Thanks to the three decades of reform and opening up,hospitals in China have made tremendous achievements in their development,yet facing new ehallenges as well.to address these challenges,there is an urgent need for these hospitals to further their reform under the guideline of the scientific concept of development.This will help them strengthen their hospital culture,quality control,technology,human resources development,and their leadership,in order to achieve a better and faster growth,better serving the role to build a harmonious socialist society.

Adult ; Femur Head Necrosis ; chemically induced ; drug therapy ; Glucocorticoids ; therapeutic use ; Humans ; Male ; Paraquat ; poisoning

Objective To investigate the expression of IgG4 in liver tissues of patients with type Ⅰ autoimmune hepatitis (AIH) and to analyze the clinical manifestation,biochemical indexes,immunological genetic features,pathological characteristics and the effects of immunosuppressive therapy.Methods From March 2012 to July 2013,45 patients diagnosed as type Ⅰ AIH were enrolled.Immunostaining of CD38,IgG and IgG4 in liver tissue slices was performed,inflammation grade G and fibrosis stage S were determined.At the same time,serological indexes (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),IgG,antinuclear antibody (ANA) titer,antibodies to asialoglycoprotein receptor (ASGPRAb)) of the patients were collected,serum IgG4 was tested and the response to immunosuppressive therapy was observed.Wilcoxon rank sum test and t test were performed for quantitative data comparison.Spearman correlation coefficient was used for correlation analysis.Results Among 45 patients with type Ⅰ AIH,five patients (11.1％) were IgG4 associated AIH (IgG4-AIH group).There were no significant differences in age,gender,biochemical indexes (serum levels of ALT,AST,ALP),immunity indexes (serum levels of IgG,ANA titer,ASGPRAb) and degree of liver fibrosis between patients with IgG4-associated AIH and classical AIH (40 cases) (all P＞ 0.05).Compared with classical AIH group (18.3(6.7) mg/L).The serum level of IgG4 of IgG4 AIH group was 25.8(9.2) mg/L,which significantly increased (Z=-2.041,P＜0.05).However,there was no significant difference in serum level of IgG4 between the two groups (P＞0.05).There was no correlation between the number of infiltrated IgG4 positive plasma cells and the serum level of IgG4 (r=0.311,P=0.279).The inflammation in the liver tissues of IgG4-AIH group was more significant compared with that of classic AIH group (H=4.120,P＜0.05).The number of CD38' or IgG+ plasma cells was larger compared with that of classical AIH (CD38(39.3(13.5)/high power field (HPF) vs (21.3(8.8))/HPF,IgG(39.3 (14.0))/HPFvs (18.5(8.9))/HPF;Z ＝-3.561 and-3.584,both P＜0.01).The number of IgG4+ plasma cells in liver tissues was positively correlated with the number of CD38+ or IgG+ plasma cells (r=0.884 and 0.791,both P＜0.01).Conclusions Among patients with type Ⅰ AIH,the incidence of IgG4-associated AIH was not high.The serum level of IgG4 did not significantly increase in these patients.However,the histological inflammation activity was significant along with many CD38+ or IgG+ plasma cells infiltration.

Objective To study the correlation between the main parameters and the effect of repression in MR fluid attenuated inversion recovery(FLAIR).Methods 0.5 unit was used in this experiment.The protein aqua of different material appearance and concentration was prepared.FLAIR was performed using the tube imitative experimented method and with different paramters.The best scan parameters were selected by comparison each other and their relativity was analysed.Results The best technical parameters:TR=4000~5000 ms,TE=90~100 ms,TI=1800~2000 ms.Conclusion TI is the key parameter in determining the repression effect,TR and TE only determine the scans time and layer number.FLAIR's repress result is stable,and it can estimate the protein content in the protein aqua.

Objective To study CT and MRI findings of the spongiform myelinopathy in poisoning by heroin.Methods CT and MRI findings in 6 patients with spongiform myelinopathy in poisoning by heroin were retrospectively analyzed with review of literature.Results The lesions were located in white matter,they were multiform and symmetrically distributed.On plain CT scans,the lesions were low density.On MRI,the lesions were low signal on T1WI and high signal on T2WI.The border of lesions was clear or not and no enhancement appeared.MRI is precedent of CT in the diagnosis of this disease,totally 55 focal lesions in the brain ,4 in midbrain and 8 in cerebellum were displayed by MRI.Conclusion CT and MRI findings of the spongiform myelinopathy in poisoning by heroin are more characteristic,according to the drug taking history and central nervous system symptom of patients,differentiating this disease from the other demyelinating disease is not difficult.

Transcranial Doppler can be used for diagnosing,monitoring,identifying the site of arterial occlusion,selecting appropriate cases for thrombolysis,and monitoring arterial recanalization during intravenous thrombolysis,and intra-arterial and intravenous thrombolysis with recombinant tissue plasminogen activator,The continuous monitoring of low frequency transcranial ultrasound has the effect of assisted thrombolysis;however,there are still controversies on the frequencies used in clinical practice.Transcranial Doppler assisted with microbubble contrast agent may further enhance the effect of thrombolysis.

