Objective:To study the changes of endothelin-1(ET-1) and malondialdehyde (MDA) in Kawasaki disease (KD) and to probe the relationship between the changes of ET-1, MDA and coronary artery pathological changes. Methods: KD group included 42 patients ( male 25, female 17), with a mean age of (3.25?0.75) years old; control group included 30 normal children (male 19, female 11), with a mean age of (3.58?0.55) years old. Serum contents of ET-1 and MDA were measured by radioimmunology and modified thiabarbituricaid(TBA) method in 2 groups, and the inner diameters of coronary artery and aorta were measured by color echocardiography. KD group was subdivided into dilated-coronary artery group and undilated group for comparison.Results: Serum contents of ET-1 and MDA in KD group were apparently higher than those in control group (-[76.63?18.36-] vs -[41.55?16.68-] pg/ml and -[3.18?0.60-] vs -[1.52?0.24-] ?mol/L,respectively;P

Objective To investigate the effects of chin lift on the patency of upper airway in normal conscious adults using magnetic resonance imaging (MRI).Methods Sixteen healthy volunteers aged 21-35 yr with a body mass index of 17-26 kg/m2 were enrolled in this study.The subjects lay on their back with their heads slightly extended.The lower jaw was first left in standard position.The mouth was slightly open (the distance between the upper and lower incisors was 0.5 cm).The chin was then lifted upward.The upper airway (from the base of slull to the level of vocal cord) was scaned by MRI along the median sagital plane.The length of soft palate,root of tongue and epiglottis and the area of pharyngeal cavity were measured.The position of the rim of epiglottis was examined.The mean percentage changes induced by chin lift were calculated.Results Compared with standard position,chin lift significantly prolonged the length of soft palate,root of tongue and epiglottis and increased the area of pharyngeal cavity.The percentage change in the position of the rim of epiglottis was largest after chin lift.Conclusion Chin lift significantly improve the patency of the upper airway in conscious adult by changing the position of the rim of epiglottis and increasing the area of pharyngeal cavity.

Objective To analyze the natural changes of maternal thyroid function among women with subclinical thyroid dysfunction and euthyroid women during pregnancy.Methods A total of 4 042 singleton pregnant women received routine antenatal care in the Obstetrics and Gynecology Hospital of Fudan University between April and November 2012 were enrolled.Thyroid-stimulatinghormones (TSH),freetriiodothyronine (FT3) and free thyroxine (FT4) of 7 136 samples from 4 042 singleton pregnant women were tested at 8-12+6,13-19+6,20-27+6,and 28-40 weeks of gestation and were used to establish the normal gestationalspecific reference values of thyroid function.Among 3 895 women having thyroid function tested at 8-19+6 weeks of gestation with negative thyroid antibodies,there were 93 cases of subclinical hyperthyroidism,91 cases of subclinical hypothyroidism (SCH),three cases of hyperthyroidism and 3 708 cases euthyroid.There were 1 118 women [1 607 euthyroid cases,17 cases of subclinical hypothyroidism (SCH) and 34 cases of subclinical hyperthyroidism] had thyroid function retested at 20-27+6 and 28-40 weeks of gestation,and without medicinal intervention.Analysis of variance and LSD test were used to analyze the changes of maternal thyroid function.Results (1) The reference ranges of TSH at 8-12+6,13-19+6,20 27+6 and 28-40 weeks of gestation [median (Pz5-P97.5)] were 1.32 (0.03-4.17),1.83 (0.19-4.94),2.27 (0.70-5.42) and 2.34 (0.63-5.52) mU/L respectively.(2) Without medicinal intervention,thyroid function became normal in 80％ (45/56) SCH women at 20-27+6 weeks,but 20％ (9/45) of them developed SCH again at 28-40 weeks.The thyroid function became normal in 75％ (70/93) women with subclinical hyperthyroidism at 20-27+6 weeks,but in 15％ (14/93) of them,thyroid function remained abnormal at 28-40 weeks.9.40％ (30/319) and 6.25％ (21/336) euthyroid women with TSH ≥ 3 mU/L at 8-19+6 weeks of gestation developed SCH at 20-27+6 weeks and 28-40 weeks,while 0.42％ (5/1 202) and 0.86％ (10/1 163) euthyroid women with TSH ＜3 mU/L had SCH.1.66％ (20/1 202) and 1.98％ (23/1 163) euthyroid women with TSH＜3 mU/L at 8-19+6 weeks of gestation developed subclinical hyperthyroidism at 20-27+6 weeks and 28-40 weeks of gestation.(3) In comparison between 8-19+6 weeks and 20-27+6 weeks of gestation,TSH levels increased by (0.47±0.03) mU/L in euthyroid women,and more significantly in subclinical hyperthyroidism women [(0.82±0.06) mU/L],but decreased by (1.67±0.25) mU/L in SCH women (LSD test,all P＜0.05).The FT3 levels decreased by (0.47±0.02) pmol/L in euthyroid women,and more significantly in subclinical hyperthyroidism and SCH groups [(1.02± 0.18) and (0.72±0.08) pmol/L,LSD test,all P＜0.05].FT4 decreased by (2.31 ±0.04) pmol/L in euthyroid women,and more significanly in subclinical hyperthyroidism women [(4.63± 0.62) pmol/L] (LSD test,P＜0.05),but the decrement in SCH group [(1.78±0.28) pmol/L] was similar to euthyroid women (LSD test,P＞0.05).There were no significant differences in changes of TSH,FT3 and FT4 at 20-27+6 weeks and 28-40 weeks among euthyroid women,SCH and subclinical hyperthyroidism groups (F=1.01,1.14 and 2.04,all P＞0.05).Conclusions Women with subclinical thyroid dysfunction with negative thyroid antibodies experience significantly different natural changes when compared with euthyroid women,especially before 28 weeks of gestation.

