Objective To evaluate the clinical effect and safety of umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations.Methods From January 2009 to December 2012,clinical data of 18 women with complicated monochorionic multiple gestations who experienced intrauterine percutaneous umbilical cord ligation in Peking University Third Hospital were collected.Among the patients,6 were selective intrauterine growth restriction (1 with type Ⅰ,4 with type Ⅱ,1 with type Ⅲ) ; 4 were acrania or hydropic twins; 4 were aeardiac twins,2 were complicated triplet gestation; 1 was twin-twin transfusion syndrome with right ventricular dysplasia and 1 was monochorionic diamniotic (MCDA) with caesarean section history.The procedure was performed under both endoscopic and sonographic guidance.The gestational age at the time of the procedure were 17-27 +6 weeks.The procedure and perinatal outcome were analyzed.Results (1) The procedure was performed successfully in all the 18 cases.The average duration of the procedure was 63 min (24-156 min).The blood loss was 7.6 ml (5-20 ml).The mean gestational age at the time of the procedure was 20 weeks (17-27 +6 weeks).The average birth weight of the neonates was 2441 g(1000-3400 g).(2) There were 20 fetuses survived.Two fetuses had cardiac anomalies and were terminated in the following 2-3 weeks.Intrauterus fetal demise occured in 3 twin reverse arterial perfusion syndrome (TRAP) cases 3-14 weeks after the procedure.1 case delivered as early preterm birth at 28 weeks and the neonate died of respiratory distress syndrome (RDS) and hypoxie-ischemicencephalopathy (HIE).Fourteen neonates were in healthy and normal development by 3-51 months' followup.(3) Fourteen cases delivered at more than 28 weeks (28-38 weeks,averagely 33 + 1 weeks).The gestational weeks were prolonged by 5-21 weeks (averagely 13 +4 weeks).Among them,3 case were early preterm birth (28-33 weeks) and 3 were late preterm birth (34-36 weeks).Conclusion Percutaneous umbilical cord ligation is a reliable technique for the fetocide of complicated monochrionic mutilple gestations,especially for monochronic monoamniotie pregnancies.

Objective To summarize the treatments and perinatal outcomes of patients with twin-twin transfusion syndrome (TTTS).Methods Seventy one cases of TTTS hospitalized in Peking University Third Hospital from January 1,2007 to December 31,2012 were included into the study.They were treated with expectant therapy,amnioreduction,laser surgery or selective fetal reduction.The relationship between outcomes and different staging or treatment procedures of these cases were retrospectively analyzed,and the differences were compared by analysis of variances,Chi-square test and nonparametric test.Results Twenty-five cases received expectant treatment.The rate that at least one baby survived more than 30 days was 32％ (8/25),and 5/15 of the live babies had neonatal brain injury.Sixteen cases received amnioreduction,of which the rate that at least one baby survived more than 30 days was 4/16,and 3/15 of the live babies had brain injury.Twenty-five cases received fetoscopic laser coagulation of vascular anastomoses.The rate that at least one baby survived more than 30 days was 60％ (15/25),which was higher than that of the expectant group and amnioreduction group (x2=4.938,P=0.045 and x2=5.056,P=0.043) ; the brain injury rate among the live babies was 7％ (2/28),which was lower than that of the expectant group (x2=4.702,P=0.040),but similar to the amnioreduction group (x2=1.490,P=0.320).Five patients received selective fetal reduction operation.Among which,one received fetoscopic cord ligation and delivered one healthy baby; the other four cases received radio frequency ablation,after which one was aborted and three delivered at full term.The rate that at least one baby survived more than 30 days was 12/18 in 18 cases with stage Ⅰ TTTS,which was better than that in stage Ⅲ and Ⅳ (4/17 and 6/18) (x2=4.933 and 2.778,both P＜0.05).The rate that at least one baby survived more than 30 days in stage Ⅳ cases was only half of that in stage Ⅰ (6/18 vs 12/18),and the brain injury rate among the live babies was 4/12,similar to that in stage Ⅰ,Ⅱ and Ⅲ [16％ (4/25),0/14 and 2/11,x2=5.361,P=0.118].Conclusion The prognosis of TTTS is very poor,early diagnosis and early treatment could improve the outcomes.Fetoscopic laser coagulation ensures a relatively higher survival rate and low brain injury rate for TTTS.