Aim To observe the changes of endothelin receptors and their subtypes of left ventricules in normal SD rats and dilated cardiomyopathy rats. Methods To establish the best conditions of the binding experiment, different protein concentrations, incubation temperature ?and?incubating?time?were?tested? with 125 I-ET-1 ligand respectively. With the selected conditions, saturation binding experiments were performed to determine the amount of endothelin receptor and its subtypes in normal SD rats and in dilated cardiomyopathy ones. Results (1) The optimal incubating temperature was 37 ℃. Under this condition, the binding amount of 125 I-ET-1 increased rapidly in 0～30 minutes, and reached to saturation point at 60 minutes, and there was a linear correlation between 125 I-ET-1 binding amount and cell membrane protein concentration. (2) Endothelin-1, bosentan,BQ123,BQ788 etc. could competitively suppress the bound of 125 I-ET-1 to endothelin receptors. (3) The amount of endothelin receptor in left ventricle of dilated cardiomyopathy rats was ( 92.21? 34.34) nmol?kg -1 protein, which was significantly low than that in normal SD ones. There was no change on the ratio of endothelin receptor subtypes A and B. Conclusion 125I-ET-1 can be used to determine the amount of endothelin receptor and its subtypes in varied tissues specifically. The amount of endothelin receptor in left ventricle of dilated cardiomyopathy rats is down regulated, but the ratio of endothelin receptor subtype A vs B remains to be 21.

Aza Compounds ; analysis ; Heterocyclic Compounds ; analysis ; Sensitivity and Specificity ; Spectrophotometry, Ultraviolet ; methods ; Workplace

Objective To investigate the effect of solute cartier organic anion transporter family, member 1B1 (SLCOIBI) gene variants on the response to therapy with repaglinide in type 2 diabetes. Methods 100 newly-diagnosed type 2 diabetic patients were treated with repaglinide during a course of 48 weeks. Anthropometrie parameters and indices related to glucose metabolism were measured periodically. Genotypes of SLCO1B1 D130N and V174A were detected by PCR-restriction fragment length polymorphism (RFLP) and sequencing respectively. Results Eighty-nine patients accomplished the 48-week follow-up visits. D130N variant in SLCO1B1 gene was associated with repaglinide treatment, DD genotype had better HbA1C lowering effect than N allele carrier [△HbA1C: (-2.29±0.23) % vs (-1.49±0.21)%, P<0.05]. No association was detected between D130N and the other effects of repaglinide on glucose metabolism related phenotypes. Conclusion D130N variant in SLCO1B1 gene is associated with the response to repaglinide treatment in patients with type 2 diabetes. DD homozygotes had a better effect than N allele carriers.

Objective To improve the knowledge of intestinal Behcet's disease.Methods From October 2012 to January 2014,36 patients with intestinal Behcet's disease were collected.The general information of the patients,manifestation of Behcet's disease,digestive symptoms,lab findings,imaging findings,endoscopic examination results,treatment and prognosis of Behcet's disease were analyzed.Chi square test and Fisher exact probability test were performed for count data analysis.Single factor and multi factors of efficacy were analyzed by Logistic regression analysis.Results Among 36 patients with Behcet's disease (male 19 and female 17),the mean onset age was 26.5 years old and the average course of disease was (8.2±6.8) years.Symptoms of digestive system of 91.7％ (33/36) patients showed up later than system manifestations of Behcet's disease appeared.All 36 patients had oral ulcer.The rates of genital ulcers,skin diseases,inflammation and joint disease were 63.9％ (23/36),58.3％ (21/36),25.0％ (9/36) and 25.0％ (9/36),respectively.The main symptoms of digestive system were abdominal pain,diarrhea,bloating and hemafecia,of which abdominal pain was the predominant symptom and the incidence rate was 75.0％ (27/36).Gastrointestinal bleeding,intestinal perforation,intestinal obstruction and arteriovenous fistula were the common complications of Behcet's disease and the incidence rates were 36.1％ (13/36),2.8％ (1/36),2.8％ (1/36) and 2.8％ (1/36),respectively.Among patients with ocular lesions,male patients were more than female patients (male six and female three),and the difference was statistically significant (x2 =0.111,P＜0.05).Erythrocyte sedimentation rate increased in 55.6％ (20/36) patients.C-reactive protein was positive in 27.8％ (10/36) patients.Nine patients received computed tomography (CT) examination,there were five cases with thickened bowel wall and one case with proliferative lesions at ileocecal valve.Ileocecum was the predilection site,and accounted for 36.1％ of the disease (13/36).Endoscopic appearance was mainly ulcers.Pathological examination indicated non-specific acute and chronic gastrointestinal mucosal inflammation and the formation of inflammatory granulation tissue.Twerty-two patients received sulfasalazine (SASP) treatment and 24 patients accepted glucocorticoid therapy.After Behcet's disease recurrence,five patients received combined immunosuppressive therapy,five patients received immunosuppressive therapy and tumor necrosis factor (TNF) antagonist treatment,and nine patients received TNF antagonist treatment.All the patients treated together with proton pump inhibitor (PPI).Twelve patients without glucocorticoid treatment took thalidomide and immunosuppressive therapy.The efficacy was good in patients with immunosuppressive therapy or TNF antagonist treatment and the recurrence rate was low (r=3.984,P ＜ 0.05).Conclusions Most patients with intestinal Behcet' s disease are young adults.Symptoms of digestive system show up later than system manifestations of Behcet's disease appeared.Ileocecum is the predilection site of digestive system.The common endoscopic appearance is ulcers.Corticosteroids and sulfasalazine are the main therapy,which could be much more effective when combined with tumor necrosis factor antagonists or immunosuppressive therapy.