Objective To discuss the value of emergency bedside ultrasound in diagnose of blunt abdominal injury. Methods Portable ultrasound was used in 184 patients with blunt abdominal trauma in emergency department. The abnormal changes of the sound and image of the abdomen were observed,paying equal attention to free intraperitoneal fluid and gas. Results The emergency bedside ultrasound identified 169 (91.8%) patients with blunt abdominal injury, of whom 149 patients (95.5%) with single-organ injury and 20 patients (71.4%) with multi-organ injury. There were 21 patients missed diagnosis and three misdiagnosed, with rate of missed diagnosis and misdiagnosis of 13%. Surgical treatment was performed in 119 patients and conservative treatment in 65, which were proved by CT/MRI examination or clinic conservative treatment. Conclusion Emergency bedside ultrasound can provide fast and credible diagnostic information for blunt abdominal trauma, with high diagnosis accordance rate.

Objective:To study the diagnostic value of audiological and vestibular function examination in the pontocerebellar angle tumor.Method:The data of audiological and vestibular function test were analized retrospectively in 20 subjects with tumors of the pontocerebellar angle.Result:Pure tone and ABR waveforms were abnormal in 20 subjects (21 ears),moreover acoustic stapedius reflex and the vestibular function were abnormal in 19 subjects.Conclusion:It′s valuable that audiological and vestibular function examinations are able to diagnosis the pontocerebellar angle tumor.

Objective To explore the procedures of breast repair and reconstruction after mastectomy with three methods for optimal appearances of the breast.Methods Three methods were adopted in this study:(1)Two-stage breast reconstruction operation with ampliate latissimus dorsi myocutaneous flap after mastectomy;(2)One stage breast reconstruction operation with transverse rectus adbominis myocutaneous(TRAM)flap after mastectomy;and(3)Two-stage breast reconstruction and nipple repair operation with tissue expander/implant after mastectomy preserving pectoralis major museulus or implants along under pectoralis major musculus.Results All of the flaps survived well and were well-shaped in total 10 patients(10 breasts)with a flap breast reconstruetion,in which the superior ratios were 83.33%.The appearance and volume were not satisfactory in 1 patiant treated with the method of tissue expander/implant,because the volume of tissue inflation was smaller than another one and 100 ml implant was applied.The partial flap necrosis occurred in 1 case with the method of TRAM flap.Conclusions With the development of plastic surgery technique,the appearances and shapes of reconstructed breast achieve the satisfactory effects.After the ampliate latissimus dorsi myocutaneous flap is applied,the appearance and volume of reconstructed breast are similar to the healthy one.The two-stage nipple repair operation is applied with breast reconstruction operation by the tissue expander/implant after mastectomy preserving pectoralis major musculus.According to the different methods of mastectomy to choose suitable procedures of breast reconstruction,the satisfactory appearances and psychotherapy will be achieved.

Objective To compare the detection of flu A by nucleic acid amplification assav and rapid antigen assay in nasopharynx swabs and oropharynx swabs of flu-like patients.Methods A total of 170 flu-like patients were recruited in out-patient of Youan Hospital from September to October in 2009.Both nasopharynx swabs and oropharynx swabs were collected.Flu A virus was detected by both real-time reverse transcriptation polymerase chain reaction (RT-PCR) and rapid antigen assay.The data were analyzed by chi square test.Results For nasopharynx swabs,the positive rate of nucleic acid amplification assay was 74.1%(126/170),while that of rapid antigen assay was 65.9%(112/170)(X2=2.75,P>0.05).However,for oropharynx swabs,the positive rate of nucleic acid amplification assay was much higher than that of rapid antigen assay(62.9% vs 38.8%)(X2=19.78,P<0.01).Moreover,for nucleic acid amplification assay,the positive rate of nasopharynx swabs were higher than that of oropharynx swabs (X2=4. 90, P<0. 05). For rapid antigen assay, the positive rate of nasopharynx swabs was also higher than that of oropharynx swabs (X2=24.95, P<0.01). Based on the outcome of flu A detected with nasopharynx swabs by the nucleic acid amplification assay,the sensitivities of oropharynx swabs by nucleic acid amplification assay,oropharynx swabs by rapid antigen assay, nasopharynx swabs by rapid antigen assay were 81.7%,50.0% and 94.8%, respectively; the specifieities were 90.9%, 93.2% and 95.5%, respectively;the positive predictive values were 96. 3%, 95. 5% and 98.2%, respectively; the negative predictive values were 63.5 %, 39.4 % and 72.40%, respectively; Kappa coefficients were 0.64, 0.30 and 0.75,respectively; the total coincidences were 84.1%, 61.20% and 89.4%, respectively. Conclusions The detection of flu A with nasopharynx swabs is more sensitive than oropharynx swabs, and nucleic acid amplification assay is more sensitive than rapid antigen assay.

