Objective　This was a follow-up study of suicidal patients to assess the influence over time of different risk factors.Method　A cohort of 73 patients admitted to a psychiatric department after a suicide attempt was followed-up for 5 years.Results　In total,61.6% reattemped,15.1% of which had committed suicide during the follow-up.The rist factors for suicide included history of family psychiatric or suicide,and a poor social support,et al.Conclusion　The results suggest a high repetition rate of suicide attempters in the psychotic patients who had previous suicidal behaviour and them positive family history.The preventive strategy to suicide in patients,such as set up good social network and should pay mroe attention to psyciologic rehabilitation period after discharge.

[Objective]To analyze the clinical and biological characteristics of suspected malignant thyroid nodules associated with Hashimoto thyroiditis .To summarize different characteristics of benign and malignant nodules,diagnosis and treatment of suspected malignant nodules associated with Hashimoto's thy-roiditis. [Methods]Surgical y and pathological y confirmed, 58 cases of suspected malignant thyroid nodules associated with Hashimoto's thyroiditis were retro-spectively analyzed with clinical and pathological data. The differences of gender, age, number of nodules, calcification, and thyroid hormone and thyroid an-tibodies levels between malignant and benign nodules were compared from January 2009 to December 2011 .[Results] The average age of malignant thyroid nodules coexisting with HT group was significantly lower than that of benign nodules coexisting with HT group( P<0.05). The proportion of nodular calcifi-cation in malignant thyroid nodules coexisting with HT group was significantly higher than that in benign nodules coexisting with HT group( P<0.05). Pre-operative TSH and anti-TG levels in malignant thyroid nodules coexisting with HT group were significantly higher than that in benign nodules coexisting with HT group. Preoperative FT3, FT4, anti-TPO levels, sex ratio and number of lesions between the two groups were not statistical y significant. [Conclu-sions] The key point of preoperative diagnosis:patients of malignant thyroid nodules coexisting with HT are associated with youth, calcified nodules, elevated serum TSH and anti-TG levels.

BACKGROUND: Amfetamine, one of the levarterenols, can improve the recovery of motor function of animals after cerebral ischemia. Chlorimipramine can inhibit the re-intake of 5-serotonin and levarterenol and improve the level of them in brain. OBJECTIVE: To observe the effect of chlorimipramine on motor function of rats with focal cerebral ischemic injury.DESIGN: Randomized grouping and controlled animal study. SETTING: Neuropsychiatry Team of Aerial Clinical Medical Department of the Fourth Military Medical University of Chinese PLA. MATERIALS: The experiment was completed in the Morphological Laboratory of Aerial Aerospace Medical Department of the Fourth Military Medical University of Chinese PLA. All the 24 SD rats were divided into sham operation group, ischemia group and ischemic medication group with 8 in each group. Rats in ischemic medication group were perfused with 10 mg/kg chlorimipramine solution (2.5 g/L) once a day through mouth 24 hours after ischemia, and rats in sham operation group and ischemia group were perfused with the same volume of distilled water through mouth. METHODS: Middle cerebral artery (MCA) models of ischemia/reperfusion rats were established with inserted lining method. After modeling, the operations were performed as followed: ① holding test of net screen: Net screen was put horizontally, and then rats were put on it. One side of the screen was raised gradually; then it was turned over 125° within 2 s, and maintained at this placement. Time of holding rats on net screen was recorded. ② Test of struggling to tear off rubberized cloth: 0.5 cm2 medical rubberized cloth was adhered to the ventral of anterior claws of rats, and then rats were sent to the observing box to record the time of tearing off rubberized cloth. 1, 3, 7, 14 and 28 days after operation were the observing time points. MAIN OUTCOME MEASURES: Times of holding rats on the net screen and tearing off the rubberized cloth of rats with focal cerebral is chemia.RESULTS: ① Time of muscular strength test of rats in ischemia group and ischemic medication group was shorter than that of rats in sham operation group, and there was significant difference [3 days after operation:(54±4), (20±5) and (21±4) s in sham operation group, ischemia group and ischemic medication group respectively, P ＜ 0.01]. Holding time was longer in ischemic medication group than that in ischemia group, and there was significant difference [28 days after operation: (51±5) and (54±5) s in ischemia group and ischemic medication group respectively, P ＜ 0.05]. ②Time of tearing off the rubberized cloth was longer in ischemia group and ischemic medication group than that in sham operation group, and there was significant difference [3 days after operation: (47±9), (188±20) and (172±22) s in sham operation group, ischemia group and ischemic medication group respectively, P ＜ 0.01]. The time in ischemic medication group was shorter than that in ischemia group, and there was no significant difference (P ＞ 0.05).CONCLUSION: Chlorimipramine has great effect on the recovery of muscular strength after focal cerebral ischemia, but has poor effect on sense and refined motor function, which is in coincidence with the poor recovery of refined motor function of limbs after hemiplegia.