Objective To study the clinical effect of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treating twin to twin transfusion syndrome.Methods The clinical data of 44 consecutive cases of twin to twin transfusion syndrome (TTTS) who had FLOC in the Department of Obstetrics and Gynaecology of Peking University Third Hospital were reviewed and analyzed for perioperative complications,perinatal outcomes and fetal survival rate.Results (1) Patient characteristics:the mean maternal age was (29±4) years,the median gestational age at TTFS being primarily diagnosed was 20.4 weeks,the median gestational age at FLOC was 21.2 weeks.According to the Quintero staging system,there were 9 cases had stages progressed before the operation.(2) FLOC parameter and intraoperative complications:44 cases all could tolerate the operation; there was 1 case of placenta vascular rupture in the operation,no fetal body injury by laser or placental abruption.3 cases underwent cervical cerclage following FLOC.The average operation time of 41 cases alone with FLOC was (60.1± 15.1) minutes.(3) Postoperative complications:the rate of intrauterine fetal death was 15％ (13/88),the rate of intrauterine growth restriction after FLOC was 5％ (4/88),the rate of membranes rupture less than 28 weeks was 16％ (7/44),the rate of TAPS after FLOC was 5％ (2/44),the rate of membrane sepration after FLOC was 5％ (2/44).(4) Perinatal outcome and survival rate:there were 25 patients after FLOC had delivered in the perinatal period.The average gestational age of delivery was (33.5±2.7) weeks.The donor fetuses survival rate was 88％ (22/25),the recipient fetuses survival rate was 100％ (25/25).The birth weight of donor fetuses was significantly less than that of recipient fetuses (1 631g vs 2 071 g,P=0.016).From Quintero staging Ⅰ to Ⅳ,the rate that 44 cases of TTTS had entered the perinatal period was 4/7,11/14,7/19,3/4; both twins survival rates were 4/7,10/14,5/19,3/4; all the fetal survival rate was 8/14,75％ (21/28),32％ (12/38),6/8,respectively.(5) Compared the early stage (Ⅰ + Ⅱ) with the advanced stage (Ⅲ + Ⅳ),the rates that 44 cases of TTTS had entered the perinatal period (71％ vs 44％) and that both twins survived (67％ vs 35％) had no statistically significance.The rate that all the fetus survived in the early stage was significantly (69％ vs 39％) more than that in the advanced stage.(6) All the cases of neoborn were followed up till 1 month postpartum,the donor fetuses and the recipient fetuses had 12 and 5 cases of cardiac abnormalities respectively,each had 1 case of neonatal death and 2 cases of neonatal white matter damage.Conclusions FLOC for TTTS is associated with a better survival rate.Quintero staging probably does not effectively predict the fetal diagnosis of TTTS after FLOC.When TTTS diagnosed,the sooner FLOC given,the better fetal prognosis had.

Background and purpose:Breast cancer is one of the most common carcinoma among female patients with high mortalities. Drug-resistance is the major reason that leads to chemotherapy failure in clinical practice. MCF-7/ADR is a multi-drug resistant cell line that was established on the basis of breast cancer cell line MCF-7. This research aimed to investigate the anti-apoptotic effect of c-fos in resistant breast cancer cell MCF-7/ADR, and to compare with its sensitive counterpart MCF-7.Methods:Doxorubicin with various concentrations was used to treat MCF-7 as well as its MDR- counterpart MCF-7/ADR. The growth inhibitory rate of MCF-7 and MCF-7/ADR wasdetermined by MTT assay. Additionally, RT-PCR was used to test the expression of P-gp and c-fos mRNA in MCF-7 and MCF-7/ADR; The expression of c-fos mRNA was detected by RT-PCR after 3 μmol doxorubicin treatment;We further established cell lines that stably interfered with c-fos, named MCF-7/ADR/si-fos-8B, MCF-7/ADR/si-fos-3D. Flow cytometry and MTT assay were used to investigate the apoptosis rate and inhibitory rate in these above cells under the treatment of 5-FU, CDDP or γ-radiation. At last, RT-PCR and Western blot analysis were used to detect the expression of bax, bcl-2, puma, p53.Results:The expression of c-fos and P-gp (MDR-1) was up-regulated in MCF-7/ADR, compared with its sensitive counterpart MCF-7. Additionally, the resistant fold of MCF-7/ADR to doxorubicin was nearly 40; The expression of c-fos was gradually up-regulated after 3 μmol doxorubicin treatment; The sensitivity to drugs (5-FU and CDDP) was increased after c-fos interference while the apoptosis rate was also increased after 5-FU, CDDP and γ-radiation treatment. RT-PCR and Western blot analysis indicated that up-regulation ofbax,puma,p53 after c-fos interference while the expression of bcl-2 was down-regulated.Conclusion:c-fos may act as an anti-apoptotic protein in resistant breast cancer cell line MCF-7/ADR by regulating the expression of apoptosis related proteins, and may play a vital role in the formation of multi-drug resistance phenotype.