Objective To analyze the influence of the polymorphisms of human leucocyte antigen (HLA)-Ⅰ molecule and the effects on plasma viral load of human immunodeficiency virus (HIV) infected male homosexual population in Beijing.Methods The HLA-A,HLA-B,HLA-C allele were typed by sequence specific primer-polymerase chain reaction (SSP-PCR),and viral load was detected in 157 chronic HIV infected persons.Normally distributed measurement data were analyzed by one-way or multi-way analysis of variance,while data of abnormal distributions were analyzed by Mann-Whitney U test.Results Among 157 chronic HIV infected persons,the number of Bw4 motifs on HLA-B loci was associated with a lower level of viral load (F=3.01,P=0.045).In these HIV infected persons,the viral load in HLA-B carrying Bw4/4 homozygote was (4.19±0.76) lg IU/mL,in HLA-B carrying Bw6/6 homozygote was (4.63±0.74) lg IU/mL (t=2.27,P=0.010).The viral load of those who carried three,one or none Bw4 motifs on HLA-A and HLA-B loci were (3.92± 0.97),(4.54±0.88) and (4.60±0.72) lg IU/mL,respectively (three vs none:t=2.53,P=0.015; three vs one:t=2.11,P=0.039).HIV infected persons who carried homozygote on any loci of HLA-A,HLA-B,HLA-C had comparable levels of plasma viral load to those who carried heterozygote on HLA-A,HLA-B,HLA-C loci.Among the persons who carried heterozygote on HLA-A,HLA B,HLA-C loci,Bw4/4 homozygote on HLA-B had lower levels of viral load than Bw6/6 homozygote on HLA-B (median:4.09 lg IU/mL vs 4.55 lg IU/mL,U=210.50,P=0.041).HIV infected persons who carried A30/B13/C06 or A33/B58/C03 haplotype had comparable levels of plasma viral load to those without A30/B13/C06 or A33/B58/C03 haplotype (t=0.40,P=0.69; t=0.68,P=0.49,respectively).Conclusions Bw4/4 homozygote on HLA-B loci is associated with lower HIV viral load.Furthermore,the plasma viral load of HIV infected persons carrying heterozygote on HLA-A,HLA-B,HLA-C loci could be influenced by the Bw4/4 homozygote on HLA-B locus,with a lower viral load.

Objective To analyze the clinical,radiological and pathdogical characteristics of idiopathic lymphoid interstitial pneumonia (idiopathic LIP) and to discuss its diagnosis,treatment and prognosis.Methods Respiratory physicians,pathologists and radiologists together retrospectively analyzed the clinical,chest roentgenogram,computerized tomography,pathologicM,diagnostic and therapeutic data of 3 patients with idiopathic LIP confirmed by lung biopsy.and reviewed the relevant literatures.Results The major symptoms of the 3 cases of idiopathic LIP were prgressive dyspnea and dry cough.Higher levels of γ-globulins in serum were found in all the cases.The characteristic radiographic manifestations were bilateral diffuse nodules and cysts.The pathologic feature was diffuse interstitial inflammation with polyclonal lymphocytes infiltration,especially with plasma lymphocytes.Corticosteroids and cytotoxic agents were used and good response to therapy was observed in the cases.Conclusions Idiopathic LIP has some characteristics on the clinical,radiological and pathological features,but the best diagnostic method depends on a clinical-radiological-pathological approach.The disease usually shows good response to combinative therapy of corticosteroids and cytotoxic agents.

Objective To analyze the influence factors of medical staff blood-bome occupational exposure by structural equation modeling,in order to improve medical staff of blood-borne occupational exposure protection performance of the system to provide the theory basis for operation.Methods The influence factors of medical staff blood-borne occupational exposure and their correlation were analyzed by exploratory factor analysis and structural equation modeling fitting.Results Model fitting was ideal,hospital decision-makers and department management directly affected the behavior intention of medical staff,department management greatly influenced by the behavioral intention to the medical personnel,path coefficient was 0.27.Hospital decision-makers of behavioral intention to the medical personnel directly affect smaller,path coefficient was 0.03,but its indirect impact on behavioral intention by department management.Behavioral intention of occupational exposure protection action,the path coefficient was 0.80,behavioral intention determined the basic medical personnel blood-borne occupational exposure protection behavior.Conclusions Hospital should improve the system of standards and to establish effective communication channels,at the same time enhance the care ability.Enforcement departments should improve the standard system,equipped with adequate safety equipment,for the medical staff to provide the best working environment,so as to improve the medical staff of blood-borne occupational exposure protection behavior compliance.

