Objective To study the pathological and ultramicrostructural characteristics of organ tissues in relation to the clinical course of severe acute respiratory syndrome (SARS). Methods Post-mortem tissue samples of organs (lungs, heart, liver, spleen, kidneys, pancreas, stomach ) were obtained by needle biopsy from four SARS patients who died in middle and late stages 3-5 weeks after the onset of the disease. The pathological samples were studied by light and electron microscope, immunohistochemistry, histochemistry and indirect immuno-fluorescent antibody test. Results The main pathological features were early interstitial pulmonary fibrosis or organizing pneumonia. Fibroblasts were increased in the interalveoli septa and young connective tissue was found to fill the alveoli. Diffuse alveolar damage (DAD) with alveolar pneumocytes proliferation and an increase in macrophages were found. Desquamative alveolitis also existed at the same time. Squamous metaplasia and syncytial giant cells with multinuclei could be seen. CD3 + and CD20 + lymphocytes were markedly decreased and CD68 + macrophages and S-100 + dendritic cells increased in spleen. Proliferation of bone marrow cells became restrained . Hepatocytes were vacuolated with fatty degeneration. Electron microscopy showed the presence of coronavirus-like particles 80-60nm in diameter enveloped in the cytoplasm of the type Ⅱ pneumocytes, endothelial cells and lymphocytes. Conclusions A novel coronavirus is the cause of the newly recognized severe acute respiratory syndrom (SARS). The main target organs are lung and immune system. Different pulmonary pathological features were found in patients dying from the disease in different stages. All of specimens showed positive reaction of SARS-fluorescence antibody.

Objective To discover the vital role of Rab27B in tumor cells and its potential molecular mechanism by means of quantitative proteomics analysis of Rab27B knockdown in MHCC97H.Methods The expression of Rab27B in MHCC97H cells was knocked down by the combination of Tet-on advanced inducible expression system and RNA interference technology.Then, proteins extracted from the cells were identified by LC-MS/MS system after FASP digestion and iTRAQ 4-plex labeling. Finally, the properties of differentially expressed proteins, including the subcellular localizations, biological processes and molecular functions, were analyzed by the bioinformatics method.Results There were 448 differentially expressed proteins (|Ratio|>1.21, P<0.05) identified in MHCC97H cells after Rab27B knock-down.The expression levels of 229 or 219 proteins were positively or negatively correlated with Rab27B, respectively. These differentially expressed proteins were mainly involved in vesicle transport, macromolecule localization, cellular response to stimulus.Furthermore, there were 26 differentially expressed proteins participating in 8 tumor-related signal pathways, eleven of which were in the focal adhesion signal pathway.Conclusion The analysis of quantitative proteomics in Rab27B-knockdown MHCC97H cell line by iTRAQ suggests that Rab27B not only has an impact on the exosomal secretion of tumor cells, but also regulates master proteins in signal pathways involved in cell proliferation and migration.

Objective To identify the key factors triggering medical disputes induced by differences in cognition between doctors and patients in order to control the occurrence and development of medical disputes. Methods From 2002 to 2006,the outpatients,inpatients and medical staff of 3 hospitals in Shanghai(class 3 first level general hospital,n=2;class 3 first level special hospital,n=1) were investigated,and random sampling method was employed for the research analysis. Results There were significant differences between doctors and patients in cognition of influential factors triggering medical disputes such as health law,medical services,rights and obligations. Conclusion The differences in cognition between doctors and patients are important causes for medical disputes,and effective prevention and intervention measures must be taken.

