Objective To investigate the clinical and pathological features of Churge-Strauss syndrome(CSS) combined leukocytoclastic vasculitis.Methods The clinical data of 1 patient with CSS combined leukocytoclastic vasculitis was analyzed retrospectively.Results The main symptoms of the case were peripheral nerve damage,violation of the skin lesions,gastrointestinal tract,lung,and central nervous system;peripheral blood eosinophil count was high.The pathological examine showed vessel wall and skin organizations had a large number of eosinophils infiltration,small vessel walls,as well as granuloma formation around multiple segmental fibrinoid necrotizing vasculitis.Eventually died of multiple organ failure.Conclusion The clinical manifestations of CSS combined leukocytoclastic vasculitis have vasculitis and peripheral neuropathy mainly;the pathological features are that vessel wall and skin organizations have a large number of inflammatory cells infiltration;the late multi-system are involved,and the prognosis is poor.

Objective To explore the applied value of static and dynamic of virtual defecography technology in the etiological diagnosis of constipation.Methods 50 patients with constipation were included.Conventional cleaning enema was performed firstly.Then they were injected the virtual defecography agentwith lateral position,filling the rectum,sigmoid and descending colon.Thirdly,siting on the qualities commode,adjusting height coincides with the left and right femur,displaying the pubic symphysis and coccyx dynamic acquisition image acquisition with the speed of 4/s,the dynamic changes of the rectum and anal canal were analyzed and measured.Results Among 50 patients,32 cases with rectocele,1 case with rectal bend,2 cases with anal canal stenosis,7 cases with rectal prolapse,4 cases pelvic floor spasm syndrome,and 4 cases with no cause.Conclusion Static and dynamic virtualdefecography was an important method in the etiological diagnosis of patients with constipation.

Objective To evaluate the value of Epstein-Barr virus (EBV) IgG antibody to EBV Rta protein(Rta-IgG),IgA antibody to EBV early antigen (EA-IgA) and IgA antibody to EBV viral capsid antigen(VCA-IgA) for nasopharyngeal carcinoma (NPC) diagnosis.Methods From May 2012 to July 2013,serum samples from 8 884 healthy donors,1 546 clinical screening patients and 155 NPC patients in Fujian Medical University Union Hospital were collected,and EBV Rta-IgG,EA-IgA and VCA-IgA were detected by ELISA.The ROC curve analysis and correlation analysis were performed to assess the value of Rta-IgG,EA-IgA and VCA-IgA for NPC diagnosis.The positive rate among three kinds of antibodies were compared with chi-square test.Results Positive rates of EBV Rta-IgG,VCA-IgA and EA-IgA in NPC patient group were 81.9％ (127/155),90.3％ (140/155) and 48.3％ (75/155),respectively,which were higher than those in clinical screening patient group and healthy donor group (x2 =1 538.6,479.3 and 643.3 respectively,P ＜ 0.01).The sensitivity of VCA-IgA (90.3％,140/155) and the specificity of EA-IgA (95.1％,9 915/10 430) were the highest in all groups.Further analysis showed that negative predictive value of EBV Rta-IgG,VCA-IgA and EA-IgA for NPC diagnosis were 99.7％ (9 826/9 854),99.8％ (8 168/8 183),99.2％ (9 915/9 995),respectively,suggesting that three anti-EBV antibodies showed very good negative predictive value for NPC diagnosis.Next,combined detection of three anti-EBV antibodies could improve the sensitivity (94.1％,146/155) and specificity (98.9％,10 469/10 585) for the NPC diagnosis.Conclusion The EBV Rta-IgG,VCA-IgA and EA-IgA all show the clinical value for NPC diagnosis,and combined detection for Rta-IgG,VCA-IgA and EA-IgA is more suitable to screen NPC and can improve the sensitivity and specificity of NPC diagnosis.