Objective To explore the accuracy and clinical application of Pyrosequencing for detection of drug resistant relevant mutation in the polymerase gene of Hepatitis B virus (HBV).Methods Compared with Sanger sequencing,the accuracy and sensitivity of Pyrosequencing were assessed.Pyrosequencing was used to determine the serum of 1164 patients with chronic Hepatitis B and its results were analyzed.Results The sensitivity of Pyrosequencing was 1 × 103 KIU/L,the same as Sanger sequencing.But Pyrosequencing was more stable and specific than Sanger sequencing to detect low rate of mutation with over 10％ mutation.The mutations couldn't be detected in 248 patients with chronic Hepatitis B,but positive results occurred in 919 patients,among them,61.5 ％ without mutation,38.5 ％ with mutation (including 47.5％ of the single locus mutation and 52.5％ of the combined mutation).Other sites had different degree of mutations except the sites of rtI169T and rtA194T; the main mutation sites in patients with chronic Hepatitis B were rtM204V/I (32.1％),rtL180M (19.8％),rtA181V/T (6.7％) and rtN236T (5.3％),in which fractional mutation had high ratio in the sites of rtA181V/T (6.7％) and rtN236T (5.3％).Conclusions Pyrosequencing has good sensitivity,specificity and accuracy and can early detect the drug resistant relevant mutation in the polymerase gene of HBV,which is suitable for monitoring patients with chronic Hepatitis B for the treatment of nucleoside analogues (acid).The different sites and frequencies of mutations may be associated with different habits of doctors for using different anti-HBV drugs.

To illustrate the location of HSP-70 (heat\|shock protein\|70)correlative response in acute stage between middle and inner ear when mammalian middle ear infected by bacteria, and investigate the possibility to cause autoimmune inner ear injure by HSP-70 that induced by otitis media. An animal model of acute otitis media was established by inoculating Klebsiella pneumoniae (K.p) into middle ear of guinea pigs. Animals were sacrificed 1,3,5 and 7days after inoculation.Investigation of the locations of HSP-70 in middle ear mucosa and cochlea structures were detected by immunocytochemical technique .The results showed that light stain of HSP-70 existed in the superficial epithelium cells of normal mucosa and cochlea structures such as stria vascularis, spiral ligament and Corti′s organ.Heavy stain appeared in the same sites in the infected ears . No different positive sites was observed in all animals.Our findings suggested that HSP-70 were expressed in middle ear mucosa and inner ear structures during acute middle ear infective stage.The HSP-70 provide a material base for causing autoimmune inner ear injure during middle ear bacteria infection.

Objective To investigate the changes of pulsatile tinnitus on HRCT and MRI CE 3D-SPGR image.Methods CT and MRI images of 1 5 pulsatile tinnitus patients were retrospective analysis.All 1 5 patients underwent temporal bone HRCT and MRI CE 3D-SPGR scan.Abnormal changes on CT and MRI image,which caused the pulsatile tinnitus,were compared.Results In 1 5 patients,9 sides (8 cases)showed abnormal sigmoid sinuses including 4 sides of sigmoid sinuses diverticulum,5 sides sigmoid sinu-ses uncovering,8 sides dominant sigmoid sinuses.The high jugular bulb was showed in 10 sides (8 cases),the thick emissaria mas-toidea in 5 sides (4 cases),bilateral semicircular canal dehiscence in one case,glomus tympanicum tumor in one case and the cochle-ar nerve was constricted by small vessel in one case.Conclusion Cranial base vessel abnormity can be visualized more precisely on MRI CE 3D-SPGR image than that on HRCT.On the contrary,the detection of temporal bone abnormalities is superior on HRCT.

