Inquiry is the main method of history taking. The training should not be limited to the medical inpatients inquiry. Different training scenes should be taken. The outpatient history inquiry needs a similar clinic room and set time limit, and focuses on key point history inquiry as well as document writing. Some principles in emergency inquiry are introduced, such as SAMPLE principle. The key points of inquiry of different patients including elderly patients, child patients, traumatic patients and drug addiction patients are also introduced. Through the combination of theory and practice mode, the group discussion and role-play, different scenes design and standardized patients application, reasonable design of teaching hours and content distribution, as well as feedback in time, optimal teaching effect can be finally achieved.

Hedgehog pathway is an osteogenesis-related signaling pathway . During embryonic development , it regulates the growth and proliferation of progenitor cells and tissue formation. This pathway can be activated during liver injury. Activated Hedge-hog signaling pathway is involved in many aspects of liver wound-healing responses, including hepatic progenitor cell pro-liferation, myofibroblast transdifferentiation, apoptosis of various types of liver cells, inflammatory reactions, and vascular remod-eling. This article reviews the research progress in the role of Hedgehog signaling pathway in liver injury and the underlying mechanisms. The potential drug targets are also discussed. This review is to provide novel insights into antifibrotic research and therapeutic targets.

Pregnancy complicated by non-Hodgkin's lymphoma (NHL) has rarely been reported. Few reports in the medical liter-ature focus on pregnancy complicated by both NHL and hepatitis B virus infection. A multidisciplinary discussion is conducted concern-ing the treatment of the patient. The standard treatment procedure for pregnancy complicated by non-Hodgkin's lymphoma and the cre-ation of a multidisciplinary team were also discussed.

Objective To study the value of MR diffusion tensor imaging(DTI) in the staging of chronic kidney disease(CKD).Method MR diffusion tensor imaging was used on 26 CKD patients.All patients were diagnosed as CKD according to the criteria of clinical diagnostic.All MR images achieved diagnostic requirements.Diethylenetriamine pentaacetic acid(99mTc-DTPA) renal dynamic imaging was used to determine the unilateral renal function.CKD patients were determined as mildly renal impairment group and moderately to severely renal impairment group based on the glomerular filtration rate(GFR).Twenty healthy volunteers underwent DTI at the same time.The cortical and medullary ADC value and FA value were measured in all subjects who underwent conventional MRI and DTI.The paired Student's t test was used to compare the cortico-medullary difference of the mean ADC and FA values in all subjects.The oneway analysis of variance(ANOVA) was carried out to assess the difference among the medullary and cortical diffusion parameters(ADC,FA) of all the three groups,and LSD was used to assess multiple comparisons.The correlation of GFR and ADC value of the patients,and FA value of the patients were tested by Pearson correlation analysis.Results The cortical and medullary ADC values of 46 subjects were(2.25±0.25) × 10-3 and(2.10±0.20) × 10-3 mm2/s respectively,FA of them were(3.48±0.61) and(4.27±0.75) respectively(t =6.754,10.043 respectively; P＜0.01).The cortical ADC values of volunteers,mild renal impairment group,severely renal impairment group were(2.25±0.22) ×10-3,(2.31±0.19) ×103,(2.18±0.32) ×10-3mm2/s respectively.The medullary ADC value of the three groups were(2.09±0.19) × 10-3,(2.17±0.17) × 10-3,(2.06±0.24) × 10-3mm2/s respectively(F=0.968,0.882 respectively; P＞0.05).The cortical FA values of the three groups were 3.85± 0.47,3.18±0.62,3.20±0.52 respectively.The medullary FA of the three groups were 4.92±0.38,3.93±0.57,3.62 ± 0.53(F=8.725,33.705 respectively; P＜0.01).There was no correlation between cortical ADC,medullary ADC,cortical FA of the patients and GFR [(30.14±15.79) ml· min-1 · 1.73 m-2](r =0.243,0.197,0.196 respectively; P＞0.05).There was a positive correlation between medullary FA of the patients and GFR (r=0.556,P=0.003).Conclusion FA value has certain value in evaluating CKD early diagnosis and renal function.

Objective To study the expression of co-stimulatory molecules, GL50-ICOS, in thyroid tissue of patients with Graves' disease (GD) and to explore their relationship with the immune pathogenesis of GD.Methods RT-PCR, Western blot, immunohistochemistry were applied to detect the expression of GL50-ICOS in thyroid of GD. Thyrocytes were cultured in the absence or presence of pro-inflammatory cytokines. The expression of GL50 on thyroid follicular cells (TFC) was further measured by flow cytometry. Results (1) In GD patients,the percentage of CD4+ CD28- T cells was significantly increased as compared with the control healthy individuals. The expression of co-stimulatory molecule ICOS was up-regulated. (2) The mRNA level of ICOS was significantly increased in GD patients than that in nontoxic goiter(NTG) patients(P＜0.01). (3)Compared with NTG control group, the GL50 protein expression was much higher in thyroid tissues of GD patients (P ＜0.01). (4)The results of immunohistochemistry showed that GL50 expression was observed in all GD thyroid tissues, while no expression of GL50 was detected in NTG thyroid tissues(P＜0. 01). (5) The expression of GL50on primary cultured thyroid follicular cells was significantly increased under the stimulatation of pro-inflammatory cytokines in vitro. Conclusion GL50-ICOS is expressed abnormally in thyroid tissue of patients with GD.

