BACKGROUND:In high-intensity exhaustive exercise process, the body must bear the exercise intensity decreasing splanchnic blood flow“ischemia”, at the same time, along with the movement of energy and material consumption, metabolite accumulation and oxidative stress in the body cause pathological damage, leading to a decline in exercise capacity. Thus, what is the impact on kidney filtration barrier? How to adapt to the change of renal tissue? Houttuynia cordata has the functions of heat clearing and detoxifying, dieresis for treating strangurtia, hemostatic, expel ing phlegm to arrest coughing and analgesia, if it has a protective effect on the renal injury caused by acute exhaustive exercise and its mechanism has not been reported in the literature. OBJECTIVE:To explore the effect of acute exhaustive exercise on kidney filtration barrier in rats and the intervention effect of Houttuynia cordata.METHODS:After resting and watching for 3 days, Sprague-Dawley rats received adaptive running for 15 minutes at a speed of 10 m/min on a 0° treadmil . A total of 24 rats, which can finish the running, were selected. They were divided into normal control group, exhaustive exercise group and dosed exhaustive exercise group according to the weight of layer (n=8). Rats in the exhaustive exercise group and dosed exhaustive exercise group on the 10° treadmil received once exhaustive exercise. Dosed exhaustive exercise group received intraperitoneal injection of sodium houttuyfonate 10 mL/kg at 30 minutes before exercises. The normal control group did not do any exercise. RESULTS AND CONCLUSION:Compared with the normal control group, serum urea nitrogen, serum creatinine, urine protein content, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly increased, but nitric oxide content and nitric oxide synthase activity in the renal tissue were significantly deceased in the exhaustive exercise group (P<0.05 or 0.01). Glomerular filtration epithelial cells, the kidney filtration barrier of basement membrane and podocyte damage were obvious, showing abundant cellapoptosis, occasional y necrosis. Compared with the exhaustive exercise group, urine protein content, serum creatinine, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly reduced, but nitric oxide content and nitric oxide synthase activity were significantly increased in the dosed exhaustive exercise group (P<0.05). No obvious pathological changes were detected, but apoptosis was visible. These findings confirmed that houttuynine made a reduction in renal cellinjury induced by exhaustive exercise and possibly significantly reduced apoptosis, increased nitric oxide synthase content, decreased malonaldehyde, and apparently increased superoxide dismutase activity, and final y protected injured renal tissue induced by exhaustive exercise.

Objective This study aimed to investigate the characteristics of maternal death cases, the cause of maternal death and the cause of medical dispute,and recommended the relative prevention measures. Methods We retrospectively analyzed 35 cases of maternal death identified in the College of Forensic Medicine in Kunming Medical University from January 2002 to December 2012. Results In 35 maternal death cases: (1) Most maternal deaths are over 30 years old (14 cases, 40%), followed by 17 to 19 years old (6 cases, 17.1%) . And most maternal deaths came from countryside (25 cases,71.4%) . (2) 26 cases maternal deaths happened during the perinatal period (68.5%) . (3) 26 cases happened in county hospitals, township hospitals and informal medical organizations (74.3%) . 5 maternal deaths happened on the way to the hospital or at home (14.3%) . (4) 17 cases died of obstetric hemorrhagic shock (48.6%), 11 cases died of amniotic fluid embolism (31.4%), 2 cases died of amniotic fluid embolism and obstetric hemorrhagic shock (5.7%) . (5) 30 cases of medical disputes were caused by maternal death. Among them, the clinical diagnosis was not consistent with the pathological diagnosis in 20 cases (The misdiagnosis rate was 66.7%) . (6) The causes of medical dispute:clinical diagnosis was unknown in 11 cases (36.7%),11 cases were suspected that rescue was not timely or improper (36.7%),and 8 cases were suspected of misdiagnosis (26.6%) . Conclusion Obstetric hemorrhage and pulmonary amniotic fluid embolism were the main reasons of the maternal death. The incidence of maternal death and medical disputes could be reduced by improving the ability of obstetric staff,and strengthening the diagnosis and treatment about obstetric hemorrhage and pulmonary amniotic fluid embolism. At the same time, women should improve their self-care awareness, reduce early marriage and early pregnancy,and enhance the consciousness of hospital treat and cure.

