Objective To retrospectively analyze the clinical features,diagnostic experience and therapy of pulmonary embolism for reduction of misdiagnosis and missed diagnosis,and for improving the cure rate.Methods The data of clinical features,findings by auxiliary examination and therapeutic efficacy of 67 patients with pulmonary embolism admitted to the First Affiliated Hospital of General Hospital of PLA were summarized.The usual clinical manifestations were summarized based on the clinical symptoms of and the frequency of objective signs in the patients with the correct diagnosis.Auxiliary examinations included routine and sophisticated examinations such as CT pulmonary angiography(CTPA) and emission computed tomography(ECT),which were specially emphasized for summing up and optimizing the diagnosis.Comparisons were made of the therapeutic efficacy and complications between the treatment with thrombolysis combined with anticoagulation and simple anticoagulation.Results The primary clinical manifestations of the patients with pulmonary embolism included dyspnea,cough,chest pain,fever and hemoptysis,etc.Findings of D-Dimer assay might serve as a sensitive but not specific indicator in screening the suspected patients.For the sophisticated examinations,CTPA confirmed the diagnosis in 28 out of 31(90.32%) patients,and ECT confirmed the diagnosis in 39 out of 51(76.47%).All the patients who had undergone lung angiography received the final diagnosis,but the majority of them were reluctant to accept this examination because of potential risk of the technique.The total cure rate of thrombolysis combining anticoagulation was 90.62%(29/32),in which the administration of recombinant tissue-type plasminogen activator(rt-PA)-2h was most efficacious(with 100% of cure rate).Simple anticoagulation therapy gave a lower cure rate(68.57%,24/35) but a higher incidence of hemorrhagic complication(31.25%).After the administration of thrombolysis combined with anticoagulation therapy,both PaO2 and CTPA examinations showed significant changes for the better after the treatment compared with that before the treatment(P

[Objective]To investigate surgical protocol for treatment of thoracolumbar fracture with ankylosing spondylitis. [Method]A retrospective study was performed in 8 thoracolumbar-fracture patients with ankylosing spondylitis. Of them, 6 patients were neurological intact and 2 had neurological defect(Frankel grades the C level). Under general anesthesia, all of the 8 patients underwent open reduction and internal fixation with pedicle screws at two segments in both ends of the fracture. Laminectomy for decompression of the nerve tissue was performed in the 2 patients with neurological defect simultaneously.[Result]All of the 8 patients were followed up for 8 to 30 months. Solid bone healing was achieved in all of the patients. Two patients with eurological compromise had improved by two Frankel grades (complete recovery).[Conclusion]Thoracolumbar fracture in ankylosing spondylitis traverse both bone and ligaments, producing an extremely unstable situation similar to a shearing type of fracture. Reduction of the displacement and stabilization is best achieved with a pedicle screw system at two segments in both ends of the fracture.

Objective Through a survey of medical students in autonomous learning, to understand students' learning motivation and learning strategies and find out the existing problems, and to provide the basis for the school to organize autonomous learning and improve the teaching quality. Methods Convenient sampling method was used to extract 1 500 students' autonomous learning scale who were freshman and sophomore, junior students and 1 467 valid questionnaires were collected. According to the corresponding research situation of Zhejiang Normal University, SPSS 19.0 was used to compare the different types of students in the school, and the t test or q test were also done. Results The situation of college students' autonomous learning was better. The girl's average score was (312.51 ±14.03) which was higher than the boys in the school (286.16 ±13.69)and the girls in the control group (302.67 ±10.37). The difference was statistically significant (P<0.05). The average total score of the junior college students (307.92 ±13.84) was better than that of freshman and sophomore (P<0.05), which suggested that junior students had the strongest independent learning ability. Conclusion Colleges and universities should be based on the actual situation of students and formulate corresponding policies and measures from the autonomous learning motivation, the boys dor-mitory management, to ensure the stability of teaching quality improvement.

