Objective To compare the neonatal outcomes of different gestational age at which elective cesarean sections at term were performed. Methods All the cases of cesarean section registered in Peking Union Medical College Hospital from September 2002 to November 2009 were collected. Women with viable singleton pregnancies delivered before the onset of labor and without recognized indications for cesarean section after 37 weeks at term were included and their general information and outcomes were compared with one-way ANOVA. All the maternal data and neonatal adverse events were compared with Cochran-Armitage test among different gestational weeks, including respiratory complications (respiratory distress syndrome or transient tachypnea of the newborn), infections, admission to the neonatal intensive care unit (NICU), and hospitalization in NICU＞5 d. Results Of 8122 primary cesarean sections and 594 repeat cesarean sections at term, 4565 and 409 cases were performed electively as the primary or repeat cesarean section. Among the 4565 women underwent primary elective cesarean sections, 2194 (48.1%) were before 39 gestational weeks,and 1828 (40.0%) at 39-39+6 weeks. While, among the 409 repeat elective cesareans sections, these figures were 275 (67.2%) and 120 (29.3%), respectively. No fetal or neonatal death occurred during perinatal period. Compared with births at 39-39+6 weeks, births at 37-37+6 weeks or 38-38+6 weeks were associated with increased risk of the neonatal adverse events. For the primary cesarean section cases, the odds ratio (OR) for births at 37-37+6 weeks and 38-38+6 weeks was 1.4 (95% CI: 0.9-2.0) and 1.1 (95% CI: 0.9-1.4), respectively. For the repeat cesarean section cases, OR for births at 37-37+6 weeks and 38-38+6 weeks was 2.5 (95% CI: 1.1-5.8) and 1.3 (95% CI: 0.6-2.7) respectively. Conclusions Elective cesarean section before 39 weeks of gestation is popular and associated with adverse neonatal outcomes. Elective cesarean section performed after 39-39+6 gestational weeks might decrease the risk of adverse neonatal outcomes.

This paper presents successful surgical treatment of a-trial fibrillation by a simplified maze procedure (SMP) in 3 patients. All of them suffered from rheumatic heart valvular diseases complicated with atrial fibrillation (AF) for 3 to 10 years. Their heart function were in class III-IV(NYHA). The diameter of the left atrium varied from 52-58 mm and the cardiothoracic ratio 0. 64-0.70. The open heart operation was performed under conventional cardiopulmonary bypass combined with systemic hypothermia and using cardio-plegia for myocardial protection. After finishing the modified maze operation,mitral valve replacement was performed in 2 cases and mitral and aortic valve replacement together with tricuspid annuloplasty in one. Sinus rhythm recovered after cardiac ressuscitation and was maintained in the early postoperative period in all 3 cases. However, with in 3 months after the operation, one patient died of cerebrovascular accident, probably a complication of anticoagulant therapy. The other 2 patients remained well with normal sinus rhythm and their heart function was in class I 3 years after the operation. The clinical results indicate that mitral valve or mitral and aortic valve replacements plus simplified maze procedure to abolish atrial fibrillation may improve the postoperative hemodynamics by recovery of the sinus rhythm.

Objective To investigate the distribution features of upper limb involved nerves in patients with diabetic peripheral neuropathy (DPN).Methods The sensory nerve conduction velocity (SCV)and amplitude(SNAP),motor nerve conduction velocity(MCV)and amplitude(CAMP)of median,ulnar and radial nerves were examined in 98 DPN patients (DPN group) and 32 normal controls(NC group).The distributive ferture of involved upper limb nerves in DNP patients were analysed.Results (1) Comparing to NC group,the SCV and MCV of median,ulnar and radial nerves in DPN group were significantly slower (P

