Objective To investigate the possibility of interventional treatment of placenta accreta. Methods One patient with placenta accreta was treated with uterine arterial infusion of cef and MTX followed by embolization. Results Her placenta discharged through vagina at the 27th day after uterine aterial embolizayiea. No remnant was found in the uterine by Doppler imaging. The patient uneventfully recovered.Conclusions Intervetional therapy with uterine arterial embolization is a new and reliable method for treatment of placenta accheta.

Objective To investigate the relationship of the anti-inflammatory effects of tetramethylprazine with histamine and 5-hydroxytryptaphane(5-HT).Methods The contents of histamine and 5-HT in the inflammatory exudate of rats were determined by fluorescence technique.The effect of tetramethylprazine on histamine and 5-HT were analyzed by in-vitro ileum contraction test in guinea pigs.Results Tetramethylprazine significantly decreased the contents of histamine and 5-HT in the inflammatory exudate,and markedly antagonized the contraction of isolated ileum induced by histamine and 5-HT.Conclusion The anti-inflammatory mechanisms of tetramethylprazine may be related to the inhibition of the synthesis or release of histamine and 5-HT,as well as its direct antagonism.

Objective To improve the quality of medical device clinical trial.Methods To analyze medical device clinical trials conducted in our hospital from 2006 to 2010,and proposed the strategy to strengthen medical device clinical trial management.Results Most of the medical devices clinical trials were class Ⅲ medical devices clinical validation in our hospital,Surgical departments undertook most of the clinical trials.Until July 2013,49 trials were done only 56％ of undertake the project.96％ of completed trials were approved for medical device registration certificate.Conclusions The quality of clinical trials must be improved,andthe quality control process in medical device clinical trial should be reinforced.

Objective To investigate the features of malignancy in end-stage aristolochic acid nephropathy (AAN) patients undergoing renal replacement therapy in the First Affiliated Hospital of Wenhou Medical University.Methods One hundred and two patients diagnosed as end-stage AAN during 2004 to 2013 were enrolled in the study,and separately udergoing hemodialysis,peritoneal dialysis and renal transplantation,to study the features of the malignancy and its risk factors.Results (1) There were totally 42 AAN patients suffering from malignancy,and 39 of them had urinary cancer.Eight cases of urinary cancer had metastasis,and 11 cases of bladder cancer had repeated recurrences.Patients suffering from malignancy had an increased mortality compared to patients without malignancy (13/42 vs 7/60,P =0.022).(2) Thirteen malignacy cases were diagnosed before the end-stage of AAN,the rest cases appeared in 1-13 years[(4.62±3.31) years] after renal replacement.(3) A further logistic regression analysis of the 29 maligancy patients after renal replacement showed that,the dose of aristolochic acid (counted by Mutong) was the only risk factor of malignancy (P =0.091),compared with the dose of Mutong less than 60 g,the patients with an accumulated dose of Mutong more than 200 g had a 4.26 folds (95％CI 1.02,17.83)higher risk of malignancy.There was no statistic difference of the malignancy risk among different renal replacement therapies,which however might influence the pathogenic sites of the urinary cancer.The simple bladder cancer was the most common malignancy among the hemodialysis patients (72.72％),and the upper urinary tract cancer among the peritoneal dialysis patients (66.67％),while the complex of both were dominant among the renal transplantation patients(40.00％).Conclusions Among the end-stage of AAN patients undergoing renal replacement therapy in Wenzhou area,the incidence of urinary cancer is high,with a character of complex,multiple and repeated recurrences.The occurence of malignancy seems to be separated from the renal function,but turns out obviously dose-dependent.There was no statistical difference of cancer risk among hemodialysis,peritoneal dialysis,and renal transplantation,which may induce different pathogenic sites of the urinary cancer.

