Abnormal thyroid function is high risk for pregnancy.Studies from clinical observation and animal experiments have indicated that maternal sub clinical hypothyroidism during the first gestational term may lead to impairment of brain development of offspring,and early diagnosis and effective treatment may prevent the damage.Therefore,it is suggested that screening thyroid function before gestational 8 weeks in pregnant women is initiated.The changes in thyroid function during pregnancy are related to these changes in maternal thyroid physiology can lead to confusion in the diagnosis or evaluation of thyroid abnormalities.Establishment of trimester-specific reference ranges is urgently needed.Local iodine nutritional statue and testing reagent effect the measured value of thyroid function in general population,so it is recommend that all regions and hospitals should establish their own pregnancy reference ranges.

Objective · To evaluate the clinical characteristics of endometrial pathology in postmenopausal women with asymptomatic thickened endometrium. Methods · A retrospective review was conducted of the patients between October 2013 and October 2015 in the International Peace Maternity & Child Health Hospital. The postmenopausal women with asymptomatic thickened endometrium of 5 mm or more found by transvaginal ultrasonography were recruited. They underwent hysteroscopy and endometrial sampling to analyze the relationship between endometrial pathology and endometrial thickness. Results · A total of 257 patients were recruited. The average age was 61.3 years old, the average menopause period was 122 months, and the average endometrium thickness was 8.6 mm. The endometrial pathology included normal atrophic endometrium, endometrial polyp, submucous myoma, intrauterine adhesion, uterine septum, endometrial hyperplasia and endometrial cancer. The most common pathological type was endometrial polyp, accounting for 66.9% of the all patients and 83.9% (172/205) of all pathological types. Three cases of adenocarcinoma (1.2%) were diagnosed. There was significant difference in endometrial thickness among normal endometrium, endometrial polyp and endometrial cancer (P<0.05). The endometrium in endometrial cancer was the thickest, which was (13.20±5.38) mm averagely. There was significant difference in ages among the pathological types (P=0.004). Conclusion · There are few patients of malignancy among asymptomatic postmenopausal women with thickened endometrium. Follow-up visits were recommended to these women.

ObjectiveTo investigate the high risk factors,etiology,diagnosis,treatment and precaution of venous thromboembolism (VTE) in pregnancy and puerperium. MethodsData of 16 cases of VTE admitted in Department of Obstetrics and Gynecology,Peking Union Medical College Hospital from January 1992 to April 2011 were analyzed retrospectively.The differences of blood routine test and coagulation function between VTE patients (study group) and normal pregnant women (control group) were compared by paired t test in this case-control study.Results All patients were diagnosed by color Doppler ultrasound or CT pulmonary artery angiography.Five cases (31.2 ％) occurred before delivery and 11 (68.8 ％) occurred during postpartum.Two cases (12.5 ％)complicated by pulmonary thromboembolism,and one of them died.Six cases (37.5％) were older than or equal to 35 years old,and 12 cases (75.0％) had gestational complications.The hematocrit in study group were lower than that in control group (0.29±0.06 vs 0.39±0.02,t=4.56,P=0.01).There was no statistical difference between the coagulation function of the two groups.After anticoagulant therapy or surgery,15 cases recovered.One pulmonary thromboembolism patients complicated with rheumatic cardiac disease remained shock after anti-coagulants was administered,then died of hemorrhage of respiratory tract after inferior vena cava filter placement. Conclusions VTE is likcly to happen in puerperium than in pregnancy.There are no good screening indicators for thromboembolism during pregnancy and puerperium.Anticoagulation is recommended to be the first line therapy.For women with high risk of thromboembolism,it is suggested to prevent actively and treat early to decrease the complications and long-term sequelea.

Objective To investigate the changes in cells on cell cycle,cell apoptosis and susceptibility to chemotherapeutic drugs of lung adenocarcinoma A549 cells under two dimensional (2D system) and three dimensional (3D system) culture conditions. Methods The three dimensional culture of A549 cells was carried out using rotatable culture bottle and desk-top water bath shake. Flow cytometer,in situ cell apoptosis detection kit,MTT and blood cell counter were employed to compare cell cycle,cell apoptosis and susceptibility to ADM of A549 cells under different culture conditions. Results The three dimensional culture system was confirmed to have been successful by the aid of observation under inverted and electron microscope. There were significant retardation of G_ 1 phase,lower cell apoptosis rate and decreased susceptibility to ADM in A549 cells in 3D system compared with those in 2D system. Conclusions There were remarkable differences in biological characteristics of A549 cells in two culture systems,indicating that A549 cells cultivated in 3D system simulated better solid tumor in vivo . The 3D system was very useful for further investigation of the behavior of solid tumor,so that anti-carcinoma chemotherapeutic drugs could be advantageously tested in vitro before clinical application.

Objective To explore an optimal model of three dimensional in vitro cell culture for simulating solid tumors in vivo . Methods The model of three dimensional cell culture was constructed under the conditions of inhibiting the cell wall attachment and stirring the medium. Multicellular spheroids (MCS) were cultured using microcarriers (CutiSpher). Drug sensitivity of monolayer cells (MC) and MCS was tested by MTT staining and cytometry, respectively. Ultrastructures of the MC and MCS were observed by transmission electron microscopy. Results Cells in three dimensional cell culture model without microcarriers were compacted into mass at 4 d while cells in MCS were found to attach to the microcarriers at 0.5 h. MCS had more than two layers of cells growing within it at 5 d. Compared with MC, MCS was more resistant to the anticancer drug, and had more plenty of organell and microvilli with more extensive and compact cell adhesion. Conclusion MCS has strong developmental properties and can simulate the cell cell interactions in vivo , especially cell adhesion, which may contribute to the drug resistance of MCS.