Objective To investigate the relationship between adhesion molecule CD44v6,intercellular adhesion molecule-1 (ICAM-1) and lymph node metastasis in early stage of cervical squamous cell carcinoma.Methods Seventy-four specimens of cervical cancer stage Ⅰ b1,20 specimens of normal cervical tissue and 20 specimens of cervical squamous cell in situ carcinoma were collected from Jiangxi Provincial Maternal and Child Health Care Hospital.The expression of CD44v6 and ICAM-1 in cervical tissue was detected by real-time PCR and immunohistochemistry.The lymphatic vessel density (LVD) labeled by D2-40 was detected by immunohistochemistry.The relationship of CD44v6,ICAM-1 and LVD with the differentiation degree and lymph mode metastasis was investigated.Results The positive expression rate of CD44v6 and ICAM-1 in normal cervix,cervical squamous cell carcinoma in situ,and cervical carcinoma tissues was gradually increased,which were 0,75.00％,87.84％ and 10.00％,45.00％,81.08％ respectively.Their mRNA expression amount was gradually increased,which were 0,0.24±0.02,1.02±0.11 and 0.10 ± 0.00,0.19±0.02,1.03 ± 0.10 respectively,the differences were statistically significant (P＜0.01).LVD was gradually increased in normal cervix,cervical squamous cell carcinoma in situ,and cervical carcinoma (P＜0.01).The expression of CD44v6,ICAM-1 and LVD in low differentiated cervical carcinoma tissue was higher than that in high and middle differentiated cervical carcinoma (P＜0.01).The expression of CD44v6,ICAM-1and LVD in lymph node metastasis was higher than that in non-lymph node metastasis (P＜0.01).The expression of CD44v6,ICAM-1 and LVD in cervical cancer tissue had each two positive correlation (P＜0.01).Conclusion CD44v6 plays a promoting role in the progression of cervical cancer,which with ICAM-1 and LVD synergically promote the cervical cancer development,and could be used as an effective indicator for judging lymph node metastasis and diagnosis of cervical cancer.

ovel GCK-E339K mutation might be linked to this MODY2 pedigree.

[Objective] The aim of our study was to seek the mutations in MODY1～5 genes in Chinese population by direct sequencing in probands from families with early-onset type 2 diabetes.[Methods] Variants screening in MODY 1-5 genes were performed by PCR and direct sequencing in 19 probands from early-onset type 2 diabetes families.[Results] We found no mutation but many polymorphisms.There were 6,5,15,1,and 1 variants in MODY 1-5 genes respectively.[Conclusion] Our negative results in MODY genes suggest the genetic heterogeneity of different populations.Mutations in MODY 1-5 genes might not be the cause of diabetes in those 19 families.

Objective To evaluate the effect of various reduction degrees of large posterior malleolus fracture on contact condition of the tibiotalar joint using biomechanical and finite element methods.Methods Six fresh adult cadaveric calf-foot were tested with different loadings in neutral position,10 degree of dorsiflexion,and 15 degree of plantar flexion.Models included the intact ankle and posterior malleolus fracture (not fixed,fixed with 1 mm step-off,fixed with 2 mm step-off,fixed with 1 mm gap,or fixed with 2 mm gap).Tibiotalar joint contact area,contact pressure,and peak pressure were measured using the Tek-Scan pressure sensor.In addition,a three-dimensional finite element model of the ankle joint was established and tested under the simulated biomechanical conditions.Results Mter a 500 N axial loading in the intact ankle,contact area of the tibiotalar joint was (4.94 ± 0.67) cm2 and loading strength of the tibiotalar joint was (83.4 ± 2.7) ％ of total loading strength.Contact area of the tibiotalar joint in the fracture model fixed with 1 mm gap demonstrated no significant difference in all loading conditions compared with the intact model.In 15 degree of plantar flexion,contact area of the tibiotalar joint differed between the fracture model fixed with 1 mm step-off and the intact model (P ＜ 0.05).In multiple loading conditions,contact area of the tibiotalar joint differed between the fracture models fixed with 2 mm step-off or 2 mm gap and the intact model (P ＜ 0.05).Results of finite element analysis were conformed to the related biomechanical study.Conclusions Anatomic reduction should be pursued for large posterior malleolus fracture.If difficulty exists,fracture displacement should be within 1 mm step-off and 2 mm gap so as to restore the inter-joint congruity.

