Objective To investigate the value of emergent endoscopy in the acute nonvariceal gastrointestinal bleeding.Methods Retrospective analysis was done in patients with melena or haematemesis in the ward from Jan 1st 2003 to Dec 31st 2007.For emergent group,the patients took endoscopy in 48 h after bleeding.For selective group,the patients took endoscopy after 48 h.Medical outcomes and resource utilization were compared between two groups.Results The average age of 332 patients(246 males and 86 females)was(45.9?18.8)years old.In the median and low risk patients,the length and the cost of hospitalization,blood transfution and the use of PPI were lower in the emergent group than in the selective group.In the high risk patients,the above variables had no statistical difference.Conclusion For the patients whose Rockall Score were less than 5,emergent endoscopy could decrease the length and the costs of hospitalization,the transfusion volumes and the use of PPI.However,for the patients whose Rockall Score were more than 5,the advantage of emergent endoscopy need further discussion.

Objective To determine the chlorpyrifos in human blood by liquid chromatography-tandemmass spectrometry and to validate its application in poisoning cases. Methods The samples were extracted by a simple one-step protein precipitation procedure. Chromatography was performed on a Capcell Pack C18 mG II column (250 mm×2.0 mm, 5μm) using an isocratic elution of solvent A (0.1% formic acid-water with 2 mmol/L ammoniumacetate) and solvent B (methanol with 2 mmol/L ammoniumacetate) at 5∶95 (V∶V).Results The linearranged from5 to 500ng/mL (r=0.9987).Thelimitofdetection (LOD) and the lower limit of quantification (LLOQ ) were 2 ng/mL and 4 ng/mL , respectively. For this method, the precision and accuracy of intra-day and inter-day were <10% and 97.44%-101.10%, respectively. The re-sults in stability test of long-termfrozen were satisfied. The matrix effect, recovery and process efficien-cy were 64.97%-86.81%, 76.70%-85.52%, and 55.57%-66.58%, respectively. Conclusion This method can provide a rapid approach to chlorpyrifos extraction and determination in toxicological analysis of forensic and clinical treatment.

Objective To grope for an ideal immune strategy in grown-ups via comparison of immunological effects under 4 different vaccination schemes.Methods Study population was selected by stratified random cluster sampling.A total of 4 different vaccination proposals,including Strategy A (3 doses,10 μg,administrated repeatedly into the unilateral deltoid muscle at 0-1-6 months),Strategy B (2 doses,20 μg,administrated into the bilateral deltoid muscles simultaneously),Strategy C (3 doses,10 μ g,administrated repeatedly into the unilateral deltoid muscle at 0-1-2 months) and Strategy D (2 doses,10 μg,administrated to the bilateral deltoid muscles at the same time),were conducted in Liangzhou,Minqin Gulang,and the Tianzhu Tibetan Autonomic county respectively,in Wuwei city,Gansu province.Under 4 different strategies,post-vaccination immunological effectiveness was evaluated when blood samples of participants collected in the eighth months,post-first injection and in the third year,and tested by enzyme-linked immunoassays and electro-chemiluminescence immunoassay.Chi-squared test and Fisher exact test were used to evaluate the immumological differences between the 4 strategies.Wilcoxon's signed rank test and Kruskal-Waillis H test were conducted to compare the differences of the geometric mean titers (GMTs) of antibody against HBV surface antigen (anti-HBs) titers.Results A total of 1 621 eligible participants aged 16 to 60 years old,were recruited for the study.Numbers of administration and gender were testified as the presuming factors for influencing immune effectiveness.The vaccination completion rates were 53.97％ and 79.82％ in Strategy A and C,respectively,and the difference statistically significant (P＜0.05).In the first year,the protective antibody sero-conversion rates (standardization rate) were 89.21％,54.88％,92.11％,and 41.63％,in Strategy A,B,C and D,respectively,and the significant statistically differences emerged (P＜0.05) if Strategy B,C and D were compared with Strategy A (as the gold standard).Over a 3-year follow-up period,the levels of GMTs on protective antibody declined from 179.2 IU/L,51.6 IU/L,277.1 IU/L and 10.1 IU/L to 61.3 IU/L,21.2 IU/L,31.8 IU/L and 6.0 IU/L in Strategy A,B,C and D,respectively,and the differences of declination on GMTs showed statistically significant differences (P＜0.05) when compared within or between the 4 strategies.Conclusion The 0-1-2 months' prophylactic schedules (Strategy C) seemed superior to the others,in terms of effectively inducing the protective antibody,with shorter duration of vaccination,persisting longer immunity and having higher rate of completive vaccination,so is worth to be recommended as a feasible immune programme for adults,especially for migrants from the rural regions.

We report a case of chromoblastomycosis caused by , which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with strain KX078407. The susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.
Animals ; Chromoblastomycosis ; Humans ; Laser Therapy ; Lasers, Solid-State ; Male ; Middle Aged ; Rats ; Rats, Wistar ; Terbinafine ; Treatment Outcome