OBJECTIVE:To know the status quo of clinical pharmacy in main hospitals of Jiangsu province primarily,and to provide reference for promoting the construction of clinical pharmacist system and playing active role of clinical pharmacists on rational drug use and pharmaceustical care.METHODS:A mailed questionnaire investigation was conducted among 28 committee members (coming from 28 hospitals) of the Clinical Pharmacy Branch of the Medical Association in Jiangsu Province regarding the status quo of the clinical pharmacy practice,and the correlated data and results were summarized to statistical analysis.RESULTS:A total of 28 questionnaires were distributed and 28 valid questionnaires were collected,with recovery rate of 100％.Among 28 hospitals,there were 25 general hospitals and 26 third grade class A hospitals.There were 312 full-time and part-time clinical pharmacists;there were 7.32 full-time clinical pharmacists and 3.82 part-time clinical pharmacists in each visited hospital;the proportion of full-time clinical pharmacists with master's degree and intermediate title was significantly higher than that of part-time clinical pharmacists (P＜0.05).There were 144 full-time clinical pharmacists who had been trained to obtain clinical pharmacists qualifications (70.24％).In 13 hospitals with the qualification of clinical pharmacist training base of National Health and Family Planning Commission (NHFPC),the average number of teachers was 3.77;in 5 hospitals with the qualification of provincial clinical pharmacist training base,the average number of teachers was 5.80;in a hospital with the qualification of clinical pharmacist training base of NHFPC,the number of teachers was 5.The surveyed hospital had the highest proportion of clinical pharmacy related work to participate in daily physician rounds,doctor's advice and prescription review,special review of antibiotics,drug record writing,pharmaceutical information service,outpatient drug consultation and ADR monitoring,all being 100％.Expert consultation clinic occupied the lowest proportion of clinical pharmacy work (10.71％).Setting up pharmacy for operation and anaesthesia department (28.57％),community pharmaceutical care (57.14％),pharmacogenomic testing (46.43％) and participating in the management of drug clinical trials (53.57％) occupied the lower proportion of clinical pharmacy related work.The proportion of clinical pharmacy work in training base hospital was higher than that non-training base hospital.Compared to surveyed hospitals,there was statistical significance in the proportion of special review for antineoplastic drugs,hormone drugs and blood products,expert consultation,setting up pharmacy for operation and anaesthesia department,community pharmaceutical care,pharmacogenomic testing and participating in the management of drug clinical trials in provincial clinical pharmacist training base (P＜0.05).There was statistical significance in the number of specialist consultation,case analysis,inpatient injection medical orders,check pharmacy intravenous admixture medical orders and checked outpatient prescriptions,varieties and number of monitored therapeutic drugs as well as case number of pharmacogenomic testing (P＜0.05).CONCLUSIONS:It is suggested to strengthen the construction of clinical pharmacist team in third grade class A hospital in Jiangsu province,accelerate the transition of part-time clinical pharmacists,at the same time,further improve the development of clinical pharmacy related work.

Objective To study the relationship between expression of leptin and clinical pathogenesis and prognosis of stage Ⅱ colorectal cancer.Methods The clinical data of 102 patients with colorectal cancer admitted to Shaanxi Provincial Tumor Hospital between January 2005 and December 2010 was collected and statistically analyzed.The expression of leptin in postoperative colorectal cancer tissues and 40 normal colorectal tissues was detected by P-V immunohistochemical technique.Results The expression of leptin in cancer tissues were obviously higher than that in normal tissues [59.8 ％ (61/102) vs.17.5 ％ (7/40),x 2 =20.605,P =0.000].There was no association between leptin expression level and gender,age,tumor location,pathological grading,pathological types,tumor size,invasion depth and body mass index (all P ＜ 0.05).Cox multivariate regression analysis showed that leptin expression (P =0.041) and adjuvant chemotherapy (P =0.008) were independent factors affecting OS in patients with stage Ⅱ colorectal cancer.The patients with positive expression of leptin could not benefit from the adjuvant chemotherapy (P =0.259),and patients without leptin expression had improved survival when treated by adjuvant chemotherapy (P =0.021).Conclusion The expression of leptin in stage Ⅱ colorectal cancer tissues is obviously higher than that in normal tissues.Leptin is associated with chemotherapy resistance and therapy-independent prognosis.

Objective To observe the percentage of Th17 cells in peripheral blood mononuclear cells (PBMCs) and the serum level of interleukin-17 (IL-17) in children with Henoch-Sch?nlein purpura (HSP). Methods A total of 30 HSP children and 20 healthy children were selected. The percentage of Th17 cells in PBMCs was measured by lfow cytometry analysis and the serum level of IL-17 was measured by ELISA method. The results were compared between HSP children and healthy children. Results The percentage of Th17 cells in PBMCs in HSP and healthy children was (2.14 ± 0.90)%and (0.84 ± 0.41)%, respec-tively, and the difference was signiifcant between two groups (P<0.05). The serum levels of IL-17 in HSP and healthy children were (38.36 ± 13.44) pg/ml and (10.59 ± 4.17) pg/ml, respectively, and the difference was also signiifcant (P<0.05). Conclusions The percentage of Th17 cells in PBMCs was obviously increased in HSP children. It is suggested that Th17 cells may play a role in the pathology of HSP.

By introducing the PBL teaching model into the probation curriculum of endodon-tics,the authors explored the curricular arrangment and the construction of teaching materials.The monitoring of teaching quality and revision of teaching syllabus were also analyzed.To induce the model profoundly,the authors considered some problems raised during the teaching procedure should be resolved.