Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis (HCA) in preterm premature rupture of membranes (PPROM).MethodsFrom Jan.2008 to Jun.2011,230 women with PPROM at 28 -33 +6 weeks of gestation undergoing deliveries in the Second Affiliated Hospital of Wenzhou Medical College were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 138 cases in histologic chorioamnionitis (HCA group ) and 65 cases in non-chorioamnionitis (control)group.Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C-reactive protein (CRP) level at admission and before delivery,the incidence of neonatal respiratory distress syndrome (NRDS),neonatal pneumonia,bronchopulmonary dysplasia,necrotizing enterocolitis,early-onset neonatal sepsis,abnormal brain sonography findings and mortality were compared between two groups.Results( 1 ) The incidence of HCA was 68.0.％ ( 138/203 ) in all 203 cases with PPROM.(2) The occurring ruptured membrane gestation in HCA group was ( 31.1 ± 1.5 ) weeks,which were significantly earlier than (32.0 ± 1.3 ) weeks in control group ( P ＜ 0.05 ).The level of CRP of (8.2 ± 14.9) mg/L before delivery in HCA group was significantly higher than (5.5 ±7.2) mg/L in control group (P ＜ 0.05).The rate of oligohydramnios and cesearean sections were 55.1％ (76/138) and 45.7％ (63/138) in HCA group,which were significantly higher than 30.8％ (20/65) and 29.2％ (19/65) in control group (P ＜0.05).There were no significant difference in patient's age,parity,WBC count and CRP at admission between two groups (P ＞ 0.05 ).The latency period did not show significant difference between (140± 116) hours in HCA group and (129 ± 125) hours in control group (P ＞ 0.05).(3) Using multivariable logistic regression models,oligohydramnios ( OR =2.937 ),gestational age of PPROM ＜ 32 weeks ( OR =2.352),serum CRP level ＞ 8 mg/L before delivery ( OR =4.923 ) and latency period ＞ 48 -168 hours (OR =4.439) were significantly associated with HCA (P ＜0.05).(4) The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group [ ( 32.0 ± 1.5 ) weeks vs.( 32.7 ± 1.5 ) weeks,( 1680 ± 379) g vs.(2017 ± 333) g,respectively,P ＜ 0.05 ].The incidence of Apgar ＜7,abnormal brain sonograhy findings, neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group [20.3％ (28/138) vs.7.7％ (5/65),14.5％ (20/138) vs.4.6％ (3/65),12.3％ (17/138) vs.3.1％(2/65),5.8％ (8/138) vs.0,6.5％ (9/138) vs.0,12.3％ (17/138) vs.3.1％ (2/65),respectively,P ＜ 0.05 ].The incidence of necrotizing enterocolitis ( 1.5％,2/138 ) in HCA group was higher than that of controlgroup(0) and the incidence of NRDS ( 18.8％,26/138) in HCA group did not show statistical difference with 21.4％ ( 14/65 ) in control group ( P ＞ 0.05 ).ConclusionsIt was found that HCA was significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.

OBJECTIVE: To perform a Meta-analysis of all randomized controlled trials that compared the efficacy and adverse events profile of Mabs for LA HNSCC. METHOD: Several databases were searched, including CBM, PUBMED, EMBASE, and CENTRAL. Primary outcomes included overall response rate (ORR), overall survival (OS), progression-free survival (PFS). Secondary outcomes included serious adverse events, such as grade 3-4 skin reaction, dysphagia, mucositis, and nausea/vomiting. The results were expressed as relative ratio (RR) or hazard rate (HR) with their corresponding 95% CI. RESULT: The final analysis included 10 trials. The primary analyses indicated that Mabs did not improve ORR and PFS, except OS for locoregionally advanced (LA) HNSCC [ORR 1.21, 95% CI (0.97 - 1.49); PFS 0.87, 95% CI (0.75 - 1.01); OS 0.82, 95% CI (0.71 - 0.95)]. Analysis of adverse effects demonstrated that grade 3 - 4 skin reaction ERR 1.87, 95% CI (1.11 - 3.16)] was statistically significantly associated with Mabs except dysphagia ERR 0. 95, 95% CI (0.75 - 1.19)], Mucositis ERR 1.03, 95% CI (0.67 - 1.57)], and nausea/vomiting ERR 1.15, 95% CI (0.71 - 1.86)]. CONCLUSION Anti-EGFR Mabs may be satisfactory for improving OS of LA HNSCC. During the Mabs therapy, skin reaction should be much more monitored.
Antibodies, Monoclonal ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; Disease-Free Survival ; ErbB Receptors ; immunology ; Head and Neck Neoplasms ; drug therapy ; Humans ; Randomized Controlled Trials as Topic ; Squamous Cell Carcinoma of Head and Neck

