Objective To study the clinical features and pathology of renal damage in patients with MPA. Method The clinical pathological changes of 23 MPA patients were analyzed and the patients with positive ANCA were compared with those with negative ANCA. Results Most MPA patients were senile and male with the symptoms of lung damage, pleuritis, arthritis and myalgia as well as extrarenal symptoms such as fever, weight-loss, and anorexia. 65.2% of the patients were ANCA (+). Symptoms of renal function damage were hematuria and proteinuria, which could be found in all the patients. Different degree of renal damage could be detected. Glomerular cresent formation, which were mostly fibrous, could be found in all of the 23 patients. Half of the patients have tuft necrosis and interstitial vessel vasculitis. Conclusion MPA patients often have extrarenal symptoms besides renal function damage. Patients with positive ANCA differs from patients with negative ANCA in both clinical manifestation and kidney pathology.

Objective To investigate the clinical values of serum amyloid A (SAA) and hypersensitivity C reactive protein(hs-CRP) in the diagnosis of postoperative infection in patients with ovarian tumor.Methods Clinical data of 679 patients with ovarian tumor were retrospectively analyzed.According to the development of postoperative infection or not,all patients were assigned into infection group(n =45) or non-infection group(n =634).The primary outcomes indicators were SAA,hs-CRP,C reactive protein(CRP) and white blood cell.Results Compared with the non-infection group,the infection group got a significantly higher levels of SAA [(104.73 ± 34.74) mg/L vs.(6.12 ±0.74) mg/L,t =25.546,P =0.000] and hs-CRP [(142.35 ± 43.84) mg/L vs.(18.45 ± 5.39) mg/L,t =24.595,P =0.000] and white blood cell [(11.48 ± 3.59) × 109/L vs.(7.49 ± 2.83) × 109/L,t =6.305,P =0.000] and CRP [(32.58 ± 10.48) mg/L vs.(16.34 ± 8.47) mg/L,t =8.496,P =0.000].The area under the Receiver Operating Characteristic of SAA,hs-CRP,white blood cell and CRP were 0.879 (95％ confidence interval:0.825 ～ 0.920,P =0.000),0.858(95％ confidence interval:0.792 ～0.925,P =0.000),0.737(95％ confidence interval:0.658 ～0.817,P =0.000) and 0.767 (95 ％ confidence interval:0.713 ～ 0.822,P =0.000).Z tests showed that the areas under the curve of SAA and hs-CRP in the diagnosis of postoperative infection in patients with ovarian tumor were higher than white blood cells and CRP(all P ＜ 0.05).Conclusion SAA and hs-CRP have better diagnostic values in the postoperative infection of ovarian tumor,and it is worth to be popularized.

The present study was designed to investigate the effects of mifepristone on apoptosis of the decidual tissue cells and apoptotic correlated gene Fas/FasL expression in human early gestational period. The extent of DNA fragmentation of apoptotic cells were assessed by using an in situ terminal transferase reaction to label free 3′ ends of the DNA.The expression of Fas, FasL in the deciduas was examined by in situ hybridization with cDNA probe and immunohistochemical staining with polyclonal antibodies, respectively. The results showed that there were evident apoptosis in decidual tissues at about 40 days of gestation. Fas and FasL were strongly expressed in these decidual tissues. At about 50 days of gestation, there were a few apoptotic cells in the decidual tissues. Expression of Fas, FasL decreased at the same time. More apoptotic cells were observed in decidual tissues after adiministration of Mifepristone (RU486) in about 50 days of gestation. Fas, FasL mRNA and protein were up regulated after administration of Mifepristone. The results suggested that the induction of apoptosis by Mifepristone in decidual tissues might be one of the major mechanisms with regards to contraceptive and antigestational effects of mifepristone. Fas pathway might participate in the process of decidua apoptosis induced by RU486.

