Objective To evaluate the effectiveness and safety of triptorelin in the treatment of uterine leiomyoma. Methods A multi-center, prospective, randomly controlled clinical trial was carried out from Dec. 2002 to Mar. 2004 in three university hospitals. A total of 125 qualified patients with uterine leiomyoma were randomly divided into either triptorelin group (63 cases) treated with 3.75 mg triptorelin injected intramuscularly or leuprorelin group (62 cases) treated with 3.75 mg leuprorelin injected subcutaneously. Both drugs were injected every 28 days for a total of 3 months. Results All 125 patients finished the trial. The uterine volumes were similar before treatment between the triptorelin group and the leuprorelin group and were decreased significantly after drug therapy (P0.05).) The volumes of the largest leiomyoma decreased significantly after drug therapy (P0.05). Patients with serum level of 17?-estradiol 0.05). Dysmenorrhea, noncyclic pelvic pain and pressure-like symptoms were relieved quickly and remarkably in both groups after treatment. The rates of adverse event occurred in 71% of patients in both groups. The main side effects included flare-up effects and hypoestrogenic symptoms. Nine patients in the triptorelin group and 6 in the leuprorelin group received add-back therapy with tibolone 1.25-2.50 mg/d because of remarkable climacteric-like symptoms. Conclusion Treatment of uterine leiomyoma with triptorelin for 3 months is both effective and safe in Chinese women.

Objective To study the diagnostic value of serum α-L-fueosidase (AFU), transforming growth factor alpha(TGF-α)and ferritin (Fer) in primary hepatic carcinoma (PHC). Methods AFU and Fer in the serum were studied in 36 patients with benign hepatism and 56 patients with low concentration AFP of PHC hepatic carcinoma by automatic biochemistry analyzer Roche Modular. ELISA was used to assay the degree of TGF-α The sensitivity and specificity of AFU, TGF-α and Fer for low expression AFP of PHC were evaluated by ROC curve. Results The serum AFU, Fer and TGF-α levels were all significant difference in the patients than those in controls (P <0.05). The area under ROC curve of these indexes in descending order was AFU (0.707), TGF-α (0.677) and Fer (0.592). The diagnostic sensitivity of Fer was lower than AFU and TGF-α in diagnosis of AFP lowly expression PHC. The ratio showed AFU better than TGF-α The diagnostic specificity of AFU (64 %) was higher than that of TGF-α (61%) when TGF-α and AFU was at the same diagnostic sensitivity (64 %). Conclusion AFU is more valuable than Fer and TGF-α for negative or AFP lowly expression PHC, meanwhile it has much more accuracy.

Abstract: Objective To investigate the molecular characteristics of the H9N2 avian influenza virus (AIV) causing human infection in Yunnan Province in 2019, and to provide the scientific basis for the prevention and control of avian influenza in Yunnan Province. Methods Influenza virus typing was performed by real-time RT-PCR in two influenza-like illness samples, and the Illumina Miseq high-throughput sequencer was used to determine the viral genome sequence. HA and NA gene sequence alignment and phylogenetic tree construction were performed using Mega7.0 software. Results Real-time RT-PCR results showed that two influenza-like illness samples were positive for H9N2 subtype. The full length of HA and NA were obtained by genomic sequencing. Sequence system evolution analysis showed that the HA and NA of the two AIVs in Yunnan Province were in the same evolutionary clade as A/Chicken/Zhejiang/HJ/2007 and belonged to the G57 type. The HA nucleotide and amino acid homology of the two AIVs were 93.92% and 95.00%, respectively, and the NA nucleotide and amino acid homology was 93.31% and 82.03%, respectively. The nucleotide (amino acid) homology of HA was 92.29%-96.94% (93.77%-98.43%) and 92.84%-94.92% (94.18%-96.23%), respectively, and NA nucleotide homology (amino acid) were 91.81%-97.60% (77.82%-94.83%), 94.38%-97.22% (85.47%-94.55%), respectively, compared with that of human infected H9N2 epidemic strains obtained in China from 2015 to 2020. Both AIVs HA protein cleavage site sequences were PSRSSR↓GLF, which was in line with the characteristics of low pathogenic influenza. The analysis of HA protein receptor binding site showed that amino acids at positions 109, 161, 163, 191, 202, 203 and 234 were consistent with the reference strains, while amino acids at position 198 were mutated to T. N166D and 168N mutations were also found in HA protein, and both AIVs had 7 potential glycosylation sites. Analysis of the erythrocyte binding site of NA gene found that there were amino acid mutations at positions 369, 402, 403, and 432, and amino acid deletion at positions 63-65 was found in the NA genes. There were 4 and 5 potential glycosylation sites in the two AIVs, respectively, and no drug resistance site mutations were found. Conclusions　The receptor binding sites, erythrocyte binding sites and glycosylation sites of HA and NA genes of H9N2 AIV in Yunnan Province have different degrees of variation, and monitoring and prevention and control should be strengthened.

