Objective To evaluate the clinical value of fibrinogen and D-dimer(D-D)in the diagnosis of patients with acute pulmonary embolism.Methods A retrospective study was conducted.74 patients with acute pulmonary embolism were retrospectively analyzed.The general clinical data were gathered,and the patients were divided into high-risk group(n=20),moderate-risk group(n=32),and low-risk group(n=22)according to the 2008 ESC Guidelines on the diagnosis and management of acute pulmonary embolism.25 patients with physical examination were randomly recruited as control group.The plasma levels of fibrinogen and D-D were detected and compared between these groups.Receiver operating characteristic curve(ROC)was used to evaluate diagnostic biomarker performance.Results In acute pulmonary embolism patients,with the risk degree increased,the level of fibrinogen decreased[(4.20±0.82)g/L,(4.16±0.83)g/L,(3.62±0.74)g/L,(2.83±0.62)g/L](compared with control group,P=0.183,moderate-risk group,P=0.046,high-risk group,P=0.033;compared with low-risk group,moderate-risk group,P=0.041,high-risk group,P=0.037;compared with moderate-risk group,P=0.044),and the level of D-D increased[(1 845.20±3 939.56)μg/L,(4 405.27±2 356.68)μg/L,(4 360.63±2 675.40)μg/L,(16 817.00±6 878.66)μg/L](compared with the control group,low-risk group,P=0.392,moderate-risk group,P=0.042,high-risk group,P=0.027;compared with low-risk group,P=0.136,P=0.016;compared with moderate-risk group,P=0.035).The ROC curve showed that the AUC of D-D in each group were 0.865,0.834 and 0.974,respectively.AUC of FIB were 0.459,0.253 and 0.277,respectively,which were below or even significantly lower than predicted line area.Conclusion The performance of fibrinogen in the diagnosis of acute pulmonary embolism and the classification of the risk degree is very low.

Objective To explore the risk factors for the development of delayed neuropsychologic sequelae (DNS)and to characterize the clinical course following the development of DNS in acute CO poisoning cases. Methods This study included 79 cases of acute CO poisoning,and they were divided into two groups consisting of 13 cases who developed DNS and 66 cases who did not.The generally conditions of the two groups [including age, gender,exposure environment,the time of coma,whether through referral,the severity of disturbance of consciousness, computed tomography(CT)abnormal,first time to see a doctor if hyperbaric oxygen therapy]and laboratory index [carbon oxygen hemoglobin(COHb),WBC,creatine kinase (CK),creatine kinase isoenzyme (CK -MB),lactate dehydrogenase(LDH),hospitalization time,HBO]were analyzed by single factor variance analysis,Chi -square test and Mann Whitney U test.Results Compared with the non DNS group,in the DNS group,JCS score was significantly higher[(200.4 ±107.24)points vs.(94.55 ±52.71 )points,U =8.373,P <0.01 ],CT abnormal skull increased (76.9% vs.6.2%,χ2 =9.548,P <0.01),CK[(5976.33 ±4 371.92)IU /L vs.(2 384.67 ±650.86)IU /L,F =6.877],CK -MB[(51.22 ±33.28)IU /L vs.(23.47 ±15.66)IU /L,F =4.329],LDH[(395.80 ±270.04)IU /L vs.(221.87 ±101.95)IU /L,F =1.012]increased,there were statistically significant differences between the two groups by single factor analysis(all P <0.01 ).The patients with DNS had longer hospitalized time [(283.27 ± 251.08)d vs.(37.93 ±37.18)d,F =2.283]and HBO time[(51.62 ±16.69)d vs.(7.70 ±5.38)d,F =6.428], there were statistically significant differences between the two groups by single factor analysis (all P <0.01 ). Conclusion In patients with the characteristics identified in this study,administration of HBO therapy should be proactively considered after informing their family at initial stage,thus to decrease the risk of developing DNS.

BACKGROUND:Many domestic and foreign scholars and institutions are studying how to relieve radiation damage and to find the most suitable drug, while ginsenosides as the main pharmacological ingredient of ginseng show significant antioxidant effect. OBJECTIVE:To investigate the ease effect of ginsenosides on human hematopoietic stem cels under different intensities of ionizing radiations. METHODS: The CD34+ hematopoietic stem cels were isolated from the healthy cord blood. Then the cels were divided into normal group and ginsenoside-pretreated group, respectively, exposed under 1, 2, 5 Gy of X-ray irradiations for 24 hours. Cel viability was detected in irradiated hematopoietic stem cels by MTT assay. Apoptosis was estimated using the folowing assays: Annexin-V assay, caspase-3 mRNA and protein levels. The generation of reactive oxygen species was evaluated, in the presence or absence of ginsenoside in liquid cultures of CD34+ human hematopoietic stem cels irradiated with 1-, 2- and 5-Gy X-rays, using a flow cytometry assay. The Nrf-2 mRNA and protein levels were also studied by western blot analysis and RT-PCR, respectively. RESULTS AND CONCLUSION: Ionizing radiation at the therapeutic dose could decrease the viability of CD34+ cels and induce the cel apoptosis, and meanwhile, the activity of intracelular reactive oxygen species also showed a progressive increase that was correlated with the dose of ionizing radiation. However, ginsenoside pretreatment could relieve these above-mentioned effects. Ginsenoside inhibited the increase in caspase-3 activity induced by ionizing radiation, and additionaly, enhanced the mRNA and protein expressions of Nrf-2 in CD34+cels. In conclusion, ginsenoside protects CD34+ hematopoietic stem cels from radiation effects, which is probably correlated with anti-apoptosis and anti-oxidant roles of ginsenosides.

