Objective To study the clinical significance of a novel marker of platelet clumps count provided by hematology analyzer in differentiating true thrombocytopenia from EDTA-dependent pseudothrombocytopenia (EDTA-PTCP). Methods Samples from 65 cases of thrombocytopenia (including 15 EDTA-PCTP samples and 50 random samples of true thrombocytopenia) and 50 healthy controls were analyzed using hematology analyzers, and samples with low platelet counts were checked by replacing citric acid and using manual microscope observation to identify true thrombocytopenia from EDTA-PTCP. A novel marker of platelet clumps count was used to differentiate the two diseases for samples anficoagulated with EDTA or citric acid. Results In 65 patients with thrombocytopenia, platelet counts were (48±11)×109/L detected by automatic hematology analyzers. Fifty of 65 cases were true thrombocytopenia which showed low platelet counts [(48±10)×109/L by automated analyzer and (46±11)×109/L by manual assay]. No significance was observed between them (t=-1.26, P0.05). Platelet clumps counts were 86±15. No platelet clamps were detected under microscope. The other 15 cases were EDTA-PTCP [platelet counts were (48±12)×109/L and platelet clumps counts (840±184) were increased significantly by automated analyzer and using EDTA anticoagulant] which showed obviously platelet clumps and no less platelet counts under microscope. After replacing citric acid, platelet counts [(141±13)×109/L by automated analyzer and (134±17)×109/L by manual microscope assay] were increased significantly. No significance was observed between them (t=-1.29, P0.05). Platelet clumps counts (75±12) were decreased obviously compared with EDTA anticoagulant method (t=-6.82, P<0.001). No platelet clumps were detected under microscope. Conclusion Platelet clumps counts may be a useful clinical indicator for monitoring of platelet aggregates, especially for EDTA-PTCP caused by platelet clumping.

Objective To discuss the clinicopathologic and imaging features of multilocular cystic renal eell carcinoma(MCRCC). Methods The data of 8 cases(5 men and 3 women)MCRCC classified according to 2004 WHO criteria were reviewed retrospectively.The tumor was incidentally found in 5 out of 8 cases.Renal ultrasound and CT scans were available in all 8 cases.CT or enhanced CT scans showed a well-defined cystid mass with irregular thickening wall or septa in 7 cases,without visible nodules found.For treatment,open or laparoscopic radical and partial nephrectomy was done in those cases. Results Postoperative pathological findings confirmed the diagnosis of MCRCC.The mean greatest diameter of the tumors was 5.6 cm.Microscopically,the wall and septa lined by one or several layers of clear cells were observed in all cases.The TNM stage of all 8 cases was T1 N0 M0.For pathologic grade,7 cases were G1 and 1 case was G2.Seven patients were followed up and remained tumor free during the average time of 8 months. Conclusions MCRCC is an uncommon subtype of RCC,it has a lower malignant potential and a better prognosis compared with other types of RCC according to the literature.Nephron-sparing surgery may be an appropriate treatment option for MCRCC.

Objective To investigate in evaluation of various capacity requirement of probationer nurs-ing students by nurses in operation room in order to improve clinical teaching work. Methods A self-de-signed questionnaire was applied, 191 qualified teaching nurses from nine grade three A general hospitals in Beijing were invited to fdl the questionaires. The results underwent subsequent analysis. Results The teach-ers had high expectations for various capacity of the probationer nursing students. Conclusions Clinical teachers should establish feasible teaching scheme according to the existing teaching syllabus in order to in-crease teaching quality, make students gain new insights through reviewing old materials, so that they can mas-ter various technique in operation room in short time.