Objective To investigate the effects of mifepristone on apoptosis and expression of relative genes in early pregnant chorionic villi and decidua Methods The specimen of early pergnant chorionic villi and decidua obtained from 10 cases of requesting temination of pregnancy by curettage, 20 cases of mifepriston contragestation The paraffin sections were used to determine apoptotic cells by TdT mediated dUTP biotin nick end labeling method, to identify bcl 2, bax, fas, fasL and proliferating cell nuclear antigen (PCNA) by immunohistochemistry, to demonstrate fas and fasL mRNA by in situ hybridization Results In normal early pregnant specimens, apoptotic cells were mainly observed in syncytiotrophoblast, but not in cytotrophoblast cells, occationally seen in decidua cells The antigen of bax, fas, fasL were present in syncytiotrophoblast cells and decidua with lower amount While bcl 2 antigen staining was strong in cytotrophoblastic cells and in decidua PCNA protein was present in cytotrophoblastic and decidual cells only In the specimens treated with mifepristone, apoptotic cells were increased in syncytiotrophoblastic cells of villi and visualized in decidua cells The expression of fas, fasL and bax was also higher than that of nomal Conclusions Mifepristone increased apoptosis in syncytiotrophoblastic and decidua cells, but had no effect on the expression of bcl 2 and PCNA

OBJECTIVE:To establish a method for the determination of residual solvent of ethanol and toluene in diphenhydr-amine hydrochloride raw material. METHODS:Headspace capillary gas charmatography and butanone as internal standard were used. The column was Agilent DB-624 capillary column,inlet temperature was 200 ℃,hydrogen flame ionization detector was 250 ℃,the carried gas was high purity nitrogen,flow rate was 3.0 ml/min with temperature programmed,the splitting-ratio was 20∶1,the containers of headspace injector were in equilibrium at 80 ℃ for 30 min,and the injection time was 1 min. RESULTS:With this chromatographic condition,ethanol,toluene and internal standard peak were well separated;there was a good linear rela-tionship of ethanol and toluene in the range of 0.02-0.8 mg/ml (r=0.999 8 and r=0.999 4);RSDs of precision and stability test were lower than 3%;recoveries were 95.50%-103.50%(RSD=2.6%,n=9) and 96.91%-103.74%(RSD=2.2%,n=9). CON-CLUSIONS:The method is simple,sensitive and accurate,and can be used for the determination of residual solvent of ethanol and toluene in diphenhydramine hydrochloride raw material.

Objective To prevent the occurrence of violence in the emergency department,to reduce the damage to medical personnel,and to maintain the normal medical order in emergency department.Methods A retrospective analysis of medical incidents of violence in the emergency department has been made.A root cause analysis (RCA) group has been established to explore the root cause of the incident and to make the violence emergency preplan of emergency department.Results Medical personnel have been trained according to the plan.It has improved the awareness of health care workers.The incidence of violent injury incidents decreased.Conclusions The establishment and training of emergency preplan can improve the awareness and prevention ability of emergency medical staff to violence injury.The safety of medical staff in emergency department can be guaranteed.

Objective To observe the injury of some chief organ induced by paraquat (PQ) poisoning in rats, and to explore the mechanism. Method A total of 60 inbred line SD rats were randomly divided into experimental group (n = 30) and control group (n = 30), and each group was further divided into 6 subgroups (n =5) as per the sacrifice of rats at different intervals. The rats of experimental group received the intra-abdominal injection of paraquat (1 mg/mL, 18 mg/kg), and the rats of control group were treated with the same amount of saline solution instead. The rats of each subgroup were sacrificed separately 2 h,6 h, 12 h,24 h,72 h and 120 h after administration of PQ or saline. Lungs, livers and kidneys were taken for histopathological study. Results There was noticeable exudate in lung tissue of rats in experimental group in the early stage. And then the cystic changes in the liver of rats in experimental group were found. A noticeable hemoglobin was found in the renal tubules 24 h after modeling. But the exudation in lung decreased 24 h later, and in the mean time, the disorganization of pulmonary alveoli was obvious and some remarkable collagen appeared in the interstitial tissue of lung, and it was significantly obvious 72 h after modeling. In the liver of rats in experimental group, the injured tissue had some extent of repair in 72 h after modeling, and recovered gradually. But the injury of kidney was exacerbated 72 h after modeling. In the control group, the lung, liver and kidney were not changed in all stages after modeling.Conclusions The paraquat could induce failure of some chief organs in SD rats. The injury was most remarkable in the lung in a progressive way. The kidney injury was not more severe than that of lung tissue, but the pathological changes of the kidney became worse and worse as time taken. The injury of liver induced by paraquat was slight, and the injury could heal up gradually.

