Objective To investigate the suitable mode of induced termination of pregnancy at second and third trimester for women with scarred uterus. Methods A retrospective study was performed in 90 cases of second and third trimester pregnant women with scarred uterus, who requested termination of pregnancy due to medical indications in Beijing Obstetrics and Gynecology Hospital from September 2002 to June 2009. The indications of termination of pregnancy were fetal anomaly, serious pregnant complication and intrauterine fetal deaths. 72 second trimester pregnant women and 18 third trimester pregnant women were included in this study. The interval time of previous operation to this pregnancy were recorded. And it was <2 years in 20 cases and ≥2 years in 70 cases. The patients with normal Hepatic function began to take mifepristone and had an allergic test of Ethacridine Lactate. The method of mifepristone combined with Ethacridine Lactate were adopted when the allergic test was negative (group A, 54 cases). The method of mifepristone combined with earbeprost methylate suppositories were used in the patients who had a positive reaction to the allergic test of Ethacridine Lactate, or who failed to amniotomy to inject Ethacridine Lactate because of oligohydramnios or small gestational age(group B, 36 cases). Record the detail information of every patient. (1) Age, gestational weeks, gravidity and parity. (2) The mode of previous operation (inducing the scar of uterus), previous operation time and indication. (3) The mode of induced labor in this pregnancy, the interval time from administration to uterine contraction, delivery or not and the interval time from induction to delivery. (4) Postpartum hemorrhage, the successful rate of induce labor, placental retention ratio and rupture of uterus or not. Results (1) It had no significant difference between group A and group B in age, gravidity, parity and the interval time of previous operation to this pregnancy (P> 0.05). But there was significant difference between two groups in gestational weeks of induction(16 weeks vs. 25 weeks,P<0.01). (2) It had no significant difference between two groups in successful rate of induction and postpartum hemorrhage(P>0.05), but the time from induction to regular uterine contraction and delivery in group B was significant shorter than that of group A(P<0.01). The rate of delivery with 24 hours in group B was 94%. It was significant higher than that of group A(13%, P<0.01). (3) The rate of retained placenta in group B (31%, 11/35) was significant higher than group A (10%, 5/52), but the ratio of residual of placenta and membranes in group A was significant higher than that of group B(54% vs. 34% ). It was no significant difference in total rate of postpartum complication between two groups. Further analysis was done in relationship of complication and the time of previous operation. It was no significant difference between the over 2 years group and the less 2 years group in the incidence rate of complications including placental retention, residual of placenta and membranes, rupture of uterus, placental abruption and postpartum hemorrhage. (4) There was 1 case of uterine rupture in group B and 1 case of placental abruption in group A. Conclusions Both of methods of mifepristone combined with carboprost methylate suppositories and the mifepristone combined with Ethacridine lactate are feasible to induced second trimester and late trimester termination of pregnancy for women with scarred uterus. But sufficient preoperation preparation and the course of induction and labor careful monitoring must be done to prevent the uterine rupture.

Ojective To investigate the value of preoperative B-type ultrasonicd examination in the choice of incision of minicholecystectomy. Methods Before performing minicholecystectomy the size of gallbladder and the thickness of abdominal wall measured by B-type ultrasonography the projections postion of gallbladder bottom and neck on abdominal wall were marked in 95 patlents. Results The incision of 82 cases were determined by the linea formed with linking the projection of gallbladder bottom to neck on abdominal wall. The procedure with two aperture was chosen in 11 cases and the incision was extended in 2 cases out of them. The operation visual field was clear and common bile duct and hepatic artery and port vein could be differentiated. The incidenec of complications was 5.3%(5/95) and no severe complication occurred. Conclusions Preoperative B-type ultrasonogrophy is a simple and effective method for the choice of incision of minicholecystectomy in the term of individuation