Objective To study the efficacy of Liangxue-Zhuyu decoction combined with montelukast in the treatment of henoch schonlein purpura (HSP) and its influence on immunologic function. Methods A total of 95 HSP children treated in department of pediatrics from February 2014 to December 2016 were enrolled, and then were randomly divided into observation group (n=48) and control group (n=47), meanwhile another 48 healthy children admitted to a medical examination were selected as the healthy group. The patients in the control group were given the treatment of oral montelukast sodium chewable tablets before sleeping (the dose:2-6 years old 4 mg/d, 6-14 years old 5 mg/d), and the patients in the observation group accepted the therapy of Liangxue-Zhuyu decoction based on the treatment of the control group.The course of the treatment in the two groups were 30d. The time of clinical symptom regression and adverse reactions were recorded, and the clinical efficacy was evaluated. Monoclonal antibody immunofluorescence method and Enzyme-linked immunosorbent assay (ELISA) were used to detect the levels of serum T lymphocyte subsets and INF-γ and IL-10 before and after treatment, and their differences among three groups were compared. Results The effective rates of the observation group was 95.8% (46/48), which was significantly higher than 76.6% (36/47) of control group (x 2=7.441,P<0.05).The subsided time of the symptoms,including purpura(5.0 ± 1.3 d vs.6.6 ± 2.6 d,t=3.816), abdominal pain(3.1 ± 2.1 d vs.4.1 ± 2.6 d,t=2.139),joint pain(4.3 ± 1.5 d vs.5.4 ± 1.9 d,t=3.416),fecal occult blood(4.5 ± 1.5 d vs.6.1 ± 1.9 d,t=4.404)of the observation group were significantly shorter than those of the control group(P<0.05).After the treatment,the CD4(45.14% ± 9.32% vs.41.02% ± 9.97%),CD8(25.10% ± 4.69% vs.21.52% ± 5.71%)of the observation group was significantly higher than those of the control group, and the CD4/CD8(1.62 ± 0.32 vs.1.95 ± 0.35)and IL-10(33.07 ± 1.86 pg/ml vs.53.92 ± 2.98 pg/ml)of the observation group was significantly lower than this of the control group (P<0.05). Conclusions The efficacy of the Liangxue-Zhuyu decoction combined with montelukast for HSP was definite,and the effect was rapid with little side effects. The mechanism might be related to regulating the secretion of T lymphocyte and IL-10, thereby to correct Th1/Th2 cell balance and disturbance of immune function.