Objective To explore the treatment using two different ventilation tubes insertion for secretory o-titis media ,and to determine which factors are associated with the tympanic membrane perforation after a extrusion or surgical removal of a ventilation tube(VT) .Methods A retrospective analysis of 121 cases (210 ears) with re-fractory secretory otitis media from 1998 June to 2013 March was carried out .There were 58 cases (105 ears ) and 63 cases (105 ears) in patients and control group ,respectively .All subjects had more than 2 years of history ,and were treated by two types of ventilation tube (Goode -T and Shepard tube) .Various factors were analyzed to deter-mine the factors associated with persistence of a tympanic membrane perforation after VT extrusion or removal ,in-cluding gender ,age ,medical history ,ventilation tube pattern ,location ,history of previous VT insertions ,intuba-tion period reason for VT insertion ,condition of the TM ,nature of the tympanic cavity effusion and previous ade-noidectomy ,et .Results Analysis factors of perforation group (105 ears) and the control group (without perfora-tion ,105 ears) ,were statistically significant in ventilation tube pattern (χ2 =6 .916 ,P<0 .01) ,history of previous VT insertions(χ2 =7 .325 ,P<0 .01) ,frequency of previous VT insertions (χ2 =13 .01 ,P<0 .01)and the nature of the tympanic cavity effusion(χ2 =7 .04 ,P<0 .01) .The proportion of perforation group about Goode - T ventilation tube ,history of previous VT insertions ,the frequency of tube (more than 3 times) ,mucus of the middle ear cavity were 58 .4% ,57 .3% ,66 .7% and 57 .9% respectively ,others had no significant difference between the two groups . The multivariate analysis showed that ,regardless of the ventilation tube ,the frequency of tube was the tympanic membrane perforation risk factor ;Goode-T tube increased the risk of perforation of tympanic membrane was 1 .637 times than Shepard tube(OR=1 .637 ,P<0 .01) .Conclusion Using the Goode - T type ventilation tube ,history of previous VT insertions ,the frequency of tube (more than 3 times) ,mucus of the middle ear cavity were four risk factors for persistence of a tympanic membrane perforation after VT insertion for secretory otitis media .

Objective To study the efficacy of hyperbaric oxygen(HO)for the delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)Method One hundred and eleven patients who were diagnozed as the DEACMP from November 2000 to March 2007 in Tangdu Hospital the Fourth Military Medical University were randomly divided into two groups.Thirty-six cases were treated by onventional approach(group A),and 76 cases by HO besides conventional treatment(group B).The efficacy of HO was evaluated after 4courses of treatment. The curative effects were evaluated as(1)cured:clinical symptoms and signs fully disappeared,abnormal electroencephalogram recovered,patients were completely self-help and competent enough for routine work.(2)improved:chnical symptoms and signs partly disappeared,abnormal electroencephalogram partly recovered,patients were partial self-help and incompetent enough for routine work.(3)inefficacy:patient's condition didn't changed.Data were expressed as((x)±s)and analyzed with the chi-quare test and t-test.The statistical significance was established as P＜0.05.Results In group B,62(81.58%)were in good recover,9(11.84%)improved and 5(6.94%)were inefficacy;while in group A:21(58.33%)were in good recover,5(13.89%)were improved and 10(27.78%)were inefficacy.The effciency rate in group B was significantly higher(93.42%)than that(72.22%)in group A(P＜0.05),and the required time for the therapeutic effect noticed time in group B were significantly shorter(P＜0.05)Conclusions HO Can improve the therapeutic effects on DEACMP

