Objective To investigate the clinical characteristic and treatment of dieulafoy lesion in order to improve the early diagnosis and treatment.Methods A retrospective review of clinical records of 15 cases of dieulafoy lesion admitted to our emergency department from October 2005 to August 2012 was carried out.Results The male patients were more vulnerable to this disease than female patients,thereby the ratio of male to female patients was 6.5∶ 1,and the mean age was 48.3 years.The precipitating factors were often obscure,and some possible factors were related with certain amount of wine (1/15),using nonsteroidal anti-inflammatory drugs (2/15),and eating irritant food (2/15),and a few patients had a past history of hypertension (3/15) or diabetes mellitus (5/15) and no patient had past history of peptic lesion and cirrhosis of liver.The Dieulafoy' s lesion occurred suddenly without premonitory symptoms such as pain or upset of stomach,presented with the episodes of hematemesis or hemafecia,and the patients were in a stage of shock and moderate to severe anemia because of massive blood loss.The majority of lesions located at the posterior wall of the stomach (9/15) or adjacent to the lesser curvature (10/15).Endoscopy was of prime importance for confirming the diagnosis of Dieulafoy's lesions.Endoscopic treatments included hemostasis with clipping combined with epinephrine submucosa injection and successfully excising the lesion in 14 patients (14./15).Surgical treatment was done in 1 patient after failure of endoscopic treatments.Conclusions Dieulafoy lesion is characterized by sudden massive hemorrhage of the alimentary tract,it most commonly locates in the pars posterior of stomach adjacent to the lesser curvature in the middle-aged and the elderly males.Endoscopy is the most simple and essential method to confirm the diagnosis,and emergency endoscopic hemostasis with clipping for treating Dieulafoy lesion is an effective therapeutic strategy.

Emergency practice is an important part of clinical study.At present,the emergency teaching content of general practice is so wide that the teaching time is not enough,We do not pay enough attention to the cultivation of clinical thinking,pre-hospital care,two-way referral,and first aid skills training and so on.In this paper,the development of community emergency oriented teaching content,cultivation of de-escalation clinical thinking,and the pre-hospital emergency training and other aspects are studied for the students' teaching in emergency practice in order to improve the clinical practice teaching level of general medicine sttdents.

Objective To investigate the regularity of variation in number of emergency patients visiting doctors within each 24 h during holidays and festival days,so as to provide a scientific basis for hospital administration and the rational allocation of human resources.Methods Based on the hospital's statistical data of emergency patients visiting doctors during winters from December 2010 to February 2014,a retrospective analysis was carried out for the number and the visiting time of emergency patients on holidays (weekends,the minor long holiday of 3 days for New Year and the major long holiday of 7 days for spring festival) and on general working days (Monday to Friday),respectively.The variation in number of patients and peak time of visiting doctors were analyzed by using circular distribution method,and compared the differences in the number of emergency patients visiting doctors and peak time period between holidays and working days.Results Most of emergency patient visitors were 50-79 years old males; the number of emergency patients on holidays was significantly higher than that on general working days,especially during the seven-day spring festival (P ＜ 0.01),while the number on New Year' s day was similar to that on weekends; peak time for emergency patients' visiting doctors was from 13:05 to 0:28 during general working days.On the contrary,the peak time occurred earlier at 10:05 until 21:05 during the holidays if the hospital offers half-day outpatient service,and in the absence of outpatient service,the peak time emerged further earlier at 9:16 until 21:26 during holidays.Conclusions The ages,number and the peak time of emergency patients visiting doctors on holidays are different from those on the general working days,so medical staff on duty should be arranged reasonably to follow this regularity.

Objective To study the association between platelet distribution width (PDW) and other indexes in coronary heart disease (CHD) patients with heart failure (HF).Methods Five hundred and ninety-one CHD patients with HF were divided into control group with their NT-proBNP＜300 ng/L (n=228),mild HF group with their NT-proBNP=300-3000 ng/L (n=191),and severe HF group with their NT-proBNP＞3000 ng/L(n=172).Their blood and echocardiographic parameters were recorded.Results The PDW was significantly shorter in 3 groups after treatment than before treatment (0.129±0.031 vs 0.133±0.027,0.133±0.030 vs 0.141± 0.029,0.139±0.028 vs 0.148±0.029,P＜0.05,P＜0.01),and was significantly longer in mild HF group and severe HF group than in control group and in severe HF group than in mild HF group after tgreatment (P＜0.05,P＜0.01).Multivariate stepwise regression analysis showed that PDW was positively associated with NT-proBNP and LAD (P=0.001,P=0.000) and negatively associated with LVEF (P=0.003).Conclusion PDW increases with the severity of HF in CHD patients and can thus play an auxiliary role in assessing the severity of their HF.