Objective To analyze the risk factors and prognosis of Clostridium difficile infection (CDI) among hospitalized patients with inflammatory bowel disease (IBD).Methods From March 2014 to February 2015,216 first-time hospitalized patients with IBD were enrolled.Once hospitalized,stool samples were obtained for Clostridium difficile culture immediately,and at the same time toxins of Clostridium difficile (tcd) A and tcdB were detected by polymerase chain reaction(PCR).The incidence and risk factors of CDI in enrolled patients were analyzed.Chi square test and nonparametric test were performed for statistical analysis.Results Among the 216 IBD patients,there were 73 patients with ulcerative colitis(UC) and 143 patients with Crohn's disease(CD).The positive rate of CDI was 13.9 ％ (30/216) in IBD patients.The positive rate of CDI was 24.7 ％ (18/73) in UC patients,which was higher than that of CD patients (8.4％,12/143),and the difference was statistically significant (x2 =10.690,P＜0.01).As the severity of the disease increased,the rate of CDI positive patients in UC patients increased.Among three patients at remission period,17 patients at mild active stage,23 patients at moderate active stage and 30 patients at severe active stage,the CDI positive patients were zero,two,five,11,respectively,and the difference was statistically significant (x2 =4.820,P=0.028).In UC patients,the incidences of patients with hospitalization history in other hospitals within three months before admission in CDI positive group and negative group were 6/18 and 7.3％ (4/55),respectively,and the difference was statistically significant (x2 =5.740,P=0.020).In 30 days before admission,the rates of patients with proton pump inhibitor (PPI) taking history of two groups were 7/18 and 7.3％ (4/55),and the difference was statistically significant (x2=8.270,P=0.004).The length of hospital stay in CDI negative UC patients was 7.0 d (5.0 d,12.0 d),which was shorter than that of CDI positive patients (10.5 d (8.8 d,18.2 d)),and the difference was statistically significant (U=277.000,P=0.005).The rate of patients underwent intestinal operation in CDI negative CD patients within three months after CDI examination was 10.7 ％ (14/131),which was significantly lower than that of CDI positive patients (5/12) (x2 =4.520,P=0.010).Conclusions The incidence of CDI in hospitalized IBD patients was high,especially in UC patients;the risk factors included disease severity,prior hospitalization history within three months before admission and PPI taking history within 30 days before admission.CDI was correlated with poor prognosis.

Objective To investigate the value of ultrasound-guided core needle biopsy in diagnosing precancerous lesions of breast cancer.Methods Totally 605 cases were enrolled.Ultrasound characteristics were recorded.The pathological diagnosis on ultrasound-guided core needle biopsy was compared with the findings of the excisional biopsy and follow-up results.Results In all of the 605 cases,3 cases were failed on ultrasound-guided core needle biopsy because of less biopsied tissue.The accuracy of ultrasound-guided core needle biopsy was 97.84％ (589/602),the Kappa value was 0.96 (P=0.01).In biopsy,42 cases were precancerous lesions of breast cancer,and divided into according group (n=32) and upgrading group (n=10) according to surgical pathology or follow-up results.The rate of underestimation was 23.81 ％ (10/ 42).Compared to according group,microcalcification,acoustic attenuation,rich vascular and suspicious axillary lymph nodes had statistical difference in upgrading group (all P＜0.05).Conclusion Ultrasound-guided core needle biopsy is ac curate in the diagnosis of breast neoplasm,however,ultrasound-guided core needle biopsy diagnosis of precancerous lesions are partly underestimated.To some degree,ultrasound characteristics of precancerous lesions of breast cancer could predict the underestimation.

Objective To observe the effect of Zhixuebao particles combined with Marvelon in the treatment of dysfunctional uterine bleeding in adolescent.Methods69 cases from October 2013 to March 2015 were randomly divided into observation group with 34 cases and control group with 35 patients.The control group was treated with Marvelon and observation group was another treated with Zhixuebao particles.Related indicators of two groups were compared.ResultsEndometrial thickness, menstrual volume and menstrual period of observation group were lower than that of control group(P<0.05).The bleeding time, stop bleeding time of observation group were shorter than that of control group (P<0.05).After treatment,hormone LH, FSH, P levels of observation group were lower than that of control group(P<0.05);Total effective rate of bservation group was 94.12%, higher than control group 74.29%(P<0.05).ConclusionZhixuebao particles combined with Marvelon is effective in treating dysfunctional uterine bleeding in adolescent, can improve hormone levels and it is worthy of further research and application.

To culture creative persons with ability,experimental teaching systems has to be revolutionized.Comparatively concentrated and appropriately dispersed experimental managing pattern can be adopted to build up a new experimental teaching system,which combines systematic teaching and further exploration.The questions on how to develop open laboratory,change traditional experimental teaching pattern,improve the use of instrument and laboratory,pool fund to avoid repeated construction,and achieve fully share of resources are discussed in this article.