Objective To measure the equity of resources allocation in obstetric healthcare in Zhejiang Province, and provide evidence for decision making by healthcare departments of the government. Methods Lorenz curve and Gini coefficient were used to measure the equity of obstetric healthcare resources. Results The investigation found such allocation as equitable as measured by the layout of the number of live births, as the Gini coefficient of the distribution of obstetric doctors, nurses and beds was 0.1697,0.1971 and 0.1497 respectively by total birth, failing within the equitable range. However, when measured by geographic distribution, such coefficient were 0.2701, 0.3216 and 0.3341 respectively in cities, which were less equitable yet still within equitable range. Conclusions The government and health bureaus are recommended to scientifically predict the number of immigrants and rationally deploy healthcare resources according to the service radius of healthcare resources;moreover, more gynecologic doctors and nurses should be trained to improve the human resource structure in gynecologic departments. These effort can cater to the growing healthcare demands of the society resulting from a growing population of immigrants.

Cultivation of Medical Humanism Spirit has special value in the teaching of psychiatry,but which was ignored in the teaching. This paper explored the way to integrate humanistic spirit education into the teaching process of psychiatry.

Objective To investigate the expression of melatonin MT1 receptor in rats with acute necrotizing pancreatitis (ANP) and the protective effects of melatonin (MT) pre-intervention for the pancreas. Methods Fifty-four male Sprague-Dawley (SD) rats were randomly divided into three groups:sham-operation group, ANP group and MT-pretreated group. The models of ANP were induced by retrograde injection sodium taurocholate into the bili-pancreatic duct. MT group undergoing intraperitoneal injection 50 mg/kg 30 minutes before the establishment of ANP models. Four, 8 and 12 hours after the onset of operation, the levels of serum amylase and pathological changes of the pancreas were observed. The contents of malondialdehyde (MDA), superoxide dismutase (SOD) and tumor necrosis factor-alpha (TNFα) in the pancreas were measured. The expression of MT1 protein and MT1 mRNA in pancreas were separately analyzed by immunohistochemistry and real-time PCR. Results (1) Pancreatic pathological damage in ANP groups was progressive exacerbated. It was obviously ameliorated in MT group as compared with ANP group ( P ＜ 0.05 ); (2) Compared with SO group, the levels of serum amylase, MDA and TNFα in the pancreas were significantly increased in ANP group (P ＜0.05 or P ＜0.01 ). They were markedly decreased in MT group as compared with ANP group [ 12 h, (2348.00 ±278.90)U/L vs (3194. 83 ±538.10)U/L,(2.255 ± 0.472 ) μmol/L vs ( 2.960 ± 0.722 ) μ mol/L, ( 102.929 ± 29.399 ) ng/L vs ( 378. 544 ±183.454)ng/L, P ＜ 0.05 ]. The level of SOD was decreased in ANP group compared with SO group (P ＜0.05) and increased in MT group[ 12h, (11.448 ± 1.594)U/L vs (8.427 ± 1.950)U/L, P＜0.05] ;(3)Compared with SO group, the expression of MT1 protein and MT1 mRNA in ANP group were down-regulated as the severity of the disease increased ( P ＜ 0.05 ). They were significantly higher in MT group than ANP group. Conclusions Melatonin pre-intervention is able to increase SOD level and decrease MDA, TNFα levels, thereby reducing pancreatic injury. The MT1 might play an important role in the pathogenesis of ANP. MT might exert protective effects for the pancreas in ANP rats through increase the expression of MT1.

Objective In comparison of the performances for the detection of Clostridium difficile toxin B genes from stool between BD MAX Cdiff assay and a laboratory-developed (LD) assay.The LD assay was evaluated in clinical application.Methods This study was a clinical application research.A total of 147 stool specimens from patients with diarrhea in Hangzhou First Hospital affiliated with Zhejiang Chinese Medical University were detected by the two assays from 1 July to 30 September 2014.DNA extraction and amplification of the tcdB gene were performed automatically on the BD MAX platform.Meanwhile, the tcdA and tcdB gene were detected by the LD real-time PCR assay after DNA extraction.Then, the results were analyzed by use of SPSS 10.0.Results A total of 147 stool samples were collected.There were 33 C.difficile positive cases and 114 negative cases detected by both of two assays.However, there were four stool samples had incongruent results.In comparison with BD MAX, the LD assay had a sensitivity of 93.94% (31/33), a specificity of 98.25% (112/114), a positive predictive value of 93.94% (31/33), and negative predictive value 98.25% (112/114).Furthermore, the results of the LD assay were statistically coherent with that of the BD assay (Kappa=0.922, P<0.01).Conclusions The LD assay was highly sensitive and accurate as BD MAX Cdiff assay in the detection of toxigenic Clostridium difficile.Furthermore, this LD assay could be also applied to detection of clinical stool samples directly with low cost.The assay will be more promising in diagnosis of toxigenic C.difficile in clinical application in China due to no additional instrument needed.