Objective To detect the expression and potential correlation of ERK1 and P16 in gastrointestinal stromal tumor group and in control group.Methods Tissue chip and immunohistochemistry Elivison were used to detect the expression of ERK1 and P16 in 40 cases of gastrointestinal stromal tumor and 40 cases of control tissues.Quantitative analysis of mean absorbent density of the expression of ERK1 and P16 was conducted with image analytic software.Results The expressions of ERK was higher in GIST group than that in control group(P

Objective To observe the corneal nerve fibres damage in different stage of diabetic retinopathy (DR) with type 2 diabetes.Methods A cross-sectional study.One hundred and twenty eyes of 120 patients with type 2 diabetes served as diabetes group.According to International Clinical Diabetic Retinopathy Disease Severity Scales (2002),diabetes patients were classified into 4 subgroups:patients without diabetic retinopathy (NDR),patients with mild or moderate non-proliferative diabetic retinopathy (mNPDR),patients with severe non-proliferative diabetic retinopathy (sNPDR) and patients with proliferative diabetic retinopathy (PDR),each subgroup has 30 eyes of 30 patients.Another 30 eyes of 30 healthy participants served as control group.All eyes were scanned with HRT3 in vivo corneal confocal microscopy.Images of sub-basal nerve plexus were quantified including nerve fiber length (NFL),nerve fiber density (NFD),nerve fiber branch density (NFB),and nerve tortuosity (NT).The correlations of corneal nerve fiber with age,duration of diabetes and glycated hemoglobin (HbA1 c) were analyzed using Spearman correlation analysis.Results NFL,NFD and NFB were found to be significantly lower in diabetic patients (F=147.315,142.586,65.898;P=0.000,0.000,0.000),NT was significantly greater in diabetic patients (F=39.431,P=0.000),when compared to control group.In diabetic patients,NFL,NFD and NFB were gradually reduced with DR severity,NT was gradually increased with DR severity.While the difference ofNFL,NFD,NFB,NT was not statistically significant between sNPDR and PDR subgroups (P＞.0.05),but was statistically significant between other subgroups (P＜0.05).Spearman correlation analysis results showed that age (r=-0.071,-0.080,0.001,0.100;P=0.391,0.328,0.991,0.224) and HbAlc (r=-0.109,-0.115,-0.126,0.025;P=0.238,0.211,0.169,0.781) had no correlation with NFL,NFD,NFB,NT.Duration of diabetes was negatively correlated with the NFL,NFD (r=-0.212,-0.264;P=0.020,0.004),positive correlated with NT (r=0.261,P=0.004),and had no correlation with NFB (r=-0.119,P=0.194).Conclusions Corneal nerve fiber loss and nerve tortuosity increased were found in patients with type 2 diabetes,and even without diabetic retinopathy.The progress of corneal neuropathy was correlated with the severity of DR,but it was not change significantly between sNPDR and PDR.