Objective To discuss the clinical effect of normal saline flushing and heparinized saline flushing in invasive arterial blood pressure monitoring in the critical patients. Methods A total of 140 critical patients were randomly divided into the experimental group and the control group with 70 cases in each group according to the envelope method. The experimental group used normal saline for tube flushing, the control group used heparinized saline (5 U/ml) for tube flushing. The incidence of complications and coagulation index were compared between two groups. Results There was no statistically difference in the incidence of the catheter jam and local infection (P>0.05). The incidence of bleeding events was 14.3% (10/70) in the control group, which was higher than 2.9% (2/70) of the experimental group. The difference was statistically significant(χ2=4.466, P<0.05). The activated partial thromboplastin time, prothrombin time of the control group were (32.22 ± 4.22) s, (11.56 ± 2.12) s, which were longer than (29.84 ± 3.64) s, (10.66 ± 1.48) s of the experimental group. And international normalized ratio of the control group was 1.12±0.14, which was higher than 1.03±0.20 of the experimental group. The difference was statistically significant (t values were-3.573,-2.912,-3.084, P <0.05). Conclusions The normal saline flushing liquid was more safer and reliable in the invasive arterial blood pressure monitoring.

Objective To improve the understanding of blastic plasmacytoid dendric cell neoplasm (BPDCN). Methods The clinicopathological features of 2 cases with BPDCN diagnosed in the Department of Pathology in Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College were analyzed retrospectively. The relevant literatures were reviewed as well. Results The two BPDCN patients were both elderly men with skin nodules. The tumor cells infiltrated diffusely into the whole dermis with sparing the epidermis. BPDCN cells were small to medium size with round or oval irregular nuclei and small nucleoli. Numerous mitoses figures were seen. Immunohistochemistry stain showed that CD4 and CD56 were positive and CD20 and CD3 were negative in the 2 BPDCN cases. Only 1 case was positive for CD123. Conclusions BPDCN is a rare malignant hematopoietic tumor, which is likely to involve skin. The features of morphology and immunophenotype are crucial to make correct diagnosis.

Objective:To explore the expression of IL-22 in the patients with rheumatoid arthritis,and to define the clinical sig-nificance of IL-22 cells for RA. Methods: A total of 50 RA patients, 15 OA patients and 15 healthy controls were enrolled. The proportion of Th22 cells in peripheral blood and synovial fluid( SF) of RA patients was detected by flow cytometry;the levels of IL-22 in serum and synovial fluid of RA patients were detected by ELISA. The clinical parameters of disease activity were assessed including ESR,RF,CRP,DAS28,anti CCP and the degree of bone erosions determined by X-rays. Pearson correlation analysis,t test and Kruskal-Wallis H test were used for statistical analysis. Results:The proportion of Th22 cells in RA patients was higher than that of OA patients (t=2. 290 ,P=0. 021) and healthy controls(t=2. 524,P=0. 015). IL-22 levels in RA patients were higher than that of OA patients (t=2. 560,P=0. 014) and healthy controls(t=2. 768,P=0. 009). IL-22 in the RF positive group were higher than that of RF negative group(t=2. 322,P=0. 035). IL-22 in the anti-CCP antibody positive group were higher than that of anti-CCP antibody negative group (t=2. 504,P=0. 015). The levels of IL-22 were correlated positively with ESR,RF,DAS28(r=0. 312,0. 314,0. 332,P<0. 05). The levels of IL-22 were increased gradually along with the aggravation of bone erosions. There were statistical significant difference among different X-ray stagings(H=9. 14,χ20.05(3)=7. 81,H> χ20.05(3),P<0. 05). Serum IL-22 levels in the RA patients with joint effusion were higher than that of without(t=2. 587,P=0. 012). The levels of IL-22 in SF were higher than that in serum(t=2. 668,P=0. 011),and had no correlation with the proportion of Th22 cells in SF. Conclusion: The expression of IL-22 in serum and joint effusion of RA patients increase. The level of IL-22 may be useful marker for assessment of disease activity and finding of bone erosions. Therapeutic targeting of IL-22 may be valuable for the intervention of RA.