A method for determination of residues of 26 β2-agonists in pork liver was developed using high performance liquid chromatography with tandem mass spectrometric ( HPLC-MS/MS ) . After enzymatic hydrolysis with β-Glucuronidase/Arylsulfatase for 12 hours, the pH of sample solution was adjusted to 1 using perchloric acid for protein precipitation. The precipitate was extracted with 0. 1mol/L perchloric acid aqueous. The extracts in the above two steps were combined and adjusted to pH 4 for the solid phase extraction ( MCX) . And then the 26 β2-agonists residues in the extracts were separated on a reversed phase HPLC column using a gradient elution program of 0. 1% formic acid aqueous solution (A) and 0. 1% formic acid in acetonitrile solution ( B) . Multiple reaction monitoring ( MRM) with positive polarity was selected to monitor qualitative and quantitative ion. Based on the optimized method, 26 β2-agonists could be analyzed in 15 min. The recoveries ranged from 64 . 0% to 112 . 7% for the 26 kinds ofβ2-agonists residues with three spiked levels of 5, 10 and 20 μg/kg. The relative standard deviations ( RSDs) were less than 15. 2%. The limits of detection (LOD) for the 26 kinds of β2-agonists were 0. 15-1. 35 μg/kg.

Objective To investigate the efficacy of double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.Methods The retrospective cohort study was adopted.The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People's Hospital from March 2011 to March 2015 were collected.Of 208 patients,106 patients undergoing double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double-“ U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group.Observation indicators included (1) surgical effects:anastomosis time,postoperative pancreatic leakage,duration of hospital stay,(2) follow-up situations.The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed by t test.Count data were analyzed using the chi-square test.Results (1) Surgical effects:208 patients underwent successful surgery without occurrence of death.The anastomosis time was (13.0 ± 1.5) minutes in the double-“ U” group and (20.0 ± 1.6) minutes in the Child group,with a statistically significant difference between the 2 groups (t =4.713,P ＜ 0.05).Two patients in the double-“ U” group were complicated with grade A of pancreatic leakage,including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant.Nine patients in the Child group were complicated with pancreatic leakage,including 6 in grade A,1 in grade B and 2 in grade C,and there were 6 of 33 patients (4 in grade A,1 in grade B,1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A,1 in grade C) with fibrotic pancreatic remnant.There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (x2 =2.951,4.994,P ＜ 0.05).The duration of postoperative hospital stay was (13.5 ± 1.2)days in the double-“U” group and (15.7 ± 2.6)days in the Child group,with a statistically significant difference (t =1.011,P ＜ 0.05).No readmission in the 2 groups occurred.(2) Followup situations:91 of 106 patients in the double-“U” group were followed up for 6-54 months with a median time of 30 months.During the follow-up,8 patients were dead,12 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months.During the follow-up,10 patients were dead,11 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Conclusion Double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time,incidence of pancreatic leakage and duration of postoperative hospital stay,and it is especially suitable for the patients with normal pancreatic remnant.

Objective To observe the changes of plasma neuropeptide Y(NPY) and neurotensin(NT) levels in patients with essential hypertension and the relationship between those changes and damage of cardiac function. Methods Eighty patients of essential hypertension and 28 normal controls were chosen. The cardiac function was divided into 3 classes on the standard of New York Heart Association(NYHA). The plasma NPY,NT concentration was determined by radioimmunoassay. Results The level of NPY in hypertension patients was higher than that of the normal controls(P