Objective:To assess type C behavior in patients with oral lichen planus (OLP) in order to provide basis for clinical prevention,treatment and psychological intervention of OLP.Methods:Type C behavior scale was used on 85 OLP patients and 85 control patients,who were in accordance with the inclusion criteria,in order to investigate their type C behavior.The scale included 9 items:anxiety,depression,anger,anger toward inside (anger-in),anger toward outside (anger-out),reasoning,domination,optimism,and social support.Scores of the 9 items between OLP patients and control group were calculated under the instruction of the scale and were statistically analyzed,and OLP group was further stratified statistically by sex,reticulate-erosive-ulcerative (REU) pathological type and course of diseases,and the scores of each group were analyzed and compared.Results:Among the 85 OLP patients,there were more females,more non-erosive lesion type,and the most common site for OLP was the buccal mucosa.The scores of the type-C behavior questionnaire for anxiety,depression,anger and optimism were respectively 43.01 ± 7.47,44.02 ± 7.61,21.56 ± 5.26,22.15 ± 4.00 among the OLP patients and were 37.94 ±8.70,39.58 ±7.35,18.12 ±5.39,24.05 ±3.23 among control group,with significant differences (P ＜ 0.05 for all) between the two groups.The female OLP patients had higher anxiety,depression,anger scores (43.21 ± 6.97,44.29 ± 7.54,21.64 ± 5.09) and lower reasoning,domination,optimism scores (39.12 ±5.66,16.29 ±3.95,22.05 ±4.12) with significant differences (P ＜0.05 for all) compared with those of the female controls.The scores between male patients and male controls showed no significant difference.The patients with erosive lesions had higher anger score (22.94 ± 5.26) than that of the patients without erosive lesions (20.60 ± 5.03),with a significant difference (P ＜ 0.05).With the development of the disease,the tendency of anxiety and depression of the patients were more obvious,while optimism scores remained declining.The patients suffering more than 3 years of OLP had higher anger-toward-outside scores (17.36 ± 3.35) than the patients suffering less than 3 years of OLP (15.19±3.99),with a significant difference (P ＜0.05).Conclusion:OLP patients showed an obvious type C behavior characteristic,especially in anxiety,depression,anger and low optimism.This research provides the C behavior characteristic of OLP for further psychological consultation or intervention during OLP treatment.

Objective To construct a recombinant lentiviral expression vector containing NIS and EGFP gene,and to explore the feasibility of NIS gene for monitoring the bone marrow derived mesenchymal stem cells (BMSCs) migration to the intracranial glioma.Methods The NIS and EGFP gene fragments were subcloned into lentiviral vector pLVX-puro,then packaged and amplified in HEK293T cells to obtain recombinant lentivirus pLVX-CMV-NIS-EGFP.pLVX-CMV-0-EGFP was constructed as control.BMSCs were isolated,cultured,and transfected by lentivirus.The antibiotic-resistant transfected BMSCs (BMSCs-NIS-EGFP and BMSCs-EGFP) were selected.The expression of NIS gene was examined by Western blot.Functional NIS activity was confirmed by the uptake of 125I and the inhibition effect of NaClO4.The nude mice intracranial glioma models were established.MicroSPECT was performed at 24 h post BMSCs-NIS-EGFP injection via the tail vein.Results pLVX-CMV-NIS-EGFP and pLVX-CMV-0-EGFP were successfully constructed and packaged.BMSCs were successfully isolated and cultured.Stable cell lines BMSCs-NIS-EGFP and BMSCs-EGFP were constructed after lentivirus transfection and puromycin selection.The expression of NIS gene was detected by Western blot in BMSCs-NIS-EGFP,but not in BMSCs-EGFP.BMSCs-NIS-EGFP showed significantly more uptake of 125I (nearly 10 times than the uptake in BMSCs-EGFP) and the uptake could be significantly inhibited by NaClO4.The nude mice intracranial glioma models were successfully established and the BMSCs-NIS-EGFP in glioma foci could be visualized by microSPECT imaging at 24 h post injection.Conclusions A recombinant lentivirus containing NIS gene could be successfully constructed for monitoring BMSCs migration towards intracranial glioma.It might provide evidence on the research of BMSCs and NIS gene mediated therapy for glioma.

Objective To explore mechanism ( s) is dynamic expression and internal relations of c-kit gene and miR-21 in rat ventricular remodeling .Methods SD rats( n=140) were randomly divided into normal control group ( n=15 ) and heart failure model group ( n=125 ) .Heart failure model:4 mg/kg intraperitoneal injection of adria-mycin.To detect the cardiac function of rats in eight weeks , proving the heart failure .Then harvest the rat heart , frozen section , using immunohistochemistry and immunofluorescence color to detect the expression changes of miR-21 and c-kit in myocardial tissue .Results The emergence of the pathological changes of cardiac muscle cells after myocardial infarction in the heart failure groups and the control group didn't appear the myocardial infarction and heart failure .Immunohistochemistry and immunofluorescence show that miR-21 positive cells in normal and heart failure myocardium mainly express in vascular endothelium ,a few myocardial cells and stem cells , and endocardial expressing quantity fell more than epicardial;c-kit positive cells tend to cluster together , mainly gather in the epi-cardial and its nearby , and the expressing quantity decrease significantly after heart failure .A small number of cells exsit miR-21 and c-kit common expression in both groups ( P<0.05 ) .Conclusions The decreased expression of c-kit and miR-21 is highly related to rats heart failure and left ventricular remodeling .

