OBJECTIVETo report the postmortem findings of a case of highly pathogenic H5N1 avian influenza virus occurring in human beings.

METHODSPostmortem examination was carried out in a deceased caused by highly pathogenic H5N1 avian influenza virus. Detailed light microscopy of major organs, including heart, lungs, liver, spleen, kidneys and brain, was performed. The lung tissue was further investigated by histochemistry, immunohistochemistry and electron microscopy.

RESULTSMajor histopathologic changes in lungs secondary to highly pathogenic H5N1 avian influenza virus included diffuse alveolar damage, hyaline membrane formation and focal hemorrhage. Some of the alveolar spaces contained lightly eosinophilic liquid, lymphocytes, macrophages, plasma cells and small number of neutrophils. Congested capillaries were commonly seen in the alveolar septa which were focally rimmed by hyaline membrane. Immunohistochemical study showed that the lymphocytes were mainly of T lineage and macrophages were also demonstrated.

CONCLUSIONSHighly pathogenic H5N1 avian influenza virus causes pathologic changes mostly in lungs, including diffuse alveolar damage and acute exudative changes (involving mainly T lymphocytes and macrophages). The resulting parenchymal destruction, consolidation, pulmonary edema and hemorrhage eventually lead to respiratory distress and death.

Adult ; Autopsy ; CD3 Complex ; analysis ; Fatal Outcome ; Female ; Humans ; Immunohistochemistry ; Influenza A Virus, H5N1 Subtype ; isolation & purification ; Influenza, Human ; metabolism ; pathology ; virology ; Leukocyte Common Antigens ; analysis ; Lung ; pathology ; ultrastructure ; virology ; Microscopy, Electron

Action Potentials ; drug effects ; Calcium Channel Blockers ; pharmacology ; Cinnarizine ; analogs & derivatives ; pharmacology ; Heart Atria ; Humans ; Isoproterenol ; antagonists & inhibitors ; Microelectrodes ; Purkinje Fibers ; drug effects ; physiology

BACKGROUNDTertiary hospitals serve as the medical service center within the region and play an important role in the medical and health service system. They are also the key targets of public hospital reform in the new era in China. Through the reform of health system, the public hospital efficiency has changed remarkably. Therefore, this study aimed to provide some advice for efficiency assessment of public hospitals in China by comparing and analyzing the consistency of results obtained by three commonly used methods for examining hospital efficiency, that is, ratio analysis (RA), stochastic frontier analysis (SFA), and data envelopment analysis (DEA).

METHODSThe theoretical basis, operational processes, and the application status of RA, SFA, and DEA were learned through literature analysis. Then, the empirical analysis was conducted based on measured data from 51 tertiary public hospitals in Beijing from 2009 to 2011.

RESULTSThe average values of hospital efficiency calculated by SFA with index screening and principal component analysis (PCA) results and those calculated by DEA with index screening results were relatively stable. The efficiency of specialized hospitals was higher than that of general hospitals and that of traditional Chinese medicine hospitals. The results obtained by SFA with index screening results and the results obtained by SFA with PCA results showed a relatively high correlation (r-value in 2009, 2010, and 2011 were 0.869, 0.753, and 0.842, respectively, P < 0.01). The correlation between results obtained by DEA with index screening results and PCA results and results obtained by other methods showed statistical significance, but the correlation between results obtained by DEA with index screening results and PCA results was lower than that between results obtained by SFA with index screening results and PCA results.

CONCLUSIONSRA is not suitable for multi-index evaluation of hospital efficiency. In the given conditions, SFA is a stable efficiency analysis method. In the evaluation of hospital efficiency, DEA combined with PCA should be adopted with caution due to its poor stability.

China ; Hospitals, Public ; methods ; statistics & numerical data ; Humans ; Principal Component Analysis ; Stochastic Processes

Background and Objective: Mutations in DNA repair system are related to carcinogenesis.This study was to evaluate the correlations of polymorphisms and haplotypes of XPD gene with individual susceptibility to gastric cancer. Methods: Genomic DNA were extracted from peripheral blood leukocytes of 207 gastric cancer patients and 212 healthy controls. Genotypes at codon 312 and codon 751 polymorphic sites were identified by amplification refractory mutation system-polymerase chain reaction(ARMS-PCR) or polymerase chain reaction-restriction fragment length polymorphism (PCRPFLP), respectively. Results: At codon 312, the frequency of GA or AA genotype was higher in the gastric cancer patients than in the healthy controls (P＜0.01,OR=3.41, 95% CI: 2.06-4.79; P＜0.01, OR=3.47,95% CI:1.39-8.68). No significant difference was found in the distribution of the polymorphism at codon 751 between the two groups(P＞0.05). By the haplotype AA (codon 312A-codon 751A) analysis, the frequency of heterozygote(-/AA) or homozygote (AA/AA) was higher in the patients than in the controls (P＜0.01 ,OR=2.81, 95% CI:1.82-4.34;P=0.02,OR=3.92, 95%CI:1.31-11.70,respectively). Whereas there were no significant differences of the other three haplotypes between the patients and the controls (P＞0.05).Conclusions: The polymorphism of XPD at codon 312 might contribute to the etiology of gastric cancer.The haplotype AA (codon 312A-codon 751A) would be a critical risk factor of the susceptibility to gastric cancer.