BACKGROUND:Hyperbaric oxygen (HBO) can increase oxygen diffusing capacity, thereby, improve hypoxic state of brain edema and brain tissue and promote the recovery of physiological function of brain cells in focal zone, the establishment of bypass circuit, and regeneration and repair of brain cells.OBJECTIVE: To observe the effect of hyperbaric oxygen on c-fos oncogene expression of rats at different time points following acute focal cerebral ischemia/reperfusion(I/R) injury.DESIGN : Randomized grouping animal experiment.SETTING: Department of Emergency, Tangdu Hospital, Fourth Military Medical University of Chinese PLA; Department of Laboratory Medicine, Xi'an Gaoxin Hospital;The General Hospital of the Air Force of Chinese PLA; Hyperbaric Oxygen Treatment Center, Department of Aerospace Medicine, Fourth Military Medical University of Chinese PLA.MATERIALS: This experiment was carried out in the Hyperbaric Oxygen Treatment Center, Department of Aerospace Medicine, Fourth Military Medical University of Chinese PLA in April 2002. Sixty-five 2-month-old healthy male SD rats.METHODS: The involved rats were randomized into: model group (n =20), normal control group (n =5), pure oxygen treatment group (n =20) and HBO treatment group (n =20). In the model group, following the method of Koizumi et al, rat models of middle cerebral artery (MCA) ischemia were developed. In the normal control group, only occlusion of arterial blood flow was omitted; In the pure oxygen treatment group, the operation procedure was the same as that of model group, and embolus being drawn out at ischemia for 1 hour, rats were placed in the hyperbaric cabin at 2,9,21, 45 and 69 hours after embolus being inserted, and they inhaled pure oxygen under the normal pressure; In the HBO treatment group, the operation procedure was the same as that of model group, and rats inhaled pure oxygen for 1 hour under 0.25 MPa pressure. MAIN OUTCOME MEASURES: By means of immunohistochemical and pathohistological methods, neutrophilic infiltration,c-fos oncogene protein and positive cell expression in cerebral cortex, preoptic area and corpora striatum of rats in each group were observed at cerebral I/R 5, 12, 24 and 72 hours; Neuronal necrosis degree in cerebral cortex, medial area of corpora striatum and preoptic area, and cerebrovascular leakage area of left cerebral hemisphere of rats were calculated.RESULTS: Sixty-five rats were involved in the final analysis. ① c-fos positive products mainly focused in the center of the preoptic area, but they were occasionally seen in the contralateral cortex, slightly expressed in the preoptic area and moderately expressed in the corpora striatum, c-fos positive products began to reduce in the above-mentioned area at ischemia 12 hours, and were obviously reduced at ischemia 24 hours; c-fos positive products in the cerebral cortex and preoptic area were obviously weakened in the HBO treatment group than in the simple ischemia group; At I/R 12 hours,neutrophils in the preoptic area and corpora striatum were significantly lower in the HBO treatment group than in the model group, respectively(P ＜ 0.05); At I/R 24 hours, neutrophils in the cerebral cortex, preoptic area and corpora striatum were significantly lower in the HBO treatment group than in the model group (P ＜ 0.05). ② Cerebrovascular leakage area was more significantly contracted in the HBO treatment group than in the model group (P＜ 0.05); At I/R 72 hours, the number of injured nerve cells in the optic chiasm cortex, medial area of corpora striatum and preoptic area was significantly smaller in the HBO treatment group than in the model group (P＜0.05). Neuronal damage was not found in the sham-operation group.CONCLUSION: HBO can markedly contract cerebrovascular leakage area of rats with acute focal cerebral ischemia/reperfusion injury, alleviate the symptoms of nervous system, inhibit neutrophilic infiltration and c-fos oncogene protein expression in the infarct area, and reduce neuronal necrosis in the "penumbral region".