Objective To explore the effect of Sunset Abelmoschus on podocyte injury in adriamycin-induced nephropathy rats.Methods Fifty male SD rats were randomly divided into five groups:sham operation group (n=10),model group (n=10),Sunset Abelmoschus low dose group (0.5 g·kg-1· d-1 n=10),middle dose group (1.0 g· kg-1· d-1,n=10) and high dose group (2.0 g· kg-1· d-1,n=10).Unilateral nephrectomy combined repeated adriamycin injection were performed to establish adriamycininduced nephropathy models.The rats were administered with the corresponding dose of Sunset Abelmoschus during the experiment period.Urinary protein,urinary N-acetyl glucose aminotransferase (NAG),serum albumin,serum creatinine and blood lipid were measured before operation and 2,4,6,8 weeks after operation.The rats were sacrificed on week 8 for the renal histological examination,including light microscope and electron microscope.Expression of nephrin was examined by immunofluorescence assays.Results As compared to model group,urinary protein and NAG significantly decreases in Sunset Abelmoschus groups in each time point,especially in high dose group (P＜0.01),meanwhile the serum albumin increased and the disturbance of lipid metabolism was improved in Sunset Abelmoschus groups (P＜0.05).Compared with sham group,Scr increased significantly in model group and Sunset Abelmoschus groups at the 4th week.At the 8th week,Scr in high dose group was lower than that in model group (P＜0.05),and the ratio of glomerular globe sclerosis and segmental sclerosis,tubulointerstitial damage reduced in Sunset Abelmoschus groups,especially in high dose group.The podocyte damage and the extent of foot process fusion were improved in Sunset Abelmoschus groups compared with model group.Expression of nephrin increased in Sunset Abelmoschus groups than that in model group.Conclusion Sunset Abelmoschus can ameliorate proteinuria and renal tissue damage of adriamycin-induced nephropathy rats,whose mechanism may be associated with the improvement of podocyte injury.

Objective To investigate the effect of different dose of dexmedetomidine for pre-venting the visceral traction reaction during caesarean section under spinal anesthesia.Methods Two hundred ASA physical status Ⅰ-Ⅱ patients,full-term primiparas scheduled for elective cesarean sec-tion were enrolled in this randomized,placebo-controlled study.Patients were randomly allocated to receive dexmedetomidine in four groups:group C (0.9% normal saline),group D1(dexmedetomidine 0.6 μg/kg),group D2(dexmedetomidine 0.8 μg/kg),group D3 (dexmedetomidine 1.0 μg/kg),50 cases in each group.Two minutes after cutting umbilical,groups D1,D2,D3 received an intravenous infusion single-dose of 0.6,0.8,1.0 μg/kg dexmedetomidine respectively for 10 minutes.Group C was injected the same dose of saline.Maternal blood pressure (BP),heart rate (HR),Ramsay scores,visceral traction reaction conditions were recorded at three points:before iv (T0 ),10 min af-ter iv (T1 )and abdominal exploration (T2 ).Results As for the inhibition of visceral traction pain, groups D2 and D3 were obviously better than groups D1 and C,and there was no statistically signifi-cant difference between groups D2 and D3 at T2 (P <0.05 ).The effects of slowing down heart rate and increasing blood pressure were weaker in group D2 than that in group D3 at T2 .Ramsay scores were higher in groups D2 and D3 than in groups D1 and C (P <0.05),and there was no significant difference between groups D2 and D3 at T2 .Conclusion Administration of dexmedetomidine 0.8 μg/kg could alleviate the visceral traction reaction and had little effect on maternal hemodynamics.

ObjectiveTo investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).MethodsThe clinical features,therapies,pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital,from January 2005 to April 2011.ResultsThere were 8 pregnant womenwith 21-OHD including 5siinplevirilizing patientsand 3nonclassical 21-OHD women.Eightpatientswereacceptedprogestationalandprenatalcontinuallowerglucocorticoid treatment.During the gestational period,the dosage of glucocorticoid was adjusted in one pregnancy.The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [ (70 ± 38 ) versus (24 ±23) nmol/L,P ＜ 0.05].The fertility and offspring rate of 8 patients was 8/12,the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7).Four patients were accepted genital reconstructive surgery ( clitorectomy,clitoroplasty,vulvoplasty) before pregnancy.The incidence of GDM was 1/8.All patients selected caesarean at from 37 +6 gestation weeks to 39+6 gestation weeks.The average newborn birth weight was (3210 ± 447 ) g,and height was (48 ±2) cm of 8 neonates,none of them was CAH.Conclusions Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD.It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment.The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

Investigate the cleaning ability of manual ProTaper on mandibular second molars with C-shaped (c-shaped root) or normal root canal(separated root). Twenty mandibular second molars with C-shaped root or with separated roots were sectioned at 3.0, 5.5 and 8.0 mm from the root apex. The images of pre-preparation and F1, F2, and F3-prepapared of manual ProTaper were captured respectively. The cross-sectional areas of the canals were measured and the formula of area after treatment/area before treatment was used to calculate the area ratio. The data were analyzed by SPSS 10.0. The results showed that there was no statistically difference between cross-section root canal area ratios in two groups. Significant differences were found between the cross-section canal area ratio of F1 and F2, F1 and F3 at section 5 mm of S group, and F1 and F3 at section 3 mm of C group. The results suggested that the increasing of cross-section ratio of the two kinds of canals was not obviously concerned with their anatomical morphology.