OBJECTIVE: To study the distribution and drug sensitivity test of bacteria of patients on chronic rhinosinusitis with or without nasal polyps. METHOD: The purulent discharges were collected from sinus of 175 patients with chronic rhinosinusitis with or without nasal polyps during endoscopic sinus surgery. The results of germiculture and drug sensitivity test were analyzed. RESULT: From 175 specimens, 118 (67%) showed positive results in germiculture. Among them, 79 strains of gram positive bacteria and 39 strains of gram negative bacteria were detected. Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus haemolyticus were the most common pathogens in gram positive bacteria. The most common pathogens of gram negative bacteria were P. Aeruginosa, Enterobacter aerogenes, Enterobacter cloacae. The sensitive antibiotic on gram positive bacteria were amikacin, Daptomycin, Linezolid, vancomycin, teicoplanin, amoxicillin and clavulanate potassium, cefuroxime, respectively. The sensitive antibiotics on Gram negative bacteria were amikacin, Cefoperazone/sulbactam and imipenem, ceftazidime ceftazidime, aztreonam, levofloxacin, respectively. CONCLUSION Bacterial infection was common happened in the sinus cavity of patients with chronic rhinosinusitis with or without nasal polyps. Gram positive bacteria were the main pathogenic bacteria and gram positive bacteria and gram negative bacteria have great differences in the sensitivity of antibiotics. For patients with chronic rhinosinusitis, the using of antibiotics should depend on the drug sensitivity test.
Bacterial Infections ; complications ; drug therapy ; Gram-Negative Bacteria ; drug effects ; Gram-Positive Bacteria ; drug effects ; Humans ; Microbial Sensitivity Tests ; Nasal Polyps ; microbiology ; Rhinitis ; microbiology ; Sinusitis ; microbiology

Objective To evaluate clinical effect of volume modulated arc therapy ( VMAT) for spinal metastases .Methods Twenty patients with spinal metastases who had been treated with VMAT were chosen to participate in the study .The prescribed dose varied from 45 to 60 Gy within 15 -20 fractions, 3 Gy per fraction, and one fraction per day of VMAT .Pain and quality of life were measured before VMAT and at several time points up to 6 months after treatment , by the numerical rating scale (NRS) and verbal rating scale (VRS) and the quality of life scale for bone metastases (EORTC QLQ-BM22) questionnaire.In addition, Frankel grading was used to evaluate the neurological function of spinal cord.The primary endpoint was frequency and duration of complete pain relief , and the secondary endpoint was death.Results At the end of the follow-up, the number of patients reporting no pain from spinal metastases, as measured by the NRS, increased from 0 of 20 before VMAT to 10 of 14 ( t =20.24, P<0.05) .NRS-reported pain reduction from baseline to 1 weeks and 4 weeks after VMAT were clinically meaningful with NRS score (6.50 ±0.51) at baseline,(4.30 ±0.47)at 1 week and(2.50 ±0.50)at 4 weeks (t=15.98, 27.57, P<0.05).The pain reduction maintained until the end of the follow-up.These improvements were accompanied by significant reduction in opioid use during the first 6 months after VMAT (16 of 20 patients with strong opioid use at baseline vs.6 of 18 at 6 months; t =8.46, P <0.05). According to EORTC QLQ-BM22 questionnaire , patients obtained significant improvement in pain location , severity, and function with the score (46.50 ±1.50)at baseline, (38.35 ±0.98) at 4 weeks(t=21.51, P<0.05).However,no significant alleviation in social psychology was reported (P>0.05).After VMAT, the patients who suffered from nerve function impairment recovered to different extent . No one had radiation-induced injury , such as radiation myelitis , radiation pneumonitis , etc.Median survival time was 10 month.Conclusions VMAT is a safe and effective treatment method for spinal metastases .Significant reductions in patient-reported pain were observed , along with nerve dysfunction improved .The patients′quality of life was significantly improved .VMAT has no late spinal cord toxicities .