Background Researches showed that CD4+CD25+ natural regulatory T cells (nTregs) play an important role in maintaining peripheral immune tolerance, while immunotherapy using in vitro-expanded induced regulatory T cells (iTregs) suppresses allograft rejection in multiple organ transplantation.The inducing method of iTregs still needs to be optimized.Furthermore,the effect of iTregs on grafts of keratoplasty is unclear.Objective This study was to investigate the inducing and expansion method of iTregs and explore its inhibitory effects on corneal allograft rejection.Methods Bone marrow-derived dendritic cells (BMDCs) were isolated from C57BL/6 mice femora and cultured.CD4+ CD25+ T cells and CD4+ CD25-T cells were isolated from mouse spleen and separated using flow cytometry.The CD4+CD25-T cells were divided into negative control group (CD4+CD25-T cells), CD3/ 28 antibody bead group (CD4+CD25-T cells+CD3/28 antibody bead) ,2.5 ng/ml transforming growth factor (TGF)-β1 induced group and 10.0 ng/ml TGF-β1 induced group.The iTregs was formed after induction of different concentrations of TGF-β1 and CD3/CD28 antibody bead (1 : 1).CD3/CD28 antibody bead (1 : 2) , interleukin-2 (IL-2) and TGF-β1 were used to expand iTregs.The phenotype and proliferation of iTregs were assayed by flow cytometry,and the inhibitory effect of iTregs on effector T cells (Teffs) was analyzed by mixed lymphocyte reaction.Allogenic keratoplasty model (C57BL/6→BALB/c) was build,and 0.1 ml iTregs or nTregs suspension or PBS was injected via posterior venous plexus of fellow eyes to assess the graft survival time.The use and care of the mice followed the ARVO statement.Results The CD4+CD25+ T cell proportions were (6±3)％ ,(91±4)％ ,(91±3)％ and (86± 6) ％ in the negative control group,CD3/CD28 antibody bead group, 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1induced group, showing significant increases in the CD3/CD28 antibody bead group, 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group compared with the negative control group (all at P＜0.01).The Foxp3+ T cell proportions of the CD3/CD28 antibody bead group,2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group were (1.18 ±0.20) ％ , (8.70± 1.80) ％ and (21.80±3.36) ％ , showing significant increases in the 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group compared with the CD3/CD28 antibody bead group (both at P＜0.01).Compared with the nTregs, the expression of CD69 was lower, and the expressions of PD-1 and Foxp3 were raised in the iTregs (all at P＜0.01).The proliferation of Teffs were decreased when cocultured with iTregs in comparison with nTregs at 1 : 1,1 : 2,1 : 4,1 : 8,1 : 16 Tregs/Teffs rations (all at P＜ 0.01).The survival time of mouse corneal grafts was 4 weeks with the permanent tolerance of 50％ in the iTregs injected group,which was superior to the 3 weeks survival time and 17％ permanent tolerance in the nTregs injected group(P＜0.05).Conclusions TGF-β1 can induce CD4+ CD25-T cells to form iTregs, which highly express Foxp3.iTregs show a stronger inhibitory effect on the growth of lymphocytes than nTregs, and therefore suppress the graft rejection after keratoplasty.

05). Conclusion The maternal serum level of ADAM 12 in the first-trimester is a potential marker for aneupolyhaploid screening and early fetal loss prediction, and is suggested to be tested at 9-12 gestational weeks as part of prenatal screening.

This paper introduces the history of Ilizarov technology,led to the design and application of Bone Lengthening Growth Diary,and describes the specific application effect.On this basis,to think about Bone Lengthe-ning Growth Diary’ clincial application:constantly improve the nurses’ professional level; follow the basic princi-ples of medical ethics;strengthen the doctor-patient communication and humanstic care.

Objective To explore the application and effects of bone lengthening growth diary in self management of patients after lower limb lengthening. Methods A total of 54 cases applying lower limb lengthening were divided into the experimental group (n=28) and the control group (n=26) with random digit table. The basic treatment was consistent, the control group was given routine guidance, the experi-mental group implemented self- management with bone lengthening growth diary. Self- recognition of disease was assessed and compared between the two groups 12 weeks after operation. Self- efficacy and self- manage ment were assessed and compared between the two groups 2 and 12 weeks after operation. Results The self- recognition of disease in the observation group was better than that of the control group, for patients with higher self- recognition degree (21 cases vs. 10 cases), χ2=8.64, P<0.05, the difference was significantly different. The total scores of self- efficacy and self- management in the observation group were higher than those of the control group,(48. 42±3.43) vs.(34.14±4.13),t=11.750, P<0.01;(55.35±2.69) vs.(42.15±3.67), t=15.130, P<0.01, the difference was significantly different. Conclusions Bone lengthening growth diary plays a beneficial role on self-management of patients with lower limb lengthening.