Objective To investigate the effect of 3％ sodium chloride injection on fluid resuscitation in children with septic shock.Methods Eighty-four children with sepsis in intensive care unit were selected and divided into two groups according to random number table method,42 cases in each group.The control group was treated with 0.9％ sodium chloride injection for fluid resuscitation.The observation group was slowly given 3％ sodium chloride injection for fluid resuscitation.The changes of the two groups were observed.The success time of fluid resuscitation,hospitalization time and success rate of the two groups were compared.Results After intervention,the systolic blood pressure,central venous pressure and 24h urine output in the observation group were (85.6 ± 4.3) mmHg,(7.1 ± 0.5) cmH2O,(250.8 ± 11.9) mL,respectively,which in the control group were (66.9 ± 2.6)mmHg,(4.6 ±0.2)cmH2O,(50.1 ± 5.0)mL,respectively,the differences between the two groups were statistically significant (t =23.536,29.361 and 98.339,all P ＜ 0.05).The success time of fluid resuscitation,hospitalization time of the observation group were (6.7 ± 1.1) h,(4.1 ± 0.2) d,respectively,which were significantly shorter than those of the control group [(18.5 ± 2.3) h,(6.3 ± 0.5) d,t =29.272,25.838,all P ＜ 0.05).The success rate of treatment of the observation group (95.0％) was higher than that of the control group (65.0％) (x2 =7.941,P ＜ 0.05).Conclusion 3 ％ sodium chloride injection can effectively treat fluid resuscitation,improve tissue perfusion,shorten the hospitalization time and improve the success rate of treatment for children with septic shock.

Objective To evaluate the results of one-day care for gestational diabetes mellitus (GDM) and pregnancy outcome after application of new diagnostic criteria.Methods We retrospectively analyzed the clinical features of a GDM group (n=841) and a normal glucose metabolism group (n=3 043) who delivered in Department of Obstetrics and Gynecology,Peking University First Hospital between July 1,2011 and June 30,2012,to discuss the difference in maternal and newborn outcomes between these two groups,and to compare the maternal and newborn outcomes between the GDM one-day care group (study group,n=605) and non-GDM one-day care group (control group,n=236).Statistical analysis was performed by t test and x2 test.Results The average age of pregnant women with GDM was (31.5±4.2) years,which was higher than the normal glucose metabolism group (30.0±3.7) years (t=9.13,P＜0.01).The average age of the study group was (31.7±4.2) years,and the average age of the control group was (31.7±4.9) years,which was not a significant difference (t=2.32,P＞0.05).In the oral glucose tolerance test,fasting blood glucose level was (5.2±0.5) mmol/L,which was significantly lower than that in the control group (5.3±0.8) mmol/L (t=2.48,P＜0.05).The difference between 1 and 2 h glucose sugar levels did not differ significantly (P＞0.05) between the two groups.In the GDM and normal glucose metabolism groups of pregnant women,the incidence of macrosomia was 6.5％ (55/841) and 5.9％ (182/3 043),respectively,although the difference was not significant (x2=0.36,P＞0.05).In the GDM group,the rate of premature delivery was significantly higher than in the normal glucose metabolism group [preterm birth:10.1％ (83/841) and 7.4％ (225/3 043),x2=5.56; P＜0.05)].In the GDM group,gestational hypertension and mild pre-eclampsia were significantly more frequent than in the normal glucose metabolism group [gestational hypertension:4.2％ (35/841) vs 2.6％ (82/3 043),x2=4.85; mild pre-eclampsia:1.7％ (14/841) vs 0.9％ (26/3 043),x2=4.24; P＜0.05].The incidence of severe pre-eclampsia was 2.4％ (20/841) and 1.6％ (49/3 043),respectively,which was not significantly different (x2=2.22,P＞0.05) between the two groups.The rate of insulin use was 9.3％ (78/841) in the GDM group.In the study group,the rate of insulin use was 7.9％ (48/605),compared with 11.9％ (28/236) in the control group; this difference was not significant (x2=3.54,P＞0.05).In the study group,the incidence of macrosomia and hypertensive disorder complicating pregnancy (HDP) was similar to that in the control group [macrosomia:6.9％ (42/605) vs 5.3％ (13/236),respectively; x2=0.57; HDP:7.4％ (45/605) vs 9.9％ (24/236),x2=1.68; P＜0.05].The rate of premature delivery in the study group was significantly lower than in the control group [7.2％ (44/605) vs 16.0％ (38/236),x2=15.04,P＜0.05].In the study group,among the 561 cases of term birth,there were 42 cases of macrosomia.The average age of macrosomic and non-macrosomic pregnant women [(31.4±3.9) vs (31.7±4.2) years,t=4.27],pre-pregnancy body mass index [(23.5±3.9) vs (22.6±3.2),t=1.58],gestational weight gain [(16.1±5.6) vs (15.7± 11.4) kg,t=0.22] and pregnant weeks at visit to a one-day care clinic [(27.5 ± 4.3) vs (28.1 ± 2.8) weeks,t=0.86; P＞0.05] showed no significant differences.In women who delivered an infant with macrosomia,glycosylated hemoglobin levels in mid and late pregnancy were higher than in woman who did not deliver an infant with macrosomia [(5.6±0.4) ％ vs (5.4±0.4) ％,t=2.13,P＜0.05].Conclusions Through one-day care for GDM,the rate of preterm labor is reduced.This is a good model for group management of GDM women,and more efforts is required to improve its effect.

