Objective To explore operation method,key technique and clinical therapeutic effect of laparoscopy assisted vaginal hysterectomy. Methods Retrospective analysis was conducted on operation method and post operative clinical data of SO cases had LAVH ( LAVH group) , 60 cases had total abdominal hysterectomy (TAH group) and 60 cases had transvaginal hysterectomy ( TVH group), treated from October 2009 to December 2010. Results The blood loss during operation,time to first flatus,incidence of postoperative pyrexia,hospitalization day,time of getting out of bed in LAVH group were (101. 6±6. 2)ml, (22. 9±6. 1 ) min,2% ,0,(5.0 ±1.5)d,(25. 1±5.3)h; the 7 indices in TAH group were (174.0 ±6.9)ml,(35.3±4.3) min,10%,3.3%,(8.5±1.6)d,(56.4±.6.1)h; and the 7 indices in the TVH group were (189.0±8.2) ml, (26.0±8.2)min,6.7%,1.7%,(7.8±3.5)d,(49.4±3. 8) h. The numbers in LAVH group were all lower than those in TAH group and TVH group ( Ps < 0. 05 ). Conclusion LAVH has advantages of less operation blood loss,less injury to body and sooner recovery,less complications compared with TAH and TVH. This is a safe and effective operation type,which is worth of popularizing.

Objective To investigate the effect of the prescription of Yiqiyangyin Huoxuehuayu on the mice model with viral dilated cardiomyopathy by examining the levels of serum ?-IFN.Methods Replicated the animal models of early viral dilated cardiomyopathy by injecting the CVB3m virus to the peritoneal cavity of the Balb/c mice.Two hundred and ten Balb/c mice were divided into 4 groups at random:blank group,model group,high and low dose traditional Chinese medicine group.The blank group has 30 mice.The other three group has 60 mice each.The mice of high dose traditional Chinese medicine group and low dose traditional Chinese medicine group were treated with the prescription of Yiqiyangyin Huoxuehuayu.The change of pathomorphology in the cardiac muscle tissue,the rate of death,the weight change and the cardiac weight index were observed after 4 weeks of the treatment.At the same time,ELISA method was used to exam the levels of serum ?-IFN.Results The prescription of Yiqiyangyin Huoxuehuayu can induce the expression of serum ?-IFN in the mice with viral dilated cardiomyopathy.The mean level of serum ?-IFN of the high dose traditional Chinese medicine group and low dose traditional Chinese medicine group were significantly higher than that of the model group.Conclusions The prescription of Yiqiyangyin Huoxuehuayu can inhibit the viral replication and regulate the immunologic function.

The neonatal burst suppression is a severe EEG pattern and always demonstrates serious damage of nerve system. But the outcome of these patients depends on the different etiology. A total of 256 cases of video EEG recordings were analyzed in order to summarize the etiology and outcome of burst suppression. The results showed that some patients in all 17 cases of burst suppression showed EEG improvement. The etiology was the dominant factor in long term outcome. It was suggested that effective video EEG monitoring is helpful for etiologic study and prognosis evaluation.
Electroencephalography/*methods ; Hypoxia-Ischemia, Brain/diagnosis ; Monitoring, Physiologic/methods ; Neonatology/methods ; Video Recording

Objective To explore the effect of hypoxia on exosomes secreted by renal tubular epithelial cells and the function of exosomes in chronic kidney diseases.Methods (1) The supernatant of renal tubular epithelial cells which were cultured in normoxia (21％ O2) or hypoxia(1％ O2) for 48 h was collected and centrifuged gradiently to harvest exosomes.Exosomes were identified and compared by transmission electron microscope, nanoparticle tracking analysis, Western blotting and measurement of the protein concentration.(2) Primary peritoneal macrophages of rats were co-cultured with exosomes in different concentrations (1, 10, 50, 100, 300 mg/L).The expression of interleukin-6(IL-6), tumor necrosis factor-α (TNF-α), inducible nitric oxide synthase (iNOS) in cells and supernatant were separately detected by quantitative real-time PCR (qRT-PCR) and ELISA, and the expression of phospho (p)-STAT/STAT and suppressors of cytokine signaling 1 (SOCS1) in macrophages was detected by Western blotting.At last, the expression of inflammatory microRNAs (miR) in exosomes was measured by qRT-PCR.Results (1) The vesicles harvested by gradient centrifugation were less than 150 nm and expressed CD63 which was characteristic of exosomes.Hypoxia had no effect on the morphology of exosomes, but stimulated their secretion.(2) Hypoxic exosomes dose-dependently improved the expression of IL-6, TNF-α, iNOS in macrophages polarized by lipopolysaccharide (LPS) and increased the expression of p-STAT while decreased the expression of SOCS1 (P ＜ 0.01).MicroRNAs referred to inflammation such as miR-155 and miR-27a increased in hypoxic exosomes compared to that in normoxic exosomes (P ＜ 0.05).Conclusions Hypoxia makes exosomes promoted the polarization of macrophages to M1, which may account for the microinflammation in chronic kidney diseases.

