Objective:The clinical features,maternal and fetal outcomes and management of pregnant women with uterine malformation during the pednatal period were investigated.Methods:99 pregnant patients with uterine malformation as research group and 100 pregnant patients without uterine malformation as control group were recruited in Peking Union Medical College hospital from January 1 st in 2000 to September 30th in 2008.A retrospective study was done to compare the clinical features,matemal and fetal outcomes in these two groups.Clinical management of pregnancy with uterine malformation.Results:In the research group,the incidence of caesarean section,threatened abortion,preterm rupture of membrane,abnormal presentation,and placenta accrete were higher than those in the control group.The average fetal weight was smaller than that of control group.There were no significant differences in postpartum hemorrhage and perinatal child death in these two groups.Conclusions:Patients with uterine malformations more likely undergo C-section.Postpartum hemorrhage and other pregnant complications should be paid more attention.

[Objective]To use urodynamic method to evaluate "free sacro-capsule"pre-operation and post-operation effect,also evaluate bladder and urethral function.[Method]Twenty children were included in this study.[Result]All children had none damage after operation.The PVR and DLPP of post-operative group are significantly decreased.The BC and MCC of post-operation group was significantly higher than pre-operation group(P

ObjectiveTo discuss the interaction of pregnancy and myasthenia gravis(MG) and the management of pregnancy with MG.MethodsSeven cases of pregnancy with MG in Peking Union Medical College Hospital were analyzed retrospectively,with respect to the therapy of MG,pregnancy complications and outcomes.Results Totally 38 683 pregnant women were admitted to Peking Union Medical College Hospital between Oct.1983 and Oct.2010.Among them there were 9 patients suffered from MG,with the incidence of 0.023％.Two pregnancies were terminated because of personal reasons,and seven continued.( 1 ) Onset of MG:in the 7 cases,6 were diagnosed before conception,with the mean course of 5.9 years.The other one occurred in the third trimester.(2) Management:all the cases were under close surveillance during pregnancy.Four women took thymectomy before conception,and one of them kept taking medication after surgery. In those who received thymectomy,3 cases remained stable and 1 case worsened during prenancy.The latter one took medication at 33 weeks,and continued to full term.MG exacerbated in the other three women who had not undergone thymectomy before conception.Among them, one woman complicated with systemic lupus erythematosus and lupus nephritis delivered the baby at 31 weeks.(3) Delivery and neonatal outcomes:cesarean deliveries were performed in 5 cases and the other two underwent vaginal deliveries.All the newborns were admitted to neonatal intensive care unit for surveillance.There were three smaller than gestational week (SGA) infants.No MG was observed in newborns.ConclusionsPatients with MG should have an overall evaluation before conception.The course of MG during pregnancy is unpredictable.They may get a promising outcome under the control of a multidisciplinary team including obstetricians and neurologists.Newborns should be carefully monitored for sings of transitory MG in the department of pediatrics.

Objective To investigate the prenatal diagnosis and prenatal genetic conselling of pseudomosaic trisomy 20. Methods One case of pseudomosaic trisomy 20 was analyzed and relative literatures were reviewed. Results A 31-year-old gravid 1, para 0 woman underwent amniocentesis at 18 weeks of gestation due to high risk of trisomy 21 during maternal serum screening in September, 2012. Interphase fluorescence in situ hybridization (FISH) of amniocytes with probes GLP13/GLP21/CSP18/CSPX/CSPY showed a normal result, while cytogenetic analysis of cultured amniocytes revealed a karyotype of 47,XY,+20[7]/46,XY[9]. The level of trisomy in the cultured amniocytes was 7/16. Cordocentesis revealed a karyotype of 46,XY in cultured cord blood cells. Interphase FISH analysis was performed using the probes D20Z1 (20p11.1-q11.1) and D20S1157/20QTEL14 (20 per/qter). Each probe showed two signals in all uncultured amniocytes. The prenatal ultrasound findings were unremarkable. The mosaicism was considered to be pseudomosaicism. After genetic counseling, the parents selected to continue the pregnancy. A healthy male baby was delivered at 39 weeks of gestation. Postnatal cytogenetic analysis revealed a karyotype of 46,XY in peripheral blood lymphocytes. Interphase FISH analysis of the uncultured buccal cast-off cells using the probes D20Z1 and D20S1157/20QTEL14 showed normal results in 100%cells. There was no phenotypic abnormality at the age of seven months. Conclusions When mosaic trisomy 20 is identified in amniocytes, further evaluation and genetic counseling are required. Interphase FISH of the uncultured amniocytes with a chromosome-specific probe is a useful tool for confirmation of the prenatal diagnosis of mosaicism. Genetic analysis of multiple tissues is required postnatally.