Objective To detect the patterns of cognitive impairment between patients with paranoid schizophrenia and patients with bipolar mania by using the Cambridge Neuropsychological Test Automated Battery (CANTAB) ,and to explore research clues for finding of cognitive endophenotype in patients with paranoid schizophrenia or bipolar mania. Methods Six CANTAB subtests and the seven subtests of the Wechsler Abbreviated Scale of Intelligence (WAIS short form) were administered to 35 patients with paranoid schizophrenia and 33 patients with bipolar mania who were drug naive experiencing an acute episode, as well as 30 healthy controls. Results Patients with paranoid schizophrenia and bipolar mania demonstrated impairments in 13 of the 15 cognitive indicators in CANTAB. After controlling IQ, both patient groups remained as significantly different from normal controls in terms of search strategy(36. 8 ±3.56,37.24 ±4. 21,30. 33 ±6.24) ,between-search errors(40. 86 ± 19.97,40.24 ± 18.92,15.4 ±17.22) on the SWM test,the proportion of hits(0.54 ±0. 18,0.56 ±0.15,0.78 ± 0.17) on the RVIP test,total errors(45.26 ±36.36,46.61 ±33.32,14 ± 11.7) and EDS errors (12.43 ±9.96, 13.18 ±8.98,4.97 ±6.09)on the IED test. Between search error in the SWM test was positively correlation with YMRS scores ( r=0.38, P=0.039) in bipolar patients. Conclusion Both patient groups demonstrated a comparable profile of cognitive impairments during active periods of their condition. The cognitive impairment index may be a discreet cognitive endophenotype overlapping the disorders.

ObjectiveTo examine biochemical characteristics of the frontal lobe and hippocampus in unaffected parentsof schizophreniaprohandsusingprotonmagneticresonancespectroscopy(1H-MRS).Method 19 unaffected fathers of schizophrenia probands with matched 19 male healthy control subjects and 24 unaffected mothers of schizophrenia probands with matched 24 female healthy control subjects were included in the study.1 H-MRS was performed in two sides of the hippocampus and frontal lobes regions.The ratios of N-Acetylaspartate ( NAA ),choline (Cho) to creatine (Cr) were measured.One-sample T test and paired-samples t test were used for statistic process.ResultsUnaffected mothers of schizophrenia probands had a higher Cho/Cr ratio ( left ( 1.10 ± 0.13,right ( 1.08 ± 0.12 ) ) in the frontal white matter compared with matched female health control subjects(left( 1.03 ± 0.10),right( 1.02 ± 0.09 )).The NAA/Cr ratio was significantly reduced in the left frontal white matter of female health control subjects compared to right( 1.64 ± 0.12 vs 1.74 ± 0.13 ),but this difference was not observed in unaffected mothers of schizophrenia probands.There were no significant differences in metabolites for frontal lobe and hippocampus regions between unaffected fathers of schizophrenia probands and male healthy control subjects groups( all P＞0.05 ).ConclusionThe results implicate that the metabolic abnormalities and disappeared asymmetry of NAA/Cr might exist in the frontal white matter among unaffected mothers of schizophrenia probands.

ObjectiveTo identify the metabolic alterations on prefrontal lobes and hippocampus in male patients with the first-episode mania using proton magnetic resonance spectroscopy(H-MRS).Method 18 male patients with the first-episode mania and 27 healthy subjects matched for age,gender,and years of education were included in the study.1 H-MRS was performed in two sides of the hippocampus and frontal lobes regions.The ratios of N-acetylaspartate (NAA),choline (Cho) to creatine (Cr) were measured.One-sample t test and paired-samples t test were used for statistic process.ResultsMale patients with the first-episode mania presented decreased NAA/Cr in left frontal lobe and hippocampus regions when compared to normal controls( left frontal lobe (1.68 ±0.19 vs 1.86 ± 0.19),hippocampus ( 1.32 ± 0.10 vs 1.43 ± 0.16 ),P ＜ 0.01 ),but there were no significant difference in NAA/Cr for right frontal lobe and hippocampus regions between groups ( all P ＞ 0.05 ).Two groups also showcd no significant difference for Cho/Cr in bilateral frontal lobe and hippocampus (P ＞ 0.05 ).Conclusion There is significant difference of manifestation of 1H-MRS between male patients with mania and normal controls,which reflects neuronal dysfunction in the prefrontal lobes and hippocampus.