Objective To assess the distribution of vaginal microflora in healthy women and investigate their cognition of lower reproductive tract infection-related knowledge as well as personal hygiene habits and character of behavior in seeking medical treatment. Methods Total of 1660 healthy women who had physical check-ups at the Medical Center of Renji Hospital were selected and received gynecologic examination, as well as routine examination, pH examination and bacterial culture of the vaginal discharge. In addition, 860 of them were randomly selected for questionnaire survey, in which reproductive tract infection -related knowledge and personal hygiene habits as well as behavior in seeking medical treatment were involved. Results Among the 1660 eensused women, vaginal average pH was 4. 16±0.21. The positive rate of Candida in vaginal discharge routine examination was 3.86% (64/1660), which was lower than that in aerobes culture 7.71% (128/1660). Candida alhicans was the most populous species 78.9% (101/128) ,followed by 7.8% (10/128) and 7.0% (9/128) for the Candida glabrata and Candida krusei respectively. The most populous species of vaginal microflora were hemolytic streptococcus A (63.80%, 1059/1660), Staphylococcus epidermidis (14.28%, 237/1660), and Enterococcus faecalis (D) group ( 11.44%, 190/1660). The questionnaire survey showed that 88.4% (760/860) of 860 women took active treatment when feeling unwell, 92.1% (792/860) of them had good hygiene practices, and only 21.2% (182/860) had the habit of vaginal douching. In addition, 50.0% (430/860) of them had the desire to obtain reproductive health knowledge through out-patient consultation. Conclusions Vulvovaginal Candida disease ranks the first in all types of vaginitis, among which, Candida albicans is the most populous species followed by the Candida glabrata and Candida krusei. Hemolytic streptococcus A and Staphylococcus epidermidis are the most common species of vaginal mieroflora in healthy women. The censused women have high awareness of reproductive health care and pay mueh attention to common gynecologic diseases such as lower reproductive tract infection. Nevertheless, we should strengthen the public education of reproductive health-related knowledge.

Objective To evaluate the efficacy of stereotactic body radiation therapy (SBRT) for hepatic metastases from colorectal cancer,and to collect data for the application of this technique.Methods A total of 28 patients from No.306 Hospital of PLA,including 17 male and 11 female with median age of 63.8 (range from 31 to 86),were treated with SBRT for colorectal cancer with liver metastases with 54 lesions in total.The GTV,CTV and PTV were delineated above the enhanced CT scans acquired during normal quiet respiration.CTV was obtained by adding 5 mm isotropic margin from GTV,and PTV was obtained by adding 5 to 10 mm isotropic margin from CTV.Prescription dose line covered 50％-60％ of isodose curve at 3-6 Gy/fraction.The total dose was 39-45 Gy and the biologically equivalent doses(BED)was 50.7-65.3 Gy.The patients were followed-up beginning at 3 months after SBRT.The change in size of the lesion based on enhanced CT or MR scans was evaluated.Toxicity was evaluated and scored according to the RTOG criteria.Local control rate and survival rate were analysed.Results All patients completed the treatment.With median follow-up of 15.1 months (range frome 3 to 30 months),7 patients survived at the end of follow-up.The local control rate (LC) was 79.2％,and 1-and 2-year overall survival rate(OS) were 82.7％ and 48.6％,respectively.There was a close corelation between the size of lesion and the LC.The LC (PR + CR) was much better at the size of lesion less than 14 cm3 than that at the size more than 65 cm3(x2 =4.17,P＜0.05).When the size was more than 180 cm3,the LC was zero.Toxicity included fatigue (60.7％),grade 1 and 2 digestive system toxicity (28.6％),a transient grade 1 and 2 bone marrow suppression (46.4％) and a transient increase in transaminase(17.8％).No grade 3 toxicity and above and late toxicity were observed.Conclusions Stereotactic body radiation therapy could be suggested as the first choice for the selected patients who suffer form colorectal liver metastases,especially for those who cannot undergo surgery.

