Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.

Objective To investigate the regulating function of p120-catenin (p120ctn) on proliferation and invasion of human bladder cancer cell T24.Methods Special siRNA was used to silence the expression of p120ctn in T24 cells.MTT assay was used to examine the T24 cell growth rate.The invasion of T24 cells and the control cells were measured by transwell chamber assay.Results The silencing of p120ctn could improve the proliferation and the invasiveness of T24 tumor cells.Transwell chamber assay showed that the in vitro invasion function of T24 cells was significant increase after p120ctn-siRNA.Conclusion p120ctn inhibited the bladder cancer proliferation and invasiveness of bladder carcinoma cells.

Objective To investigate the perinatal outcomes and management of pregnancy with leukemia.Methods From June 1,1980 to July 31,2011,23 pregnant women with leukemia,were admitted to the Department of Obstetrics of Peking University People's Hospital.Clinical data of these women were collected and analyzed retrospectively.Among the 23 cases,nine were diagnosed before pregnancy including four with acute myeloid leukemia (AML) and five with chronic myeloid leukemia (CML),and 14 diagnosed during pregnancy including eight with acute leukemia (AL) [seven with AML and one with acute lymphocytic leukemia (ALL)] and six with CML.The prognosis of the mothers and infants were followed up.Results (1)Managements during pregnancy:For the four cases with AML,two were completely recovered and the other two had completed chemotherapy five years before pregnancy,and no relapse was reported during pregnancy.The other five cases with CML were stable during pregnancy although the results of blood routine tests were abnormal.Among them,one case was treated with hydroxyurea and one with imatinib during pregnancy,while the other three women received no treatment.For those 14 cases diagnosed during pregnancy,all were recorded with abnormal white blood counts,and nine complicated with anemia and abnormal platelet count and four with either anemia or abnormal platelet count.Among the eight cases with AL,six received chemotherapy during pregnancy and two did not due to intrauterine fetal death and 40 weeks of gestation on admission,respectively.For the six CML women,two received hydroxyurea,one took imatinib,one took leukapheresis and one accepted plateletpheresis during pregnancy,but one woman received no treatment due to regular contractions on admission.(2) Perinatal outcomes:The average gestational weeks on delivery was (38.3±2.3) weeks,and the average birth weight of newborns was (2 755 ±486) g.There were two cases of disseminated intravascular coagulation,five pre-eclampsia and one placental abruption during pregnancy.Five women were complicated with postpartum hemorrhage [average bleeding volume was (1 200± 751) ml] and two cases of puerperal infection.One pregnant woman died.Among the 23 perinatal infants,there were four premature infants,four low birth weight infants,two still births,one with congenital malformations,and two infants had abnormal blood routine tests.Eight babies were delivered by caesarean section,12 through vagina and two required forceps assistants.(3) Follow-ups:Except for one woman died during pregnancy,four of the other 22 cases were lost.Among the rest 18 cases with the follow-up from three months to 13 years,11 women survived and seven died due to leukemia.All newborns were healthy.Conclusions Pregnancy with leukemia is an extremely high-risk obstetric condition,but for patients with bearing requirement,better perinatal outcome might be achieved under proper management.

Objective To investigate the perinatal outcomes of pregnancy with chronic myeloid leukemia (CML) and how to manage it during pregnancy. Methods To retrospectively analyse the clinical datas about the perinatal outcome and the obstetric management of the 16 cases of pregnancy with CML during the last 30 years in a single center. Results ( 1 ) Management ang perinatal outcomes: among the 16 pregnancies nine ended with therapeutic abortion during the first or second trimester and no CML complications were observed. The average gestation week was 7 weeks(5 - 13 weeks)when they came to our hospital. Seven pregnancies gave birth, among which CML was diagnosed during pregnancy in four patients and pregnancy was confirmed during CML in three patients. The average gestation week was 36 weeks (27 -40 weeks +2)when they came to our hospital. Among the seven women three were treated with hydroxyurea (one became pregnant while she was on hydroxyurea and she elected to continue her pregnancy and continued to use hydroxyurea), one with leukapheresis twice after her 40 weeks of gestation, one with plateletpheresis and three hadn't any treatment. In the seven pregnacies three developed severe preeclampsias, including the two had hydroxyurea during the gestation. The average delivery gestational week was 38 weeks (33 weeks +4 -41 weeks), two were premature birth. Two caesarean sections, three vaginal deliveries and two forceps deliveries. There were two postpartum hemorrhage, during the 24 hours the amount of bleeding was 1500 - 1800 ml and secondary disseminated intravascular coagulation happened. Seven patients gave birth to seven infants whose average birth weight was 2469 g( 1820 - 2810 g), of whom two were premature infants, two low birth weight infants, one had congenital malformation and two had abnormal blood routine examinations. (2) Management after delivery and prognosis: during the nine patients who ended pregnancy with therapeutic abortion during the first or second trimester four withdraw, one died whose course of disease was 3 years and the other four were alive during 5 months to 72 months, among which one had stem cell transplantation, two are taking imatinib mesylate and one takes hydroxyurea. Among the seven patients who deliveried two withdraw, two died and three are alive. Among the seven infants two withdraw,the other five have normal development following 4 months to 9 years. Conclusions CML patient may have successful pregnancy and delivery, and it is not the absolute indication for terminating pregnancy. On the other hand, CML and the treatment during pregnancy can have side effect on the mother and the fetus, so the patients should be monitored and treated in tertiary hospitals.

