and preventing esophageal variceal bleeding. Methods From Oct. 1996 to Dec. 2001, 60 patients with portal hypertension were admitted to our department because of variceal bleeding and submitted to the treatment with the combination TIPSS and azygoportal disconnection. According to Child Pugh classification, 11 patients were in class A, 37 in class B, and 12 in class C. 41 patients showed mild ascites and 8 with severe ascites. The mild and severe esophageal varices were proven by upper digestive barium meal. The procedure was divided into two stages; first, TIPSS procedure with the stent of diameter 0.8cm and length 6-7cm was successfully inplanted in all patients, second, all patients underwent azygoportal disconnection two weeks later after TIPSS. Results After the combination TIPSS and azygoportal disconnection, the recent complications included three cases with bleeding at operative fields, one case with infradiaphagmatic abscess and seven with slight encephalopathy. No rebleeding of esophageal varices and death occurred during the treatment. During the follow up of 1-5 years, the rates of shunt occlusion, rebleeding and death were 11.9%, 3.5% and 7.0% respectively. Conclusions The combination TIPSS and azygoportal disconnection is an efficient therapeutic methods for portal hypertension.

OBJECTIVE To investigate the qacA/B genes in meticillin-resistant Staphylococcus aureus(MRSA) and their significance.METHODS Totally 221 MRSA strains were clinically isolated.The genes of qacA/B were analyzed using polymerase chain reaction(PCR).RESULTS From them 101 strains were found the qacA/B genes,the positive rate of qacA/B genes was 45.7%.And 71 strains were selected for qacA PCR detection,20(28.2%) were with qacA gene and 27(38.0%) were with qacA/B gene,suggesting that the seven strains be with qacB gene.CONCLUSIONS MRSA strains have emerged the high-frequency qacA/B disinfectant resistance gene.Application of chlorhexidine and other disinfectants to prevent postoperative nosocomial infections must be reassessed.The efficacy of existing disinfectants or disinfection methods should arouse our wider attention.Disinfectant resistance gene detection technology provides a practical means for the research of the disinfectant-resistant bacteria and the clinical application of the molecular epidemiology research.

Objective To develop an HPLC method for the simultaneous determination of 7-ethyl-10-hydroxycamptothecin-10-palmitic acid ester(SN38-PA)and its active metabolite 7-ethyl-10-hydroxycamptothecin(SN38)in rat plasma. Methods The inter standard was 10-hydroxycamptothecin. The protein in plasma was precipitated with methanol after acidification with formic acid. SN38-PA and SN38 were separated on Agilent C18 column(4.6 mm×250 mm,5μm) with gradient elution by using the mobile phase of methanol-0.2% formic acid solution. The flow rate was 1 ml/min. The detection wavelength was set at 372 nm. The column temperature was maintained at 30℃. Results The linear ranges for SN38-PA and SN38 were 0.25-62.5(r=0.9998) and 0.05-12.5 μg/ml (r=0.9997) respectively. The limits of quantification were 0.18 and 0.04 μg/ml, respectively. The average relative recovery of SN38-PA and SN38 were 95.89% and 97.03%. The average absolutely recovery of SN38-PA and SN38 were 99.54% and 99.84%. The RSD for intra-day and inter-day were both less than 3%. Conclusion The method is fast, convenient, accurate and sensitive, so it can be used for determination of SN38-PA and SN38 in vivo.

Objective To explore the significance of peritubular capillary C4d deposition in the diagnosis, treatment and prognosis of the patients with acute renal allograft rejection.Methods 86 allograft biopsies obtained from 78 kidney transplants were examined by immunohistochemistry on routine paraffin sections using anti-C4d polyclonal antibody. The relationship of C4d and functions, therapies and prognoses of allografts was analyzed. Results There were 32 allograft biopsies with Banff type Ⅰ rejection, 51 with Banff type Ⅱ rejection and 3 with Banff type Ⅲ rejection. Thirty biopsies were positive in C4d deposition. For 28 patients, at least one biopsy exhibited peritubular C4d deposition. There was no significant difference between type Ⅰ and type Ⅱ rejection ( 21.9 % vs 39.2 % , P= 0.101 ). The C4d~ + group had proportionately more patients with pregnant history (P= 0.020 ), more patients with high panel-reactive antibody levels (P= 0.013 ), and more retransplanted patients (P= 0.016 ). Mean serum creatinine was significantly higher in C4d positive patients than in negative patients[( 312.56 ? 196.26 ) ?mol/L vs ( 210.97 ? 136.59 ) ?mol/L, P= 0.0115 ]. Patients with C4d deposition were more commonly resistant to antirejection therapy with bolus steroids ( 75.0 % vs 28.0 % , P= 0.000 ) and ATG ( 66.7 % vs 12.5 % , P= 0.027 ). More patients with peritubular C4d deposition lost their grafts during the study period (64.3 % vs 90.0 %, P= 0.006 ).Conclusion Acute rejection with C4d deposition were resistant to antirejection therapy with steroids and/or ATG, and associated with inferior graft outcome.

Objective To study the methodology of the ear reconstruction using Medpor framework. Methods Using Medpor material as ear framework, 112 cases of ear reconstruction were performed using the expanded skin flap on the mastoid region(method Ⅰ) and the temporal fascia flap adding skin graft ( method Ⅱ) to cover ear framework. Twenty-three cases adopted method Ⅰand 89 cases adopted methodⅡ. Results One hundred and nine cases of the reconstructed ear were successful with a good appearance and 3 cases were failure. The exposure of Medpor framework occurred in 17 cases in this series. Among them the method Ⅰ occurred in 8 cases (34 %) and the method Ⅱ was used in 9 cases (10%). The exposure of Medpor framework in 14 cases were repaired using local skin flap or local fascia flap and skin graft. In 3 cases Medpor framework had to be removed due to the sever exposure. Conclusion It seems that Medpor framework is a good alternative for the ear reconstruction.