OBJECTIVE To investigate the status of hospital acquired infection correctly,and to clarify the difficulty of dealing with it as well as to improve the survey and management level.METHODS Thirty-four cases of hospital acquired infection were diagnosed by cross-sectional survey,followed and then analyzed.RESULTS The incidence of hospital acquired infection was 7.6% in our hospital,the average time of hospitalization was 38.68 days which 3.98 times of the average hospitalization time of whole patients.The average hospitalization fee was 24 065.9 Yuan,4.5 times of the average fee of whole patients.CONCLUSIONS Patients susceptible to hospital acquired infection include old patients(≥60-year-old),basic illness≥3,and operated patients,the main risk factors of hospital acquired infection in our hospital include invasive cathelization,operation,combination using of more than 2 antibiotics and using of steroid.

Objective To study the relationship between red blood cell distribution width (RDW) and the malignant arrhythmia event of patients with chronic heart failure (CHF) during hospitalization. Methods A retrospective study was conducted. The clinical data of patients with CHF admitted to Department of Emergency and Cardiology of Peking University Third Hospital from January 2014 to February 2016 were reviewed. The patients with New York Heart Association (NYHA) Class Ⅱ, Ⅲ, Ⅳ at hospital admission and courses lasted at least six months were enrolled. The patients were divided into two groups according to malignant arrhythmia events (ventricular tachycardia, ventricular flutter or ventricular fibrillation) during hospitalization, i.e. malignant arrhythmia group and non-malignant arrhythmia group. The value of RDW and left ventricular ejection fraction (LVEF) were compared between two groups, and correlation of RDW, LVEF and malignant arrhythmia events by Spearman rank correlation analysis were studied, and the predictive value of RDW and LVEF for malignant arrhythmia events in patients with CHF was analyzed with receiver operating characteristic (ROC) curve. Results A total of 226 CHF patients were enrolled with 148 male and 78 female, the average age was (61.52±13.27) years old (range: 26-91 years old), the average hospitalization days were (14.5±3.5) days (range: 14-21 days), and malignant arrhythmia occurred in 102 patients (45.13%) during hospitalization. There were no statistically differences in gender, age, past history, etiology of heart disease, the usage of angiotensin receptor converting enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor inhibitors (ARB) and beta blockers, serum potassium levels and so on between two groups. Compared with non-malignant arrhythmia group, the value of the RDW was significantly increased in malignant arrhythmia group [(13.28±1.07)% vs. (12.87±1.32)%, t = 2.531, P = 0.012], but the levels of LVEF was significantly reduced (0.425±0.116 vs. 0.458±0.104, t = 2.249, P = 0.026), the proportion of patients with NYHA Class Ⅱ was significantly lower (4.90% vs. 19.35%, χ2= 10.451, P = 0.000) and that of NYHA Class Ⅳ was just the opposite (57.84% vs. 41.13%, χ2 = 6.264, P = 0.011). The value of the RDW showed positively correlation with the malignant arrhythmia events (r = 0.758, P = 0.023), while LVEF was negatively correlated (r = -0.719, P = 0.019). The area under the ROC curve (AUC) for predicting the malignant arrhythmia events of RDW and LVEF was 0.882 [95% confidence interval (95%CI) = 0.839-0.925), 0.903 (95%CI = 0.866-0.941), respectively. The sensitivity and specificity for RDW in predicting in-hospital malignant arrhythmia event respectively were 82.0% and 79.0% with the optimal cut-off of 14.20%, and those for LVEF were 78.0% and 85.0% with the optimal cut-off of 0.375. Conclusion RDW can be used to predict the occurrence of malignant arrhythmia in patients with CHF during hospitalization.

AIM: To study the role of NOS2 in the devel op ment of cardiac dysfunction after rat myocardial infarction by observing effects of S-methylisothiourea (SMT) on left ventricular morphology and haemodynamics. METHODS: An selective NOS2 inhibitor, was used. Administration o f SMT by gavage began 30 min before coronary ligation. Six weeks later, left ventricular morphologic and haemodynamic parameters were o bserved,and NOS2 expression, plasma NO 2-/NO 3- level and myocardial fibr osis were studied. RESULTS: Six weeks after myocardial infarction, NOS2 level in ra t non-infarct cardiac muscle, plasma NO 2-/NO 3- level, CVP and LVEDP were higher than that in controls. Long term administration of SMT decreased plasma NO 2-/NO 3- level [(26.6?6.1) ?mol/L vs (50.1?10.4) ?mol/L, P