A new method was proposed for analysis of the organic compounds in cigarette smoke by high resolution Orbitrap mass spectrometry based on polyacrylonitrile-silica (PAN-SiO2) nanofiber membrane extraction and methanol elution.Hydrophobic PAN-SiO2 nanofiber membrane which was used to enrich small molecular organic compounds in cigarette smoke was prepared by the technology of electrospinning.Several parameters including the concentrations of PAN and SiO2 nanopartical,elecrospining voltage,needle aperture and flow rate of spinning solution were optimized.Under the optimal conditions,a PAN-SiO2 nanofiber membrane with good adsorption performance and great physical strength was obtained.A total of 21 compounds including acetone,styrene,acrolein,isoprene,and acrylonitrile were identified by analyzing the cigarette smoke with Orbitrap MS spectrometry in the positive ion mode.Six organic acids including salicylic acid,malic acid and lactic acid were detected in negative ion mode.The limits of detection and quantification for nicotine were 0.071 ng/L and 0.236 ng/L,respectively.

Objective To explore the clinical characteristics of liver cirrhosis patients complicated with ischemic hepatitis . Methods The clinical data were reviewed retrospectively for 30 cirrhosis patients complicated with ischemic hepatitis from January 2008 to June 2013 in the intensive care unit of Dalian Sixth People′s Hospital .Results Ischemic hepatitis was identified in 1 .6% of the patients treated at the same period in ICU .In addition to the underlying disease including cirrhosis ,the patients also showed hypovolemic shock ,severe sepsis ,acute attack of chronic heart failure and acute respiratory distress syndrome . Acute increase of serum alanine aminotransferase(ALT) and aspartate aminotransferase(AST) was also reported in association with significant decrease of albumin .The patients were treated with comprehensive measures targeting shock ,infection ,heart failure ,respiratory failure ,and relevant symptoms .The overall mortality was 66 .7% (20/30) .The mortality was significantly higher in Child‐Pugh C cirrhotic patients than Child‐Pugh A or B patients .Conclusions The ischemic hepatitis in association with liver cirrhosis is mainly induced by hypovolemic shock ,severe sepsis ,heart failure ,and respiratory failure .Typical laboratory findings are sharp elevation of serum ALT and normalization after treatment . Liver cirrhosis complicated with ischemic hepatitis features high mortality ,particularly in Child‐Pugh C cirrhosis .

AIM:To detect the expression of miRNA-363 and SOX4 in osteosarcoma tissues and to investigate the effect of miRNA-363 on the viability and apoptosis of human osteosarcoma cell line MG-63.METHODS: Real-time PCR was used to detect the expression level and the relationship of miRNA-363 and SOX4 mRNA in the osteosarcoma tis-sues and the corresponding paratumorous tissues collected from 63 patients.The expression levels of miRNA-363 and SOX4 in osteosarcoma cell line MG-63 after transfected with miRNA-363 mimics were measured .The cell viability was measured by CCK-8 assay.Flow cytometry was used to monitor the changes of cell cycle and apoptosis .The changes of SOX4 and miRNA-363 expression levels in the MG-63 cells after transfection with SOX4 siRNA or pcDNA/SOX4 was detect by real-time PCR.RESULTS:The expressed level of miRNA-363 was lower , and the expression level of SOX 4 was higher in the osteosarcoma tissues than those in the adjacent normal tissues .A significantly negative correlation between the expression levels of miRNA-363 and SOX4 was observed .The expression of miRNA-363 in the MG-63 cells after transfection with miRNA-363 mimics was significantly up-regulated, while the expression of SOX4 in the MG-63 cells was significantly down-regulated , with significant difference as compared with the cells transfected with miRNA-NC and control cells .The viability of MG-63 cells was inhibited, the cell cycle was arrested in G0/G1 phase, and the cell apoptosis was increased by transfec-tion with miRNA-363 mimics.The relative protein expression levels of SOX 4 in SOX4 siRNA group and pcNDA/SOX4 group were significantly different from those in negative control group , but the relative expression levels of miRNA-363 had no significant difference .Over-expression of SOX4 restored the viability of the MG-63 cells reduced by miR-363.CON-CLUSION:The expression level of miRNA-363 is low in human osteosarcoma tissue .miRNA-363 may inhibits the viabili-ty of osteosarcoma cell line MG-63 and promotes cell apoptosis in vitro via inhibiting the SOX4 expression.

