Objective To explore the pathognomonic findings of anaphylactic shock in forensic medicine. Methods Animal model of anaphylactic shock was developed in guinea pigs. Substance P level in plasma was determined radioimmunoassay, and detected in laryngopharyneal tissue and the lungs by immunohistochemical SABC method followed by image analysis using BI - 2000 image analyzing system. Positive index (PI) was calculated. Results There was a statistically significant difference for substance P concentration in plasma between the guinea pigs with anaphylactic shock (131.01? 18.93pg/?l)and the control animals (87.70 ?7. 60pg/?l) (P

Objective: To investigate the effects of the combination of imbalanced branched-chain amino acids and 5-fluorouracil (5-FU) on nutritional and survival condition of tumor-bearing rats. Methods: The SD rats were each given a catheterization of jejunostomy and an inoculation of Walker-256 carcinosarcoma cells subcutaneously. Forty-eight rats were randomized into 4 groups: Group A (balance amino acid + NS), Group B (balance amino acid + 5-FU), Group C (valine-depleted amino acid + 5-FU), and Group D (complex amino acid of valine-depleted and leucine-supplemented + 5-FU). The change of rat′s weight, main organ weights, serum prealbumin (PA) and transferrin (TF) concentration were investigated.In addition, rat′s survival time was observed. Results: The loss of rat′s weight in group C was significantly increased compared with group A and B (P

Objective To investigate the diagnostic criteria, clinical management and prognostic factors of primary central nervous system (CNS) histiocytic sarcoma (HS). Methods An adult patients with primary CNS HS was reported, and literature on the rare entity were reviewed. Results The patient had no previous history of disease. Magnetic resonance imaging (including magnetic resonance spectroscopy) suggested a mass in the frontal lobe with obvious vasogenic edema, which was considered glioma. Surgery was the initial treatment and the tumor was totally removed. The histological findings revealed the HS. The patient received concomitant chemoradiotherapy postoperatively and currently lived without recurrence. Conclusions Primary CNS HS is extremely rare hematopoietic malignant tumor. The pathological feature and comprehensive immunophenotype panel are the useful ways to establish the diagnosis till now. Primary CNS HS should be treated intensively with surgery, chemotherapy, and/or radiation therapy. However, prognosis is disappointed in most of patients. Concomitant chemoradiotherapy might be an alternative treatment.

Objective To discuss the cause,treatment and prevention of splenic injury during the urological surgery.Methods The clinical data of 16 cases with splenic injury in operation for renal and adrenal tumors in 496 cases were retrospectively analyzed.Nine cases were left radical nephrectomy,3 cases were left renal hamartoma enucleation,4 cases were left adrenal tumor resection.Damage located at outer edge of the spleen in 8 cases,the splenorenal ligament in 6 cases,and the splenic hilum in 2 cases.In these 16 cases,14 patients spared the spleen (Ⅰ Grade injury 8 cases,Ⅱ grade 6 cases).The injuryed spleen was directly pressed with hemostatic gauze in 3 cases; 5 patients used coagulation,bonding,hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injury used U-shaped suture and coated with fibrin glue,then compressed with hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injuries with the greater omentum stitched into the seam,sprayed biological glue,were compressed with gelatin sponge; 2 cases of grade Ⅱ injury underwent splenic artery branch ligation.The other 2 cases (1 Ⅱ grade and 1 Ⅲ grade) underwent splenectomy.Results All of the 16 patients were cured and followed up for 6 months to 5 years.There was no delayed bleeding of spleen and splenic dysfunction.One patient died of tumor recurrence 6 months after operation.Conclusions Splenic injury is a common complication during urological surgery,especially the tumor is large or adhered to spleen in the upper pole of left kidney.Once spenic injury occurs,doctors should choose the right treatment plan according to surgical injury,and try to save the spleen.

