Objective:To improve the differential awareness of lead porsoning.Methods:A case with stomachache, anemia, myasthenia, and abnormal urine color was described. The diagnosis and treatment were analyzed and discussed.Results:A middle-aged female was admitted with a 9-month medical history, compalnied with rash, stomachache. She also had evidence of hemolytic anemia,nervous system and kidneys imvolvement, and Lab test showed a significantly elevated blood lead level. It was considered to be in line with multiple organ system damage caused by lead poisoning.Conclusion:Lead poisoning can mimic the clinical presentations of rheumatic diseases, resulting in multiple system ivolvement. When the patient's clinical manifestation cannot be fully explained, some special situations should be considered, such as toxic testing.

Objective:To explore surgical techniques and summarize surgical experience of the paraumbilical flap pedicled with deep inferior epigastric vessels for the repiration of soft tissue defects in pelvic area.Methods:Between August, 2006 and August, 2018, 8 patients with soft tissue defects and bone exposure were treated with paraumbilical flap pedicled with deep inferior epigastric vessels. There were 6 males and 2 females with the average age of 35.3 (range, 12-47) years. The defects were caused by car accident in 5 cases, by high falling injury in 1 case, by soft tissue necrosis after malignant schwannoma resection in 1 case, and by soft tissue necrosis after pelvic operation of open reduction internal fixation in 1 case. The defects located at iliac spine in 5 cases, at tuber ischii in 1 case, and at buttock and perineal region in 1 case. The size of the wounds ranged from 11.0 cm×6.0 cm to 22.0 cm×8.0 cm. The size of the flaps ranged from 13.0 cm×7.0 cm to 29.0 cm×12.0 cm. The followed-up was made by outpatinet service, telephone or WeChat.Results:All flaps survived, and the wound infection was controlled. The followed-up time ranged from 12 to 46 (mean 26) months. All flaps survived uneventfully, and the texture and elasticity of the flaps were good. There were no recurrence of infection, and no ventral hernias occurred in donor sites.Conclusion:The transfer of paraumbilical flap pedicled with deep inferior epigastric vessels is a reliable method to repair large soft tissue defects in iliac spine, perineal region, buttock and tuber ischii.

Objective: To summarize the measures and experience of treatment in mass extremely severe burn patients. Methods: The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment. Results: Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients. Conclusions Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.

