Objective To investigate the clinical values of loop electrosurgical excision procedure (LEEP) in diagnosis and treatment of cervical intraepithelial neoplasia(CIN). Methods Fifty-two patients with cervical intraepithelial neoplasia underwent LEEP following cytology, colposcopy and multiple biopsies, were treated by LEEP. The cure rate, the operative time, bleeding volume and patients reaction of LEEP to the cervical intraepithelial neoplasia were investigated during the follow-up. Results The effective rate was 98.07 % in the patients treated by LEEP. The effective rate was 100 % in the patients in grade CIN Ⅰ or CIN Ⅱ by LEEP. No patients in grade CIN Ⅰ and Ⅱ had recurrence during the follow-up 1 year. The mean operative time was 7.8 minutes. The mean bleeding volume was 10 ml. No secondary bleeding and post-operative infection occurred. All these surgical specimens were checked successfully for pathology diagnosis. Conclusion The advantages to use the LEEP to manage cervical intraepithelial neoplasia include its simpleness to handle, short operative time,less bleeding, less vaginal discharge, safety, and high cure rate. LEEP can offer intact sample for pathological diagnosis. LEEP electrotome is a very ideal therapy for the cervical intraepithelial neoplasia, and can block the development of precancerosis to infiltrating carcinoma effectively.

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and pcrcutaneous transhcpatic insertion of biliary stent (PTIBS) for malignant biliary obstruction.Methods PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction, which were aused by hepatic carcinoma (n = 14), biliary duct carcinoma (n = 11), gallbladder carcinoma (n = 5),stomach carcinoma accompanied with metastasis of lymph node (n = 14), carcinoma of ampulla (n = 1 ) or carcinoma of pancreatic head (n = 11 ). The diagnosis was confirmed by ultrasonography, CT or MRI in all patients. The obstructed site was well identified, including high obstruction in 19 patients and lower obstruction in 37 patients. Based on the imaging findings, suitable interventional procedure was employed.Results PTBD or PTIBS were performed successfully in all 56 patients, of them PTBD was adopted in 11,PTIBS in 40 and both PTBD and PTIBS in 5. The serum total bilirubin decreased from (295.65±152.86)μmol/L before the procedure to (151.05 ± 107.36) μmol/L after the procedure, (P < 0.01 ). Postoperative infection could affect the fading of jaundice (P < 0.01 ), but the location of the obstruction carried no relationship with the fading of jaundice (P = 0.063). Conclusion Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction, which can markedly relieve patient of jaundice,improve the quality of life and elongate the survival period.

Objective To evaluate prognostic indicators in severe traumatic brain injury and intracania hamatomas with hernia and analyze which is the most important indicator.Methods Data of 84 cases with severe traumatic brain injury were retrospectively analyze .Age,GCS,pupil reflex,midline shift,compression of the cisteme,decompression time and complex injury were considered as possible prognostic indicators.SPSS13.0 was employed to analyze the data,Logistic regression(Forward conditional)analysis was done to confirm which are the most important prognostic indicators for severe traumatic brain injury and to evaluate the practical value in predicting prognosis(X2= 22.92,P＜ 0.01).Results 48 patients died and 36 survived.56(67%)patients had a bad prognosis(GCS≤3)and 28(33%)had a good prognosis(GCS ＞3).Those who had a shorter decompression time(≤3h)had a better prognosis than those who had a longer decompression time(＞3h),with the mortality rate of 11% and 67% respectively.Lesser cisteme compression predicts better outcome.GCS,pupil reflex,midline shift,and complex injury didn' t enter the logistic regression equation.According to compression time,90.5% of the cases' prognosis was accurately predicted,according to compression time and cisterne compression,95.2% was accurately predicted.Conclusion The mortality rate of severe traumatic brain injury with hernia was high and surgical intervention was effective.Decompression time and cisteme compression were the most important factors affecting prognosis in severe traumatic brain injury and they could predict prognosis of most cases correctly.

