Objective To study the influence of total bile acid (TBA) of maternal serum and cord blood on neonatal cardiac function in women with intrahepatic cholestasis of pregnancy (ICP). Methods The concentration of TBA in the maternal peripheral blood and neonatal cord blood were measured by enzyme in 30 women with ICP as patients group matched with 30 normogravidas as control group. The concentration of cardiac troponin Ⅰ (cTnI) in cord blood was detected by monoclonal enzymelinked immunosorbent assay.Fetal left ventricle Tei index was evaluated by color Doppler uhrasonoscope. Results (1) TBA concentration of maternal serum and cord blood at ICP group were significantly higher than that of control group [ (36.0±9.6) μmol/L vs. (3.8±0.9) μmol/L, (10.1±2.0) p, mol/L vs. (5.5±0.4 )μmol/L,P <0.01 ]. TBA concentration of maternal serum at ICP group was significantly higher than that of neonatal cord blood(P<0.01 ). Meanwhile, TBA concentration of maternal serum at control group was significantly lower than that of neonatal cord blood (P<0.01 ). (2) The Tel index of neonatal left ventricle at ICP group were significantly higher than that of control (0.58±0.04 vs. 0.43±0.03, P<0.01 ). (3) The concentration of cTnI from cord blood(0.92±0.23)μg/L at ICP group were obviously higher than that of control group [ (0.52±0.10)μg/L, P<0.01]. (4) The TBA concentration of cord blood at ICP group showed positive correlation with maternal blood TBA, cord blood cTnI and fetal left ventricle Tei index respectively( r=0.769, 0.635, 0.758,P<0.01). In the mean time, the positive correlation between the concentration of cTnI from cord blood and fetal left ventricle Tel index was also observed (r=0.637.P<0.01). Conclusions Left ventricular dysfunction and myocardial injury were shown in the neonates with ICP, which might be associated with with the elevated TBA level of maternal blood. The Tel index of fetal left ventricle could be used as a reliable parameter to monitor cardiac function and the degree of injured myocardial muscles.

Objective: To study the relation of bile acid levels and fetal hypoxia and brain injury in Intrahepatic Cholestasis of Pregnancy (ICP). Methods: From May. 2006 to Sep. 2006, we selected 30 cases of ICP as the study group, and randomly selected 30 cases of normal pregnant women for delivery during the same period as the control group in our hospital. Color Doppler ultrasound was used to measure the peak systolic velocity to end-diastolic velocity (S/D) and the resistive index (RI) of fetal middle cerebral artery, and the automatic biochemical analyzer be used to detect the total bile acid (BA) in maternal blood, and BA, pH as well as lactate in umbilical arterial serum; neuron-specific enolase (NSE) in umbilical artery serum was detected by ELISA. The results were analyzed and compared. Results:①The BA concentration in maternal blood and newborn umbilical artery blood of the study group was significantly higher than that of the control group ( P<0.01). In the study group, the BA in maternal and newborn blood were positively correlated ( r=0.937, P< 0.01) ;②Lactate and the NSE Concentration in newborn umbilical artery of the study group was significantly higher than that of the control group ( P< 0.01). The pH value innewbom umbilical artery and The S/D, RI value of fetal middle cerebral artery in the study group was significantly lower than those of control group ( P< 0.01); ③ In the study group, the NSE concentration was positively correlated with BA and lactate concentration in newborn umbilical artery, while negatively correlated with the S/D and RI values of fetal middle cerebral artery and the pH value in newborn umbilical artery ( P<0.01). Conclusions: There is the existence of hypoxia and brain injury in fetus of ICP. By measuring the blood flow changes of fetal cerebral artery with Color Doppler and detecting pH, lactate as well as NSE levels in umbilical arterial blood, we could early predict the fetal hypoxia and diagnose the fetal brain injury in ICP.

ObjectiveTo investigate the clinical efficacy of focused ultrasound for treating non-neoplastic epithelial disorders of vulvar. Methods212 patients with non-neoplastic epithelial disorders of vulvar were treated with focused ultrasound. The patients were followed up after the treatment,and symptom was observed and the efficacy was evaluated. ResultsThe efficacy of non - neoplastic epithelial disorders of vulvar of squamous hyperplasia,lichen sclerosus and mixed dystrophy was 99.2％, 100. 0％, 88.9％ respectively, the difference was not significat (P ＞ 0.05 ). The efficacy in different courses of patients was 100.0％ ( ＜ 2 years), 100.0％ (2 ～10 years) ,91.3％( ＞ 10 years) respectively,the difference was not significat( P ＞ 0.05). ConclusionFocused ultrasound was obviously effective in the treatment of patients with non-neoplastic epithelial disorders of vulvar.