Objective:To compare the newborn piglet models of hypoxic ischemic brain damage in hypoxia and hypoxia combined with occlusion of both carotid arteries. Methods: Twenty four 7-day-old piglets were divided into two groups. Group H: mechanical ventilation with low concentration of oxygen,Group HI; mechanical ventilation with low concentration of oxygen combined with occlusion of both carotid arteries. The piglets were inhaled with 10%, 8%, and 6% low-concentration oxygen for 30 min, and grouped into mild, moderate, and severe hypoxia ones. The changes of physiological parameter, cerebral blood flow and cerebral oxygen perfusion were detected. Results: There were no significant differences in blood gas analysis of oxygen saturation, blood lactic acid and pH between the two groups(P＞0. 05) . The mean arterial pressure of severe hypoxia in HI was significantly lower than in H(P＜0.05). The cerebral blood flow in H and HI was relatively stable after different degrees of hypoxia. As compared with the cerebral blood flow perfusion in group H and HI, there were no significant differences between them ( P>0. 05). The cerebral oxygen perfusion in H and HI was significantly descent after different degrees of hypoxia (P＜ 0.05). As compared with the cerebral oxygen perfusion in groups H and HI, there were no significant differences between them. Conclusion: H and HI have the same effect on physiological parameter, cerebral volume and cerebral oxygen perfusion of newborn piglets. The mechanical ventilation with low concentration of oxygen to newborn piglets can develop the HIBD model, it is not necessary to occlude carotid arteries.

Objective To analyze the changes of electroencephalographic activities during fully automated simultaneous peripheral arteriovenous exchange transfusion(ET) in neonates with hyperbilirubinemia.Methods A total of 45 neonates who suffered from severe hyperbilirubinemia and underwent fully automated simultaneous peripheral arteriovenous exchange transfusion were studied from March 2009 to March 2016 in Neonatal Intensive Care Unit of Guangzhou Women and Children's Medical Center,and 46 ETs were performed in 45 babies who were divided into 2 groups according to the severity of hyperbilirubinemia:the encephalopathy group and the none-encephalopathy group.Nineteen patients were in the encephalopathy group,in which 11 were male and 8 were female.The other 26 patients were in the none-encephalopathy group,in which 15 were male and 11 were female.Changes in amplitude integrated electroencephalogram(aEEG) during ETs were analyzed,including background activities,sleep-wake cycle (SWC)and seizures.Results Forty-five patients with hyperbilirubinemia underwent 46 fully automated simultaneous peripheral arteriovenous ETs.As a result,total bilirubin dropped from (524.90 ± 110.96)μmol/L before ETs to (245.62 ±78.97) μmol/L after ETs,with clearance rate of 53.2％.And indirect bilirubin dropped from(486.16 ±90.39) μmol/L before ETs to(222.19 ± 79.49) μmoL/L after ETs,with clearance rate of 54.3％.On the other hand,there was no significant difference in the changes of electroencephalographic activities during ETs,including background activities (x2 =0.16,P ＞ 0.05),SWC (x2 =0.71,P ＞ 0.05) and seizures (x2 =0.30,P ＞ 0.05).However,there were significant difference in suppressions on background activities between the encephalopathy group and the none-encephalopathy group(Fisher's exact test P =0.042),though there were no significant statistical differences in SWC or seizures between the 2 groups (x2 =0.65,P ＞ 0.05;x2 =2.07,P ＞ 0.05,respectively).Conclusions In neonatal hyperbilirubinemia,fully automated simultaneous peripheral arteriovenous ET is safe and efficient without significant influence on electroencephalographic activities as a whole.However,background activities are more significantly depressed in infants of bilirubin encephalopathy than that of non-encephalopathy during ET.

Objective To investigate the role of fluid therapy in treatment of septic shock in children.Methods A total of 48 pediatric patients with septic shock were enrolled.Twenty-seven patients were treated with volume expansion and 21 patients were treated with fluid resuscitation.There were no differences in use of antibiotics,inotropic and vasoactive agent in two groups.The time needed for haemodynamic stability,occurrence of pulmonary edema.length of PICU stay,and mortality were compared between two groups.Results Compared with volume expansion group,the time needed for haemodynamic stability significantly decreased in fluid resuscitation group ((216.10± 168.13) minutes vs (121.63 ± 75.59) minutes) (P < 0.05). There were no significant difference in occurrence of pulmonary edema between volume expansion group and fluid resuscitation group (14.8% vs 9.5% . P > 0.05) .Compared with volume expansion group,length of PICU stay significantly decreased in fluid resuscitation group ((6.188 ±3.250) days vs (3.944±2.711) days,P < 0.05).Compared with volume expansion group,mortality significantly decreased in fluid resuscitation group (40.7% vs 14.3%,P < 0.05) . Conclusions Rapid fluid resuscitation was associated with early reach of haemodynamic stability,short stay in PICU,improved survival rate and no increase in the risk of complication in pediatric patient with septic shock.