Objective To evaluate the diagnosis and treatment of urinary tract endometriosis.Methods Retrospective review of 10 female cases of urinary tract endometriosis was carried out. All cases age was from 28-49, and the average age was 39-year-old. The course of this disease was from 6 months to 3 years. Four of 10 cases were bladder endometriosis. The clinical presentations included the urgency, frequency, pain at micturition and lower abdomen pain during menstruation, gross hematuria coinciding with menstruation 1 case. B-ultrasound and CT showed the mass of bladder from 2. 0 -3.5 cm but were not specific. Four of 6 cases ureteral endometriosis were the left side and 2 cases were the right side. This clinical presentation included non-specific flank or abdomenal discomfort in 4 cases, intermittent gross hematuria in 1 case and 1 case renal hydronephrosis was found incidentally by B-ultrasound. B-ultrasound indicated unilateral upper urinary tract dilation and hydrops in all cases,with pyelic separation from 2.0-4.5 cm and ureteral separation from 1-2 cm. CT indicated stenosis of the lower ureter in 5 cases, ureter tumor in 1 case. Results All cases were treated surgically.Partial cystectomy were performed in 4 cases of bladder endometriosis, of which, 1 case bilateral oophorectomy and hysterectomy. Five cases were performed ureteral segmental resection, of which, 3 ureterocystostomy and 2 terminoterminal anastomosis. 1 case was performed radical nephrectomy and ureterectomy. Postoperative pathological findings confirmed the diagnosis of endometriosis. Postoperative oral hormone therapy was given to 9 cases for 6-12 months. All cases were followed for 12-60months. 2 cases ureteral endometriosis had recurrent hydronephrosis in 18-24 months. The 2 cases received ureteral stent and cured by oral hormone therapy or goserelin subcutaneous injection for 3 months. Conclusions Urinary tract endometriosis usually shows non-specific symptoms. The diagnosis can be missed on both clinical examination and preoperative work-up. Surgical treatment is effective and adjuvant hormone therapy is often recommended to prevent the recurrence.

Objective To investigate the therapeutic efficacy of castration with 125I brachtherapy in middle and late stage prostate cancer. Methods Sixty-six patients with prostate cancer from 2004 to 2009 were analyzed, 40 were at clinical stage C and 26 were at clinical stage D, 42 had a pathologic grade G2 and 24 had a pathologic grade G3. The first endocrinal therapy used was total androgen blockade (chemical castration and anti-androgen drugs). The therapeutic time was three months before bilateral orchidectomy and brachtherapy. A 3D radiotherapy planning system was used for brachtherapy with transrectal ultrasound-guided radioactive 125I seed uniform implantation. Follow-up endocrinal therapy was decided according to a monthly check of serum PSA (prostate specific antigen) levels. After six months, serum PSA, IPSS and volume of the prostate before and after treatment were compared. Results The operations were completed successfully in all cases. The mean number of 125I seeds implanted was 55. The mean follow-up was 10 to 62 months, with an average of 49 months. Serum PSA, IPSS and the volume of the prostate was reduced significantly six months after operation (P<0.05). Conclusions Castration with 125I brachtherapy is an effective approach in combination therapy for treating middle and late stage prostate cancer.

Objective To discuss the effect of invasive intracranial pressure (ICP) monitoring in treating traumatic brain injury (TBI).Methods A total of 116 patients with TBI (including 112 with severe TBI,3 with moderate TBI and 1 with slight TBI) were monitored by using invasive ICP monitoring device in Tiantan Hospital from July 2003 to December 2007.All patients underwent ICP monitoring within first 24 hours after admission and treated with corresponding therapy including drug therapy and surgical treatment.Results Of all,74 patients survived but 42 with severe TBI died.Of 75 patients with GCS 3-5,33 died,with morbidity rate of 44%.Of 37 patieats with GCS 6-8,nine died,with morbidity rate of 24%.Four patients with GCS 9-15 survived.Conclusions Continuous ICP monitoring can help timely understanding of ICP changes for early diagnosis and correct treatment of TBI and is useful for judgment of prognosis.Low GCS and high ICP are predictors for bad outcome.

Objective To investigate the occurrence of posttraumatic stress disorder (PTSD) and the relationship between PTSD and emotional regulation strategies of mothers with neonates hospitalized in the neonatal intensive care unit (NICU). Methods One hundred and twenty-seven postpartum women with neonate hospitalized in the NICU were selected from a general hospital. All the cases were investigated by PTSD check list-Civilian version (PCL-C) and emotion regulation questionnaire (ERQ). Results The incidence of PTSD of postpartum women with neonate in NICU was 13.4%(17/127). The expressive suppression scores in positive PTSD group were (17.76±2.46) points,which were significantly higher than (14.16 ± 5.14) points in negative PTSD group (t=-4.659, P<0.01). Expressive suppression contributed significantly positive correlation to the total and the dimension scores of PCL-C (r=0.187-0.243, P<0.05 or 0.01). Expressive suppression was found to contribute significantly to the explained variance in mothers′ PTSD (P<0.05), whereas no association was found between PTSD and cognitive reappraisal (P>0.05). Conclusions The admission of neonates to the NICU is a stressful event for mothers, which could cause PTSD symptoms. PTSD has a closer relationship with expressive suppression, rather than cognitive reappraisal. Therefore, health workers should instruct mothers with neonates in NICU to regulate emotions by appropriate coping strategies, decreasing the possibility of psychological problems, promoting the mental health of women in the perinatal period.