Objective To describe the general characteristics of patients with acute chest pain in order to analyze factors associated with patients’utilization of emergency medical services (EMS).Methods A total of 747 eligible patients with acute chest pain admitted to emergency department of Qilu Hospital were consecutively enrolled from October 2014 to April 2015.Clinical data including demographic features, mode of arrival,past medical history,risk factors,symptoms and signs were collected prospectively by using standardized case report form.Univariate and multivariate analyses were carried out to investigate the association between the decision to use EMS and related factors including demographic features,past medical history,risk factors,symptoms and signs.Results Of the total 747 eligible patients,414 (55.4%)were male ,and the mean age was (57.2 ± 15.8)year;333 (44.6%)were female,and the mean age was (61.7 ±14.9)year.Of them,171 (22.9%)patients used EMS,and 143 chest pain patients with more than 75 years old were more inclined to use EMS (P <0.01),whereas 152 patients in 65 -75 years age group accounted for the lowest proportion of using EMS.Men were more inclined to use EMS than women (P <0.05),and 483 patients with typical chest pain used more EMS than patients with atypical chest pain (P <0.05);Of them,356 patients with a history of hypertension and 54 patients with a history of cerebral infarction were more inclined to use EMS (P <0.05 and P <0.01,respectively).Multivariate logistic regression analysis showed that male,older than 75 years,history of cerebral infarction were independent factors associated with EMS use (P <0.05).Conclusions This study indicated that only less than one-third of emergency department visits with acute chest pain decide to use EMS when symptoms occurred. Factors including male,older than 75 years,and a history of cerebral infarction were associated with more use of EMS.In order to promote patient asking for EMS timely,more work should be done.

Objective To investigate the effects of apolipoprotein E (ApoE) deficiency on neuromyelitis optica (NMO) model of spinal cord sections induced by NMO-IgG and complement in vitro.Methods NMO-IgG was extracted from the patients with NMO,and complementary serum from healthy people.The spinal cord sections of seven days old C57BL / 6J mice with wild type (WT) or ApoE knockout (ApoE-/-) were cultured for seven days.The spinal cords of the two genotypes were randomly divided into experimental groups (NMO-ApoE-/-group,NMO-WT group) and control groups (C-AopE-/-group,C-WT group),respectively.The experimental groups were treated with NMO-IgG and complementary serum,and the control groups only with complementary serum.Then all the sections were continued incubating for 24 h before harvested.Immunofluorescence staining and modified thick tissue film immunofluorescence were used to detect the expression of aquaporin 4 (AQP4),glial fibrillary acidic protein (GFAP),ionic calcium fibronectin (IBA1),myelin basic protein (MBP) and human neurofilament protein L (NFL) respectively.The lesion score was calculated according to the areas percentage of AQP4 and GFAP deficiency in spinal cord sections.Results Compared with the respective control groups,the expressions of AQP4,GFAP,MBP and NFL were deficient in the experimental groups (The percentages of missing area in the NMO-ApoE-/-group were 83.88％ ± 5.01％,82.44％ ± 6.11％,45.02％ ± 5.11％ and 54.65％ ± 7.66％ respectively,while the percentages of missing area in the C-ApoE-/-group were 10.44％ ± 4.07％,5.73％ ±0.82％,9.12％ ±1.41％ and 5.72％ ±0.81％,t=34.143,37.269,20.300,19.051,allP ＜0.05;The percentages of missing area in the NMO-WT group were 77.74％ ± 6.75％,75.62％ ± 5.76％,37.60％ ± 4.88％ and 46.29％ ± 4.98％,while the percentages of missing area in the C-WT group were 9.31％ ± 2.97％,5.80％ ± 0.82％,9.10％ ± 1.63％,5.80％ ± 0.81％ respectively,t =27.828,35.934,16.613,24.057,all P ＜ 0.05).While IBA1 was up-regulated and the damage scores were higher in both the NMO-ApoE-/-group and the NMO-WT group.The percentages of missing area in the NMO-ApoE-/-group and the NMO-WT group showed statistically significant difference (t =2.194,2.436,3.149,2.746,all P ＜ 0.05).The expression level of IBA1 in the NMO-WT group was higher than that in the C-WT group (19.88 ± 1.11 vs 11.18 ±0.65,t =25.270,P ＜0.05),while the expression level of IBA1 in the NMO-ApoE-/-group was higher than that in the NMO-WT group (25.81 ± 1.61 vs 19.88 ± 1.11,t =9.101,P ＜0.05).The degree of deficiency or up-regulation of above-mentioned proteins was more obvious in the NMO-ApoE-/-group than that in the NMO-WT group.Conclusions NMO-IgG extracted from NMO patients can induce NMO-like damage in isolated tissue at the presence of complement.ApoE deficiency promotes the further activation of microglia,thereby aggravates the injury of astrocyte in the model of NMO.