Objective To calculate the incidence of chromosomal abnormalities at second trimester in women who were 35 or older at their expected date of birth.Methods The amniocentesis and karyotyping results in Peking Union Medical College Hospital from January 1st,2001 to June 30th,2011 were retrospectively analyzed.The only indication for amniocentesis in these group of woman was advanced maternal age.A total of 6584 cases Were included in this study and were divided into two groups according to maternal age,ie.35-39 and ≥40 year old group.The incidences of fetal 47,+ 21,47,+ 18 and sex aneuploidies were calculated and compared between two groups by Chi-square test.Results Altogether,121 cases were diagnosed to be abnormal chromosome,and the overall incidence was 18.38‰ (121/6584).The abnormal karyotypes included 111 cases of aneuploidies (mosaicism included) and 10 cases of structural abnormalities.The aneuploidies included 59 cases of 47,+21 (8.96‰,59/6584),25 cases of 47,+18 (3.80‰,25/6584),2 cases of 47,+13 (0.30‰,2/6584) and 25 cases of sex aneuploidies (3.80‰,25/6584).Fetal 47,+21 was the most frequent chromosomal abnormality,accounting for 53.15％ (59/111) of all aneuploidies.The incidence of fetal 47,+21 was significantly higher in ≥40 year-old group than that of 35-39 year old group[13.99‰(16/1144) vs 7.90‰(43/5440),x2=3.937,P=0.047].There were no statistical differences of the incidences of fetal 47,+ 18 and sex aneuploidies between the two groups.Conclusions The main fetal chromosomal abnormalities in women aged 35 and older are the aneuploidies of chromosome 21,18,13 and sex chromosomes.The incidence of fetal 47,+21 is significantly increased in the women aged 40 years and older.So prenatal screening should be provided first to women at 35-39 years of age and amniocentesis should be the first choice of prenatal diagnosis for women over 40 years old.

Objective To establish normal reference intervals of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in children′s hospital.Methods A total of 183 fresh EDTA anticoagulant samples and 125 fresh urine in healthy children were collected from May 2014 to October 2014.According to the CLSI C28-A2 ,the unilateral upper limit 95% was established the normal reference value in different age group.Results There was significant difference in four groups (P<0.05).The normal reference intervals of plasma NGAL in healthy children:0 to <7 months;<291.28 μg/L;7 months to <5 years old;<150.87 μg/L;5 years old to <9 years old:<127.93 μg/L;9 years old to ≤16 years old:<161.74 μg/L;the normal reference intervals of healthy children urine NGAL:0 to <7 months:<257.31 μg/L;7 months to <5 years old:<201.55 μg/L;5years old to <9 years old:<197.69 μg/L;9 years old to ≤16 years old:<151.46 μg/L.Plasma and urine NGAL results in neonatal group were higher than the other three groups.Conclusion The normal reference intervals of plasma and urine NGAL in children′s hospital is established.this could provide clinical evidence for the diagnosis and treatment of acute renal injury in pediatric patients.

Objective To establish a reversed-phase high performance liquid chromatograph ( RP-HPLC ) method for determination of equilibrium solubility and oil/water partition coeficient of phloridzin in different solvents. Methods A RP-HPLC method was established to detect the concentration of phloridzin in water and different organic solvents. The partition coefficients in the n-octanol-water/buffer solution systems of phloridzin were determined by shaking flask method. The Inertsil ODS-3 (4.6 mm×150 mm, 5μm) column was used and the detection wavelength was 284 nm.The flow rate was 1.0 mL??min-1, and acetonitrile-0.05% phosphoric acid(30??70)was used as mobile phase. Results The equilibrium solubility of phloridzin was 2.07 mg??mL-1 in water and 838.63 mg??mL-1 in methanol at 25 ℃.A good linear relationship of phloridzin was obtained within the range of 0.054 9-1.098 0 μg.The regression equation was Y=2 152.9X+7.26 (r=0.999 9).The solubility values of phloridzin were higher in ethanol and propylene glycol than in other solvents. Conclusion RP-HPLC method is simple, quick and accurate for the determination of phloridzin.Phloridzin was almost insoluble in petroleum ether and poorly soluble in water.The equilibrium solubility is higher in methanol than in other solvents. The apparent distribution coefficient of phloridzin varies significantly with pH under the alkaline conditions but less in the acidic solution.

