Abdominal pain is a common presentation to the family physician clinic and emergency departments and although common, it is often a symptom of serious disease, with many diagnostic challenges that the physician has to overcome. The missed surgical abdomen often results in high morbidity and mortality to the patient, and high medico-legal risk to physicians. In certain patient groups, such as the elderly, the women of childbearing age and the immunocompromised, presentation of abdominal pain can be atypical, and hence additional caution and consideration should be taken. In order to mitigate risk in the challenging primary healthcare environment that the primary physician faces where investigative resources can be limited, a careful diagnostic approach with regards to history taking and physical examination is used, coupled with good documentation of findings and patient discussion.

Objective:To explore the possible specific perinatal risk factors in the development of autism through comparing the perinatal risk factors between patients with autism and other psychotic disorders.Methods: In this retrospective research,197 cases with autism and 93 cases with other psychotic disorders were selected and assessed with the self-made scale of perinatal risk factors.Statistical analyses were performed using t test and Chi-square test.Results:Compared with the control group,the autistic subjects had a significantly higher frequency of the perinatal risk factors(51 % vs.68%,P=0.003),particularly the rate of catching a cold during their mothers' pregnancy(14.2% vs.6.5%,P=0.038)and the rate of prematurity(10.7% vs.3.2%,P=0.022)than the control subjects.Feeding methods was different between the two groups(P=0.038).Conclusion:Catching a cold during mothers' pregnancy,prematurity and feeding methods may be related to the development of autism.

ObjectiveTo explore a procedure to correct the multiple facial deformities by using the expanded frontal flap combined with the axial flaps.MethodsAccording to the face deformity we used the rectangle 100-350 ml expanders behind the frontal hairline,after finishing the tissue expanding,adopted two or three axial flaps based on the supraoribital,supratrochlear or temporal vessels. ResultsA total of 13 cases were treated with this approach.7 eases were nose and lip defect reconstruction after burn,in which temporal vessel-based flap was used in 2 cases and supraoribital or supratrochlear vessel-based flaps in 5 cases.The other 6 cases were nasal reconstruction combined with the frontal defect correction by using random flaps,including 2 cases of pigmented nevus,1 neurofibroma,and 3 burn scars.All the flaps survived and satisfactory appearance was obtained.Conclusions The expanded frontal flap combined with axial flap based on multiple vessels is a good approach to correct the multiple facial deformities.

The aim of the experimental study is to investigate shortterm toxicity of an initial domestic Methotrexate microspheres(MTX-ms)by hepatic arterial infusion in rats,provide some experimental bases for clinic interventional treatment of liver carcinoma with this new chemoembolization agent.Compareing with control group and MTX group, MTX-ms of largedoses could result in temporal rise of GPT and AKP,deterioration or necroses of animal's liver at different degrees,12 days later a number of microspheres could still be found in the small arteries of the necrotizing area.No pathological changes related to microsphere could be found in other main organs(heart,spleen,lung and kidney).Results suggested that chemoembolization effect of MTX-ms is relatively strong;for effectively oc- cluding blood flow of hepatic arteries on the level of small arteries.Meanwhile MTX-ms oc- clud blood supply of liver carcinoma,they may also cause damages of normal liver tissue. Clinically more attention ought to be paid to the dosage of MTX1 microspheres and thus avoid the overflow of more microspheres to the normal liver tissue causing damage.

Background Wearing of soft contact lens,as one of the important methods to correct ametropia,has been widely applied at present.The clinically deleterious effects of soft contact lens have been reported,but researches about influence of apoptosis of corneal epithelial cells are scant.Objective This study was to detect and compare the ratio of apoptosis of corneal epithelial cells between the patients with contact lens wearing and without contact lens wearing,and explore the influence of soft contact lens wearing for long term on growth of corneal epithelial cells after injury.Methods A retrospective nest case-controlled study was designed.Forty eyes of 20 myopic patients with wearing of soft contact lens for ≥5 years and 40 eyes of 20 myopic patients without wearing of soft contact lens were included in Affiliated Hospital of Guiyang Medical College.All the patients received the off-flap epipolis laser in situ keratomileusis (Epi-LASIK) from 2010 October to 2011 June.The corneal flaps were collected during the surgery.The apoptosis of corneal epithelial cells was detected by flow cytometry(FCM),and the difference of apoptotic proportion between the two groups was compared using independent sample t test.Results The FCM scatter plot showed that compared to the without contact lens wearing group,the early stage of apoptotic cells with high staining annexin V and low staining proaium iodide (PI) were much more,and survival cells with low staining annexin V and PI were less,and necrotic and late stage of apoptotic cells with high staining of annexin V/PI were more in the with contact lens wearing group.The early stage of apoptosis proportion of corneal epithelial cells was (11.23 ± 5.31)％ in the with contact lens wearing group,and that in the without contact lens wearing group was (7.31± 5.43)％,showing a significant difference between them (t=2.754,P=0.008).Conclusions A long term wearing of contact lens induce more apoptosis of corneal epithelial cells,which can result in a disorder of structure and function of ocular surface during the wound healing stage.