OBJECTIVETo study the principle and surgical managements for the patients with anatomic variants of hepatic artery in the procedure of pancreaticoduodenectomy (PD).

METHODSOne hundred and seventy-six patients who underwent PD between January 2000 and July 2007 were investigated retrospectively. Hepatic arterial variants were analyzed according to the intraoperative finding and CT imaging were reviewed postoperatively.

RESULTSHepatic arterial variants were found intraoperatively in 20 cases of all 176 patients. Accessory right heptic artery, replaced right heptic artery and common heptic artery arising from the superior mesenteric artery (SMA) were present in 9 (5.1%), 5 (2.8%), 4 (2.3%) cases respectively,and replaced right heptic artery coming from the gastroduodenal artery was present in 2 cases (2.9%). All the variants of hepatic arteries arising from the superior mesenteric artery could be observed in spiral CT imaging. Most of the variant arteries were dissected intact intraoperatively except 2 cases with accessory right heptic artery arising from SMA.

CONCLUSIONSPerforming CT scan preoperatively, especially CTA,is effective to diagnose these disorders. Skillful surgical techniques can manage the anatomic variants safely.

Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Radiography ; Retrospective Studies

OBJECTIVETo study the clinicopathologic features, immunophenotype and differential diagnosis of plexiform angiomyxoid myofibroblastic tumor (PAMT) of the stomach.

METHODSThe clinical and pathologic findings of 3 cases of PAMT in the gastric antrum were retrospectively analyzed. Immunohistochemical study was carried out and the literature was reviewed.

RESULTSThe age of patients ranged from 31 to 47 years. The male-to-female ratio was 1:2. The clinical presentation included epigastric pain and distension. Endoscopically, the tumor mass protruded into the gastric cavity at the antrum and ranged from 4.5 cm to 8.0 cm in greatest dimension. One of the tumors studied was associated with surface ulceration. Histologically, the tumors were located in the gastric wall. They were composed of bland spindle cells and small vessels arranged in a plexiform or nodular pattern within a myxoid stroma. Immunohistochemical study showed that the spindle cells were consistently positive for smooth muscle actin and muscle-specific actin. There was focal staining for h-caldesmon, desmin in case 3 and focal positive for epithelial membrane antigen, CAM5.2 in case 1. Further, CD10 and progesterone receptor were positive in case 3.

CONCLUSIONSPAMT represents a rare novel mesenchymal tumor of the stomach, with a propensity of gastric antral involvement. The distinctive pathologic features help to differentiate this entity from other benign and malignant tumors.

Actins ; metabolism ; Adenomyoma ; metabolism ; pathology ; Adult ; Antigens, CD34 ; metabolism ; Diagnosis, Differential ; Female ; Fibromatosis, Abdominal ; metabolism ; pathology ; Follow-Up Studies ; Gastrectomy ; methods ; Gastrointestinal Stromal Tumors ; metabolism ; pathology ; Humans ; Male ; Middle Aged ; Myofibroma ; metabolism ; pathology ; surgery ; Myxoma ; metabolism ; pathology ; surgery ; Proto-Oncogene Proteins c-kit ; metabolism ; Stomach Neoplasms ; metabolism ; pathology ; surgery

As propose of organ repair stem cell therapy technology, articular cartilage cannot be repaired by itself has become one of the research hotspots, repair of articular cartilage with mesenchymal stem cells has shown obvious advantages for the treatment. The scholars have made a preliminary study on the role of mesenchymal stem cells from different sources in the repair of knee articular cartilage, and with the combination of transplantation and cartilage tissue engineering, these technologies improved the human cartilage repair effect of bone marrow, adipose, synovium, cord blood derived stem cells, which achieved good clinical curative effect. Due to the different sources, the dominant and recessive factors, each stem cell will have certain advantages and disadvantages. At present, the clinical research is still in the experimental stage, there is no definite conclusion on which kind of stem cell or technology is more suitable for human cartilage repair. This requires the validation of large-scale or combining with new processing technology clinical trials and the long-term clinical effect, it also provides for the basis for further clinical research.

OBJECTIVEHepatitis B e antigen (HBeAg) seroconversion and/or hepatitis B surface antigen (HBsAg) clearance are considered as good prognostic indicators of treatment outcome in HBeAg-positive chronic hepatitis B (CHB) patients. While a sustained virological response (SVR) can be achieved by a finite 48-week course of pegylated-interferon alfa-2a (Peg-IFNalpha-2a), it has been suggested that longer-term treatment can improve the rate of SVR. Therefore, the aim of this study was to compare the effects of prolonged and routine Peg-IFNa-2a therapy in patients with HBeAg-positive CHB.