Objective To evaluate the feasibility of intra-utero fetal lamb surgical repair. Methods Six twin lambs underwent surgery intra-utero at 112 days of gestation (term 140～160 days). After maternal laparotomy and Hysterotomy, fetal lamb′s toe was excised or its cleft lip was repaired in one of twin. Results At 30 to 32 days post operation,five lambs were spontamcously delivered and the other was cesarean delivery to full term gestation. Fetal wounds healed without inflammation and scar formation. Conclusions The methods of fetal lamb intro utero surgical repair is feasible.

Objective To evaluate the multi-spiral CT(MSCT)imaging features and classification of renal pelvis carcinoma.Meth-ods 76 patients of renal pelvis carcinoma proved pathologically were analyzed retrospectively,and divided into different types ac-cording to the MSCT features.The MSCT differences for different types were analyzed.Results Most of the tumors showed iso-density or slight hyperdensity (95%)on un-enhanced images,and persistent mild-to-moderate enhancement (91%)in enhanced im-ages.All cases were divided into three types:pelvic mass type in 30 cases (39%),substance invasion type in 25 cases (33%),wall thickening type in 21 cases (28%).All cases were also divided into two types:substance invasion type(25 cases,33%)and renal pelvis type(5 1 cases,67%).The occurrence rate of local low enhancement,whole kidney low enhancement,hydronephrosis,lymph node metastasis and vein tumor thrombus were 80%,20%,48%,52%,1 6% in substance invasion type cases,and 4%,42%, 75%,4%,6% in the renal pelvis type cases,respectivily.Conclusion MSCT multiphase enhancement scanning shows important valuation in the diagnosis and classification of renal pelvis carcinoma.Obvious differences of CT features are showed for different types.The diagnosis accuracy may be improved by the knowledge of substance invasion type.

Objective To explore the related factors with skin flap necrosis,we concluded the cases of patients with skin defects after free flap plantation.Methods From 2001 to 2016,188 cases about 20 influencing factors were analyzed (The characteristics of patients:age,sex,smoke,diabetes,high blood pressure;Preoperative factors:injured sections,injured causes,preoperative wound infection,preoperative wound osteomyelitis,the time from injury to operation;Intraoperative factors:operator,operation time,anesthesia time,intraoperative rehydration fluids,the way of vascular anastomosis,the number of venous anastomosis,the area of flap;Postoperative factors:flap hematoma,flap infection,vascular crisis) and multivariate logistic regression analysis was used to analyze the relationship between these risk factors and flap necrosis.Results All 188 cases were treated with free anterolateral thigh flap to repair soft tissue defect and it was revealed that the 174 cases were successful (92.55％) and 23 cases were occured vascular crisis (12.23％),8 cases were arterial crisis,11 cases were vein crisis,4 cases were ateriovenous crisis.After the treatment,the rescue was successful in 5 cases (38.46％).After the analysis we made the conclusion that the number of venous anastomoses,flap hematoma and vascular crisis were related with the skin flap necrosis.Conclusion The number of venous anastomose (≥2) will increase blood return to make the flap easier to survive.Intraoperative stanching and drainage tube placement work will reduce the skin flap hematoma as a result of reducing the skin flap necrosis.Artery and venous crisis handled in time,can enhance the survival rate of flap.