Objective: Study of the results and the degree on occupational noise-induced deafness in-to the different high frequency hearing threshold weighted value, in order to provide theoretical basis for the re-vision of diagnostic criteria on occupational noise-induced deafness. Methods: A retrospective study was con-ducted to investigate the cases on the diagnosis of occupational noise-induced deafness in Guangdong province hospital for occupational disease prevention and treatment from January 2016 to January 2017. Based on the re-sults of the 3 hearing test for each test interval greater than 3 days in the hospital, the best threshold of each frequency was obtained, and based on the diagnostic criteria of occupational noise deafness in 2007 edition, Chi square test, t test and variance analysis were used to measure SPSS21.0 data, their differences are tested among the means of speech frequency and the high frequency weighted value into different age group, noise ex-posure group, and diagnostic classification between different dimensions. Results: 1. There were totally 168 cases in accordance with the study plan, male 154 cases, female 14 cases, the average age was 41.18 ±6.07 years old. 2. The diagnosis rate was increased into the weighted value of different high frequency than the mean value of pure speech frequency, the weighted 4 kHz frequency increased by 13.69% (χ²=9.880, P=0.002) , 6 kHz increased by 15.47% (χ²=9.985, P=0.002) and 4 kHz+6 kHz increased by15.47% (χ²=9.985, P=0.002) , the difference was statistically significant. The diagnostic rate of different high threshold had no obvious differ-ence between the genders. 3. The age groups were divided into less than or equal to 40years old group (A group) and 40-50 years old group (group B) , there were higher the diagnostic rate between high frequency weighted 4 kHz (A group χ²=3.380, P=0.050; B group χ²=4.054, P=0.032) , weighted 6 kHz (A group χ²=6.362, P=0.012; B group χ²=4.054, P=0.032) , high frequency weighted 4 kHz+6 kHz (A group χ²=6.362, P=0.012; B group χ²=4.054, P=0.032) than those of speech frequency average value in the same group on oc-cupational noise-induced deafness diagnosis rate, the difference was statistically significant. There was no sig-nificant difference between age groups (χ²=2.265, P=0.944) . 4. The better ear's mean value of pure speech fre-quency and the weighted values into different high frequency of working years on each group were compared, working years more than 10 years group was significantly higher than that of average thresholds of each frequen-cy band in 3-5 group (F=2.271, P=0.001) , 6-10 group (F=1.563, P=0.046) , the difference was statistically significant. The different high frequency weighted values were higher than those of the mean value of pure speech frequency, and the high frequency weighted 4 kHz+6 kHz had the highest frequency difference, with an average increase of 2.83 dB. 5. The diagnostic rate into weighted different high frequency was higher in the mild, moderate and severe grades than in the pure speech frequency. In the comparison of diagnosis for mild occupational noise-induced deafness, in addition to the weighted 3 kHz high frequency (χ²=3.117, P=0.077) had no significant difference, the weighted 4 kHz (χ²=10.835, P=0.001) , 6 kHz (χ²=9.985, P=0.002) , 3 kHz+4 kHz (χ²=6.315, P=0.012) , 3 kHz+6 kHz (χ²=6.315, P=0.012) , 4 kHz+6 kHz (χ²=9.985, P=0.002) , 3 kHz+4 kHz+6 kHz (χ²=7.667, P=0.002) were significantly higher than the diagnosis rate of the mean value of pure speech frequency. There was no significant difference between the two groups in the moderate and se-vere grades (P>0.05) . Conclusion Bring into different high frequency hearing threshold weighted value in-creases the diagnostic rate of occupational noise-induced deafness, the weighted 4 kHz, 6 kHz and 4 kHz+ 6 kHz high frequency value affects the result greatly, and the weighted 4 kHz+6 kHz high frequency hearing threshold value is maximum the effect on occupational noise-induced deafness diagnosis.

OBJECTIVE: To analyze the impact of GBZ 49-2014 Diagnosis of Occupational Noise-induced Deafness and GBZ49-2007 Diagnostic Criteria of Occupational Noise-induced Deafness on the diagnosis of occupational noise-induced deafness( ONID). METHODS: A total of 84 individuals,who were workers exposed to noise and diagnosed as observation subjects by GBZ 49-2007 were selected as the subjects of study by judgment sampling. They were diagnosed based on the criteria of GBZ 49-2014 and GBZ 49-2007. The impact of different diagnostic audiometry,different age and gender correction methods and the inclusion of a weighting of 0. 1 high-frequency 4. 0 k Hz hearing threshold of GBZ 49-2014 on the diagnosis of ONID was analyzed. RESULTS: The binaural high frequency threshold average( BHFTA) calculated by GBZ 49-2014 were lower than that of GBZ 49-2007 [( 52. 1 ± 10. 3) vs( 52. 8 ± 10. 1) d B,P < 0. 05 ],but monaural threshold of weighted value( MTWV) of the good ear calculated by GBZ 49-2014 were higher than speech frequency threshold average( SPTA) of the good ear of GBZ 49-2007 [( 23. 2 ± 4. 1) vs( 19. 3 ± 4. 8) d B,P < 0. 01]. All of the 84 patients had BHFTA ≥40 d B and SPTA < 26 d B when diagnosed by GBZ 49-2007,and could not be diagnosed as ONID. A total of33. 3% patients had BHFTA ≥40 d B and MTWV ≥26 d B when diagnosed by GBZ 49-2014 which could be diagnosed as mild ONID. The detection rate of ONID was 21. 4% to 34. 5%( P < 0. 01) when the threshold of 4. 0 k Hz was used as the weighting diagnostic threshold of hearing in the case of using different diagnostic audiograms and different age and sex correction methods. CONCLUSION: A high-frequency hearing threshold of 4. 0 k Hz with a weighting of 0. 1 was included in GBZ 49-2014 as a diagnostic threshold,which reduced the diagnostic threshold of ONID.