Objective To explore the effect of security,self-acceptance,self-concept,intemet addiction,anxiety,depression on the suicidal ideation of internet addiction patients.Methods The safety,self-acceptance,self-concept,internet addiction,anxiety and depression of 220 internet addiction patients were assessed using the corresponding scale tools.Suicidal ideation was used as the dependent variable,and each influencing factor was used as the independent variable.Correlation analysis,multiple stepwise regression analysis and path analysis were utilized to analyze the predisposing factors.Results The suicidal ideation (12.65 ±5.72) was positively correlated with internet addiction assessment (73.35± 15.83),depression self-evaluation (56.33± 13.75) and anxiety self-assessment (48.93± 17.20) (r=0.250,0.636,0.531,P＜ 0.01),while negatively correlated with security (50.26± 12.33),self-acceptance (38.29±7.15),and self-concept (56.47± 17.92) (r=-0.390,-0.297,-0.298,P＜ 0.01).Sequentially depression (β =0.571,P＜ 0.01),anxiety (β =0.173,P=0.003) were entered into the multiple regression equation.Path analysis based on the structural equation model showed that suicidal ideation had a direct effect with depression and anxiety,with effect values of 0.583 and 0.176.There were indirect effects of self-concept,self-acceptance,sense of security,and internet addiction assessment.The effect values were-0.137,-0.117,-0.281,and 0.034.The total effect of suicidal ideation and self-concept,self-acceptance,sense of security,internet addiction,depression self-assessment,and anxiety self-assessment were-0.137,-0.117,-0.281,0.034,0.583 and 0.176 respectively.Conclusions The influence of security,self-acceptance,and self-concept on suicidal ideation is produced through the mediating effects of depression and anxiety,and it has a negative predictive effect.There is no direct causal relationship between internet addiction and suicidal ideation.

Objective To discuss our drug clinical trial institution's experience and findings during the process of establishing drug clinical trial central pharmacy.Methods Analyze the previous key issues identified during the drug management under different modes,discuss the necessity and feasibility of establishing drug clinical trial central pharmacy.Meanwhile,discuss the planning and construction of hardware including location site of the central pharmacy,equipment and facilities,staff,as well as software such as electronic management system and standard operation procedures.Results After the adoption of central trial pharmacy,space and energy are saved,manpower and material resources are saved,the quality of clinical trials also improved.Conclusions Standardized and unified management of investigational drugs through establishing drug clinical trial central pharmacy,is the strong guarantee for the drug safety of human subject,as well as the accuracy and scientificity of trial results.

Objective To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment,and to provide theoretical basis for design of illness percep-tion questionnaire for patients with somatic symptoms disorder. Methods A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive quali-tative study. The data were sorted,encoded,classified,summarized and refined using MAXQDA10 software. Results Three main themes and six sub-themes of illness perception in patients with somatic symptom dis-order were analyzed and sorted out:(1) symptom recognition:including three sub-themes,low understanding of the disease and denial of somatic symptoms as mental illness;(2)drug taking concerns:including two sub-themes worrying about side effects of drugs,drug addiction and having difficulty to stick to the long-term reg-ular medication;(3)emotional reaction:including the obvious negative emotions of depression and helpless-ness sub-theme. Conclusion Patients with somatic symptom disorder have a general bias in illness percep-tion,which has a potential adverse effect on treatment compliance. Therefore,it is necessary for clinical med-ical staff to early estimate patients’illness perception,and carry out mental health education and rational e-motional behavior therapy.

Objective: To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment, and to provide theoretical basis for design of illness perception questionnaire for patients with somatic symptoms disorder. Methods: A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive qualitative study. The data were sorted, encoded, classified, summarized and refined using MAXQDA10 software. Results: Three main themes and six sub-themes of illness perception in patients with somatic symptom disorder were analyzed and sorted out: (1) symptom recognition: including three sub-themes, low understanding of the disease and denial of somatic symptoms as mental illness; (2)drug taking concerns: including two sub-themes worrying about side effects of drugs, drug addiction and having difficulty to stick to the long-term regular medication; (3)emotional reaction: including the obvious negative emotions of depression and helplessness sub-theme. Conclusion Patients with somatic symptom disorder have a general bias in illness perception, which has a potential adverse effect on treatment compliance. Therefore, it is necessary for clinical medical staff to early estimate patients’illness perception, and carry out mental health education and rational emotional behavior therapy.