ObjectiveTo investigate the karyotypes of amiotic fluid cells and compare the incidence of chromosomal abnormality as well as to evaluate the clinical significance of abnormal karyotypes. MethodsA total of 13 648 pregnant women came to Shanghai Jiai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fuclan University to do amniocentesis from September 1998 to November 2010, and 13 795 amniotic fluid specimens were successfully extracted and cultured, thus 13 795 fetuses received karyotype diagnosis. These fetuses were grouped according to different indications. If maternal age was ≥ 35, the fetuses were grouped into the advanced maternal age group (4065) ; and if maternal serum screening test revealed high-risk of trisomy 18 or trisomy 21, the fetuses were grouped into the high-risk serum screening group (6462) ; and those with abnormal signs of ultrasound screening were grouped into the abnormal ultrasound signs group (1539); and if either of the parents was with chromosome abnormalities, the fetus was grouped into the paternal/maternal abnormality group ( 108 ) ; whereas the remainder were grouped in other factors group ( 1621 ). The amniotic fluid cells were in-situ cultured on coverslips, harvested by conventional G-banded methods, and then analyzed by two doctors. In order to get rapid diagnosis, some pregnant women whose gestational age ≥26 weeks accepted fluorescense in situ hybridization (FISH). FISH was done on 78 uncultured amniotic fluid specimens using probes located at chromosome 13,18,21, X,Y. Some parents were required to analyze lymphocyte karyotype to help judging the origin of abnormal karyotype. Results( 1 ) Classification and composition of abnormal karyotypes in each group : a total of 388 abnormal karyotypes were found among 13 795 fetuses, and the abnormal rate was 2. 813％ (388/13 795).Of the 388 fetuses, aneuploidy was the most common pattern which was up to 59. 8％(232/388);autosomal structural abnormality rate was 24. 7％ ( 96/388 ) ; mosaicism was 12.4％ (48/388). Other uncommon abnormal karyotypes included marker chromosome (5/388,1.3％), sex chromosomal structural abnormality (4/388,1.0％) and triploid (3/388, 0. 8％ ). Aneuploidy was the most common in most groups except the patemal/matemal abnormality group. There were four cases of rare aneuploid in the advanced maternal age group,the high-risk serum screening group and the abnormal ultrasound signs group respectively. Every type of abnormality could be found in the abnormal ultrasound signs group, and autosomal structural abnormalities were concentratedin paternal/maternalabnormality group. Mosaicism mainly distributed in the high-risk serum screening group, accounting for 20. 0％ (29/145) of abnormalities in this group. (2) Abnormal types and the incidence: the most common type was trisomy 21 ( 138/388,35.6％ ),followed by autosomal balanced structural rearrangements( 80/388, 20. 6％ ), mosaicism(48/388,12. 4％ )and trisomy 18 (44/388,11.3％ ). Others included non-balanced autosomal structural rearrangements (16/388,4. 1％ ), 45 ,X0 ( 16/388,4. 1％ ) and 47 ,XXY( 15/388,3.9％ ). (3) Lymphocyte karyotype analysis of the couples: parents of 153 fetuses were analyzed to determine the origin of abnormal karyotype. Fifty-eight familial and 95 de novo abnormalities were found. FISH results were the same with G-banding karyotype, and two of these were trisomy 21. Conclusions Abnormal karyotype composition is different according to different maternal amniocentisis indications. There is a variety of abnormal karyotypes in the second trimester pregnancy, and the risk of fetal malformation is related with the kind of abnormal karyotype.