Objective To investigate the value of fasting plasma glucose (FPG) in 75 g oral glucose tolerance test (OGTT) on the diagnosis of gestational diabetes mellitus (GDM).Methods Data of 6516 pregnant women who accepted prenatal cares from Beijing Obstetrics and Gynecology Hospital,Capital Medical University between Jan.2010 and Dec.2010 were collected.All patients had normal FPG at first trimester,and accepted 75 g OGTT after abnormal 50 g glucose challenge test (≥7.8 mmol/L).According to the result of OGTT,they were divided into 12 groups,and Chisquare test was used to analyze the role of FPG of OGTT in GDM diagnosis.Results According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria,15.0％ (980/ 6516) of this group of pregnant women was diagnosed with GDM by FPG (≥5.1 mmol/L) of OGTT in this study.Then,the rest 5536 pregnant women with normal FPG of OGTT were divided into 12 groups according to FPG level (FPG level interval 0.1 mmol/L).As FPG level rose,the incidence of GDM also rose (X2 =282.175,P =0.000).Similar results also appeared when the interval was 0.2 mmol/L and the FPG level was between 4.0 and 4.8 mmol/L (X2 =274.364,P=0.000).When FPG level was lower than 4.2 mmol/L(22.1％,1226/5536),the incidence of GDM diagnosed by OGTT was 3.6％ (44/1226).And when FPG level of OGTT was higher than 4.8 mmol/L,the incidence of GDM was 26.2％ (298/1138).Conclusions FPG screening is recommended between 24 and 28 gestational weeks before OGTT,and GDM low-risk women whose FPG ≤4.2 mmol/L do not need OGTT.

[Objective]To evaluate the clinical treatment results for diastematomyelia treated by operation. [Method]Data from patients with diastematomyelia admitted to our hospital from May 1978 to January 2006 were reviewed. According to the classification, there were single-tube in 25 and double-tube in 96 patients. One hundred and two patients with diastematomyelia were treated by operation and ninteen by conservative treatment. The clinical results were retrospectively analyzed according to scoring neural function and monitoring the peak P40 of posterior trivial nerve cortical somatosensory evoked potential (PTNCSEP) before and after treatment.[Result]The total operative effective rate of double-tube diastematomyelia amounted to 86% during a follow-up period of 6 months to 15 years,more significant in patients with pain.The scores of neural function and PTNCSEP were significantly improved. But patients with single-tube diastematomyelia had no obvious change after operation.[Conclusion]The spinal cord is damaged severely in double-tube diastematomyelia and gradually aggravated.Operation can get symptomatic relief in many patients and terminate spinal cord lesion. So operation should be performed as soon as the diagnosis is made. The spinal cord is damaged slightly in single-tube diastematomyelia and surgery is not indicated.

Objective To study the changes of intrapartum cesarean rate, cesarean indications and pregnancy outcomes after the new partogram applied. Methods Totally 3 290 pregnant women trying to vaginal delivery which were managed according to the new partogram in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from August to October in 2014 (new partogram group) were involved;2 987 pregnancy women trying to vaginal delivery from May to July in 2014 which were managed according to the old partogram (old partogram group) were involved as control. The intrapartum cesarean rate, cesarean indications and the pregnancy outcomes between the two groups were analyzed. Results The rate of intrapartum cesarean delivery was 8.50%(254/2 987) in old partogram group, and was significantly higher than that in new partogram group (6.2%, 204/3 290;P<0.01). Cesarean indications in old partogram group included 18 labor protraction (7.1%, 18/254), 82 labor arrest (32.3%, 82/254), 44 relative cephalopelvic disproportion (17.3%, 44/254), 80 fetal distress (31.5%, 80/254), 23 intrauterine infection (9.1%, 23/254) and 7 cesarean delivery on maternal request (CDMR;2.8%, 7/254) . Cesarean indications in new partogram group included 33 labor arrest (16.2%, 33/204), 71 relative cephalopelvic disproportion (34.8%, 71/204), 73 fetal distress (35.8%, 73/204) and 22 intrauterine infection (10.8%, 22/204), 5 CDMR (2.5%, 5/204). There were no significant differences in incidence of asphyxia neonatorum and puerperal morbidity (P>0.05), but the incidence of postpartum hemorrhage in new partogram group was higher than the old partogram group [6.9% (14/204) versus 1.6% (4/254), P<0.05]. Conclusion After the new partogram applied, the rate of intrapartum cesarean delivery is significantly decreased, but the incidence of postpartum hemorrhage is increased.