Objective To investigate the effect of immunoglobulin G (IgG) in bullous pempbigoid (BP) blister fluid on the secretion of chemokines by human keratinocytes. Methods IgG was obtained from the blister fluid of patients with bullous pemphigoid and sera of normal human controls, then purified by sequential precipitation with caprylic acid and ammonium sulfate. The immunological activity of blister fluid was tested before and after the purification by BP180 ELISA kit. Keratinocytes were isolated from the foreskin tissue of yong adults, and subjected to primary culture. After 3 passages, the primary keratinocytes were harvested and subcultured in the presence of purified IgG of 0.5, 1, 2, 4 and 8 g/L, respectively, for 24 hours, or IgG of 4 g/L for 3, 6, 12, 24 hours, respectively, followed by the detection of levels of eotaxin, monocyte chemoattractant protein (MCP)-1 and interleukin (IL)-8 in the supemate of keratinocytes by ELISA. Results The valence of IgG remained unchanged after the purification with caprylic acid and ammonium sulfate. Compared with IgG from the sera of normal controls, that from bullous pemphigoid blister fluid sig- nificantly enhanced the secretion of IL-8 by keratinocytes in a time- and dose-dependent manner (both P < 0.01 ). Neither eotaxin nor MCP-1 was detected in the supemate of control IgG-treated, BP IgG-treated or untreated keratinocytes. Condusions The IgG in BP blister fluid has been proved to stimulate the secretion of IL-8 by cultured human keratinocytes, which may be involved in the pathogenesis of BP.

Objective:To investigate the neonatal outcomes and prognosis of fetuses who were prenatally diagnosed with intraventricular hemorrhage(IVH) to provide evidence for clinical consultation and management.Methods:Clinical data of fetal IVH cases ( n=89) diagnosed by fetal neurosonogram (NSG) in Peking University First Hospital from January 2012 to April 2020 were retrospectively collected, and neonatal outcomes were analyzed, involving fetuses with different grades of IVH and coexisting abnormalities. These patients were followed up for more than three months after birth. Two child development screening systems, Ages & Stages Questionnaires (Third Edition) (ASQ-3) and Ages & Stages Questionnaires: Social-Emotional (ASQ-SE), were used to assess the development of the patients from several aspects including physical growth, oral communication, motor ability and social emotions. Descriptive statistical analysis was used in this study. Results:(1) A total of 89 fetuses were enrolled and 66.3% (59/89) of them underwent fetal cranial MRI examination after ultrasound diagnosis. Among these 59 cases, 32(54.2%) had the same results with fetal NSG; 20(33.9%) with the diagnosis of remote ventricular cystic hemorrhage by fetal NSG, but misdiagnosed by MRI, were all confirmed by neonatal craniocerebral ultrasound; 7(11.9%) were lost to follow-up or terminated. In addition to IVH that was consistent with the ultrasound diagnosis, MRI also found three cases of cortical malformation, three cases of subdural hemorrhage and two cases of cerebral parenchymal hemorrhage. (2) Among the 89 cases, 37 (41.6%) underwent neonatal craniocerebral ultrasound examination after birth showing small amount of remote IVH, which was consistent with previous fetal NSG diagnosis. (3) There were 38 cases complicated by lateral ventricular widening (three lost to follow-up, 18 were terminated , one died in uterus, 15 with good and one with poor outcome), 10 cases by severe IVH sequelae (one lost to follow-up and nine were terminated) and 10 by craniocerebral malformation (one lost to follow-up, eight were terminated and one with poor neonatal prognosis). Two cases with extracranial malformation (ureteropelvic junction obstruction) were healthy after birth. (4) There were 29, 30, 16 and 14 cases of gradeⅠ,Ⅱ,Ⅲ andⅣ of fetal IVH, respectively. Among all cases, 12 were lost to follow-up; three died in uterus (all with gradeⅣ IVH); 31 were terminated and 43 were born and followed up. During the follow-up of the 43 cases, two (one grade Ⅰ case with corpus callosum dysplasia and one grade Ⅲ case with fetal cytomegalovirus infection) had poor prognosis, while the other 41 (one gradeⅢ, 17 gradeⅡ and 23 gradeⅠcases) showed no severe abnormalities.Conclusions:Fetal NSG is the first choice in screening fetal IVH and MRI can be a valuable aid. The neonatal prognosis may be associated with the grade of hemorrhage and coexisting abnormalities. Fetuses with isolated grade Ⅰ or Ⅱ IVH usually have a relatively good prognosis.

OBJECTIVE To investigate the bacterial contamination status of ventilator systems and corresponding measurements.METHODS Bacterial culture samples of auxiliary equipments of 36 ventilators,including inlet and outlet tube,mask,humidifier,water collector,nebulizer,and air filter,were respectively collected.The culture results were reported to the infectious disease control office of the hospital.After improved the sterilization management,then repetition of bacterial culture was performed and the results were compared with the former.RESULTS The first cultural results demonstrated severe bacterial contamination and the positive rate of inlet tube,humidifer,water collector,nebulizer,and air filter was even higher than 50%.After countermeasures were conducted,the positive rate of second bacterial culture of all ventilator systems was significantly dropped to less than 5.5%.CONCLUSIONS Bacterial contamination of ventilator systems commonly exists which can be significantly diminished by improved conception of asepsis and standardized sterilization.