Objective To investigate the values of three-dimensional visualization technology in the diagnosis and surgical treatment of hepatic hemangioma. Methods Thirty two patients with hepatic hemangioma who had been hospitalized during the period from July 2010 to January 2014 in our hospital were scanned by 64-slice spiral computerized tomography (CT) before surgical treatment. Three-dimensional (3D) reconstruction based on the CT data was carried out to achieve dignosis and surgical planning. Assisted with the 3D model , we chose the best surgical procedure for liver resection, protecting the major blood vessels near hemangioma and retaining normal liver tissue as far as possible. Results The location, size and shape of hepatic hemangioma, vascular variation, and spatial relationship with intrahepatic vessel were shown factually by three-dimensional reconstruction. All the hemangiomas were preoperatively assessed to be resectable. The compliance rate for preoperative surgical planning to actual surgery was 100%. Under assistance of the 3D model during surgery , 14 patients received laparoscopic hepatectomy and 18 underwent hepatectomy. Pringle′s maneuver was applied in 18 patients , with blocking time of (15.32 ± 7.12) min and blood loss of (188.63 ± 66.37) mL. The postoperative complications included pleural effusion in 5 patients and incision infection in one patients. Conclusions Three-dimensional visualization technology for the individualized diagnosis and treatment of hepatic hemangioma helps reduce surgical trauma and incidence of postoperative complications.

Objective To study the medical image three dimensional visualization system(MI-3DVS)in the diagnosis and treatment of hepatolithiasis.Methods The data of 64-slice spiral computed tomography of 54 patients with hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from August 2008 to August 2010 were collected.The liver and bile duct were three dimensionally(3D)constructed.Preoperative diagnosis and pathological classification were made according to the results of the 3D model of liver and bile duct.The optimal surgical procedure was determined by simulating operations based on the 3D model.The compliance of simulated operation and actual operation was observed,and residual stones were detected by cholangiography.Results Of the 54 patients,11 were with type Ⅰ,5 with type Ⅱ(including 2 patients with type Ⅱ a and 3 with Ⅱ b),38 with type E.There were 23 patients with intrahepatic bile duct stricture and 27 with atrophy-hypertrophy syndrome complex.The anatomy of intra-and extrahepatic bile duct,dilation and stricture of the bile duct,site,size and number of the bile duct stones were clearly displayed in the MI-3DVS.The compliance rate of simulated surgery and actual surgery was 94%(51/54).There was no residual stones in 51 patients who received elective surgery and the rate of residual stone of the 54 patients was 6%(3/54).Conclusion Acurate preoperative diagnosis and intraoperative precise operation can be achieved and the rate of residual stone can be reduced by using the MI-3DVS.

Pancreatic cancer is malignant with a poor prognosis,and its incidence is rising worldwide in recent years.Multiple slices spiral computed tomography and computed angiography are the first choice for the diagnosis of pancreatic cancer,while misdiagnosis of pancreatic cancer still exists.From August 2009 to October 2011,80 patients with pancreatic or periampullary cancer were diagnosed using the medical image three dimensional visualization system (MI-3DVS).The threedimensional models of the liver,pancreas,vascular system and tumors were reconstructed successfully based on the 64-slice spiral computed tomography data.According to the analysis of the three dimensional models,4 patients underwent standard pancreaticoduodenectomy,1 received palliative surgery.MI3DVS plays an important role in the diagnosis and assessement of resectability of pancreatic and periampullary cancer.

Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.