For the purpose of determining the time of death,the life history (the growth and development) and the sum of effective temperature of Lucilia Sericata were studied under the ordinary temperature. On the bases of the growth and development of the fly ,we have established three linear regression equations between the sum of effective temperature and the length of larvae or weigth pupa of Lucilia Sericata (K 1=2 0880+0 8014X 1、K 2=54 0917-2 8814X 2、K 3=133 2180-2 6312X 3).These linear regression equations provide a reliable,scientific method for estimating the time of death in forensic medicine practice.

A 51-year-old man presented with multiple, disseminated dark erythematous maculopapules and nodules over the body surface for more than 1 year. Initially, the patient presented with dark erythematous macules on the trunk without discomfort. Then, lesions gradually spread over the whole body surface with the development of tenderness. Physical examination revealed multiple disseminated dark erythematous, well-demarcated maculopapules, infiltrative plaques and subcutaneous nodules on the face, neck, trunk, upper and lower limbs. Some lesions were tender on palpation. An enlarged cherry-like lymph node was detected on the right inguina. Bone marrow inspiration showed that lymphocytes amounted to 32.5%, and naive lymphocytes accounted for 10%. These lymphocytes varied in size with irregular shape, moderate amount of basophilic cytoplasm, irregular nuclei and granular chromatin. Histopathological examination revealed diffuse infiltrate of numerous medium-sized atypical blastic cells with irregular nuclei in superficial dermis and subcutaneous fat tissue. The blastic cells showed sparse fine-granular chromatin, obscure nucleoli and obvious karyokinesis. Immunophenotype examination showed that tumor cells were strongly positive for CD4, CD56 and CD43, weakly positive for CD68 and terminal deoxynucleotidyl transferase, but negative for L26, CD3, CD38, granzyme B and myeloperoxidase. The diagnosis of BPDCN is confirmed based on typical clinical features, histopathology and immunohistology findings.

AIM: To establish a quality control method of analysing Lajiao Fengshi Plaster qualitatively and quantitatively. METHODS: Capsaicin was identificated by TLC and menthol,borneol were determinated by GC Lajiao Fengshi Plaster,silica gel as plate,ligarine(60～90?C)-acetoacetate(3(∶)2) as mobile phase,0.5% solution of dichloroquinonechlorimide R in methanol R.as chromogenic agent to identificate capsaicin.The internal standard of GC,naphthalene was employed.10% PEG-20M as the stationary phase,column temperature at 150(?C,) and FID as the detector to determine methol and borneol. RESULTS: There were the same spot corresponding in colour and position sample and reference capsaicin,but negative control had not such colour spot in the same plate of TLC.Menthol,borneol and naphthalene had been separated well under the chromatographic condition.The average recovery of menthol,borneol were 97.44%(RSD=0.93%),98.09%(RSD=1.26%),respectively. CONCLUSION: The method is sensitive,accurate and reproducible and can be used to control the quality of Lajiao Fengshi Plaster.

AIM: To develop a method to detemine pinostrobin in Weitengning Talets (Lindera reflexae Hemsl.) by HPLC. METHODS:A C_(18) column was used,methyl alcohol-water(80∶20) was used as a mobile phase and the wavelength of UV detector was set at 290 nm. RESULTS:The linearity of this method was good with the average recovery of 97.9%,RSD was 0.74%(n=5). CONCLUSION:The methed is simple,reliable,sensitivity,and with good reproducibility.It can be used in quality control of Weitengning Tablets.

Objective To analyze the clinical characteristics ,treatment and outcome of Ebola virus disease so as to provide early clinical recognition and treatment for this disease .Methods The clinical manifestations and treatment of 5 cases of Ebola virus disease in Ebola Holding Center of Sierra‐Leone China Friendship Hospital from 15 March 2015 to 15 May 2015 were retrospectively analyzed .And the clinical characteristics and possible effective treatment were discussed combined with related literature . Results Five patients were diagnosed with Ebola virus disease by polymerase chain reaction and 4 cases of 5 patients had confirmed contact history ,while 1 case had no clear contact history .All the 5 cases presented with low fever ,headache and joint pain .Three cases then progressed into severe gastrointestinal symptoms such as nausea ,vomiting ,diarrhea and hypovolemic shock .The patients presented with fast heart rate and shortness of breath and other inflammatory response syndrome in acute phase .One patient rapidly progressed to liver pain ,jaundice and anuria ,then died .Three severe cases recovered after treated with fluid resuscitation ,circulation maintenance and electrolyte balance in acute phase .Conclusions The early symptoms of Ebola virus disease are low fever ,joint pain and nausea .Frequent vomiting ,diarrhea , low blood pressure and electrolyte disorder indicate severe conditions .Shock and electrolyte disorder are deadly complications .Early recognition ,diagnosis and treatment are the key to improve the prognosis .