AIM　In order to improve the biological activity and reduce the side effects and toxicity, a series of novel estrogen receptor antagonists were designed. METHODS　The key triphenylethylene intermediates were obtained by the McMurry reaction. The target compounds were prepared by etherification. The binding affinities of the target compounds for the estrogen receptor in rat uterine cytosol were measured by a competitive binding assay and their estrogen agonistic/antagonistic properties were investigated in the 3-day uterine weight assay in the immature rats. RESULTS　Thirty-five new compounds have been synthesized and their geometric configuration were determined by X-ray crystallography and 1HNMR spectral data. CONCLUSION　All of the test compounds showed affinity for the estrogen receptor (IC50<10-6 mol.L-1), especially compound 35 with IC50 1.07×10-8 mol.L-1. Some compounds are antagonists, inhibiting uterus growth; others are agonists, promoting uterus growth. Compounds 14 and 27 are superior antagonists to tamoxifen.

Objective:To investigate the occurrence and influencing factors of perioperative complications after robotic gynecologic surgery.Methods:The clinical data and occurrence of perioperative complications in 1 000 cases robotic surgery completed in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:(1) Clinical data: the average age of the patients was (50.2±10.4) years old, and the average body mass index (BMI) was (24.4±3.6) kg/m 2. Among 1 000 cases, 811 cases of them were malignant tumors, including 405 cases of cervical cancer, 279 cases of endometrial carcinoma, 112 cases of epithelial ovarian cancer (EOC), 15 cases of vulvar cancer; 189 cases of them were benign diseases, including 43 cases of uterine prolapse, 57 cases hysterectomy of uterine leiomyoma and adenomyosis of the uterus ≥12 weeks, 84 cases myomectomy of uterine leiomyoma, and 5 cases of fallopian tubal ligation requiring anastomosis. Surgical methods: in patients with malignant tumors, cervical cancer, hysterectomy plus salpingectomy or salpingo-oophorectomy for stage Ⅰa1, and radical hysterectomy plus pelvic lymphatic dissection plus salpingectomy or salpingo-oophorectomy for stage Ⅰa2-Ⅱb. Endometrial carcinoma, performed by staging surgery. Staging surgery for EOC with early stage and cytoreductive surgery with advanced EOC. Vulvar cancer, extensive vulvar resection plus inguinal lymphadenectomy. In patients with benign diseases, uterine prolapse, hysterectomy plus salpingectomy or salpingo-oophorectomy plus sacrocolpopexy. Uterine leiomyoma or adenomyosis with uterus ≥ 12 weeks, hysterectomy plus salpingectomy or salpingo-oophorectomy. Myomectomy for patients requiring uterine preservation with uterine leiomyoma. Tubal anastomosis for patients with fallopian tubal ligation. (2) Surgical complications: intraoperative complications occurred in 25 patients (2.5%, 25/1 000), including 11 patients with vascular laceration, 11 patients with ureteral injury, 2 patients with bladder injury, and 1 patient with intestinal injury. Postoperative complications occurred in 130 patients (13.0%, 130/1 000), including 66 cases of lower limb venous thrombosis, 20 cases of lymphatic cyst, 8 cases of hydronephrosis, 9 cases of ileus, 16 cases with infection, 6 cases with genital fistula, 4 cases with trocar site herniation and 1 case with subcutaneous emphysema. The incidence of intraoperative complications was 3.1% (25/811) in malignant tumors and no case in benign diseases, the incidence rate in malignant tumors was significantly higher than that in benign diseases ( χ2=4.778, P=0.029). The incidence rate in cervical cancer (4.2%, 17/405) and EOC (3.6%, 4/112) were significantly higher than those in endometrial carcinoma (1.4%, 4/279) and vulvar cancer (0/15; P<0.05). The incidence of postoperative complications was 15.2% (123/811) in malignant tumors and 3.7% (7/189) in benign diseases. The incidence rate in malignant tumors was significantly higher than that in benign diseases ( χ2=17.807, P<0.01), but there were no significant difference among different malignant tumors ( χ2=4.318, P=0.229). (3) The correlative factors affecting the occurrence of surgical complications: patient′s age, BMI, previous pelvic or abdominal surgery history, the nature of disease (malignant or benign), operation time, and comorbidities had a significant impact on the incidence of postoperative complications ( P<0.05). Multivariate logistic regression analysis showed that the patient′s age ≥40 years old, BMI ≥25 kg/m 2, previous pelvic or abdominal surgery history, malignant tumors and comorbidities were independent influential factors of the postoperative complications ( P<0.05). Conclusions:Perioperative complications vary according to the type of the surgery. The age, BMI, previous pelvic or abdominal surgery history, malignant tumors, and comorbidities are influential factors of postoperative complications.