Acute Disease ; Adult ; Embolectomy ; Humans ; Male ; Pulmonary Embolism ; therapy ; Thrombolytic Therapy

OBJECTIVETo study the central modulation mechanism on the relative specificity of the Heart and Lung Meridians and to provide the experimental evidence for deeply study on correlation between meridian-viscera and brain.

METHODSTen healthy students in Anhui College of TCM were chosen and a modified block design was adopted. After 32 time points of resting and 32 of rotation needling, then 48 of resting and 32 stimulating, and 16 resting time points, functional imagings were collected at last. All the process would last for 10 min 44 sec. Acupuncture work was finished by one acupuncturist with extensive experience by acupuncture at the left Shenmen (HT 7) or Taiyuan (LU 8) with the disposable sterile stainless steel needle, and uniform reinforcing-reducing method was used with frequency of 1 Hz and depth of 1.0 cm. After the experiment, the sensation of acupuncture and the other feeling or psychic process were inquired and recorded detailedly. These data were analyzed by AFNI software.

RESULTSAcupuncture at Taiyuan (LU 8) could excite the contralateral frontal lobe, apical lobe, cerebral ganglion, VI, VIII areas and inferior semilunar lobule of cerebellum, and restrain bilateral callosal gyrus and homolateral gyrus rectus. Acupuncture at Shenmen (HT 7) could excite the contralateral IV-VIII areas of cerebellum, and homolateral VI, VII areas of cerebellum, and restrain parts of homolateral apical lobe.

CONCLUSIONAcupuncture at Shenmen (HT 7) of the Heart Meridian and Taiyuan (LU 8) of the Lung Meridian can excite or restrain different brain areas, indicating that there are relatively specific corresponding brain areas for the Heart Meridian and Lung Meridian.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Brain ; diagnostic imaging ; physiopathology ; Female ; Heart ; physiopathology ; Humans ; Lung ; physiopathology ; Magnetic Resonance Imaging ; Male ; Meridians ; Radiography ; Young Adult

OBJECTIVETo explore action mechanism of electroacupuncture for coronary atherosclerotic heart disease (CHD) in order to provide experimental support for clinical acupoint selection.

METHODSAmong sixty clean-grade healthy male Wistar rats, twenty-four cases were randomly selected as a normal control group and an electroacupuncture (EA) preconditioning group, 12 cases in each one. Then rats in the EA preconditioning group and the rest 36 rats were fed with high fat diet for 12 weeks to duplicate the CHD model. When the models were successfully established, the rats were randomly divided into a model control group, an EA group and a medication group, 12 cases in each one. EA was applied with Hwa-to SDZ-IV apparatus in the EA preconditioning group at "Neiguan" (PC 6) and "Xinshu" (BL 15), 1 mA in current intensity, 2 Hz in frequency, 30 min per times, once every other day for 14 weeks. When model was established, the same acupoint and method was used in the EA group for 2 weeks while intragastric administration of atorvastatin mixed suspension, 0.25 mg/kg, once a day, was applied in the medication group for 2 weeks. The content of oxidized low-density lipoprotein (oxLDL) in the serum was tested by double antibody enzyme-linked immunosorbent assay (ELISA) while content of lectin-like oxidized low density lipoprotein receptor-1 (LOX-1) in coronary arterial tissue was test by western blot method. Expression of LOX-1 mRNA was tested by fluorogenic quantitative polymerase chain reaction (PCR).

RESULTSAfter model was duplicated successfully, the content of oxLDL in the serum and the expression of LOX-1 and its mRNA in coronary arterial tissue in the model control group were increased significantly compared with those in the normal control group (all P < 0.01). Compared with the model control group, the content of oxLDL in the serum and the expression of LOX-1 and its mRNA in coronary arterial tissue in the EA preconditioning group, EA group and medication group were significantly reduced (all P < 0.01).

CONCLUSIONThe electroacupuncture at "Neiguan" (PC 6) and "Xinshu" (BL 15) could effectively reduce the content of oxLDL in the serum and expression of LOX-1 and its mRAN in coronary arterial tissue in CHD rats. The oxidative modificatory low-density lipoprotein and its specific receptor system could be one of the ways to prevention and treatment of acupuncture for CHD.

Animals ; Coronary Disease ; genetics ; metabolism ; therapy ; Disease Models, Animal ; Electroacupuncture ; Humans ; Lipoproteins, LDL ; genetics ; metabolism ; Male ; Rats ; Rats, Wistar ; Scavenger Receptors, Class E ; genetics ; metabolism

OBJECTIVETo investigate the pathological changes of liver in children with hepatitis B virus associated glomerulonephritis (HBV-GN).

METHODSThirteen children with HBV-GN (aged from 2-14 years) underwent renal and liver biopsy. The biopsy findings were analyzed.

