Objective To analyze the change of disease spectrum and the direct cause of death in Xi'an Children's Hospital emergency patients in the past 2 years.Methods The cases of death in 130 emergency cases from 2009 to 2010 were retrospectively analyzed.Results The main causes of death in 2009 were pneumonia,congenital heart disease,asphyxia,neonatal pulmonary hemorrhage and intracranial hemorrhage.Meanwhile,The main cause of death in 2010 were pneumonia,asphyxia,viral encephalitis,congenital heart disease and neonatal pulmonary hemorrhage,which significantly changed compared with 2009.Major direct causes of death were found:respiratory failure in 25 cases (27.5％),heart failure in 17 patients ( 18.7％ ),shock in 17patients ( 18.7％ ),asphyxia in 16 cases ( 17.5％ ),and hernia in 16 cases ( 17.5％ ),Conclusion In order to reduce the mortality rate of emergency patients,we should strengthen health care,actively manage pulmonary infection,systemic infection,and shock,control heart failure,and prevent aspiration.

Antigens, CD34 ; metabolism ; Carcinoma, Renal Cell ; metabolism ; pathology ; Central Nervous System Neoplasms ; metabolism ; pathology ; surgery ; ultrastructure ; Diagnosis, Differential ; Ependymoma ; metabolism ; pathology ; Hemangioblastoma ; metabolism ; pathology ; surgery ; ultrastructure ; Humans ; Meningeal Neoplasms ; metabolism ; pathology ; Meningioma ; metabolism ; pathology ; Mutation ; Neoplasm Recurrence, Local ; Prognosis ; Receptor, Epidermal Growth Factor ; metabolism ; Vimentin ; metabolism ; von Hippel-Lindau Disease ; genetics ; metabolism ; pathology ; surgery

Astrocytoma ; diagnosis ; genetics ; pathology ; surgery ; Gene Expression Regulation, Neoplastic ; Humans ; Prognosis

Adult ; Female ; Humans ; Immunohistochemistry ; methods ; Male ; Meningeal Neoplasms ; immunology ; ultrastructure ; Meningioma ; immunology ; ultrastructure ; Microscopy, Electron ; Middle Aged ; Paraganglioma ; physiopathology

The First Affiliated Hospital of Zhejiang University founded an online hospital campus leveraging the Internet-plus environment. Supported by the offline hospital, this campus made full use of Internet features and advantages in its attempts to optimize the distribution of medical resources,to improve the accessibility of medical service, to reduce medical costs, and to expand the service coverage among others. Meanwhile,this online system, via interconnection with the hospital′s HIS system, achieved online medical insurance payment,prescriptions checking and drug delivery service.

Objective To summarize the clinical characteristics of adrenal tumors combined with renal carcinoma and to extend the clinical understanding of the situation.Methods To analyze the data of 1 100 patients with adrenal tumors hospitalized in Peking University First Hospital from Jan.1994 to Mar.2012 retrospectively,in the series there were 42 combined with renal carcinoma.Results There were 27 males,15 females,aged 29 to 83 years,mean 60.5 years old.In 42 renal carcinomas,there were 29 (69.0％) clear cell carcinomas,5 (11.9 ％) cystic renal carcinomas,2 (4.8％)clear cell with granulosa cell hybrid carcinomas,1 renal lymphoma,1 (2.4％) spindle cell tumor,1 acidophilic cell adenoma,and 1 undifferentiated type of renal cell carcinoma and pathologically not clear in 2 cases (4.8％).Clinical manifestations were not specific.In 42 adrenal tumors,20 situated in the left,and 17 right,and 5 were bilateral.35 cases were considered primary adrenal tumors,in which 3 were diagnosed primary hyperaldosteronism,32 were non-functional tumors.Other 7 were non-functional matastatic carcinomas.25 patients underwent resection of adrenal tumors,and pathology revealed 22 (88.0％) were primary,in which 12 (54.6％) were cortical adenomas,7 (31.9％) hyperplasia,1 (4.5 ％) pheochromocytoma,1 (4.5 ％) ganglioneuroma,1 (4.5 ％)adenoma with hyperplasia;2 (8.0％)metastatic tumors,and 1 (4.0％) non-Hodgkin' s lymphoma.The mean diameter of primary adrenal tumors was 1.9 cm,while that of metastatic carcinoma was 3.84 cm.25 underwent abdominal ultrasonography,40 underwent computed tomography (CT) scan,6 underwent magnetic resonance imaging (MRI) scan,positive rate was 72.0％,97.5％,and 100.0％ respectively.25 patients who underwent surgery were followed up,17 survived for 8 months-6 years,4 died,in which 1 metastatic carcinoma died of intraoperative bleeding,1 died of adrenal lymphoma,2 died because of other disease,4 were lost to follow-up.Conclusions The most common type of renal carcinoma combined with adrenal tumors was clear cell carcinoma,while majority of the adrenal tumors were primary with non-specific clinical manifestations and function.The adrenal tumors might be located in the same or the opposite side of renal carcinoma,also might be bilateral which were more common in metastatic carcinomas and always bigger than primary ones.CT/MRI scans were important in judging the nature of the tumors and pathology was the gold standard.The non-functioning primary adrenal tumors could be safely followed up,and the isolated metastatic carcinoma should be resected.Prognosis depends mainly on that of renal carcinoma.