Objective To evaluate the residual risk (i.e.failure risk in detecting aneuploidies abnormalities except for chromosome 13,18,21,X and Y) of cytogenetic abnormalities using interphase fluorescence in situ hybridization (FISH) for the second-trimester amniocytes.Methods The results of interphase FISH and conventional karyotyping of 2 837 consecutive amniotic fluid specimens were analyzed retrospectively.Probes for chromosomes 13,18,21,X and Y were used.The detection rate and residual risk for interphase FISH were calculated for the following three major clinical indications for prenatal diagnosis (advanced maternal age,abnormal maternal serum screening indicating an increased risk for trisomy 18 or trisomy 21,and ultrasound abnormalities).Results Consecutive interphase FISH and karyotyping of second-trimester amniocytes for prenatal diagnosis were performed from January 1,2010 to July 31,2013.Among the 2 837 cases,85 (3.0％) cases with abnormal karyotypes were found,including 73 cases of aneuploidies involving chromosome 13,18,21,X and Y,which were considered detectable by interphase FISH; 12 cases of chromosomal anomalies,other than aneuploidies of chromosome 13,18,21,X and Y,were diagnosed after karyotyping and were not detected by interphase FISH,including six cases of balanced rearrangements,five cases of imbalanced rearrangements,and one case of pseudomosaic of trisomy 20.Of these 12 chromosomal anomalies,three cases of imbalanced rearrangements involving chromosome 21 showed positive FISH results,and the other nine cases showed negative FISH results among which four case of hereditary balanced rearrangemerts and two cases of novel balanced rearrangements.The total detection rate for interphase FISH was 89.4％ (76/85),the misdiagnosis rate of chromosome abnormalities was 14.1％(12/85),and the residual risk was 0.43％ (12/2 761) following interphase FISH of the second-trimester amniocytes.Conclusions Interphase FISH is a useful adjunct to conventional karyotyping,but should not be regarded as a replacement for karyotyping as too many structural chromosomal abnormalities will be missed.Providing patients with a detection rate and residual risk during counselling may help them understand the advantages and limitations of interphase FISH in their prenatal diagnostic evaluation.

Objective To evaluate the effects of applying clinical pathway (CP) in clinical teaching of gynecology and obstetrics. Methods Totally 200 clinical specialist interns selected for the study were randomly divided into two groups (each 100), respectively, using CP teaching and tradi-tional teaching. After the internship, professional assessment (clinical skills assessment, theory test, the respondent)were conducted to two groups of students and their professional examination scores were compared, while questionnaires were conducted in the CP teaching group. All date were analyzed by SPSS 17.0 software. Chi-square test was used for enumeration date while t test was used for mea-surement data. Results CP teaching team of professional test results [(80.01 ± 9.34) vs. (72.37 ± 10.79)], the passing rate(96%vs. 87%) were superior to the traditional teaching group(P=0.000 and 0.022). The questionnaire showed that: applying CP in clinical teaching of obstetrics and gynecology can improve interns' learning enthusiasm and initiative, improve their comprehensive analysis ability, clinical thinking ability, practical ability and many other capabilities and it got about 90% of interns' recognition. Conclusions The application of the CP in clinical teaching of obstetrics and gynecology can help enhance the teaching effectiveness, standardize the teaching process, and improve the qual-ity of teachers teaching gynecology and obstetrics.

Objective To study the clinical presentations,diagnosis and managements of primary hyperparathyroidism (pHPT) in pregnancy.Methods A total of five cases of pHPT in pregnancy were enrolled from January 2005 to December 2014 in Peking Union Medical College Hospital.Their clinical presentations,managements,maternal-fetal complications and pregnancy outcomes were retrospectively analyzed.Results The median age was 32 (29,41) years.Of the five cases,three were diagnosed in the second trimester,one was before pregnancy and one was after delivery.Most of the clinical symptoms were nonspecific to pHPT,such as nausea,vomiting and loss of appetite.Frequent urination and nocturia occurred in one;unconsciousness and manifestations of acute pancreatitis and eclampsia relevant symptoms were complained of by one.The common maternal complications were nephrolithiasis and hydronephrosis (3/5),osteoporosis (2/5),anemia (2/5) and kaliopenia (2/5),while the severe complications were hypercalcemic crisis (2/5),acute pancreatitis (1/5),eclampsia (1/5),HELLP (hemolysis,elevated liver enzymes and low platelets) syndrome (1/5),disscminated intravascular coagulation (DIC) (1/5),cerebral infarction (1/5) and intrauterine fetal death of one twin (1/5).The median level of calcium in serum samples was 3.70 (2.78,4.50) mmol/L;the median level of parathyroid hormone (PTH) in serum samples was 294 (151,634) pg/ml.All of the five cases were positive for parathyroid ultrasonography.Four cases received parathyroid radionuclide imaging and had positive results.One asymptomatic patient received no specific treatment,whereas the neonate presented with hypocalcemia after birth.Two cases received surgical resections in the second trimester;one of them had a live birth without fetal complication,while the other had induced abortion.Two cases received postpartum surgery;one asymptomatic patient had a live birth without fetal complication,whilc thc other with twin pregnancy suffered stillbirths (one intrauterine fetal death and one neonatal death).Pathologic diagnosis were solitary parathyroid adenomas in four cases who received surgery.Their operations were effective except that one case,which was improved after treatment,was complicated with secondary hypoparathyroidism.Conclusions The symptoms of pHPT in pregnancy are often nonspecific,but it can cause maternal and fetal morbidity and mortality.Early diagnosis of pHPT,followed by appropriate managements,has been shown to significantly reduce the complications.Surgical management should be a safe and effective choice.