ObjectiveTo investigate the high risk factors,etiology,diagnosis,treatment and precaution of venous thromboembolism (VTE) in pregnancy and puerperium. MethodsData of 16 cases of VTE admitted in Department of Obstetrics and Gynecology,Peking Union Medical College Hospital from January 1992 to April 2011 were analyzed retrospectively.The differences of blood routine test and coagulation function between VTE patients (study group) and normal pregnant women (control group) were compared by paired t test in this case-control study.Results All patients were diagnosed by color Doppler ultrasound or CT pulmonary artery angiography.Five cases (31.2 ％) occurred before delivery and 11 (68.8 ％) occurred during postpartum.Two cases (12.5 ％)complicated by pulmonary thromboembolism,and one of them died.Six cases (37.5％) were older than or equal to 35 years old,and 12 cases (75.0％) had gestational complications.The hematocrit in study group were lower than that in control group (0.29±0.06 vs 0.39±0.02,t=4.56,P=0.01).There was no statistical difference between the coagulation function of the two groups.After anticoagulant therapy or surgery,15 cases recovered.One pulmonary thromboembolism patients complicated with rheumatic cardiac disease remained shock after anti-coagulants was administered,then died of hemorrhage of respiratory tract after inferior vena cava filter placement. Conclusions VTE is likcly to happen in puerperium than in pregnancy.There are no good screening indicators for thromboembolism during pregnancy and puerperium.Anticoagulation is recommended to be the first line therapy.For women with high risk of thromboembolism,it is suggested to prevent actively and treat early to decrease the complications and long-term sequelea.

MicroRNAs (miRNAs) are a class of highly conserved small noncoding single stranded RNAs.They participate in the regulation of target genes through the degradation of mRNA and/or inhibition of translation.As the most abundant miRNAs in the central nervous system,miRNA-124 (miR-124) has been widely given attention in recent years.The recent research suggests that miR-124 is closely associated with ischemic cerebral injury,but its specific regulation mechanism remains unclear.This article reviews the roles of miR-124 in ischemic cerebral injury.

10.3969/j.issn.2095-4344.2013.24.008

Objective To observe the characteristics of liver-kidney yin deficiency syndrome in late stage of spontaneously hypertension rats (SHRs). Methods Ten 12-month-old healthy male SHRs were put into syndrome observer group (SHR group), while ten male WKY rats with the same age were set as control group (WKY group). Syndrome differentiation method on rats was employed to transform the four-diagnostic information into general behavior indexes with the same significance. The afternoon anal temperature, tongue color, holding power, ability of learning and memory, serum estradiol and testosterone level were observed, compared and analyzed. Results Compared with the WKY group, rats in the SHR group had higher afternoon anal temperature, redder tongues, poorer strength and claw holding power and their ability of learning and memory was retarded; the level of serum estradiol was lower;the ratio of estradiol to testosterone was higher. All of these were largely in line with deficiency of live-kidney yin syndrome. Conclusion SHRs in late stage show characteristics of liver-kidney yin deficiency syndrome.

Objective To explore the value of MRI in differentiation diagnosis of benign ovarian mucin-ous cystadenoma ( MC) and borderline mucous cystadenoma ( BMC).Methods MRI data of 23 cases of benign MC and 14 cases of BMC, confirmed by surgery and pathology, were retrospectively analyzed, including tumor lo-cation, shape, size, loculation, signal intensity of cyst fluid, cyst wall, cyst septum and nodules, and they were compared with pathological results.Results Single loculus benign cystadenoma nodules showed isointensity T2 WI signal, low T1 WI signal, and low DWI signal.Single loculus borderline cystadenoma nodules showed high T2 WI signal, low T1 WI signal, and high DWI signal.Signs such as honeycomb loculi of multilocular cystadeno-ma, cyst fluid of high T1 WI signal, cyst fluid of low T2 W1 signal, cyst wall and irregularly thickened cyst septum ( >3 mm) were more seen in BMC (7/11, 6/11 and 7/11) than in MC (5/18, 4/18 and 5/18);5 cases were with cyst sediments (MC=4, BMC=1), showing moderate T2WI signals, and high T1WI signals.Broken fish-ing net gathering was only restricted to MC (5/18) with characteristics.Benign multilocular cystadenoma nodules showed low DWI signal,and borderline multilocular cystadenoma nodules showed high DWI signal.Conclusion MRI can well display pathological characteristics of ovarian MC, which has practical value for the differentiation and diagnosis of MC and BMC and can provide the reference for clinical surgery.

Objective To identify the typical imaging features of steatocystoma multiplex on mammography.Methods Mammographic findings in 9 patients with clinical and pathological diagnosis of steatocystoma multiplex were analyzed along with a review of the current literature.Results Four of the nine patients with steatocystoma multiplex had a positive family history.Nine patients showed multiple,round,thin-walled fatty,radiolucent nodules with well-defined margin.These nodules are located in the superficial layer of the axilla bilaterally.They are also seen on the skin of breast(7 cases),the anterior chest wall (4 cases) and the upper arm (3 cases).Conclusion Recognition of the characteristic mammographic features of Steatocystoma multiplex is important in the management of these patients.