Objective To establish the type Ⅱ collagen specific T cell line of Wistar rat and observe its effect on transferring arthritis.Methods The Wistar rats were immunized with emulsified chicken type Ⅱ collagen (CCⅡ) in complete Freund′s adjuvant by intradermal injection to induce the rat model of collagen induced arthritis (CIA).The lymphocytes were obtained from mesenteric lymph nodes of CIA rats,and the type Ⅱ collagen reactive T cell line was selected and propagated by CCⅡ stimulating in vitro .The proliferation response and phenotype were analyzed by 3 H TdR incorporation and fluorescence activated cell sorter (FACS).The onset of arthritis and pathological characteristic in ankle joints of recipient rats were observed with naked eye and histochemical examination.Anti CCⅡ antibody in serum was assayed by enzyme linked immunosorbent assay (ELISA).Results A T cell line was successfully established.The results of FACS labeled with fluorescent antibodies showed that 98 2% of the line cells were T cells,of which 89 7% were CD4 + T cells.The results of adoptive transfer showed that the incidence of arthritis was 50% when the injected cell number was 5?10 7,meanwhile the level of anti CCⅡ antibody in serum was elevated more than that of the control.Conclusion A cell line has been successfully established.The result of arthritis transferring by T cell line shows that the T cell plays a great role in the pathogenesis of CIA and provides a research datum for rheumatoid arthritis therapy with T cell vaccine.

Objective To explore the feasibility of novel nano-particle HIF-1 α@Fe3 O4 labeled pancreatic cancer PANC1 cells as well as the changes of signal intensity in 3.0T MRI scan.Methods Pancreatic cancer PANC1 cells were cultured in hypoxia condition,and hypoxia-inducible-factor-1 α(HIF-1 α) and stem cell markers CD133,Oct-4,Sox-2 were detected by Western blot assay.Cells cultured under hypoxia for 24 h were collected and then co-incubated with 5,15 and 45 μg/ml HIF-1α@Fe3O4 for 24 h.The number of HIF-1 α@Fe3O4 labeled PANC1 cells and cell survival rate were detected,and the signal intensity of T2 WI image for PANC1 cells was measured by a 3.0T MRI system.Results In hypoxia condition,HIF-1 α level was obviously increased compared with that of normoxic culture,which was further increased with the increase of hypoxia time(all P ＜ 0.05).Stem-cell markers CD133,Oct-4 and Sox-2 was positively correlated with HIF-1α level.Co-cultured with different concentrations of HIF-1α@Fe3O4 for 24 h,blue-stained iron particles in cytoplasm of PANC1 cells was dosage-dependently increased,and the peak was at the concentration of 45 μg/ml,which could reach 100％.The survival rate of the PANC1 cells cultured in normoxic condition,the unlabeled and labeled in hypoxic condition group were(87.0 ± 2.1) ％,(84.7 ± 2.7) ％ and (85 ± 3.8) ％,respectively,and the difference was not statistically significant (P ＞ 0.05).In 3.0T MRI scan,T2 WI signal intensity in unlabeled group and 5,15 and 45 μg/ml labeled group was 1.017 ± 0.046,0.793 ± 0.041,0.447 ± 0.032 and 0.240 ± 0.031,and the difference was not statistically significant (F =80.0,P ＞ 0.05).Conclusions Hypoxia condition could promote and maintain the stemness in PANC1 cells.HIF-1α@Fe3O4 probe could successfully label HIF-1α highly expressed PANC1 cells during hypoxia condition,and a significant decrease in T2WI signal intensity can be detected by a 3.0T MRI system.

OBJECTIVETo examine the impact of single nucleotide polymorphisms in obesity-related genes on risk of obesity and metabolic disorder in childhood.

METHODSA total of 3 503 Chinese children aged 6 to 18 years participated in the study, including 1 229 obese, 655 overweight and 1 619 normal weight children (diagnosed by the Chinese age- and sex- specific BMI cutoffs). Body size parameters were assessed and venipuncture blood samples were collected after a 12-hour overnight fast. Plasma glucose, insulin and serum lipid profiles were measured.Genomic DNA was isolated from peripheral blood white cells using the salt fractionation method. A total of 11 single nucleotide polymorphisms were genotyped by TaqMan allelic discrimination assays with the GeneAmp 7900 sequence detection system (Applied Biosystems, Foster City, CA, USA) (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, FAIM2 rs7138803, BDNF rs6265, NPC1 rs1805081, PCSK1 rs6235, KCTD15 rs29941, BAT2 rs2844479, SEC16B rs10913469 and SH2B1 rs4788102). Multiple factor analysis was performed to estimate the association between the variant and obesity-related traits. The false discovery rate (FDR) approach was used to correct for multiple comparisons.