Objective:To probe into the status characteristics and the dynamic change trend of the psychological stress among medical staff at four time points after exposed to blood-borne pathogen.Methods:A longitudinal study was carried out among 78 medical personnel in this study,with 67 of hepatitis B virus,5 of hepatitis C virus,4 of HIV and 2 of treponema pallidum respectively.Perceived stress scale (PSS-4),Post-traumatic stress disorder Checklist-5 (PCL-5),Hospital anxiety and depression scale (HADS) were used to assess the psychological status,including perceived stress,post-traumatic stress symptom,anxiety and depression at the four times.Data analysis was performed using repeated measures analysis of variance (RMANOVA) and paired sample t test to explore time effect of the psychological stress reaction in the exposed population.Results:The scores of PSS-4,PCL-5,HADS-A,and HADS-D increased from exposure,and gained highest at one month after exposed,then gradually declined with time (Ps ＜ 0.05).Conclusion:It suggests that the levels of perceived stress,post-traumatic stress symptom,anxiety,depression may be the highest at one month after exposed.

Objective To explore the chronergy of fibrinolysin and its influence on fibrinogen ( FIB ) and thrombus precursor protein (TpP) in treatment of acute cerebral infarction (ACI). Methods The clinical trial adopted the randomized single-blind placebo-controlled design.Totally, 150 patients with ACI (onset time≤12 h) were chosen and randomly divided into experimental group A ( group A receiving treatment of fibrinolysin after 12 h onset of ACI ) , experimental group B ( group B receiving treatment of fibrinolysin after 24 h onset of ACI) and control group ( group C without fibrinolysin treatment) , 50 cases in each group.The patients in experimental group A and B received basic treatment for ACI and fibrinolysin treatment.Patients in group C were given the basic treatment for ACI and placebo.The level of FIB and TpP before and after 7 days treatment, NIHSS scores before and after 14 days treatment, BI scores before and after 90 days treatment, incidence rate of progressive cerebral infarction ( PCI ) , stroke recurrence and mortality rate of the three groups were analyzed to evaluate the clinical effect of fibrinolysin.Hepatic and renal function before and after 7 days treatment, incidence rates of haemorrhage and hypersensitiveness were analyzed to evaluate the security of fibrinolysin. Results The NIHSS score of patients in group A, B and C (4.0±1.6, 6.5±2.2 and 8.0±4.7) was declined significantly after treatment (P<0.05).Group A and B declined more than group C (P<0.05).Group A declined even more than group B (P<0.05).The BI score of patients in group A, B and C after treatment was 68.5±30.6, 55.6±29.2 and 49.7±28.9.The BI score of all groups increased significantly after treatment (P<0.05).Compared with group B and C, group A increased more significantly (P<0.05).The incidence rate of progressive stroke in group A, B and C was 4%, 20% and 30%, respectively.The incidence rate of progressive stroke in group A was lower than that in group B and C (P<0.05).The recurrence rate of stroke after 90 days treatment in group A, B and C was 6.3%, 8.3% and 25.5%, respectively.The recurrence rate of stroke after 1 year treatment in group A, B and C was 10.4%, 12.5% and 31.9%, respectively.The recurrence rates of stroke in group A and B 90 days and 1 year after treatment were significantly lower than those in group C (P<0.05). There was no significant difference in the mortality between the three groups (P>0.05).The FIB in group A, B and C after treatment was (2.74±0.75) g?L-1,(2.82±0.83) and (3.67±1.35) g?L-1, respectively.The level of FIB in the three groups did not decrease significantly after treatment (P>0.05).However, the level of FIB in group A and B declined significantly as compared with that in group C.The TpP in group A, B and C after treatment was (3.56±1.26) mg?L-1, (3.43±1.22) and (13.21±6.54) mg?L-1, respectively.The level of TpP in group A and group B decreased significantly after treatment (P<0.05). The level of TpP in group A and B declined even more significantly than that in group C.Fibrinolysin did neither obviously injure liver and kidney nor increase the risk of bleeding, and had low hypersensitiveness incidence rate. Conclusion Treatment with fibrinolysin within 24 h after onset of cerebra infarction benefits the patients. However, dosing after 12 h onset of ACI benefits more than dosing after 24 h.Fibrinolysin plays a role of anti-thrombosis primarily by lowering the TpP level, and its influence on fibrinogen is limited.