METHODSEighty-six consecutive patients diagnosed with HBeAg-positive CHB at our hospital between September 2006 and October 2009 were enrolled in the study. The patients were randomly assigned to receive Peg-IFNa-2a (180 mug once weekly) for either 48 weeks (routine therapy group, n = 53) or 72 weeks (prolonged therapy group, n = 33). Serum samples were collected from each patient every three months until the end of the 24-week follow-up, and standard viral and biochemical tests were carried out. Relapse was defined as HBV DNA concentrations more than 105 copies/mL or an HBeAg-positive test at the end of the 24-week follow-up. Chi-squared test and the t-test were used to determine the significance of intergroup differences. Logistic regression analysis was employed to determine the correlation of outcome parameters to treatment duration, expressed as odds ratio (OR) with 95% confidence interval (CI).

RESULTSThe two treatment groups were similar at baseline (pre-treatment) in demographic data, sex ratio, age, alanine aminotransferase (ALT) level, HBV DNA load, and semi-quantitative level of HBeAg (s/co) (all, P more than 0.05). At the end of the 24-week follow-up, there were significant differences between the 48-week treatment group and the 72-week treatment group in patients with HBV DNA negativity (62.3% vs. 97.0%, x2 = 13.273, P = 0.000), HBeAg seroconversion (39.6% vs. 57.6%, x2 = 6.765, P = 0.009), HBsAg clearance (15.1% vs. 36.4%, x2 = 5.155, P = 0.023), and relapse (58.5% vs. 33.3%, x2 = 6.713, P = 0.010). Logistic regression analysis indicated that therapy duration was correlated to HBeAg clearance (OR = 3.702, 95% CI: 1.225 to 11.188) and male sex (OR = 3.005, 95% CI: 1.038 to 8.696) but not to HBeAg level at baseline (OR = 0.999, 95% CI: 0.998 to 1.000) or age (OR = 0.902, 95% CI: 0.839 to 0.970).

CONCLUSIONIn this single-center cohort study, superior therapeutic benefit was achieved by extending the Peg-IFNa-2a therapy out to 72 weeks for patients with HBeAg-positive CHB. The prolonged duration therapy produced a higher HBsAg loss ratio, HBeAg seroconversion ratio, HBV DNA negativity ratio, and a lower relapse ratio. Furthermore, HBeAg clearance was positively correlated with duration and male sex.

Adult ; Antiviral Agents ; therapeutic use ; DNA, Viral ; blood ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; blood ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Polyethylene Glycols ; therapeutic use ; Recombinant Proteins ; therapeutic use ; Treatment Outcome ; Young Adult

OBJECTIVETo observe metabolomic changes in urine of chronic superficial gastritis (CSG) patients with Pi-qi deficiency syndrome (PQDS) or Pi-Wei dampness-heat syndrome (PWDHS), thereby providing scientific evidence for syndrome typing of them.

METHODSUrine samples were collected from CSG patients with PQDS/PWDHS and healthy volunteers, 10 in each group. Proton nuclear magnetic resonance spectroscopy (1H-NMR) based metabonomic analysis was performed on urine samples. Contents of related biomarkers were analyzed by principal component analysis (PCA), partial least square discriminant analysis (PLS-DA), and urivariate statistical analysis.

RESULTSPLS-DA analysis showed that metabolites among CSG patients with PQDS/PWDHS and healthy volunteers could be mutually distinguished. Seven differentially identified metabolites were screened from urines of CSG patients with PQDS and healthy volunteers included glutamate, methionine, α-oxoglutarate, dimethylglycine, creatinine, taurine, and glucose. Four differentially identified metabolites were screened from urines of CSG patients with PWDHS and healthy volunteers included 2-hydroxybutyric acid, trimethylamine oxide, taurine, and hippuric acid. Eleven differentially identified metabolites were screened from urines of CSG patients with PQDS and PWDHS included fucose, β-hydroxybutyric acid, alanine, glutamate, methionine, succinic acid, citric acid, creatinine, glucose, hippuric acid, and lactic acid.

CONCLUSIONThe metabolic differences of CSG patients PQDS and PWDHS mainly manifested in glycometabolism, lipid metabolism, and amino acids catabolism, and 1H-NMR based metabonomics may be used in classified study of Chinese medical syndrome typing.

Biomarkers ; urine ; Discriminant Analysis ; Gastritis ; urine ; Hot Temperature ; Humans ; Hydroxybutyrates ; Ketoglutaric Acids ; Least-Squares Analysis ; Medicine, Chinese Traditional ; Metabolome ; physiology ; Metabolomics ; Principal Component Analysis ; Proton Magnetic Resonance Spectroscopy ; Qi ; Syndrome