Objective To investigate the relationship of fetal total bile acid (TBA) concentration with the change of fetal pancreas endocrine secretion and its impact on fetal growth and development in intrahepatic cholestasis of pregnancy(ICP). Methods The concentrations of TBA, insulin, glucagon and glucose in the cord blood were measured in 30 fetuses with maternal ICP (case group) and 30 fetuses of normogravidas(control group) after elective cesarean section during the same period in the Department of Obstetrics of Xiangya Second Hospital of Central South University from March 2007 to February 2008. The cord blood TBA concentration was investigated by enzyme method and the concentrations of insulin and glucagon were investigated by radioimmunoassay. The glucose was measured by oxidase-superoxide method. The neonatal weight, length and the ponderal index (PI) were measured after parturition. Results (1) The cord blood insulin concentration (9.0±3.3) mU/L and the ratio of insulin over glucagon 0. 048±0. 028 in the case group was significantly lower than that of controls(10.1±3.7) mU/L,0.050±0. 020 (P<0.05). The concentrations of TBA(10.3±3. 8)μmol/L and glucagon(235±57) ng/L in case group were obviously higher than that in controls (4.1±1.3)μol/L, (205±34) ng/L(P<0.05). But no difference was shown in the glucose concentration in cord blood between the ease and control groups [(3.4±1.1) mmol/L vs (3.6± 1.2 )mmol/L, P > 0.05]. (2)The neonatal weight and length in case group were significantly lower than that of control [(3163±478) g vs (3498±393)g, (46.5±2.3) cm vs (49.3±1.9)cm, P<0.01]; while the Ponderal index in ease group was significantly higher than that of control group (3.13±0. 23 vs 2. 92±0. 29,P <0.01). (3) The cord blood TBA concentration respectively showed a linear relationship with the cord blood insulin concentration, the cord blood glucagon concentration and the ratio of insulin over glucagon in the case group. With the increase in cord blood TBA concentration, the cord insulin concentration and the ratio of insulin over glucagon decreased; meanwhile the cord blood glucagon concentration rose(P<0.01). The cord blood insulin concentration and the ratio of insulin over glucagon in case group were respectively positively correlated with the neonatal weight and length, and were negatively correlated with the PI (P<0.01); while the cord glucagon concentration was respectively negatively correlated with the neonatal weight and length, and positively correlated with the P1 (P < 0.01 ).Conclusions In 1CP fetus pancreas, there are hypoinsulinism, glucagon oversecretion, and decrease of the ratio of insulin over glucagon, which is closely correlated with fetal TBA concentration. The endocrine function of fetal pancreas affects the fetal growth and development.

Objective To investigate the clinical features of capillary leakage syndrome ( CLS ) occurring in critically ill newborns in Guangzhou. Methods Three tertiary hospitals in Guangzhou were chosen as research field;critically ill newborns with diagnosis as CLS in NICU of three hospitals were retro-spectively studied from January 2011 to December 2015; and the morbidity,mortality,causes,treatment and outcome of CLS neonates were analyzed. Results There were 49 cases diagnosed as CLS, accounting for 1. 62%(49/3 029)of the total number of critically ill newborns admitted to NICUs in the same period. The common primary factors were preterm low birth weight(34 cases,69. 4%),respiratory distress syndrome(38 cases,77. 5%),congenital anomaly(19 cases,38. 8%),asphyxia(17 cases,34. 7%),and intrauterine infec-tion(12 cases,24. 5%). The 83. 7%(41/49) of CLS occurred within 72 hours after admission. The overall mortality of CLS was 30. 6%( 15/49 ) . The main lethal cause was multiple organ dysfunction syndrome (60. 0%,9/15). Treatment included antibiotics,vasoactive drugs,fluid resuscitation,corticosteroids,and me-chanical ventilation. Conclusion CLS is a common critical illness in NICU with high mortality and poor prognosis. Early prediction and early intervention could improve survival and prognosis in critically ill neonates with CLS.

