Objective To investigate clinical characteristics and outcomes of twin pregnancies complicated with growth discordance.Methods Five hundred and seventy-six twin pregnancies who delivered between January 1,2000 and July 31,2012 in Peking University First Hospital were retrospectively analyzed.Cases with twin-twin transfusion syndrome had been excluded.Fetal weight was estimated by abdominal circumference and femur length; neonatal birth weight was recorded.The weight difference between two babies was divided by the weight of the bigger one to obtain the differential ratio.Twin pregnancy complicated with growth discordance was diagnosed if the ratio was equal or greater than 25％ (discordance group,n=68),and growth concordance was diagnosed if the ratio was less than 25％ (concordance group,n=508).The incidence of twin pregnancies complicated with growth discordance was analyzed.The incidence of maternal complications,premature delivery,perinatal death and neonatal complications were compared between the two groups.Chisquare test and t test were used for statistical analysis.Results The incidence of twin pregnancies complicated with growth discordance was 11.8％ (68/576).The incidence of growth discordance in monochorionic twins was higher than that in dichorionic twins [17.6％ (40/227) vs 8.0％ (28/349),x2=11.40,P＜0.05].The gestational age at delivery in the discordance group was earlier than that in the concordance group [(35.6±4.1) weeks vs (36.6±3.2) weeks,t=-1.66,P＜0.05],and the incidence of premature delivery in the discordance group was higher than that in the concordance group [58.8％ (40/68) vs 47.6％ (242/508),x2=3.85,P＜0.05].The perinatal mortality in discordance group was higher than that in the concordance group [9.6％ (13/136) vs 4.7％ (48/1 016),x2=5.84,P＜0.05].Among babies in discordance group,the incidence of intracranial lesion in monochorionic twins was higher than that in dichorionic twins [20.9％ (14/67) vs 6.8％ (3/44),x2=4.06,P＜0.05].Conclusions Twin pregnancies with growth discordance are prone to adverse pregnancy outcomes.Prenatal care should be strengthened and fetal condition should be assessed timely.It is suggested that neonates should undergo overall checkup and long-term follow-up.

AIM:To demonstate the expression of human cytochrome P450 3A4 isozyme in the transgenic cell line CHL - 3A4 established in this laboratory. METHODS:Nifedipine (NIF) can induce the reversal of the brug resistance for adriamycin of multidrug resistant(MDR) cell K562r. The NIF is the specific substlate for CYP3A4. To determine the NIF oxidase activity of the transgenic CHL - 3A4 cells by comparing the biological effect of NIF, which preinculbated with or without CHL - 3A4 S9 mix. RESULTS: When the multidrug resistance cell K562r was cultured in medium with NIF (12. 5 ?g? L- 1 ), a calcium channel blocker and specific substrate for CYP3A, it's IC50 for adri- amycin declined from(6.47?0.60) mg ? L- 1 to (0. 89?0. 15) mg? L-1. When cells were cultured in NIF(exactly the same concentration ) pretreated with CHL - 3A4 S9 mix,no reversal of MDR was observed [IC50 for adriamycin is (6.10?0.50) mg? L-1 ] while if NIF was pretreated with CHL S9 or inactivated CHL - 3A4 S9 mix, its biological effect was not deteriorated [IC50 for adriamycin is (0. 32?0.90) and (0.32?0.04) mg?L-1, P

Objective To investigate the different expression of various subtypes of human leukocyte antigen-G(HLA-G)in placenta of patients complicated with severe pre-eclampsia.Methods Ten placental samples from early-onset severe pre-eclamptic pregnancies and ten from late-onset severe preeclamptic pregnancies were collected as study group; ten placental samples from preterm pregnancies and ten from normal pregnancies were collected as control group.The levels of HLA-G protein in the four groups were measured by western blot and immunohistochemistry.Results(1)HLA-G1 protein decreased significantly in both the early-onset(2.4 ± 0.6 versus 2.9 ± 1.1,P ＜ 0.05)and the late-onset pre-eclampsia groups (3.5 ± 2.1 versus 4.2 ± 2.4,P ＜ 0.05).(2)HLA-G5 protein increased in the late-onset pre-eclampsia groups(1.8 ± 1.1 versus 1.1 ± 0.9,P ＜ 0.05); the increase in the early-onset pre-eclampsia group is not obvious(1.6 ± 0.9 versus 1.4 ± 0.7,P ＞ 0.05).(3)The level of HLA-G1 protein in placenta from patients complicated with premature labor is lower(2.9 ± 1.1 versus 4.2 ± 2.4,P ＜ 0.05); HLA-G5 protein does not change significantly(1.4 ± 0.7 versus 1.1 ± 0.9,P ＞ 0.05).(4)HLA-G1 and G5 proteins mainly express in the placenta extravillous cytotrophoblast cells.There is also a high level of expression around the blood vessels and in the extraembryonic mesoderm.Conclusions(1)HLA-G1 decreased significantly in both the early-onset and late-onset pre-eclamptic patients.(2)HLA-G5 increased in both the early-onset and late-onset pre-eclamptic patients,and the increase in the late-onset pre-eclamptic patients is obvious.(3)In late pregnancy,the level of HLA-G1 is lower in patients complicated with premature labor,this may be the result of its earlier pregnancy week; HLA-G5 does not change significantly.(4)HLA-G1 and G5 mainly express in the placenta extravillous cytotrophoblast cells.