RESULTSAfter sex, age and pubertal stage adjustment and correction for multiple testing, the rs9939609-A, rs17782313-C, rs10938397-G, and rs7138803-A alleles were associated with higher BMI (β = 0.352-0.747), fat mass percentage(β = 0.568-1.113), waist circumference (β = 0.885-1.649) and waist-to-height ratio(β = 0.005-0.010) (all P values < 0.01) in Chinese children. The rs6265-G allele increased BMI(β = 0.251, P = 0.020). The rs9939609-A, rs17782313-C, and rs10938397-G and rs6265-G alleles were also associated with risk of obesity (OR = 1.386, 95%CI:1.171-1.642; OR = 1.367, 95%CI:1.196-1.563; OR = 1.242, 95%CI:1.102-1.400; OR = 1.156, 95%CI:1.031-1.296).Rs7138803 was associated with risk of obesity only in boys (OR = 1.234, 95%CI:1.043-1.460). GNPDA2 rs10938397-G allele was associated with risk of insulin resistance(OR = 1.205, 95%CI:1.069-1.359), but there was no significance after adjusting for BMI.

CONCLUSIONThe association of FTO rs9939609-A, MC4R rs17782313-C, GNPDA2 rs10938397-G, and FAIM2 rs7138803-A with higher BMI, fat mass percentage, waist circumference, and waist-to height ratio and risk of obesity, and BDNF rs6265-G allele may increase BMI and obesity risk in Chinese children. GNPDA2 rs10938397-G may increase the risk of childhood insulin resistance depending on BMI.

Adolescent ; Alleles ; Asian Continental Ancestry Group ; Body Mass Index ; Child ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Metabolic Diseases ; Obesity ; Overweight ; Polymorphism, Single Nucleotide ; Risk Factors ; Waist Circumference

Objective To explore the difference between T cells in the synovial fluid and peripheral blood in patients with rheumatoid arthritis(RA). Method Samples from 22 patients were studied. The differentiation and activation markers expressed on T cell surface were detected by immunofluorscence using flow cytometer. The specific proliferation of collagen Ⅱ and heat shock protein 70 was analyzed using standard 3H-TdR incorporation method. Restricted V beta usage of these T cell was analyzed by semi-quantitied RT-PCR. Results The majority of the T cell subsets in the synovial fluid were demonstrated to be CD4 and CD8 positive cells in which (40?10)% were CD4 positive and (36?16)% were CD8 T cells respectively. The ratio between CD4 and CD8 was much lower than that found in the PBL of RA patients. The percentage of CD3+/CD25+ T cells was (16?6)%. The specific proliferation of collagen Ⅱ and HSP70 to CD3+/CD25+ T cell was higher than that of CD3+/CD25+ negative T cells. The T cell receptor expressed on the T cells from both peripheral blood and synovial fluid were tested for ?? TCR (70?26)%. However, the T cells in the synovial fluid showed V?14,16 and 17 restriction. Conclusion The data here reported indicates that T cell subsets in the synovial fluid and peripheral blood circulation in patients with rheumatoid arthritis are different. The T cells in the synovial fluid demonstrates more activation and higher reactivation to collagen Ⅱ and HSP70. The TCR of T cells showes V?14,16 and 17 restriction.

Objective:To investigate the mid-to-long term therapeutic effects of allogeneic bone composite prosthesis reconstruction in patients with large bone defects after the resection of distal femoral tumors.Methods:From June 2013 to December 2018, a total of 19 patients with malignant tumors of the distal femur who underwent reconstruction with allogeneic bone composite prosthesis in the Department of Bone Tumor, Shanghai General Hospital were retrospectively collected. There were 10 males and 9 females, aged 22.3±11 years (range, 11-42 years). The mean body mass index was 19.3±3.4 kg/m 2 (range, 14-27 kg/m 2). There were 18 cases of osteosarcoma and 1 case of Ewing's sarcoma. According to Ennecking staging, there were 17 cases of stage IIB and 2 cases of stage III. The intraoperative blood loss and operation time were recorded, and the prosthesis and patient survival conditions and postoperative complications were observed. The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) 93 function score. Results:All patients successfully completed the operation. The operation time was 187.3±39.8 min (range, 110-260 min), the intraoperative blood loss was 284.9±87.0 ml (range, 200-500 ml), and the blood transfusion volume was 327±213 ml (range, 100-800 ml). The remaining length of the proximal femur was 153.7±26.6 mm (range, 93-190 mm), and the length of allogeneic bone was 84.1±24.6 mm (range, 39-134 mm). Among the 19 patients, 9 patients (47%) achieved bony union with an average healing time of 16.7±4.8 months (range, 10-25 months), and 7 patients had delayed healing with an average healing time of 18.4±4.0 months (range, 15-25 months). The remaining 10 cases were nonunion between allogeneic bone and host bone. All patients were followed up for 80.7±20.2 months (range, 56-121 months). During the follow-up, 3 cases died due to pulmonary metastasis of bone tumors, and the time of death was 57 months, 63 months, and 59 months after surgery, respectively. At the last follow-up, the patient survival rate was 84% (16/19), and the MSTS 93 function score of the 16 patients was (24.3±2.4) points (range, 21-28 points), with an excellent rate of 100% (16/16). Seven patients underwent revision surgery, 3 cases were aseptic loosening, 3 cases were prosthesis stem fracture at the junction of the allograft bone and the host bone, and 1 case was periprosthetic infection, among which the patient with periprosthetic infection had poor local soft tissue conditions due to preoperative radiotherapy, and the infection was controlled after two revision surgeries. Five cases were revised with allogeneic bone composite prosthesis, and 2 cases were revised with short-stem giant prosthesis with cortical steel plate or locking nail. After revision, the remaining length of the proximal femur was 143.4±31 mm (range, 91-175 mm), and the length of the allograft bone was 92.6±26.6 mm (range, 61-123 mm). The 7 revised patients were still in follow-up. There were no cases of pulmonary infection, nerve injury, deep vein thrombosis or other complications after surgery.Conclusion:The survival period of patients after the surgery to reconstruct large bone defects following the resection of malignant tumors at the distal end of the femur using allogeneic bone composite prosthesis is satisfactory, and the limb function is good. However, the incidence of prosthesis complications is high, which can be reconstructed through revision.