Glucocorticoid receptor (GR) is identified as a member of nuclear receptor family. To exert its biological action, the ligand bound GR is translocated from the cytoplasm into the nucleus by regulating transcriptional signals of related genes. In clinical practice, the effects of glucocorticoid are often mediated by GR signaling pathways. An increasing number of studies have indicated that GR signaling pathways play an essential role in the proliferation, invasion and prognosis of bladder cancer. Meanwhile, the new-generation selective GR activator improves its anti-tumor effects, and at the same time reduces the adverse reactions of hormones, which probably raises the prospect for the treatment of bladder cancer.
Animals ; Antineoplastic Agents ; pharmacology ; Cell Nucleus ; genetics ; Humans ; Prognosis ; Protein Transport ; genetics ; Receptors, Glucocorticoid ; agonists ; physiology ; Signal Transduction ; genetics ; Transcriptional Activation ; drug effects ; physiology ; Urinary Bladder Neoplasms ; genetics ; physiopathology

Integrin alphavbeta3 plays a major role in various signaling pathways, cell apoptosis, and tumor angiogenesis. To examine the functions and roles of alphavbeta3 integrin, a stable CHO-677 cell line expressing the murine alphavbeta3 heterodimer (designated as "CHO-677-malphavbeta3" cells) was established using a highly efficient lentiviral-mediated gene transfer technique. Integrin subunits alphav and beta3 were detected at the gene and protein levels by polymerase chain reaction (PCR) and indirect immunofluorescent assay (IFA), respectively, in the CHO-677-malphavbeta3 cell line at the 20th passage, implying that these genes were successfully introduced into the CHO-677 cells and expressed stably. A plaque-forming assay, 50% tissue culture infective dose (TCID50), real-time quantitative reverse transcription-PCR, and IFA were used to detect the replication levels of Foot-and-mouth disease virus (FMDV) in the CHO-677-malphavbeta3 cell line. After infection with FMDV/O/ZK/93, the cell line showed a significant increase in viral RNA and protein compared with CHO-677 cells. These findings suggest that we successfully established a stable alphavbeta3-receptor-expressing cell line with increased susceptibility to FMDV. This cell line will be very useful for further investigation of alphavbeta3 integrin, and as a cell model for FMDV research.
Animals ; Animals, Suckling ; CHO Cells ; Cloning, Molecular ; Cricetulus ; DNA, Complementary/genetics/metabolism ; Disease Susceptibility/virology ; Foot-and-Mouth Disease/*genetics/virology ; Foot-and-Mouth Disease Virus/*physiology ; Integrin alphaVbeta3/*genetics/metabolism ; Mice

Objective To explore the changes of neutrophil elastase (NE) and surfactant protein A (SP-A) in acute lung injury(ALI) rats,and the effect of antioxidant. Methods Sixty healthy mature Wister rats were divided into 2 groups, the control group and treatment group. The rats in two groups all received peritoneal injection of E. coli to establish the ALI animal model. 30 minutes after injection of E. coli,the rats in treatment group were injected reduced glutathione from vena caudalis. The levels of NE in blood and expressions of SP-A in lung tissue were detected at 3,6 and 12 hours after injection of E. coli. Results ALI symptom appeared 3 hours after injection of E. coli in the control group, obvious after 6 hours, the rats vomi-ted pink secretion after 12 hours. Lung edema and bleeding were found by pathologic examination. No obvious symptom was found in treatment group after 3 hours, slight tachypnea after 6 hours, slight edema in pulmonary tissue after 12 hours. After administration of reduced glutathione,levels of NE at 3,6 and 12 hours in the treatment group were lower than those in the control group,and indicated statistical significance in 6 and 12 hours(P <0. 05) ;Levels of SP-A in 3,6 and 12 hours in the treatment group were higher than those in the control group, and indicated statistical significance in 3,6 and 12 hours (P < 0. 05). Conclusion Dysfunction of pulmonary surfactant is secondary in ALI, degradation of SP-A is the one of reasons, the application of reduced glutathione as antioxidant, could effectively suppress NE to decompose basosexine elastin of cells and destroy surface active protein, has protective effect on ALI.