RESULTSDifferent degrees of hepatic lesions were seen in all of the 13 patients, mild lesions accounting for 69.2% (9/13). HBSAg positive was the most common in the liver tissue [76.9% (10/13)]. Among the renal lesions, membranous glomerulopathy accounted for 69.2%( 9/13), followed by membranoproliferative glomerulonephritis 30.8% (4/13). HBsAg and HBcAg positive were presented in all patients' kidney tissues. HBV antigens were detected in stroma between nephric tubule in all samples. Four patients presented with HBcAg positive in both live and kidneys.

CONCLUSIONSThe children with HBV-GN couple with liver lesions. The severity of the renal lesions is not always accord with that of the liver lesions. The appearance of HBcAg in both kidneys and liver indicates severe lesions of the two organs. It is suggested that a liver-kidney holistic treatment is necessary for children with HBV-GN.

Adolescent ; Child ; Child, Preschool ; Female ; Glomerulonephritis ; pathology ; Hepatitis B ; complications ; pathology ; Hepatitis B Core Antigens ; analysis ; Humans ; Kidney ; pathology ; Liver ; pathology ; Male

OBJECTIVE: To discuss the pathologic features, treatment and prognosis of the children with isolated proteinuria (IP). METHODS: Twenty-one children with IP were enrolled according to their renal biopsy and were followed up for 0.5 to 10 years. RESULTS: Renal biopsy was performed in all children. Among them 13 were mesangial proliferation glomerulonephritis (MsPGN) (including 3 minor, 6 moderate, and 4 severe ones), 2 minimal change nephritis (MCN), 3 IgA nephropathy (IgAN) (1 in Grade I and 2 in Grade II), 2 focal segmemtal glomerulosclerosis (FSGS) and 1 endocapillary proliferative glomerulonephritis (EnPGN). Interstitial changes could be found in MsPGN and FSGS mostly, presenting interstitial fibrosis, infiltration of inflammatory cells, atrophy of renal tubule, and the vacuolar degeneration of epithelia. All children accepted the medical treatment except the EnPGN case. Fifteen children recovered with no relapse; proteinuria persisted in 3 severe MsPGN and FSGS cases; 2 got the impaired renal function accompanied by persistent proteinuria; and 1 had hypertension. CONCLUSION The different degrees of renal damage can be found in all IP children who have persistent proteinuria. Most patients can get good outcome after aggressive therapies. However, the prognosis of those with severe MsPGN and FSGS was not so optimistic, and some reno-protective treatments should be given to postpone the deterioration of the renal function.
Adolescent ; Biopsy, Needle ; Child ; Child, Preschool ; Female ; Glomerulonephritis, Membranoproliferative ; pathology ; Humans ; Kidney ; pathology ; Male ; Prognosis ; Proteinuria ; etiology ; pathology

OBJECTIVE: To explore the relationship between pathological features and clinical manifestations in children with nephropathy under 6 years old. METHODS: Renal biopsy by rapid percutaneous puncturation was performed on 313 children under 6 who were all diagnosed clinically as kidney diseases of 14 different kinds. The specimens were divided into 3 parts for microscope, electron microscope and immuno fluorescence examination respectively and processed by HE, PAS, PASM, and Masson staining. Immunofluorescence was used to detect the deposition of IgG, IgM, IgA, C3, C4, C1q, and Fb in the renal tissues. Additional examinations were done to detect HBs-Ag, HBeAg and HBcAg deposition in some cases with positive serum HBs-Ag. Altogether 290 of the specimens (290/313, 92.65%) were examined by electron microscope. RESULTS: All the renal biopsy performances were successful. The clinical manifestations comprised of persistent haematuria (32.92%, 103/313), idiopathic nephritic syndrome (26.1%, 82/313), acute nephritic syndrome (20.14%, 63/313), Henoch Schonlein purpura nephritis (8.32%, 26/313), HBV-nephritis (4.79%, 15/313), and isolated proteinuria (2.56%, 8/313). The main pathological patterns of glomerular disease were identified as mesangial proliferation (51.75%, 162/313), IgM nephropathy (8.31%,26/313), minor and minimal change (7.99%, 25/313), IgA nephropathy (7.35%, 23/313), endocapillary proliferative glomerulonephritis (5.11%, 16/313), focus segmental glomerulosclerosis (4.47%, 14/313), thin basement membrane nephropathy (4.47%, 14/313), and membrane nephropathy (4.47%, 14/313). Alport syndrome, congenital nephrotic syndrome, and thin basement membrane nephropathy can be diagnosed by electron microscope, white IgA nephropathy, IgM nephropathy and C1q nephropathy by immunopathology. CONCLUSION Similar clinical manifestations may differ in the pathology and the clinical features of one pathological diagnosis may vary greatly. Renal biopsy is of great help to the diagnosis, treatment and the prognosis evaluation for children with nephropathy under 6. Electron microscopes also play an important role in the diagnosis of nephropathy.
Biopsy, Needle ; Child ; Child, Preschool ; Glomerulonephritis ; diagnosis ; pathology ; Humans ; Infant ; Kidney ; pathology ; ultrastructure ; Kidney Diseases ; diagnosis ; pathology ; Nephrotic Syndrome ; diagnosis ; pathology