Objective To analyze the difference and influential factors of clinical prognosis between liver transplantation with autoimmune liver disease (AILD) and viral hepatitis cirrhosis. Methods Clinical data of 75 recipients undergoing liver transplantation from January 2002 to January 2017 were retrospectively analyzed. All recipients were divided into the AILD group (n=25) and viral hepatitis cirrhosis group (n=50). The intraoperative conditions of the recipients were observed including warm ischemia time, cold ischemia time, operation time, anhepatic phase and blood transfusion volume. Postoperative complications were observed including severe acute kidney injury (AKI), infection, acute rejection, biliary tract-related complications, vascular-related complications and post transplantation diabetes mellitus (PTDM). The follow-up status were monitored after discharge. The prognostic factors of liver transplant recipients were analyzed. Results The warm ischemia time, cold ischemia time, operation time and anhepatic phase did not significantly differ between two groups (all P > 0.05). In the AILD group, the incidence of postoperative acute rejection was remarkably higher, whereas the incidence of postoperative severe AKI was significantly lower than those in the viral hepatitis cirrhosis group (both P < 0.05). The postoperative 1-, 3- and 5-year survival rates in the AILD group was 92%, 87%, and 87%, which did not significantly differ from 88%, 88% and 88% in the viral hepatitis cirrhosis group (all P > 0.05). Univariate analysis showed that age, model for end-stage liver disease (MELD) score, severe AKI, infection and biliary tract-related complications were the influencing factors of clinical prognosis of the recipients (all P < 0.05). Conclusions The overall survival prognosis does not significantly differ between the AILD and viral hepatitis cirrhosis groups. Age, MELD score, severe AKI, infection and biliary tract-related complications are the risk factors affecting the clinical prognosis of liver transplantation recipients.

Objective To observe the condition changes in patients with chronic hepatitis B (CHB) following medication withdraw of nucleoside/nucleotide analogues (NAs) treatment and to analyze the factors related to disease relapse.Methods Eighty-five CHB patients who discontinued medication of nucleoside/nucleotide analogues for antiviral therapy in Nanjing Second Municipal Hospital from January 2002 to December 2017 were enrolled in the study, among whom 22 cases met the withdrawal criteria (standard withdrawal group ) and 63 cases did not meet the withdraw criteria ( non-standard withdrawal group).The correlation of condition changes (abnormal liver function, positive rate of HBV DNA, hepatic failure with the drug withdrawal , the course of medication, serological transformation of HBeAg during drug withdrawal, HBsAg level, and liver cirrhosis during drug administration was analyzed.Results In standard withdraw group, the medication lasted for ＞3 years, only 1 case had HBV DNA positive conversion , abnormal ALT and TBil, and liver failure.In non-standard withdraw group, 50 cases (79.4%) had HBV DNA positive conversion, 36 (57.1%) had abnormal ALT, 25 ( 39.7%) had abnormal TBil and 14 (22.2%) had liver failure.There were 19 cases with HBsAg ＞1 000 IU/mL and 3 cases with HBsAg ≤1 000 IU/mL, and 1 case with HBsAg＞1 000 IU/mL (5.3%) had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.In non-standard withdraw group, there were 52 cases with HBsAg ＞1000 IU/mL, among whom 45 cases (86.5%) had positive HBV DNA conversion , 31 (59.6%) had ALT abnormalities, 25 (48.1%) had TBil abnormalities, and 13 (25.0%) had liver failure; there were 11 patients with HBsAg ≤1 000 IU/mL, among whom 6 cases (54.5%) had HBV DNA positive conversion , 5 (45.4%) had ALT abnormalities, and no TBil abnormalities or liver failure occurred.There were 5 cases of liver cirrhosis in the standard withdraw group , only 1 case had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.None of the 17 patients with non-cirrhosis had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.There were 29 patients with liver cirrhosis in non-standard withdraw group showed positive HBV DNA conversion , 28 (96.6%) had ALT abnormalities, 22 (75.8%) had TBil abnormalities, and 11 (37.9%) had liver failure; among 34 non-cirrhosis patients, 21 (61.8%) had positive HBV DNA conversion, 8 (23.5%) had ALT abnormalities, 3 (8.8%) had TBil abnormalities, and 2 (5.9%) had liver failure.According to the standard discontinuation , 12 patients (16.7%) had positive HBV DNA transformation after HBeAg serological conversion , and no ALT abnormality, TBil abnormality and liver failure occurred.In non-standard withdraw group, only 17 cases without HBeAg serological conversion , 10 cases (58.8%) had positive HBV DNA conversion , 5 cases (29.4%) had ALT abnormalities, 2 cases (11.8%) had TBil abnormalities and liver failure did not occur.Conclusion CHB patients with medication of NAs should be discontinued according to the withdrawal criteria .and the course of medication, the immune index and the liver cirrhosis should be taken into account.