Objective To investigate the gray matter volume differences between adult hypothyroid subjects and healthy controls using voxel-based morphometry (VBM).Methods A total of 28 untreated hypothyroid patients and 28 age and gender-matched uormal controlswere recruited.The coucentrations of their freetriiodothyronine (FT3),free theroxine (FT4),and thyroid stimulating hormone (TSH)were testedfrom their venous blood on the day they accepted MR scanning.High resolution 3D-datawereobtained using 3.0 T MRI scanner.VBM analysis was performed to detect the volume differences between the groups by using voxel-wise two sample t test.Multiple regression analysis was employed to analyze the influence exerted upon gray matter volume by serum FT3,FT4,and TSH concentrationof hypothyroid patients.Results Compared to controls,gray matter volumes in the bilateral superior frontal gyri,left precentralgyrus and bilateral cerebellum were decreased in hypothyroid patients (voxels 211-2 142,t=3.36-3.69,P＜0.01,corrected).No significant correlation between the gray matter volume in the above-mentioned brain regions and the clinical variables (serum FT3,FT4,and TSH concentration) (P＞0.05) was found in the multiple regression analysis.Conclusions VBM analysis revealed that hypothyroid patients exhibited reduced gray matter volume in multiple brain regions.It suggests that the lack of thyroid hormones can lead to the structural abnormalities in adult brain and selective gray matter atrophy in multiple brain regions.

Objective To discuss the influence of individual cognitive on medical personnel blood-borne occupational exposure protection action from the angle of behavior operation.Methods Medical staff of 14 hospitals in zunyi were investigated by questionnaire designed based on the theory of health belief model,and analyzed the data by structural equation model.Results Sample data and the assumption model was ideal,the blood-borne occupational exposure protective behavior of medical staff could be explained variance of 87％ by susceptibility,severity,behavioral benefit and barrier cognition.The order of influencing factors from high to low were behavioral benefit,severity,behavioral barrier and susceptibility to cognition,and path coefficients were 0.39,0.27,-0.21,0.03.Conclusions Susceptibility,severity and behavioral benefit cognition have positive effection on protective behavior,the behavioral benefit cognition have more influence on blood-borne occupational exposure protective behavior of medical staff,and behavioral barrier cognition have negative effection,the results of health belief model can explain blood-borne occupational exposure protective behavior of medical staff better.

Objective To investigate whether Bw4 motif expressed on HLA-B affects Gag-specific T cell responses in patients with acute HIV-1 infection.Methods Sequence specific primer polymerase chain reaction ( SSP-PCR) was performed for human leukocyte antigen ( HLA) typing.Peripheral blood mononuclear cells ( PBMCs) from 36 patients with six months of acute HIV-1 infection were stimulated with HIV-1 CRF01_A/E Gag peptides to detect the HIV-1 specific T cell responses by using ELISPOT assay. Results (1) The set point viral load of 18 patients carrying no Bw4 motif on HLA-B was 4.49±0.56 which was higher than that in other 18 patients carrying 1-2 Bw4 motif(s) on HLA-B (3.78±0.75) (P=0.005). (2) T cells from 26 out of 36 patients with acute HIV-1 infection responded to P24 peptides pool including 15 patients carrying no Bw4 motif on HLA-B and 11 patients carrying 1-2 Bw4 motif( s) on HLA-B, but no significant difference was observed between them (P>0.05).The magnitude of P24-specific T cell responses induced in patients carrying no Bw4 motif on HLA-B was (1317.8 ±1238.0) SFC/106 PBMCs which was greater than that induced in patients carrying 1-2 Bw4 motif(s) on HLA-B [(549.9±778.5) SFC/106 PBMCs] ( P=0.032) .The breadth of T cell responses to P24 peptides was 2(0-5) in patients carrying no Bw4 motif on HLA-B which was broader than that of patients carrying 1-2 Bw4 motif(s) on HLA-B [1(0-4)] (P=0.080).(3) The viral loads of HIV-1 infected patients carrying no Bw4 motif on HLA-B were negatively correlated with the magnitude of P24-specific T cell responses (rs=-0.482, P=0.043) and the breadth of responses to P24 peptides (rs=-0.496, P=0.036).No correlations were observed between viral loads and the magnitude or breadth of P24-specific T cell responses in HIV-1 infected patients carrying 1-2 Bw4 motif(s) on HLA-B.Conclusion Compared with HIV-1 infected patients carrying no Bw4 motif on HLA-B, the patients carrying 1-2 Bw4 motif( s) on HLA-B showed lower levels of set point viral load, weak-ened magnitude of P24-specific T cell responses and narrowed breadth of responses to P24 peptides.