Objective To analyze the different doses of mifepristone in treatment of menopause induced by perimenopausal uterine leiomyoma , and to explore the clinical application of the effective dose of mifepristone.Methods 141 cases with perimenopausal uterine leiomyoma were divided into group A, group B and group C randomly, 47 cases in each group.Three group of patients were given mifepristone.Group A were treated with dose of 12.5 mg/d, group B was treated with 10.0 mg/d, group C was given with 5.0 mg/d.Three groups of patients continued treatment for three months. Uterine volume and leiomyoma volume were observed after treatment, and recorded status of induced menopausal after six months.Results Three groups with uterine volume and leiomyoma volume post-treatment were significantly less than pre-treatment (P<0.05);induction of menopause success rate of group A was 89.4%, menstruation incidence was 6.4%, vaginal bleeding was 2.1%, which was significantly better than the other two groups ( P<0.05) .Conclusion Different doses of mifepristone orally in treatment of perimenopausal uterine leiomyoma has a significant effect, but with 12.5mg/d induced menopause can effectively enhance the success rate , it could be used as the optimal dose of clinical treatment.

Objective To evaluate the clinical efficacy of subsegmental transcatheter arterial chemoembolization (STACE) in the treatment of moderate and advanced stages of primary hepatocellular carcinoma (HCC).Methods 93 cases of moderate and advanced stages of HCC were divided into two groups, 48 cases were treated with STACE, 45 cases with TACE. Results In the STACE group, the rates of decrease in serum AFP level and reduction of tumor size were significantly greater than those in the TACE group ( P

Objective:To observe the anti-glioma effects of lymphocyte activated by SEC in vivo and probe into therapy effects of SEC combing with operation,radiotherapy and chemotherapy.Methods:Experiment animals were SCID mice.With establishing animal model of glioma xenografted and immunity chimeric model of HuPBL-SCID,we observed the growth curve,survive time.With having operation,radiotherapy and chemotherapy,30 patients suffering from glioma were divided into control group,handle group 1 and 2,and then results were analyzed with MRI.Results:Growth curve shows:A,C and B group produced different suppress against glioma and its suppress rate were 58.5%,46.2% and 36.3%.The first death occurred at the 17th day in control group mice and all mice deaded at the 40th day.Contrasting to this,the first death occurred at the 40th day and 50% mice still were alive in group A until the day that experiment has just finished(60 day).Clinical material showed:The rate of effect(CR and PR) in control group was 40%,while the rate of effects was 50% in handle group 1 and 62.5% in handle group 2.Conclusion:SEC has extramaly potent anti-tumor activity against glioma.SEC combined with operation,radiatherapy and chemotherapy can raise treatment effect in patients with glioma.

10.3969/j.issn.2095-4344.2013.24.008

Objective To evaluate the diagnostic accuracy of diffusion tensor imaging (DTI) of corticospinal tract in amyotrophic lateral sclerosis (ALS) and find optimal testing strategies and optimal cutoff values of DTI indices for individual patient discrimination.Methods Thirty-three ALS patients and 34 healthy controls,collected at Peking Union Medical College Hospital from June 2004 through July 2005,undergoing brain DTI studies and fractional anisotropy (FA) examinations along the corticospinal tract,were analyzed by receiver operating characteristic (ROC) curves.Results Compared with the controls,ALS group had significantly decreased FA values in subcortical white matter of the precentral gyrus,the posterior limb of the internal capsule and the cerebral peduncle.In ROC analysis,the average FA value of the former two positions showed the best performance with an area under the curve of 0.917,an optimal cut-off value of 0.604,a sensitivity of 0.759 and a specificity of 0.912.The corresponding data for the average FA of all the three positions and each single position were listed as follows:average of three 0.914,0.648,0.759,0.912; precentral gyrus 0.875,0.509,0.733,0.824; internal capsule 0.845,0.692,0.656,0.941 ; and cerebral peduncle 0.752,0.742,0.656,0.735.Conclusions FA values of the corticospinal tract have a good accuracy in detecting upper motor neuron involvement in ALS.Precentral gyrus and posterior limb of the internal capsule and the average FA values of these two positions were suggested as the preferred testing places and DTI indices for clinical use.