Objective To test whether the changes of partial end-tidal carbon dioxide pressure (PETCO2) during passive leg raising (PLR) predict fluid responsiveness in mechanically ventilated patients with septic shock.Methods Forty-two mechanically ventilated patients with septic shock admitted from January 2012 to November 2012 were prospectively recruited.Hemodynamic parameters monitored by a pulse indicator continuous cardiac output(PiCCO) device and PETCO2 monitored by an expiratory-CO2 device were studied at baseline,after PLR,and after volume expansion.Fluid responsiveness was defined as an increase in cardiac index (CI) of 15％ or greater after volume expansion.The correlation between PLR-induced CI change (△CIPLR) and PETCO2 (△PETCO2-PLR) was analyzed.The value of △PETCO2-PLR to predict fluid responsiveness was evaluated by receiver operating characteristic (ROC) curves.Results A total of 42 patients were enrolled in this study,of whom,24 had a CI increase of ≥ 15％ after volume expansion (responders).After PLR,CI and PETCO2 were both significantly increased in the response group compared with baseline [(21.4 ± 12.9) ％ of CI and (9.6 ± 4.7) ％ of PETCO2,P ＜ 0.05],while no significant changes were observed (P ＞ 0.05) in the non-response group.Both △CIPLR and △PETCO2-PLR were significantly higher in responder group than in the non-responder group (both P ＜ 0.05).△CI and △PETCO2 after PLR were strongly correlated (r =0.64,P ＜ 0.05).In responders after PLR,the area under ROC curve of △PETCO2-PLR was 0.900 ± 0.056 (95％ CI 0.775-1.000,P ＜ 0.05).An increase of ≥ 5％ in △PETCO2-PLR predicted fluid responsiveness with a sensitivity of 88.0％ and specificity of 88.2％.Conclusions The change of PETCO2 induced by passive leg raising is a non-invasive and easy way to predict fluid responsiveness in mechanically ventilated patients with septic shock.

Objective To assess the clinical factors impacting on the effective time of endocrine therapy for patients with prostate cancer.Methods The chnical data of 432 patients with prostate cancer who accepted endocrine therapy were analyzed retrospectively.The endpoint of the study was failure of endocrine therapy which was defined as continuous elevation of prostate specific antigen (PSA) from nadir for 2 times and more than 0.2 μg/L.The clinical data such as age,clinical stage,lymph node metastasis,bone metastasis,Gleason score,initial PSA,and PSA nadir were collected and their rehtionship with the effective time of endocrine therapy were further assessed via COX regression model.Results Age of onset was 57-88(73.70 ± 7.28) years.Initial PSA was 10.30-588.10(27.15 ± 75.90) μ g/L.The effective time of endocrine therapy was 3-62 (27.01 ± 13.10) months.Univariate regression analysis showed that initial PSA,clinical stage,Gleason score,PSA nadir,lymph node metastasis,bone metastasis were correlated with the effective time of endocrine therapy (P ＜ 0.01).Multivariate regression analysis showed that only Gleason score was correlated with the effective time of endocrine therapy(P=0.001).Compared with patients with Gleason score equal to or less than 3+4,patients with Gleason score equal to or more than 4+3 showed 2.49 fold increased risk of therapy failure (OR =2.49,95％ CI 1.44-4.30).Conclusion Gleason score has close relationship with the effective time of endocrine therapy for patients with prostate cancer,Gleason score equal to or more than 4+3 is an indicator for poor response to endocrine therapy.

Purpose To investigate the diameter change of dorsal root ganglion (DRG) in lumbar disc herniation using three-dimensional MR neurography. Materials and Methods Sixty-ifve patients with lumbar disc herniation and 30 healthy volunteers were selected. Bilateral DRG diameter was measured using MR three-dimensional constructive interference steady state (3D-CISS) sequence at the level of L3-S1 in the control group and at the level of herniation disc in patient group including central and lateral subgroups. The relationship between the sagittal index and DRG diameter at the level of herniation disc was analyzed. Results In the control group, the DRG diameters increased from the level of L3 to S1. The DRG diameters of the central subgroup were bigger than those of the control group (t=-2.485--2.253, P<0.05). The DRG diameters of the lateral subgroup were bigger on the diseased side than the contralateral side (t=1.956-2.432, P<0.05). The DRG diameters of the contralateral side in lateral subgroup were slightly bigger than those of control group without statistical signiifcance (t=-1.248--0.981, P>0.05). The sagittal index was not correlated with DRG diameter. Conclusion 3D-CISS sequence clearly demonstrates morphological changes of lumbosacral nerve root and measures its diameter.