Objective To evaluate the efficacy of thoracic cavity perfusion with cisplatin combined with mannan peptide in nasopharyngeal carcinoma patients with malignant pleural effusion.Methods 47 cases of nasopharyngeal carcinoma patients with malignant pleural effusion with a median age of 50 years old (41-70 years old) were enrolled.Pleural effusion occurred at 38.5 months on average after diagnosis,unilateral effusion was seen in 45 patients (95.7 ％),bilateral effusion was seen in 2 patients (4.2 ％).Cisplatin combined with mannan peptide was administered through pleural puncture by PICC center vein pipe after drainage.Data of survival complications and response to the treatment were reviewed.Results 17 patients (36.1％) had a complete remission (CR),21 patients (44.6 ％) had partial remission (PR),and the total remission rate (CR+ PR) was 80.9 ％.The median survival time was 10.5 months.Patients with pleural fluid pH ≥ 7.2,glucose ≥ 60 mg/L,and lactic dehydrogenase (LDH) ＜ 600 U/L showed association with good efficacy,the efficacy rates were 85.0 ％ (34/40),86.5 ％ (32/37),89.5 ％ (34/38),the median survival time were 11.5,12.0,12.5 months.Pleural fluid pH ＜ 7.2,glucose ＜ 60 mg/L,and LDH ≥ 600 U/L showed association with poor efficacy,the efficacy rates were 42.8 ％ (3/7),50.0 ％ (5/10),44.4 ％ (4/9),the median survival time were 6.5,6.5,6.0 months (P ＜ 0.05).The curative effect of the patients with bone metastasis and (or) pulmonary metastasis without liver metastasis was more similar with that of the patients with liver metastases [(47.0 ％ (16/34) vs 57.1％ (4/7),x2 =0.01,P =0.29].But median survival time had significant difference (11.0 vs 6.0 months,P =0.02).The Cox multi-factor analysis confirmed that the LDH value of effusion was an independent factor as prognosis evaluation.Major side effects of the treatment included fever,chest pain,nausea and vomiting.Conclusion Thoracic cavity perfusion using cisplatin combined with mannan peptide is effective in the treatment of malignant pleural effusion in nasopharyngeal carcinoma patients with pleural effusion,with relatively low toxicity.LDH value is a predictive factor for survival.The patients with liver metastases appeare poor median survival time.

· AIM: To discuss the cause and management of complications during the manual small incision cataract surgery (MSICS).combined with intraocular lens implant (MSICS-IOL) were done in 160 patietns with cataract. In this paper, we reviewed the clinical data of the intraoperative complications.injury, posterior capsule rupture, iris prolapse and hyphema, were mainly caused by inexpert skill and lacking of experience.techniques, careful operation could decrease the incidence of complications during MSICS operation. By proper management, the intraoperative complications could be solved satisfactorily.

The silent cerebral infarct is an clinic symptom that is so slight or transitory as to be easily neglected. There are only neural symptoms and signs,but irresponsible infarct focus can be seen on image. The risk factors of silent cerebral infarct may be the same as those of symptomatic cerebral infarct. Such infarct is likely to influence the course, clinic symptom and prognosis of acute cerebral infarct and may foretell symptomatic cerebral infarct and deteriorate into pseudo-global paralysis or multi-infarcted dementia. Therefore elder who suffer from hypertension or diabetes and experience vertigo, headache, language barrier but without apparent signs and symptoms should receive cerebral CT or MRI. Minor or third-degree precautionary measures can be taken as a chief therapy for cerebral infarct. Alternatively vitamines B_6,B_(12) and folic acid can be supplied to reduce the chance of hyperhomocysteinemia. Headache is the initial symptom in silent brain infarct. Magnesium is effective when dehydration does not work.

Otjective To study whether there is the apoptosis of neural cells and the expressionof Bcl-2 protein in intracerebral hemorrhage (ICH) in model of rats, for the further understanding the mechanism of the delayed damage of the neural cells around the hematoma after ICH. Methods Fifty SD rats were randomly divided into 5 groups, ten in each. With the Group A as the control, the rest 40 were used to set up intracerebral hemorrhage model. The brains were taken out at 12th, 24th, 48th and 72th hours, respectively. Apoptosis cells were detected with terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL), and the expression of Bcl-2 protein was detected with immunochemical stainging methed (SP). Results In the control group, no apoptosis cells and Bcl-2protein were detected. In rest groups, the apoptosis cells and Bcl-2 protein were expressed in different degree.Apoptosis rates verified and corresponded with the time after ICH, with the peak at 48th -72th hour after hemorrhage.The peak rate of apoptosis cells was (24. 50± 2.69)% and Bcl-2 protein expression was (20. 76 ± 1.97)% . There was significant difference between the experimental groups and control (P＜0.05), and no linear relationship between the apoptosis rate and the expression of Bcl-2 protein. Conclusion Apoptosis may be an important factor in the secondary trauma of ICH. There is a time leg after hemorrhage. All this is instructive to clinical treatment in time. Bcl-2 protein keeps increasing in a certain time after hemorrhage, but not synchronize with the cell apoptosis. This indicates that bcl-2 has the effect to reduce the apoptosis of neural cells.