Objective To evaluate the imaging features of pneumonia caused by A (H1N1) influenza virus. Methods Imaging data of 51 patients with pneumonia caused by A H1N1 influenza were retrospectively reviewed. All patients underwent mobile chest radiographs and 44 patients underwent CT as well. On the basis of the lesion degree in the lung, the patients were classified into mild, moderate and serious types. Results Mild type showed patchy consolidation at chest imaging in 4 patients. Moderate type demonstrated consolidation and(or) ground -glass opacities more than 2 lung fields in 33 patients, including 30 bilateral and 3 unilateral. Serious type displayed diffuse consolidation and ground-glass opacities, probably accompanying with interstitial lesions in the lungs in 14 patients, including 6 patients with ARDS, 2 with infection and 1 with cutaneous emphysema. Conclusion The imaging features of pneumonia caused by A H1N1 influenza mainly manifest as consolidation and ground-glass opacities, probably accompanying with interstitial changes. The imaging findings show various in patients with infection. Some serious patients even develope to ARDS.

Objective Evaluating the effect of situational questions for qualifying the students'abilities in physiolo-gy examination .Methods Comparing the difficulty coefficients and discrimination indexes between situational and traditional choice questions .Results Compared with the traditional choice questions , the difficulty coefficient of situational questions increased , while the discrimination indexes were more reasonable .The discrimination indexes of situational understanding questions were higher than those of the traditional memory and understanding questions . There were no difference between discrimination indexes of the situational application questions and those of tradi -tional application questions .Conclusions Situational questions not only improved the quality of examinations , but also facilitate evaluating students'learning ability .

Objective To explore the clinical characteristics and outcomes of patients with atrial fibrillation (AF) and repeated emergency department (ED) visits.Methods Patients with AF were examined and analyzed retrospectively.Data were collected from consecutive patients from resuscitation room in the Department of Emergency of a large-scale general teaching hospital,from January 1,2011 to December 31,2015.The patients were verified by electrocardiographic examination and/or monitoring.The main outcomes were length of resuscitation room stay and outcome scales (defined as death,transfer to intensive units,to ordinary wards,or direct discharge).Results 908 patients were enrolled in the study with a mean age of 70.3 ± 12.8 years,and 494(54.4％) were female.There were 262(28.9％) cases visited ED for more than one time,and 646(71.1％) visited ED without repetition.Compared with the patients without repeated visit,patients with repeated visits were older (73.0 ± 9.8 years versus 69.2 ± 13.6 years,t=4.705,P＜0.001),and had a larger proportion of patients with CHADS2-VASc score greater or equals to 2(70.6％ versus 60.2％,x2 =8.660,P=0.003),whereas those patients had a shorter stay in the resuscitation room (13.6 ± 27.1h versus 27.0 ± 89.7h,t=3.370,P=0.001),and a higher percentage of directly discharge (73.3％ versus 61.9％,x2=10.607,P=0.001).In multiple logistic regression analysis,a higher CHADS2-VASc score and a lower quartile of the resuscitation room stay were independently predictive factors of repeated ED visits.Conclusion Patients with AF and repeated ED visits would have relatively complex condition and more comorbidities.High CHADS2-VASc score and short ED stay are independently predictive factors for repeated ED visits.

Objective To evaluate the short term results of repairing osteonecrosis of the femoral head by modified free vascularized fibular grafting through Smith-Peterson approach without cutting the rectus femoris.Methods Between January,2009 and September,2012,14 osteonecrotic hips of 14 patients who underwent free vascularized fibular grafting were retrospectively studied including 10 male and 4 female.The follow up period was 24 months.The preoperative and postoperative symptoms relief,recovery of hip function (Harris score),radiographic assessment (X-ray).Results All patients got postoperative ipsilateral hip pain relief.Average Harris hip score improved significantly (68.47 ± 5.33,86.80 ± 4.72 points in preoperation and postoperation,respectively; paired t test,t =18.724,P ＜ 0.01).Postoperative X-ray results showed there were no progresses of osteonecrosis and no collapse in the operative side within 2 years follow-up.Conclusion The short term treatment results of femoral head avascular necrosis were satisfactory by using free vascularized fibular graft through Smith-Peterson approach without cutting off the rectus femoris and it may be a relatively practical option of surgical approach.