Objective To investigate the forensic characteristics of death cases of EV71 through retrospective analysis of 9 death forensic cases of Enterovirus 71 (EV71) . Methods Nine cases of EV71 death cases were collected,and the population characteristics, histopathological change,toxicology,pathology and causes of death of these cases were discussed. Results All 9 patients had fever, cough, emesis, and were treated as influenza or hand-foot and mouth disease (HFMD) in local hospitals, the condition was still deteriorating and finally died. The 9 autopsy cases were diagnosed as brain stem encephalitis and death in forensic diagnose. Conclusion The HFMD disease caused by EV71 infection progresses rapidly often leads to medical disputes, the patient's family and hospital's opinions on the causes of death in patients are often different,identifying the cause of death is conducive to resolve the disputes.

Objective Evaluate data of 1270 cases with free flap transplant,to find the problems in the process of operation,and then to analyse its causes and how to prevent and solve it,as well as providing reference for clinical colleagues. Methods To study 1270 cases of free flaps,musculocutaneous flap and perforator flap who was treated in our hospital from October 2000 to October 2010 retrospectively. A total of 722 cases of the group were followed-up 6 months to 5 years. To detective and search the problems and imperfection from designing,harvesting,tranfer,to the management and function of donor site after free flap transplantion.And also to analysis the couse of problems and operation failure,discuss the conclude of and to provide advisable measure. Results Total 1270 free flaps were transplanted successfully except 64 can-celled or failured for some reason, the success rate was 95.0％, the postopertive necrosis rate was 3.8％.Seventy-six cases were encountered vascular complications venous crisis in 42,arterial crisis in 38.Fifty-five cases were saved successfully without surgery,and 15 cases survived completely by vessel explorative operation. Five cases were partial necrosis and 7 cases necrosis. The rate of postoperative infection of emergency cases and chronic one were 4.7％ (682 cases)and 8.8％(588 cases) which show the infective incidence of latter was higher than former. In addition, there were many other problems were found such as distal flaps necrosis,contracture,deformation,impairment function of doner site,etc. Conclusion Preventing and management timely to vessle crisis is the key to flap suvive. The principle of dissecting flap should be followed strictly,and control the indications of modified processing during flap harvest,keep the proper flap tension were technical requirements in flap transplantion. Right way of donor site closed and management of insufficient timely were equally important to prevent and solve to complications and dysfunction.

Objective To study the method of solving the complications of large allograft including resorption, nonunion and refracture by means of vascularization and the way of improving bone healing. Methods The bone defect longer than 10 cm of limbs were found in 21 cases, plate or external fixator were used to fix allograft bone, and then vascularied autologous bone or periosteum were transplanted or inserted to the massive allograft In order to vascularizate allograft, improve bone healing and prevent complications of bone resorption and osteolysis. 4 cases were implanted by local vascular bondle in one end. 4 cases were transplanted vascular iliac bone into middle part the allograft bone, 2 cases were into one end. 2 cases were transplanted by vascular fibular bone. 6 cases were used vascular periosteum. 3 cases were used combined methods. Results Twenty-one cases with 10 cm or more bone defect in this group were treated by the method above. 14 cases were achieved primary healing, 6 were healing by farther operation, 1 failure. Complications were found in 7 cases, 4 occur infection in all. All were achieved satisfactory function and outlook by follow-up. Conclusion The method of vascularied autologous bone or periosteum combined with massive allograft are effective to improve bone union, reduce the complication of bone resorption and osteolysis,which proved usefull to treat large bone defect.

Objective To investigate the forensic characteristics of death cases of Acute Interstitial Pneumonia (AIP), so as to provide references for forensic assessment of AIP. Methods The data of 27 AIP death cases were retrospectively analyzed. The data included the population characteristics, toxicology, pathology and causes of death. Results All 27 patients had clinical symptoms including fever, cough and chest tightness, 25 patiens of them were treated as upper respiratory tract infection in local hospital, and finally died of deteriorating condition. The forensic diagnosis after autopsy showed the 27 cases were died of respiratory failure caused by AIP. Conclusion AIP is a disease with rapid progression and often leads to medical disputes,the patient's families often have different opinion on the death cause of patients with the hospital,so forensic identification of the cause of death is conducive to resolve the disputes.

The top-quality course construction,in comprehensive medical university,is very important for the undergraduate teaching evaluation. The paper discussed the top-quality course construction in forensic pathology and the relevant issues in medical college course teaching,such as the status of the course,characteristic in school-running and enforcement measures,which aimed to improve cognition and enhance teaching quality and teaching level.