Objective To explore the clinical features of sentinel polyps (rectal polyps with proximal colon carcinoma) and its correlation with proximal colon carcinoma.Methods From January 2003 to December 2013,the clinical features of 963 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group (n=855) and sentinel polyps group (n 108).The characteristics under endoscopy,clinical pathological features,treatment and prognosis of the two groups were observed.Chi square test was performed for differences comparison between groups.Results The length of stay in hospital of 963 patients was from four to 33 days,the average age was (49.7 ± 9.4) years,and the majority of the patients were male (n=610,63.3％).A total of 785 patients (81.5％) had non-specific abdominal symptoms,such as frequency or habit change of defecation,hematochezia,abdominal pain,abdominal distension.The relatives within three generation of 78 patients (8.1 ％) were diagnosed with tumor and some relatives of the patients diagnosed with familial adenomatous polyposis (2.2％,21/963).The positive rate of tumor marker of sentinel polyps group was higher (69.4％,75/ 108) than that of pure polyps group (6.8％,58/855; x2 =316.285,P＜0.01).The proximal colon carcinoma of patients with sentinel polyps appeared as neoplasma with circumferential growth,there was no specific appearance between distal rectal polyps and proximal colon carcinoma.When compared with pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm (61.1％ (66/108) vs 46.9％ (401/855)),multi polyps (n＞5,38.9％ (42/108) vs 11.8％ (101/855)) and adenomatous polyp (83.3％ (90/108) vs 35.6％(304/855),x2=7.752,55.595 and 90.544,all P＜ 0.01).Majority of the proximal colon carcinoma with rectal polyps was papillary adenocarcinoma and tubular adenocarcinoma which was account for 75.9％ (82/108).Some were mucinous carcinoma and signet ring cell carcinoma.Most of the proximal colon carcinoma with rectal polys did not penetrate the serosa layer (Duk A-+Duk B,59.3％,64/108) and with little distant metastasis (Duke D,17.6％,19/ 108).Ninty-five point six percent (817/855) of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged.Forty-one point seven percent (45/108) of patients of sentinel polyps group accepted the radical operation and 19.4％ (21/108) received endoscopic submucosal dissection.Conclusions If multiple,maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope,the possibility of carcinogenesis of the polyps or the proximal colon should be awared.If the endoscope is difficult to go further or the patient can not tolerate the whole colon examination,the patient should be followed up in short-term and complete the whole colon examination.

Thyroid hormone insensitivity syndrome is an inherited syndrome characterized by high serum concentrations of thyroid hormone,accompanied by normal or slightly high serum TSH concentration due to the reduced responsiveness of target tissues to thyroid hormone.Thyroid hormone insensitivity syndromes are related to gene mutations of thyroid hormone receptors,thyroid hormone cell transport defect,and thyroid hormone metabolism defect.This article reviews the progress of pathogenesis,diagnosis,and therapeutics of thyroid hormone insensitivity syndrome.

Objective:To understand the medication safety events about cephalosporin in our hospital in order to provide evidence for the better medication safety of cephalosporin. Methods:Adverse drug reaction ( ADR) reports, medication error ( ME) reports and drug quality problem records about cephalosporin in our hospital were collected and the critical indicators in the reports were analyzed. Re-sults:The ADR reports selected in our hospital were mainly reported by pharmacists. More males were involved in the related patients, and young adults were in the majority. Second and third-generation cephalosporin were the major drugs used in the reports. The damages in skin and its appendages were the major damages in organs. The ME reports selected in our hospital were totally reported by pharma-cists. Errors in frequency and dose of drug administration were the most common, and the main causes were lack of knowledge and train-ing. No serious quality problem in cephalosporin was found in our hospital, and the inner and outer packaging in damaged conditions was the most common problems in our records. Conclusion:Cephalosporin as one widely used antibacterial agent is considered safe and effec-tive. Because of its large amount of application, cephalosporin should be paid more attention by health care professionals. MEs should be avoided as far as possible. ADRs should be treated timely and properly in order to decrease medical disputes. More attention should be paid to ensure security of drug use for patients.