Objective To evaluate the feasibility,efficacy,and short to mid-term results of endovascular management of acute type B aortic dissection complicating visceral or lower limb malperfusion.Methods A retrospective study was conducted in 23 consecutive patients with acute type B dissection complicating visceral or lower limb malperfusion treated endovascularly at a single center between July 2001 to December 2012.Of the 23 patients identified [20 men,3 women; mean age (52 ±9) ranging 42-75]presented with clinical and imaging evidence of end-organ malperfusion:renal artary in 5 (21.7％),superior mesenteric artery in 9 (39.1％),celiac trunk in 3 (13％) and lower limb in 6 (20.1％),artary renal and lower limb in 2.Results All patients had stent-graft coverage of the proximal entry tear.11 (47.8％) patients needed additional branch vessel stenting.Successful correction of malperfusion was achieved in all the patients and the successful rate of operation and technology was 100％.In 1 patient,ischemia in the lower limb was resolved after a stent was implanted to the right iliac artery.In another patient,complicated with lower limb ischemic necrosis,amputation was performed after one stage stent-graft placement.The duration of follow-up was 6 months to 72 months,mean (21 ± 11)months.There was no migration of stent-graft and end-organ ischemia.No patients suffered from paraplegia in this group.Conclusions Endovascular coverage of the proximal entry tear in acute type B aortic dissections complicating end-organ malperfusion is a reasonable first line treatment.But some cases may need a combination branch vessel stenting.

Objective To evaluate femoral artery ligation for femoral artery pseudoaneurysm secondary to drug injection. Methods Clinical data of 32 drug addicts of femoral artery pseudoaneursysm caused by drug injection undergoing femoral artery ligation and local debridement were reviewed retrospectively.The blood supply of affected limb was evaluated by oxygen saturation of distal limb and its function.All the cases were followed up at 3,6,9,and 12months after the operation. Results Surgery was successful in all cases. There were no significantly difference of the limb oxygen saturation between postoperative and preoperative period (95.1％ ± 2.8％ vs.96.9％ ± 1.9％ ; t =1.26,P =0.25 ).White blood cells and neutrophils percentage significantly decreased after surgery.All patients were followed up for 1 year.Lower extremity ischemia after 6 hours of operation in one case treated by autologous saphenous vein bypass recovered. On 3 months mild claudication was observed in 5 cases. On 6 months claudication remained in only 2 cases,which disappeared on 9 months.All patients were able to maintain normal life.Conclusions Femoral artery ligation is a safe, effective and simple treatment modality for femoral pseudoaneurysms secondary to drug injection.

Objective To report the clinical and pathological characteristics of one patient with glycogen storage disease Ⅳ (Anderson disease). Methods The patient was received detailed clinical examinations, ultrasound, electromyography, head MRI and muscle biopsy. Results The onset of the 22 years old male patient was 7yrs. The main symptoms were intolerance and fatigue in proximal limbs muscular movement, cardiopalmus by chance. Abdominal ultrasound examinations showed cirrhosis, portal hypertension, splenomegaly. Echocardiogram showed left ventricular myohypertrophia, mild mitral and tricuspid valve insufficiency. Electrophysiology study revealed widespread myogenic changes. Cranial MRI, MRA and MRS were normal. Muscle biopsy showed basophilic intracytoplasmic material in a lot of fibers deposits, which was intensively PAS-positive material and partially resistant to diastase digestion. In the electron microscope, the storage material consisted of filamentous and finely granular material. Conclusions There was the first case of glycogen storage disease Ⅳ reported in our country, mainly involved skeletal muscle, liver, spleen and cardiac muscle.

Objective To observe the correlation of histologicalactivity(HAI) of chronic hepatitis B (CHB) with CCL20 expression, and to investigate the impact of CCL20 expression in CHB infection. Methods On the basis of established competitive quantitative RT-PCR with an internal standard, the expression of the CCL20 in the hepatocytes in different infected patterns of HBV infected cells and liver biopsies were quantified and at the same time its correlation to HAI were explored. Results In the cell levels, the expression quantity of CCL20 in control cells (HepG2), persistent HBV infected hepatocytes( HepG2. 2. 15) are (2. 65 ± 0. 02) pg/106 cells, ( 1.22± 0. 04) pg/106 cells, respectively. There were significantly differences between them ( t = 39. 66, P < 0. 01 ). The expression of CCL20 was enhanced in hepatocytes stimulated by PMA but their expression pauern was not changed. Moreover, CCL20 expression in liver biopsies with CHB was (3.54 ± 0. 65 ) pg/20 mg and CCL20 expression in control groups was ( 8. 74±0. 56) pg/20 mg. The expression of CCL20 between two groups was different (t =30. 09,P <0. 01 ) and correlation lied in between HAI and CCL20 expression in liver biopsies of CHB patients ( r = 0. 675, P =0. 023 ). Conclusion CCL20 expression was down-regulated and it was correlated to HAI of liver biopsies in CHB patients.