Objective To explore the role of chemokine CXCL12 and its receptor CXCR4 in the directional migration of human prostate cancer(PCa).Methods The expression of CXCL12/CXCR4 in 18 human PCa samples and human PCa cell lines(PC3,DU145 and LNCap)was determined by immunohistochemistry and immunocytochemistry,respectively.Then the effect of CXCL12 on the migration and invasion of human PCa cell lines Was investigated by Matrigel invasion assay.Results Except 1 PCa sample,positive CXCR4 protein expression was detected in 17 clinical PCa samples.On the contrary,in 18 samples determined,only one sample expressed weak CXCL12 protein.CXCR4 rather than CXCL12 protein was exressed in PCa cell lines PC3,DU145 and LNCap.In addition,CXCL12 promoted the migration and invasion of PCa cell lines in a dose dependent manner in viiro,in which experiments PC3,LNCap cells were pretreated by antibody of CXCL12 or CXCR4 and then it was found the migrations of cells stimulated by CXCL12 were inhibited.Conclusion CXCR4 protein is expressed in human PCa and CXCL12/CXCR4 axis may play a significant role in the metastasis of prostate cancer.

Objective To investigate the feasibility and application scope of the looping technique by using a gooseneck snare and a loach guide wire in retrieving tubular foreign bodies within the vascular or ureteral duct. Methods During the period from July 2009 to Dec. 2013, six patients with ruptured catheter were admitted to authors’ hospital. All six patients were females. Three patients had internal ruptured peripherally inserted central venous catheter (PICC), one patient had ruptured implantable venous access port catheter and two patients had replacement of double “J” ureteral catheter stent. By using looping technique, i.e. a loach guide wire and a gooseneck snare were separately placed at the two ends of the tubular foreign body, then the gooseneck snare entangled the soft leading end of the loach guide wire to form a annular structure to seize the ruptured tubular catheter and then to pull it out of the body. Results With the help of the looping technique, the internal ruptured catheter or the double “J” ureteral catheter was successfully removed in all the six patients. Conclusion For the retrieval of the tubular foreign bodies within the vascular or ureteral duct, the looping technique by using a gooseneck snare and a loach guide wire is an effective and fast treatment. Therefore, this technique should be recommended in the clinical practice.

Objective To determine the effects of maternal rats exposed to chronic unpredictable stress before pregnancy on the behavior and neurobiology of the mother and their offspring.Methods Two-month Virgin female Sprague-Dawley(SD) rats were applied to study.Females were housed with sexually experienced males (ratio 3:1) for propagation after 21-day chronic unpredictable stress.The behaviors of rats and their two-month-offspring were tested.The two-month rats were injected intraperitoneally with BrdU,then the brains were removed and 20 μm frozen sections were used to detect the neurogenesis of hippocampus.Results 1.Open field test:after lactation,CUS + Pre group ((720.52 ± 238.99) cm),CUS group ((995.62 ± 191.77) cm),CON group ((464.95 ±210.11)cm) and CON + Pre group((740.76 ± 281.48)cm) had statistic difference in total distance(P ＜ 0.05).The total distance((1281.10 ±247.89)cm) and border distance((1153.20 ±238.19)cm) in female two-monthprogeny were higher than these in male two-month-progeny ((1074.70 ± 263.35) cm,(957.28 ± 82.94) cm) in CUS + Pre group (P ＜ 0.05).2.Sucrose consumption test:after lactation,the sucrose intake ((13.00 ± 3.46) g)and sucrose consumption percentage((87.00 ±9.01)％) in CUS + Pre group were higher than that in CUS group ((8.13 ± 3.36) g,(79.06 ± 6.45) ％,P ＜ 0.05).The sucrose intake ((12.43 ± 3.31) g) and sucrose consumption percentage((86.90 ± 5.80)％) in CON group were higher than that in CUS group ((8.13 ± 3.36) g,(79.06 ± 6.45) ％,P ＜ 0.05).The sucrose intake ((14.71 ± 4.39) g) and sucrose consumption percentage ((91.54 ± 1.89) ％) in CON + Pre group were significantly higher than those in CUS group ((8.13 ± 3.36) g,(79.06 ± 6.45) ％) (P ＜ 0.01).3.Immunohistochemistry:there was no statistic difference on the new neuron in dentate gyrus of hippocampus in both female and male two-month-progeny of CUS group and CON group((1.18 ±0.37) cells,(1.24 ± 0.41) cells,(1.38 ± 0.47) cells,(1.41 ± 0.35) cells) (P ＞ 0.05).Conclusion The 21d CUS before pregnancy induce the anxiety-like behavior and depressive-like behavior in maternal rats,and lactation can attenuate influence of stress to protect maternal rats.There is no effect on the behavior and cell proliferation of hippocampus in adult progeny by chronic unpredictable stress exposure before pregnancy.However,there is the difference of anxiety-like behavior in both female and male two-month-progeny.