ObjectiveTo investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).MethodsThe clinical features,therapies,pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital,from January 2005 to April 2011.ResultsThere were 8 pregnant womenwith 21-OHD including 5siinplevirilizing patientsand 3nonclassical 21-OHD women.Eightpatientswereacceptedprogestationalandprenatalcontinuallowerglucocorticoid treatment.During the gestational period,the dosage of glucocorticoid was adjusted in one pregnancy.The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [ (70 ± 38 ) versus (24 ±23) nmol/L,P ＜ 0.05].The fertility and offspring rate of 8 patients was 8/12,the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7).Four patients were accepted genital reconstructive surgery ( clitorectomy,clitoroplasty,vulvoplasty) before pregnancy.The incidence of GDM was 1/8.All patients selected caesarean at from 37 +6 gestation weeks to 39+6 gestation weeks.The average newborn birth weight was (3210 ± 447 ) g,and height was (48 ±2) cm of 8 neonates,none of them was CAH.Conclusions Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD.It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment.The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

Objective To investigate the neuroprotective effect and possible mechanism of nicorandil in mice under deep hypothermic low flow (DHLF). Methods A total of 105 3-week-old male C57/BL-6 mice were randomly divided into 7 groups: sham operation, model, nicorandil (5, 10, and 20 mg/kg), nicorandil 20 mg/kg + LY294002, and LY294002 groups (n = 15 in each group). A DHLF model was induced. At 24 h after reperfusion, the brain tissues of mice were taken out for HE and TUNEL staining. The pathological changes of cerebral cortical neurons and apoptosis were observed. Western blot was used to detect the expression levels of the total Akt, phospho-Akt (p-Akt), Bcl-2, and Bax. Results HE pathological staining showed that cortical neuronal injury was reduced, the phenomena of cel membrane depression, nuclear condensation, concentrated dye, and the blurring of the nucleus were decreased significantly in nicorandil group. The morphology of neurons was basicaly restored to normal. TUNEL staining showed that the apoptosis index in various dose groups of nicorandil was decreased significantly compared with the model group (al P < 0. 05). Western blot analysis showed that the expression levels of p-Akt and Bcl-2 proteins increased significantly in various dose groups of nicorandil compared with the model group (al P < 0. 05), and the expression level of Bax protein was decreased significantly (al P < 0. 05 ). After adding the phosphatidylinositol 3-kinase (PI3K) specific inhibitor LY294002, there was no significant difference in neurons pathological injury in the cortex compared with the model group. There was no significant difference in the apoptosis index, and the expression levels of p-Akt, Bcl-2, and Bax compared with the model group. Conclusions Nicorandil has a certain neuroprotective effect in mice under DHLF. Its mechanism may be associated with the activation of PI3K/Akt signaling pathway, and then further regulation of the downstream protein Bcl-2 and Bax expression.

Objective To investigate the curative effect of damage control theory in treating severe polytrauma patients combined with bone and joint injury. Methods A retrospective study was done on data including complication, death rate, fracture healing and joint function recovery of 63 patients with severe polytrauma combined with bone and joint injury( average ISS ≥27 points) admitted to our hospital from January 2006 to June 2009. Results Of all the patients, 57 shock patients were cured,three died of hemorrhagic shock within two hours after admission and one patient died of severe traumatic brain injury 11 hours after admission. One patient died of ARDS at 24 hours postoperatively and one died of multiple organ failure at day 6 after injury. Fracture healing was achieved in 52 patients, with satisfactory recovery of the limb function. Amputation was performed in two patients and three patients had mild claudication and pain walking. Conclusion Damage control strategy has great clinical significance in guidance of treatment of severe polytrauma combined with bone and joint injury.

Objective To investigate the clinical and MRI features and pathogenic mechanism of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE).Methods Six cases of PRES in SLE proved by integrated clinical diagnosis were collected from January 2008 to December 2013.The clinical and MRI features of these patients were studied retrospectively and the related literatures were reviewed.Results The initial episode of nervous system was involved in 4 cases.The clinical presentations were headache (2 cases),seizures (4 cases),acute confusion state (2 cases),altered mentation (1 case) and vision change (1 case).All cases had lupus nephritis and hypertension,in which 4 cases had renal failure;6 cases were treated with immunosuppressive agents and 4 cases with cyclophosphamide for lupus nephritis when they developed PRES.The vasogenic edema lesions were distributed in the parietal or occipital lobe (5 cases),the frontal lobe (4 cases),temporal lobe (4 cases),basal ganglia (3 cases),splenium (1 case) and cerebellar hemispheres (2 cases).Three major patterns of PRES included dominant parietal-occipital (2 cases),the holohemispheric watershed (3 cases),and superior frontal sulcal (1 case).Conclusions The clinical and MRI findings of PRES in patients with SLE are typical.Awareness of this entity as early as possible can help to improve curative effect and prognosis.