Objective:To investigate the potentially inappropriate medication(PIM)among elderly patients with chronic diseases in Shanghai communities and related influence factors.Method:Six community Health service Centers were choosen using stratified sampling. Total 968 elderly patients with chronic diseases who visited to the outpatient clinic of Shanghai Community Health Service Centers from July to August 2018 were included in the study. The PIM was investigated according to the 2015 Beers criteria. The χ 2 test and multivariate logistic regression model were used to analyze factors related to the PIM. Results:The survey showed that 317 elderly patients had PIM with 412 person-doses. In 134 person-doses, the PIM was unrelated to the disease; in 18 person-doses, PIM was caused by interaction of drug with disease/symptoms; in 259 person-doses PIM was related to the drugs that should be cautiously used for elderly; only in 1 person-dose the PIM was caused by the interaction between drugs. The drugs with the highest proportion of PIM were diuretics, benzodiazepines and aspirin. There were significant differences in age, kinds of diseases, kinds of drugs and times of visiting community health service centers between elderly patients with PIM and those without PIM (χ 2=42.28, 35.51, 46.47, 38.46; all P<0.05). The main PIM-related factors were age, kinds of diseases, kinds of drugs and times of visiting community health service centers. Conclusion:The study shows that the prevalence of PIM among elderly chronic diseases patients in Shanghai communities is relatively high, which is associated with the age, kinds of diseases, kinds of drugs and times of visiting community health service centers.

Objective To investigate the function of melatonin (MEL)on liver transplantation by detecting the effect of MEL on glucose regulated protein-78 (GRP-78)and CCAAT enhancer-binding protein homologous protein (CHOP)involved in the endoplasmic reticulum stress (ERS)pathways in livers of rats with liver transplantation.Methods The rat orthotopic liver transplantation model was established by using‘magnetic-loop method’.Male SD rats were randomized into 3 groups:the sham operation group (Sham group),the orthotopic liver transplantation group (OLT group)and the orthotopic liver transplantation +MEL treatment group (OLT +MEL group),8 rats in each group.Serum sample and liver sample were collected at 24 h after operation.Serum alanine aminotransferase (ALT)and aspartate aminotransferase (AST)levels were detected.Liver tissues were stained with hematoxylin-eosin (HE)and pathological changes of liver tissues of each group were observed.The messenger ribonucleic acid (mRNA)and protein expression levels of GRP-78 and CHOP were detected by polymerase chain reaction and Western blot.Results Compared with the Sham group,the serum ALT and AST of the OLT group increased significantly (both in P <0.01 ),liver tissues injury was serious,and mRNA and protein expression levels of GRP-78 and CHOP increased significantly (all in P <0.01).Compared with the OLT group,ALT and AST of the OLT +MEL group decreased significantly (both in P <0.05),liver tissues injury was alleviated,and mRNA and protein expression levels of GRP-78 and CHOP decreased significantly (all in P <0.05 ).Conclusions MEL may reduce mRNA and protein expression levels of GRP-78 and CHOP involved in the ERS pathways of transplant liver,which may be one of its mechanisms to alleviate liver injury after liver transplantation.

Objective: To investigate the clinical effect and safety of entecavir capsules in the treatment of treatment-naïve HBeAg-positive patients with chronic hepatitis B (CHB). Methods: A total of 158 HBeAg-positive CHB patients were given oral entecavir capsules at a dose of 0.5 mg/time once a day for 144 weeks. Clinical outcome and safety were evaluated at baseline and at 24, 48, 72, 96, 120, and 144 weeks of treatment respectively. The Fisher’s exact test was used for the analysis of categorical data. Results: After 144 weeks of treatment, 90.91% of all patients achieved virologic response (< 69 IU/ml), the normalization rate of alanine aminotransferase was 88.18%, the clearance rate of HBeAg was 33.33%, and the seroconversion rate of HBeAg was 24.07%. Of all patients, 2 dropped out due to adverse events and 5 experienced serious adverse reactions. Conclusion Entecavir capsules can inhibit viral replication and have good safety in treatment-naïve HBeAg-positive CHB patients.