Objective To study 6 type Ⅰ interferon (IFN)-inducible genes (IFIT4, IFI44, Ly6e,OAS1, OAS2 and OAS3) in patients with lupus nephritis (LN) and analyze its correlated expression levels with disease activity and/or clinical manifestations. Methods Total RNA was obtained simultaneously from kidney tissues and peripheral blood cells of 12 patients with diffuse proliferative lupus nephritis and 10 normal controls. Moreover, peripheral blood cells were obtained from 119 LN patients and 35 normal controls. Total RNA was extracted and reversely transcribed into complementary DNA. Gene expression levels were measured by real-time polymerase chain reaction by comparing to a housekeeping gene, and IFN score was calculated. Disease activity was determined by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Results The 6 genes were highly expressed in diffuse proliferative lupus nephritis patients compared with normal controls. IFN scores were positively correlated with SLEDAI score, the concurrent presences of anti-double-stranded DNA (anti-dsDNA) antibodies (P<0.05) and hypocomplementemia (P<0.01). Conclusion The 6 IFN-inducible genes are highly expressed iri LN patients. IFN scores are elevated in active lupus nephritis patients, in patients with positive anti-ds-DNA antibody and hypocomplementemia. IFN scores may be a useful biomarker for lupus nephritis therapy.

Objective To compare and analyze clinical effects of Bipolar transurethral plasma kinetic enucleation of prostate (PKEP) and transurethral resection of the prostate(TURP) on the treatment huge benign prostatic hyperplasia.Methods Nine-six cases of huge benign prostatic hyperplasia were selected in this hospital from March 2012 to March 2015.All the patients were divided into two groups according to different operation method,namely PKEP group and TURP group.Then the operative time,bleeding amount,bladder washing time,hospital stay,complications between two groups were compared,and the international prostate symptom score (IPSS),quality of life score (QOL),maximal urinary flow rate (Qmax),residual urine volume 6 months before and after operation were compared between the two groups.Results The operative time [(100.0 ± 3.5)min],bleeding amount [(161.0 ± 9.2) mL],bladder washing time[(15.2 ± 1.2) h],hospital stay[(10.8 ± 2.6) d],complications (6 cases) in PKEP group were less than that in the TURP group,which were(132.0±4.2)min,(198.0±12.1)mL,(36.8±1.3)h,(13.6±2.9)d,complications (18 cases)respectively(P＜0.05).The IPSS,QOL,Qmax,residual urine volume in both group were significantly improved compared with surgery before(P＜0.05),and there were no significant differences between the two groups(P＞0.05).Conclusion PKEP and TURP both are effective surgeries for the treatment of huge BPH,while PKEP has short operation time,less intraoperarive bleeding and low incidence of complications,it is worthy of further clinical promotion.

Objective To explore the safety and efficiency of patients with impacted upper ureter calculus combined with renal intrarenal infection treated by ureteroscopic pneumatic lithotripsy (URL ) and minimally invasive percutaneous nephrolithotomy (MPCNL) .Methods 126 cases of impacted upper ureteral calculi combined with renal intrarenal infection were treated in this hos-pita1 from July 2007 to July 2011 ,including 58 cases of URL ,68 cases of MPCNL .The success rate of primary lithotripsy ,stone-free rate ,postoperative adjuvant therapy ,operative time ,hospital stay ,incidence of postoperative complications and other data were analyzed .Results The success rate of group URL was 82 .76% (48/58) ,the success rate of group MPCNL was 100 .00% .The stone-free rate seven day after operation :URL was 62 .07% (36/58) ,MPCNL was 98 .53% (67/68)(P<0 .05) .The stone-free rate was 100 .00% in MPCNL group and 81 .03% in URL group one month After operation(P<0 .05) .In MPCNL group ,the rate of adjuvant ESWL was 1 .47% ,significantly lower than 37 .93% in URL group(P<0 .05) .In URL group the operative time (65 .34 ± 26 .72)min and hospital stay(4 .54 ± 1 .87)d were significantly shorter than those (96 .32 ± 30 .94)min and(7 .62 ± 1 .93)d in URL group(P<0 .05) .After the operation ,in MPCNL group ,6 patients developed high fever ,in URL group ,5 patients had high fever (P<0 .05) .Culture of blood after operation found 3 patients and 2 patients in MPCNL group and URL group were positive(P<0 .05) .There were no significant differences in the rates of hemoglobin decline between the two groups (P>0 .05) .Conclusion It has higher successful rate and stone-free rate in patients with upper ureter calculus combined with renal intrarenal infection by MPCNL than those treated by URL .The safety and efficency of the former is better that of the latter .MPCNL can be the first choice for the upper ureter calculus combined with renal intrarenal infection .