Objective To investigate into hand hygiene facilities and worker's practice of hand hygiene during 120 ambulance services in a capital city.Methods With the standard Observation Form publicized by the World Health Organization,field observation was carried out to monitor hand hygiene facilities and the practice of hand hygiene in workers during ambulance services provided by four service centers.Results A total of seven ambulances and 80 times of services were observed across a span of 21 days.The provision and position of hand hygiene facilities were found very limited in these ambulances.Of 656 times of presence of indictors for hand hygiene,the overall compliance rate was 3.04％ reflecting the practice of hand hygiene in ambulance workers.The compliance rate was found to be 0 (0/291),1.96％ (1/51),13.64％ (3/22),5.21％ (16/307) and 0(0/2) before touching patients,after body fluids exposure risk,before clean/aseptic procedures and after touching patients' surroundings respectively.Conclusions Poor practice of hand hygiene which was revealed in 120 ambulance services suggests the great need for education and training to improve patient safety and occupational health.

AIM: To study the expression and its kinetics of rice phenylalanine ammonia-lyase gene encoding into E. coli as the basis of treatment for phenylketouria. METHODS: The phenylalanine ammonia-lyase-1-cDNA(rPAL-1-cDNA) from rice was recombined into E. coli high expression vector pET-28c and transformed into E. coli host strain BL21DE3. Engineering bacteria was then inducted by isopropyl-?-D-thiogalactoside (IPTG) for 1, 3, 5, 7 hours, in order to obtain high level expression. RESULTS: After induction, the expression level of fusion protein was 21.40%, 30.60%, 35.40%, 35.43% respectively. The fusion protein exhibited a band of 78 6 kD on SDS-PAGE analysis,but was not found in controls.The target protein was mainly existed in the form of inclusion body. CONCLUSION:Rice PAL gene expressing E. coli was established by gentic engineering technique.

AIM:To clon human cytochrome P450 2A6 cDNA. METHODS:Using reverse transcription polymerase chain reaction(RT-PCR) and DNA recombinant technique, a full-length cDNA encoding cytochrome P450 2A6( CYP2A6 ) from human liver was cloned into pBluescript vector. The cDNA segment was identified by DNA sequencing.RESULTS: Comparing with the CYP2A6 sequence, the cloned CYP2A6 cDNA had two different bases, codon 8 CTG(Leu)→TTG(Leu), codon 479 GGC(Gly)→GTC(Val) and was quite different in their 3′end noncoding region. Comparing with CYP2A7 seqence reported by Fernandez-Salguero,the cloned CYP2A6 cDNA had some different in 5′ end coding sequence and several differencey in the 3′ end coding and noncoding sequence, but both codon 479 were GTC(Val).Comparing with the CYP2A7 seqence reported by Yamano,the cloned CYP2A6 cDNA had some difference in the coding sequence but the 3′ end no-coding area was the same. CONCLUSION: The cloned cDNA was a new cDNA of CYP2A6 which may be transcripted from a new allele of CYP2A6.

Objective To investigate insulin receptor (INSR) genotype exon 17 frequencies in women with polycystic ovary syndrome(PCOS) and to elucidate its role in the pathogenesis of PCOS. Methods The study involved 33 women with PCOS and 28 healthy control women who were genotyped for polymorphism of INSR gene exon 17 by single strand conformation polymorphism (SSCP) analysis. Body mass index (BMI), insulin sensitive index (ISI), the expression of INSR beta subunit, and serum concentration of luteinizing hormone(LH), total testosterone between the genotypes were compared. Results (1) The T -to- C mutation was observed in the INSR gene exon 17 (1008 bp). The frequency of the C/C genotype was significantly higher in patients (39%) than in the controls (11%) (P