Objective To develop a method of detecting dry blood spot (DBS) samples collected in the filter paper by using Surface Enhanced Raman Spectroscopy (SERSp,also known as Raman molecular fingerprint spectrum) technology.The possibility and reliability of applying the technology to the newborn screening of congenital hypothyroidism (CH) was investigated.Methods The case-control study was used.The results of CH-hTSH screening test based on the DBS samples collected in the filter paper,and the clinical diagnosis were all provided by neonatal screening center of Shanghai Children's Hospital.The results of SERSp analysis were provided by Dalian University of Technology.Six positive and six negative samples,which were confirmed respectively by CH-hTSH screening using time resolved fluoroimmunoassay (TRFIA) were chosen.With the spectrum lines of 725 cm-1 as internal standard,the SERSp from the aqueous solution of these samples were analyzed.The specific spectrum line analysis,the principal component analysis (PCA) and the scatter diagram of PCA were used to compare the results of TSH test.Results With the spectrum lines of 725 cm-1 as internal standard,the CH specific spectrum lines of 1373 cm-1 and 1400 cm-1 were discovered.They showed the most significant difference of the peak height between the positive and negative samples of CH,while TSH specific spectrum lines of 785 cm-1,827 cm-1 and 853 cm-1 failed to distinguish positive from negative samples with distinct peak height.The consistency between the results of CH-Raman Screening and CH-hTSH Screening was 91.7％ (11/12),which was proven by PCA,the scatter diagram of PCA and the specific spectrum line analysis.The sensitivity of CH-Raman Screening was 100％ and the specificity was 83.3％.Conclusion There is a new CH-Raman Screening method using the SERSp analysis,which was proven to be a promising technology in the newborn screening of congenital hypothyroidism with the DBS in the filter paper.

Objective To explore the reproductive toxicity of 2,4-D butylate to the testis in male mice.Methods Forty-eight ICR male mice were randomly divided into four groups : the control group, and three 2,4-D butylate experimental groups (10, 20, 40 mg/kg), 12 mice in each group.2,4-D butylate was intragastrically administered once a day and six days per week for five weeks .At the end of the exposure, the activities of total antioxidant capacity (T-AOC), Na+ K+-ATPase, Ca+ + Mg+ +-ATPase, lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) in testis homogenate were measured by spectrophotometry .Results The activity of T-AOC was gradually decreased with the increase of doses, with a significant difference between the high dose group and other groups .The activities of LDH in the moderate and high dose groups were significantly lower than those of the low dose group and control group , and there was a significant difference between the high dose group and moderate dose group .The activities of SDH in the testis was gradually decreased with the increase of the 2,4-D butylate dose, showing significant differences between the high dose group and the moderate dose and control groups , and between the high and moderate dose groups and the low dose group . The activities of Na +K +-ATPase in the moderate and high dose groups were significantly lower than that of the control and low dose group.The activities of Ca++Mg++-ATPase was significantly lower in the experimental groups than that in the control group.Conclusion Exposure to 2,4-D butylate has certain toxic effect on the testicular tissue in male mice .

Adult ; Carcinoma, Neuroendocrine ; complications ; diagnosis ; Carcinoma, Small Cell ; complications ; diagnosis ; Humans ; Inappropriate ADH Syndrome ; diagnosis ; etiology ; Male ; Maxillary Sinus Neoplasms ; complications ; diagnosis

OBJECTIVE: This paper highlights the therapeutic effect of tragus cartilage and temporalis fascia graft on repairing bone and skin defect in external auditory canal. METHOD: Forty-one surgical patients were recuited, including 39 cases of external auditory canal cholesteatoma and 2 cases of osteoma. External auditory canal bone wall and skin defect and mastoid air cells exposure were found during operation. We followed up these cases periodically (in 3 weeks, 3 months, 6 months and 1 year later respectively) after repairing the patients' external auditory canal bone wall and skin with tragus cartilage and temporalis fascia graft. RESULT: Twenty-nine cases healed perfectly while other 12 cases grew small granulation in 3 weeks. After shaving granulations and tamping Tela Iodoformum, wounds healed in the following week. The epithelization of the external auditory canal in our patients was complete after 3 months and no stenosis were found. Natural morphology of external auditory canal was maintained without mastoid air cells exposure after 6 months to 1 year of time. CONCLUSION It is not only convenient to acquire the tragus cartilage and temporalis fascia, but also easy to repair the defect of external auditory canal bone wall and skin. It can reconstruct the wall of external auditory canal, obliterate mastoid cells and perfectly maintain the normal form of external auditory canal via the cartilage.
Adolescent ; Adult ; Cartilage ; surgery ; Child ; Ear Auricle ; surgery ; Ear Canal ; surgery ; Fasciotomy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult