Objective To investigate the relationship between abnormalities of maternal serum markers in Down syndrome screening in second trimester and adverse pregnancy outcome.Methods Totally,1935 pregnant women were screened for Down syndrome with maternal serum tri marker with time-resolved fluorescence assay,including alpha fetoprotein (AFP),free β-human chorionic gonadotropin (β-hCG) and unconjugated estriol (uE3),between 15 and 20+6 gestational weeks at Peking Union Hospital from January 1,2009 to January 31,2011,and were followed up till delivery.The relationship between incidence of adverse pregnancy outcomes and women with normal or abnormal levels of serum markers in Down syndrome screening was investigated.T-test or Chi-square test were applied for statistical comparison.Results (1) Among the 1935 pregnant women,normal levels of serum markers were found in 1255(normal group) and 680 were abnormal(abnormal group),in which 577 with only one abnormal serum marker,89 with two and 14 with three abnormal serum markers.According to the serum marker level,the 577 women with one abnormal serum marker were further divided into five groups,including high AFP group (n=17),low AFP group (n=114),high β-hCG group (n=242),low β-hCG group (n=139) and low uE3 group (n=65).The birth weight of infants in lower AFP group and the gestational age at delivery in low β-hCG group were greater than those in normal group [(61.3±9.1) kg vs (59.5±8.3) kg,(272.6±11.8) d vs (274.4±10.1) d,t=2.21 and 1.99,both P＜0.01].(2) The incidence of adverse pregnancy outcome in normal group was 42.8％(537/1255),while comparing with the abnormal group(43.7％,297/680),no statistical significance was shown (RR =1.02,P =0.71).While comparing with the normal group,the incidences of placenta previa [25.5％ (32/1255) vs 2/17,RR=4.61,P＜0.05] and abnormal placental morphology were higher in high AFP group [4.1％ (51/1255) vs 5/17,RR=7.24,P＜ 0.05],the incidence of gestational diabetes mellitus (GDM) was higher in low AFP group [8.1％ (101/1255) vs 14.4％(16/114),RR=1.74,P＜0.05],the incidence of placenta and membrane retention was higher in high β-hCG group [3.5％ (44/1255) vs 6.2％(15/242),RR=1.77,P＜0.05],the incidence of pre-eclampsia was higher in low β-hCG group [1.7％ (21/1255) vs 6.5％ (9/ 139),RR=3.87,P＜0.05].(3) There were 89 women with two abnormal serum markers.Comparing with the normal group,the incidences of small for gestional age (SGA) infants,oligohydramnios,abruptio placenta were higher in women with low AFP but high β-hCG [SGA infants:6.9％(2/29) vs 1.8％(22/1255),RR=3.94; oligohydramnios:20.7％(6/29) vs 6.4％(80/ 1255),RR=3.24; both P＜0.05],the incidences of oligohydramnios was higher in women with both low AFP and low uE3[3/14 vs 6.4％(80/1255),RR=3.36,P＜0.05],the incidence of premature birth and GDM were higher in women with both low β-hCG and low uE3 [premature birth:2/6 vs 4.3％(54/1255),RR=7.75; GDM:3/6 vs 8.0％ (101/1255),RR=6.21; both P＜0.05].(4) There were 14 women with three abnormal serum markers.The relationship between adverse outcome and abnormal serum markers did not show any statistical significance.Conclusions The abnormality of serum markers of Down syndrome screening is closely related to adverse pregnancy outcomes,and women with abnormal serum markers should be carefully monitored during pregnancy.

Purpose　The aim is to study the preventing effect and me chanism of chitosan on fatty liver rats.Methods　The rats give n a lo w dose of carbon tetrachloride(CCl4) and fed a high-fat diet to induce fatty liver model were treated with chitosan in different concentrations.The extensio n of steatosis area and changes in mitochondrial ultrastructure in liver were es timated by a computer color image analysis system and a quantitative analysis(st ereology).Results　When rats were treated with a mid dose of c hitosan [4g/(kg*d)],the degree of hepatocytic steatosis was markedly diminished, and the injured mitochondrial structure was improved compared with model group.Co nclusion　It was suggested that chitosan might enhance the oxidative catabolism of lipid in fatty liver.

Objective This study seeks to use a meta-analytical approach to quantitatively assess the results of applying the problem-based learning(PBL) teaching model and the traditional lecture-based learning(LBL)teaching model to basic medical courses in undergraduate medical edu-cation. Methods The CNKI and VIP databases were electronically searched to retrieve randomised controlled trial studies that examined the use of PBL methods for basic medical courses in under-graduate medical education. In these studies PBL teaching model was used in experiment group and LBL teaching model was used in control group. Pass rate or test scores was used to evaluate the effect of learning. The retrieved documents ranged from the time that each database was first constructed to December 2012. After two researchers performed literature screening independently, data extraction, and quality assessment procedures in strict accordance with the inclusion and exclusion criteria of this study, the Stata 11.0 software package was utilized to conduct the meta-analysis. Results This meta-analysis examined 28 studies that included a total of 3703 subjects. The modified Jadad scores of 20 studies(71.4%) were less than 4, and those of 8 studies(28.6%) were more than or equal to 4. The meta-analysis revealed that compared with the traditional teaching model, the PBL teaching model did not produce improved examination passing rates for a course [relative risk(RR):1.05, 95%confidence interval(CI):(0.99, 1.10), P=0.098] but could improve examination scores for a course [standardized mean difference (SMD): 0.73, 95% CI: (0.51, 0.96), P<0.001]. Conclusion For basic medical courses in undergraduate medical education, compared to LBL teaching, PBL teaching can improve students' test scores but cannot improve students' pass rate. PBL used in basic medical courses has di-versified forms and lacks unified criterion, so there is still a long way to go for the appli-cation of PBL.

Objective To characterize the feasibility, key technology, indications and clinical outcome of percutaneous lumbar interbody fusion. Methods Clinical data from 32 cases [16 made, 16 female, age range 31-77 years, average disease duration (5.0±2.0) years ] underwent percutaneous nucleotomy and endplate curettage was retrospectively analyzed. After percutaneous nucleotomy and endplate curettage, one expandable spinal spacer B-twin was introduced into the intervertebral space and some allograft cancellous bone implanted around the B-twin. Indications for treatment included degenerative lumbar disc herniation (LDH) with intervetebral distability or Ⅰ degree spondylolythesis (21 cases), LDH with intervetebral space collapse (10 cases) and lumbar discogenic pain (1 case). The symptoms and function of all patients were evaluated before, 3 months and 12 months after the operation by clinical outcome judgment criterion of surgical treatment for low back pain formulated by JOA, and the rate of clinical improvement and treatment efficacy were calculated. The JOA scales preoperatively, postoperatively and on the final follow-up was compared using ANOVA in SPSS. The changes before and after surgery with the JOA score and the the rate of clinical improvement between 3 months and 12 months after the operation was also compared using χ~2 test. Results The average operation time 1 hour and blood loss < 20 ml, Surgical site: L3-4 4 cases, L4-5 19 cases, I5-S1 6 cases, L3-4 and L4-5 3 cases, B-TWIn were implanted fusion cage 35, in three cases of intervertebral space with two implantso Average in Hospital time was (10.0±2.1) d . Complication included 1 case with displacement and 1 case with secondary instability of next intervertebral space. All the patients were evaluated after a follow-up of 3-36 months (average 13 months) 32 cases of patients with low back pain JOA score: before surgery is(4.1±1.8), 3 months after surgery is (11.9±3.9), 1 year after surgery of the 22 cases is (12.0±3.2). Score before and after surgery were statistically significant differences (F = 5.67, P < 0.01). The rate of clinical improvement After surgery there was no significant difference (F = 4.18, P > 0.05). Conclusions Percutaneous posterior lumbar interbody fusion with B-twin expandable fusion cage could lead to satisfactory outcome in the treatment of degenerative disc disease and intervertebral instability,which minimize surgical soft tissue and trauma spinal damage, does not destroy the structure of spinal stability. The technique The long-term outcome, complications and fusion rate need further observing.

Objective To investigate the changes of bone mineral density (BMD) in human immunodeficiency virus (HIV)-infected patients in Changsha,and take intervention measures to prevent the occurrence of osteoporosis and fracture.Methods A total of 278 HIV-infected patients and 154 cases of healthy adults from March 2011 to May 2015 were selected.Dual energy X-ray absorptiometry (DXA) was used to detect BMD,T-score and Z-score of all the research objects,including the whole body,lumbar spine (L2～4),and left hip joint.The height and weight were measured at the same time.Results The HIV infection group had an average age of (31.53 ± 8.56) years old,and the healthy control group was (34.45 ± 8.22) years old.Height between two groups had no significant difference.The average weight of HIV infection group was 6.93 kg [95％ CI,-9.01,-4.97;P ＜0.001] lighter than that in the normal control group.BMD,T-score and Z-score of HIV infection group were significantly lower than those in norrmal control group (P ＜ 0.001).The occurrence rate of osteopenia (Z ≤-1.0)and osteoporosis (Z ≤-2.0)in HIV infection group were correspondingly 43.53％ ～ 54.68％ and 9.71％ ～23.74％,which is about 4 times of that in the healthy control group (14.28％ ～ 20.13％,0.65％ ～ 5.84％).Conclusions The average body weight of HIV-infected patients was significantly lower than that of normal control group,and the incidence of osteopenia and osteoporosis in HIV-infected group was significantly higher than that in normal control group.

Objective To identify high?risk factors of white matter damage ( WMD ) in premature infants,in order to reduce the incidence and improve the prognosis of brain injury?Methods Five hundred and seventy?seven cases of preterm infants treated from January 2012 to December 2013 in the Pediatrics Department of Affiliated Hospital of Qingdao University were slecteted?According to MRI of the brain at 2 weeks after birth, all the patients were divided into WMD group(133 cases) and the control group(444 cases)?Single?factor and multifactor logistic regression were used for the analyses of the high?risk factors of WMD?Results WMD incidence was 23?05%( 133/577) in 577 cases of premature infants,with 108 cases( 81?2%) of focal injury,5 cases(3?8%) of diffuse injury and 20 cases(15?0%) of periventricular leukomalacia(PVL) injury?There was significant statistically difference in different gestational age( P=0?017)?Multi factor Logistic regression analysis showed that metabolic acidosis(OR=4?489,P=0?000),asphyxia(OR=3?519,P=0?000),perinatal infection ( OR=2?650,P=0?003) were independent risk factors for WMD,while cesarean( OR=0?293,P=0?000) was protective factor for WMD?Conclusion WMD is a complex interaction outcome of multiple risk factors in premature infant?Perinatal hypoxia and infection are the main risk factors of WMD in premature infants.

AIM: To examine the effect of treatment with epidural blood patch on intracranial hypotension in rabbits and the possible mechanism.METHODS: The stable intracranial hypotension was made by lumbar puncture,then some blood was injected into the epidural space,and the changes of the intracranial pressure was determined continuously. Furthermore, the components of cerebrospinal fluid and the changes of choroid plexus epithelial cells, the spine and the dura were examined with electron microscope and light microscope 5 days later.RESULTS: The intracranial pressure was increased at once after the treatment with epidural blood patch and maintained at the normal level. The pathologic examinations showed that thrombus could be seen in the epidural space,and there was inflammatory reaction in the spinal dura mater. The results of electron microscope show that the choroid plexus epithelial cells appear actively for secretion.CONCLUSION: Intracranial hypotension could be effectively reversed by treatment with epidural blood patch. The possible mechanism might include physical squeeze,the leaking hole blocked and the cerebrospinal fluid increased by thrombus.

Aim To investigate the effect of total flavonoids of Chrysanthemum indicum on proliferation of synoviocytes and TRAIL/TNF-? expression of synovial tissue with adjuvant arthritis rats.Methods SD rats were divided randomly into six groups including normol,model,TFC(84,168,336 mg?kg-1)and control drug Tripterygium glycosides(30 mg?kg-1)groups.Adjuvant arthritis rat model was induced by a single intradermal injection of 0.1 ml of the complete Freund's adjuvant into the the right hind feet pads of the SD rats.The proliferation of synoviocyte was measured by MTT;The expression of TRAIL and TNF-? on synovial tissue were detected by means of immunofluorescence.Results TFC was shown to suppress the excessive synoviocyte proliferation;The expression of TRAIL was lower in model group than that of the normal group.TFC can increase the expression of TRAIL protein;The contrary to TNF-? protein.Conclusions TRAIL play a role in the development of AA.TFC can increase the lower expression of TRAIL protein,that maybe one of the mechanisms of TFC improvement AA.

Aim: To study the effects of chitosan on hepatic lipids in fatty liver rats. Methods: The rats given a low does of carbon tetrachloride (CCl4) and fed a high-fat diet were treated with chitosan in different doses. Results: When rats were treated with mid dose of chitosan (4mg? g~-1?d~-1), the contents of triglycerde (TG). total cholesterol (TC) in liver decreased significantly, the level of mitochondria malonal-dialdehyde (MDA) was markedly attenuated and the mitochondria membrane fluidity was restored, which compared with model group. Conclusion: Chitosan may decrease the hepatic lipids by reduced the lipid peroxida- tion and restored mitochondria membrane fluidity to improve the mitochondrial beta-oxida- tion.

Objective To study the effect of the extract of total flavonoids of chrysanthemum indicum(TFC) on adjuvant arthritis synovial cells. Methods 0.1ml of the complete Freund's adjuvant was subcutaneously injected into the right hind feet pads of the SD rats.24 days after immunity synovial cells in knee joint were treated with TFC and inhibition of proliferation was measured with MTT assay.DNA fragmentations were analyzed with DNA gel electrophoresis.Fluorescence staining of Hoechst 33258 to observe apoptotic body.Results The IC_50 of TFC on synovial cells was 112mg/L.DNA gel electrophoresis showed ladder-like strap.Apoptotic bodies were observed by Hoechst 33258.Conclusion TFC can inhibit proliferation and induce apoptosis in synovial cells,and exerts therapeutical effect on rheumstoid arthritis.