BACKGROUND: Recently, some people believed that the mechanisms of primary hepatic carcinoma might be caused by poor differentiation or disdifferentiation of hepatic stem cells. Studies on hepatic stem cells are in the early stage at present, and the theory of "stem cell origins" of human primary hepatic carcinoma deserves further verification. OBJECTIVE: To investigate the activation, distribution, origin and immunological expression characteristics of hepatic stem cells in different histopathologic types of primary hepatic carcinoma. DESIGN: Observational comparative study. SETTING: Tumor Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA. PARTICIPANTS: Experiments were performed at the Laboratory of Tumor Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA from September 2003 to July 2004. We took 94 cases of hepatic cellular cancer, 12 cases of intrahepatic cholangiocellular carcinoma and 10 cases of mixed hepatocarcinoma paraffin-embedded tissue blocks as research objects, with 5 cases of liver cirrhosis and 4 cases of normal liver as experimental control. These materials were collected from the archive of the Department of Pathology of Daping Hospital. Primary hepatic carcinoma tissues and corresponding adjacent liver tissues were obtained from patients who had undergone surgery for the removal of their tumors. All the patients were not treated by chemotherapy or radiotherapy before the operation. They had signed the informed consent. Main Antibodies were bought from Santa Cruz Company.METHODS: The histological and immunohistochemical characteristics were examined by haematoxylin and eosin staining and immunohistochemistry (SP method), including mouse antihuman cytokeratin 19 monoclonal antibody, mouse antihuman cytokeratin 7 monoclonal antibody, mouse antihuman cytokeratin 8&&18 monoclonal antibody, mouse antihuman c-kit monoclonal antibody, mouse antihuman Thy-1 monoclonal antibody, mouse antihuman alpha fetoprotein monoclonal antibody. MAIN OUTCOME MEASURES: Expression of immunological markers of hepatic stem cells in different histopathologic types. RESULTS: Immunological markers of hepatic stem cells expressed variously in different histopathologic types of primary hepatic carcinoma. Hepatic stem cells differentiated into hepatoma carcinoma cells in all the types. The highest expression rate of hepatic stem cell immunophenotype was found in the mixed hepatocarcinoma (P < 0.05). Immunophenotypes of hepatic stem cells were negative in normal group and cirrhosis group. CONCLUSION: Hepatic stem cells of varied differentiations and origins existed in different histopathologic types of primary hepatic carcinoma.

Objective To evaluate the therapeutic effect of lamivudine in the treatment of HBV-related liver failure.Methods We collected the literature on lamivudine used to treat liver failure in randomized control trail or clinical control trial studies from January 1989 to July 2007.All these clinical trials were carried out by comparing lamivudine treatment with routine medical treatment for liver failure.The literature must concern about mortality,total bilirubin(TBIL)or prothrombin activity(PTA).Odds ratio(OR)was applied to evaluate the effect of glucocorticoid to improve case fatality.Weighted mean differences(WMD)was applied to evaluate the effect of lamivudine to improve TBIL and PTA.Results There were only 13 literatures obtained,among them all about mortality,and 10 about TBIL and PTA.Effective index was 0.29(95%CI:0.21,0.40),-0.88(95%CI:-1.27,-0.48)and 0.60(95%CI:0.42,0.78)respectively for the 3 indexes.Conclusion Combination with lamivudine is more effective in treatment liver failure than only routine medical treatment.