Objective To investigate the effects of Yindan Xinnaotong Capsule on the osteoponin(OPN)expression in myocardium tissue of the rats after acute myocardial infarction(AMI)and to clarify the mechanism of Yindan Xinnaotong Capsule in alienating rat AMI.Methods 90 Wistar rats were used to establish AMI models by ligating of the left anterior descending coronary artery.The AMI model rats were randomly divided into AMI model group, highdoseofYindan(16g·kg-1·d-1)group,lowdoseofYindan(0.08g·kg-1·d-1)group,positivedrug control captopril(5 mg·kg-1 ·d-1 )group(n=12);at the same time sham operation group(n=10)was set up, the rats in sham operation group was treated with wearing without ligation. All the rats were administrated for 4 weeks,then the myocardium tissue samples were obtained.The histological changes of myocardium tissue were observed by HE and Masson staining;the DNA fragments of apoptotic cells were detected by TUNEL staining and the apoptotic index(AI)was calculated.The expression of OPN mRNA in non-infarction area was measured by RT-PCR.Results Compared with sham operation group,the AI of the rats in model group was significantly increased (P<0.05);compared with model group,the AI of the rats in Yindan groups and captopril group were markedly decreased(P<0.01 );compared with captopril group, the AI of the rats in high dose of Yindan group was significantly decreased(P<0.05).Compared with sham operation group,the expression level of OPN mRNA in non-infarction area of the rats in model group was significantly increased(P<0.01);compared with model group, the expression levels of OPN mRNA in non-infarction area of the rats in Yindan groups and captopril group were also decreased significantly(P<0.01);compared with captopril group,the expression level of OPN mRNA non-infarction area of the rats in high dose of Yindan group was significantly decreased(P<0.05).Conclusion Yindan Xinnaotong Capsule could obviously alleviate the apoptosis of myocardium tissue of the rats after acute myocardial infarction and decrease the expression of OPN mRNA in non-infarction area of left ventricle, which indicates that Yindan Xinnaotong Capsule may protect myocardium tissue through decreasing the OPN mRNA expression.

Objective To explore the clinical effect of traditional Chinese medicine and western medicine in treatment of patients with angina pectoris. Methods 120 cases with angina pectoris admitted in the Fourth Hospital of Baotou City from May 2012 to August 2013 were randomly divided into treatment group (n=60)and control group (n=60). All patients were given secondary prevention of coronary heart disease,and besides this, treatment group were added nitrates medications and traditional Chinese medicine treatment,while control group were only given nitrates medications.The treatment course was 14 days. The efficacy of angina pectoris,nitroglycerin loss rate and electrocardiogram efficacy were compared and the safety were evaluated between two groups. Results The efficacy of angina pectoris in treatment group was 90.00%,while control group was 71.67%,the difference was statistically significant(P<0.05 ). ECG efficiency in treatment group was 68.33%,while control group was 48.33%,the difference was statistically significant(P<0.05 ). The reduction of nitroglycerin was 86.67%,while control group was 61.67%,the difference was statistically significant(P<0.05). In addition,there were no adverse reaction in two groups. Conclusion Compared with nitrates medications,combined Chinese and Western medicine in treatment of patients with angina pectoris on basis of secondary prevention of coronary heart disease has better therapeutically effective rate.