AIM: To evaluate the analgesic effects of combining application of low-dose morphine and diprospan in intra-articular injection after knee arthroscopy.METHODS: ① A total of 100 patients with knee arthroscopy were selected from the Surgery of Joint, Department of Orthopaedics, Changzheng Hospital, the Second Military Medical University of Chinese PLA from February 2002 to January 2003, including 52 males and 48 females aged from 16 to 56 years. All of them did not have a history of administration of pain-killer before operation. Patients were classified from grade Ⅰ to grade Ⅱ based on American Society of Anesthesiologists (ASA) before operation. Meanwhile, all the patients did not have obvious histories of heart,lung and liver diseases, and all patients provided informed consent. ② All patients were randomly divided into two groups, including combination group and morphine group with 50 in each group. Patients in the combination group were given intra-articular injection with 1 mg morphine hydrochloride and 1 mL compound diprospan [Xianling Baoya Pharmaceutical Factory, Belgian; batch number: 4JBBKA35A; qualification: 1 mL (5 mg/2 mg)/ampoule] after operation.In addition, patients in morphine group were injected with 1 mg morphine hydrochloride [the First Pharmaceutical Factory, Shenyang; batch number: 020316; qualification: 1 mL (10 mg)/ampoule]. ③ At 8 and 24 hours after administration, when patients maintained the status of standing with both feet and unfolding knee joint, analgesic effect was evaluated by visual analogue scale (VAS). Scores ranged from 0 to 10. The higher the scores were, the severer the painfulness was. Moreover, various side effects were observed at 48 hours after operation. ④ Differences of data were compared with one-way analysis of variance and deep differences between the two groups were compared with q test.RESULTS: A total of 100 patients received knee arthroscopy were involved in the final analysis. ① Visual analogue scale: At 8 hours after administration, scores were similar in combination group to those in morphine group, and the scores were 1.41 ±0.74 and 1.52±0.65, respectively (q =2.72, P ＞ 0.05). At 24 hours after administration, scores were remarkably lower in combination group than those in morphine group, and the scores were 1.46±0.61 and 2.53±1.24,respectively (q =3.42, P ＜ 0.05). ② Adverse events and side effects: Side effects, which were always found out in the application of morphine in vein, were not observed in both combination group and morphine group.CONCLUSION: Combining application of low-dose morphine and compound diprospan has an excellent analgesic effect with intra-articular injection, which is superior to that of the single application of morphine. Meanwhile, the combining application of low-dose morphine and compound diprospan is safe.

Objective To optimize the formulation of metoprolol succinate ( MS) controlled release pellets by central composite design-response surface methodology .Methods MS sustained-release pellets were prepared using sugar pellet cores as starter beads , ethyl cellulose as coating materials and MS itself as a pore former .The formulation of MS sustained-release pellets was optimized by a central composite design with two factors at five levels .These two factors ( two independ-ent variables) were the pore former level and coating level , and the evaluated indexes ( namely dependent variables ) included the in vitro cumulative release percentages of MS at 1, 4, 8, 12 and 16 h, respectively.Results and Conclusion The results of mathematical equation fitting suggested that the second-order quadratic model was the optimal fitting equa-tion.According to the response surfaces , the optimum values at the pore former level and coating level weve ranged from 16%to 18%and 20% to 25%, respectively .The in vitro cumulative release percentage of MS from the pellets at 1 h reached 9.15%,which consequently eliminated the lag phase in the initial release period and exhibited a good sustained-release effect.Central composite design-response surface methodology can be applied to optimizing the coating formulation for MS sustained release pellets .

BACKGROUND:Postoperative acute mental disorders refer to patients without mental disorders suffer from neurological dysfunction after surgery. OBJECTIVE:To analyze the association between psychological resilience and postoperative acute mental disorders after total knee arthroplasty (TKA). METHODS:Convenience sampling, the Chinese Version of Connor and Davidson's resilience scale (CD-RISC), was used to measure the levels of psychological resilience in 832 patients undergoing TKA. The questionnaire covered three dimensions:tenacity, self-improvement and optimism. The incidence of postoperative acute mental disorders was observed after operation. RESULTS AND CONCLUSION:(1) The CD-RISC scores of the patients with TKA surgery were (57.64±10.07), lower than the average scores of the elderly community in China. 20 (2.4%) patients had postoperative acute mental disorders. (2) Pearson correlation analysis demonstrated the negative correlation between the levels ofresilience and the incidence of postoperative acute mental disorders (r=-2.43, P<0.05). (3) Patients with lower psychological resilience levels had a higher incidence of postoperative acute mental disorders. Developing psychological resilience may become an important strategy to reduce the occurrence of postoperative acute mental disorders.