Objective To observe the protection of Caspase inhibitor(zVAD-fmk,benzyloxycarbonyl-Val-Ala-Asp-fluoromethyl ketone) on neonatal rat with hypoxic-ischemic brain damage(HIBD).Methods Thirty-six neonatal rats,7 days old,were randomly divided into hypoxic-ischemic(HI) control group(A),zVAD-fmk treated group(B) and sham group(C).Before HI insult,a pan-Caspase inhibitor,zVAD-fmk or normal buffer solution was injected into the cerebral ventricle.The water content of cerebral hemisphere was measured and the percentage of apoptofic cells in hippocampal neurons was measured by Flow cytometer(Annexin V/PI) at 24 hours after HI insult.The effect on body weights(percentage of increased weight,WIP) and macroscopical changes(percentage of cortox and hippocampal dead neurons) were assessed at 14 days.Results Compared with group A,the water content of ischemic hemisphere and apoptosis percentage of hippocampal neurons in group B reduced significantly.The difference of percentage of increased weight at 14 days in group B was not significantly.Microscopic examination showed that cortox and hippocampus neural death rate in group B was proved significantly reduced compared with that in group A.Conclusion Intracerebral administration of zVAD-fmk has protective effects on hypoxic-ischemic brain damage in neonatal rat.

Objective To perform the comparative analysis on the test results acquired from three different types of hematology analyzers ,to explore their results comparability or whether their deviations being within the allowable range .Methods The 30 d in‐ternal quality control results collected from the three types of analyzers ,Sysmex XE2100 ,Sysmex XN3000 and Sysmex XT4000i , were analyzed and analyze .The XE2100 hematology analyzer with excellent results in repeatedly participating in the national exter‐nal quality control assessment was taken as the reference instrument ,while the Sysmex XN3000 and Sysmex XT4000i analyzers served as the contrastive instruments .Four blood samples from different patients with high ,medium and low values were randomly selected and detected for 5 d .The results of white blood cell(WBC) ,red blood cell(RBC) ,hematocrit(HCT) ,hemoglobin(HGB) and platelet(PLT) were performed the comparative analysis .Then the accuracy and comparability of the detection results were judged by F test ,regression equation and correlation coefficient .Results The detection result of WBC ,RBC ,HCT ,HGB and PLT had no statistical differences among three instruments (P> 0 .05) .The correlation of various indexes had close correlation (r≥0 .975) .The deviations conformed to the related requirements with comparability .Conclusion When conducting detection by multi‐ple instruments ,the quality control of experimental instrument should be paid attention to ,the different detection instruments should be conducted the calibration and comparison at regular intervals for ensuring the accuracy and consistency of detection re‐sults ,thus better serve clinic .

[Objective]To estimate the clinical effects of total hip arthroplasty(THA),bipolar and unipolar hemiarthroplasty for the treatment of femoral neck fractures(FNF) in the elderly.[Method]From February 1990 to February 2005,a follow-up study was done in 567 patients with femoral neck fractures in the elderly.The patients were divided into THA(n=275),bipolar hemiarthroplasty(n=195) and unipolar hemiarthroplasty(n=97) groups.The follow-up duration was from 3 to 15 years with an average of 8.5 years.The operation time,blood loss,volume of drainage,hospitalization time,complications and functional rehabilitation were compared.[Result]There were no statistical differences in the operation time,blood loss and volume of drainage between unipolar and bipolar hemiarthroplasty groups.There were no statistical differences in hospitalization time among the three groups.Compared with bipolar hemiarthroplasty,THR had a longer operation time and more blood loss,but had a higher functional scores and a lower rate of pain.Unipolar hemiarthroplasty had a lower functional scores and a higher rate of pain.[Conclusion]THR is especially suitable for those who are younger and active,bipolar hemiarthroplasty is suited to elderly patients,unipolar hemi-arthroplasty should be avoided because of its complications.

Cardiovascular disease is a major cause of morbidity and mortality in the contemporary society. Cardiac gene therapy has already been investigated in clinical studies profoundly. Adenovirus vector could transfer the gene efficiently, but low organ specificity and immuno- genie properties limited its application, With adenovims vector improved in the last few years, the third adenovims vector is probably the most potential vector systems for cardiovascular disease. This review will give a broad overview of the molecular basis of the adenovims vectors, their advantages, the development of increasingly efficient gene transfer approach, and experimental and clinical studies targeting the heart, application barriers and modified strategies.