This study was aimed to observe the therapeutic effect onendometritis rat model by Gui-Zhi Fu-Ling (GZFL) capsuleand its mechanism. Endometritis rat model was replicated. After 15 days, rats were randomly divided into six groups, which were the sham operation group, model group, lowdosage (0.5 g·kg-1) of GZFL capsule group, middle dosage (1.0 g·kg-1) of GZFL capsule group, large dosage (2.0 g·kg-1) of GZFL capsule group, and Fu-Ke Qian-Jin (FKQJ) capsule (1.2 g·kg-1) group. After 28-day intragastric administration of medication, pathological changes of endometrium were observed. The contents of monocyte chemoattractant protein-1 (MCP-1), interleukin-1β (IL-1β), interleukin-10 (IL-10) were determined in blood serum.The expression of TGF-β1 in endometritis rats were measured by immunohistochemistry. The results showed that GZFL capsule canobviously alleviate the pathologi-cal damage of endometrium in rat model. In comparison with sham operation group, the serum IL-10 content in the model group was significantly decreased, contents of MCP-1and IL-1β were significantly elevated; the TGF-β1 pro-tein expression was significantly elevatedin the uterus tissues. After the treatment of GZFL capsule, compared with the model group, the serum IL-10 was obviously elevated in the treatment group. The contents of MCP-1 and IL-1βwere obviously decreased. The expression of TGF-β1 in the uterus tissues was obviously decreased. It was concluded that GZFL capsule had treatment effect on endometritis. The mechanism may be related to the regulation of inflam-matory cytokines.

Objective To investigate the expression of Notch 1 receptor in renal tissues of patients with hepatitis B virus associated-glomerulonephritis (HBV-GN) and its role in the pathogenesis of HBV-GN.Methods A total of 48 patients with HBV-GN confirmed by renal biopsy during 2008-2010 were enrolled in the study.Distribution of Notch1 receptor in renal tissue of HBV-GN was detected by immunohistochemistry and the association between the distribution of Notch1 receptor and HBsAg was examined by double-label immunofluorescence assays.Correlations of Notch1 receptor expression with renal pathology and clinical parameters of HBV-GN were analyzed.Results Notch1 receptor distributed mainly in renal tubular epithelial cells and interstitial area as brownish red granules,and a few expression in glomerulus was also found.The positive score of Notch1 receptor expression in HBV-GN patients was significantly higher as compared to primary glomerulonephritis patients with serum HBsAg positive or negative and normal renal tissue controls.Notch1 receptor expression was more obvious in membrano-proliferative glomerulonephritis (MPGN) and mesangial proliferative nephritis (MsPGN) patients,but there was no significant difference among the different pathology groups.Distribution of Notch1 receptor was consistent with the distribution of HBsAg and its intensity was positively correlated with renal interstitial fibrosis (r=0.473,P=0.001),tubular atrophy (r=0.690,P=0.000),inflammatory cell infiltration (r=0.616,P=0.000).Negative correlation was found between renal function and the intensity of Notch1 receptor (r=-0.393,P=0.006).Conclusions Notch1 receptor expression increases in the renal tissues of HBV-GN patients and distributes mainly in renal tubular epithelial cells and interstitium,which is consistent with the distribution of HBsAg.Its intensity is closely correlated with renal interstitial lesions and renal function.Abnormal expression of Notchl receptor in renal tissue of HBV-GN may be involved in the progress of HBV-GN.

ObjectiveTo investigate the expression and distribution of Toll-like receptor 4 (TLR4) in renal tissue of HBV associated nephropathy (HBV-GN) and its role in the pathogenesis and clinical manifestations of HBV-GN.MethodsRenal tissues were sampled from 48 HBV-GN patients confirmed by renal biopsy and 154 non-HBV-GN patients.The distribution of TLR4 in renal tissue and the relationship between the distribution of TLR4 and HBsAg were detected by immunohistochemistry.Integrating case record,correlations between the expression of TLR4 with clinical parameters including pathology,glomeruli,kidney tubules lesions,renal interstitial inflammatory infiltration and blood serum HBV were analyzed.ResultsTLR4 mainly distributed in the renal tubular epithelial cells and interstitial areas as brownish red and granular,which was in consistent with HBsAg distribution.The TLR4 positive rate and score in HBV-GN group were higher than those in non-HBV-GN group (P ＜ 0.05 ).TLR4 positive score was slightly higher in mesangial proliferative glomerulonephritis group and focal segmental glomerulosclerosis group,which had no significant difference (P ＞ 0.05).Kidney tubules lesions were strongly associated with TLR4 expression (r =0.748,P ＜ 0.001 ) which increased with aggravation of renal interstitial fibrosis ( r =0.569,P ＜0.001 ),tubular atrophy ( r =0.577,P ＜ 0.001 ) and inflammatory cell infiltration ( r =0.684,P ＜0.001 ).No obvious correlation with glomeruli lesions was observed ( r =0.293,P =0.053 ).Negative correlation could be seen between TLR4 and the renal function ( R2 =0.784),systolic blood pressure ( R2 =0.869),high sensitivity C-reactive protein (R2 =0.979) and urinary protein (R2 =0.615 ) by regression analysis.Other clinical parameters had no statistical significances.ConclusionsThe expression of TLR4 is abnormal in the renal tissue of HBV-GN patients,mainly in renal tubular epithelial cells and interstitial,which is consistent with the distribution of HBsAg.Its intensity is closely related with renal interstitial lesions,renal function changes and inflammatory cell infiltration.A speculation,that HBV can promote abnormal expression of TLR4 in renal tissues of HBV-GN which may be involved in the lesion progress of HBV-GN,is made upon our study.

Confronted with similar problems and difficulties in mainland,Taiwan reformed its medical education. The reform included setting up flexible program,formulating objective and detailed rotary guide,making the best of the resources,implementing medical humanities education based on the reality and forming unique cultivation system and mode. These measures can be taken as references for medical education reform in mainland.