Objective:Limb salvage treatment for osteosarcoma in the distal tibiais challenging and the incidence of postoperative complications is high. To prove that the use of autologous bone inactivation to replant the ankle joint has a satisfactory clinical effect.Methods:This study retrospectively studied 6 cases (4 males and 2 females) of the osteosarcoma of the distal tibia from June 2018 to April 2019 in our center. The average case age was 16.8 years. All cases were first diagnosed in the center, and classic osteosarcoma was confirmed by biopsy. Before the operation, he received 4 courses of neoadjuvant chemotherapy. The tumor was resected under general anesthesia, and the tumor bone was inactivated and replanted for internal fixation and reconstruction. During the operation, the tumor segment was completely removed, and after a series of treatments, it was immersed in hypertonic saline at 65 °C for 45 min. After removal, the bone defect was filled with bone cement, and internal fixation materials such as plate screws and anchors were placed. Finally, soft tissue was rebuilt after the inactivated bone internal fixation complex (autograft-fixation composite, AFC) was replanted. Patients were treated with plaster for 3 months after surgery. Chemotherapy continued 2 weeks after surgery. Follow-up X-ray of the lower tibia were taken at 3 months, 6 months, and 12 months after the operation to evaluate the MSTS score and ankle function score (AOFAS) to evaluate the ankle function.Results:The patients were followed up for an average of 20 months. At 12 months after operation, no complications such as deep infection, mechanical failure of internal fixation, or local tumor recurrence occurred. The MSTS score averaged 26.7±2.6 points. The AOFAS average was 82.3±8.5 points. The VAS average is 2.7 points. Boneunionwasobserved in 5 cases during follow-up. All cases were satisfied with the treatment results.Conclusion:Limb salvage treatment of distal tibia osteosarcoma is more difficult. This study proves that the use of tumor bone inactivation and internal fixation to reconstruct the ankle joint can not only cure the tumor, but also has satisfactory limb function. It is an ideal strategy for limb salvage reconstruction.

Objective To explore the related factors and clinical significance of the effect of irrigation on infant with dacryocystitis. Methods A total of 318 eyes of 262 infant were treated with dacryocystitis, and their overall curative effect was observed. Single factor correlation analysis and multivariate Logistic regression were used to analyze 8 factors related to efficacy, such as age of children, length of medical history, severity of symptoms, degree of operation of nurses, degree of parental cooperation, compliance with medication, massage therapy and treatment methods. The effect of each factor on the curative effect. Results It was found that the total effective rate was 90.56 percent of the lacrimal passage in children with 318 tear channel obstruction and dacryocystitis.Single factor analysis results show that the factors influencing the curative effect of single in treatment (χ2= 88.984, P < 0.01), symptom severity (χ2=14.185,P < 0.05) length of history (χ2=18.783, P < 0.05) difference and massage therapy (χ2=10.081, P < 0.05) was statistically significant, the three factors of multiariable Logistic regression analysis results showed that the treatment (P=0.000, OR=0.148,95％ CI 0.052- 0.419) and massage therapy (P=0.012, OR=3.390, 95％ CI 1.309- 8.777) affected infant lacrimal duct flushing out main factors influencing the efficacy of tong. Conclusions The main influencing factors are the different treatment modalities, severity of symptoms the length of medical history and massage therapy in the related factors that affect the effect of infantwith dacryocystitis.