Objective To investigate the influencing factors of successfully switching to sequential ventilation in patients with prolonged weaning due to acute respiratory failure (ARF) after thoracolaparotomy based on the initial rapid shallow breathing index (RSBI) at 60 min after spontaneous breathing trial (SBT), namely, the f/VT optimal value range of 80-120 times/ (min · L), thus providing the basis for determining the ideal timing of weaning in clinical practice.Methods A prospective observational study of sequential ventilation [RSBI during the initial SBT (60 min), 80-120 breaths/ (min · L)] was carried out in 42 patients on mechanical ventilation (≥ 48 h) due to post-thoracolaparotomy ARF in the ICUs.According to the duration of the mechanical ventilation, the patients were divided into 2 groups : successfully prolonged weaning group (≥ 7 days, n =24) and refractory weaning group (＜ 7 days, n =18).The patients with cardiac failure, aged less 18 or over 80, with hepatic dysfunction, or those needing gastrointestinal decompression after esophageal surgery or upper abdomen surgery were excluded.The demographics, APACHE Ⅱ scores and duration of mechanical ventilation of both groups were recorded, and the respiratory work and oxygen metabolism variables before the switch to sequential ventilation (within 24 hours after admission to ICU) and at the time of switching (24 hours in the ICU after admission) were recorded, respectively: clinical puhnonary infection score (CPIS), assessment of cough severity, pH, PaO2, PaCO2 and PaO2/FiO2;hemodynamic and microcirculation-related variables: HR, MAP, fluid balance, BNP and Lac;endocrine and metabolism variables : Hb, ALB and random serum cortisol (COR).The clinical features and the changes of the above-mentioned variables before and at the time of switching were compared between both groups.The independent sample t test was used for the single factor comparison and Mann-Whitney U test was applied to the non-normal distributions.The Fisher exact probability test was used for the single factor comparison of ranked data such as categorical variables.Results There were no significant differences in age, gender and severity of disease between two groups (P ＞ 0.05);the successfully prolonged weaning group had longer duration of invasive mechanical ventilation and ICU stay compared with the refractory weaning group (P ＜ 0.05).There were significant differences in cough severity, PaCO2, pH, HR and fluid balance between two groups before switching (P ＜ 0.05).Compared with those before switching, in the refractory weaning group there were marked decrease in Lac (P ＜ 0.05), obvious increase in cough severity, pH, Hb and ALB (P ＜ 0.05), but there was no significant difference in COR (P ＞ 0.05);while in the successfully delayed weaning group, there were significant decrease in CPIS, PaCO2, HR, MAP, BNP, fluid balance and Lac (P ＜ 0.05), and cough severity, pH, ALB and COR showed an upward trend (P ＜ 0.05).Conclusions The key of successful sequential ventilation is within the values of RSBI ranging from 80 to 120 times/ (min · L) during the initial SBT (60 min) selected as the switching point in patients with prolonged weaning after thoracolaparotomy.The major influencing factors for determining the ideal timing of switching include the matching status between respiratory endurance and respiratory work, the balance between myocardial strength and both cardiac preload and afterload, the severe disease associated with adrenal insufficiency, and malnutrition.

Objective To observe the pulmonary inflammation and oxidative stress in rats with cecal ligation and puncture sepsis. Methods The male rats in 8 weeks were randomly divided into control group, sham operation group and model group,The ALI model of sepsis was prepared by cecal ligation and puncture (CLP). In order to achieve the effect of experimental observation, the rats were killed after the operation 12 h, and the lung tissue HE staining analysis was performed, and the levels of MPO and MDA were observed. Results The degree of lung injury and the levels of MPO and MDA in the model group were significantly higher than those in the control group and the sham operation group (P < 0.01).Conclusion Rats with cecal ligation and puncture sepsis model can well simulate sepsis inflammatory response and oxidative stress.

Objective To evaluate the clinical values of acoustic radiation force impulse(ARFI) elastography for liver fibrosis on hepatopath patients.Methods ARFI elastography was prospectively performed on 99 patients prepared to undergo hepatic surgery to get a shear wave velocity(Vs) which was the representative of liver stiffness.The fibrosis stages,inflammation grades and steatosis grades were evaluated histologically after surgery.Values of Vs were compared with the histological results.Results Values of Vs with fibrosis stage 0-4 was (1.14 ± 0.22) m/s,(1.30 ± 0.22) m/s,(1.36 ± 0.38) m/s,(1.47 ± 0.37)m/s and (1.87 ± 0.08) m/s,respectively.A significant difference was observed among them (P ＜0.001).There was a certain correlation between Vs and fibrosis stage(r =0.541,P ＜0.001).Vs was a significant predictor of stage ≥3 fibrosis with an area under the ROC curve of 0.812,sensitivity 73.2％ and specificity 81.4％ when 1.40 m/s was the cutoff value (P ＜ 0.001).Values of Vs with inflammation grade 0-3 was (1.17 ± 0.16)m/s,(1.43 ± 0.36) m/s,(1.59 ± 0.53) m/s and (1.89 ± 0.59) m/s,respectively,which were significantly different (P ＜ 0.001).A certain correlation was observed between Vs and inflammation grade(r =0.383,P ＜0.001).Values of Vs with steatosis grade 0-4 was (1.61 ±0.42) m/s,(1.47±0.58) m/s,(1.56 ± 0.71)m/s,1.13 m/s and (0.94 ± 0.95) m/s.Obvious difference didn't exist between Vs and steatosis grade (P =0.286).Obvious correlation wasn't observed between them,either (r =-0.177,P =0.080).Conclusions ARFI elastography has a certain value for the evaluation of liver fibrosis,while inflammation grade may affect its performance.