Objective To discuss the clinical features,management,pregnancy outcome and prognosis of obstetric mirror syndrome.Methods The clinical data of 12 cases with obstetric mirror syndrome at Shenzhen Maternity and Child Healthcare Hospital from April 2008 to December 2010 were collected to retrospectively analyze the clinical features, management,pregnancy outcome and prognosis.Results ( 1 ) Etiology:12 cases with obstetric mirror syndrome included 9 cases of Bart's hydrops fetalis,2 cases with fetal complicated congenital cardiac anomalies,and 1 case of unknown etiology.(2)Gestational age at diagnosis and at delivery:gestational age at diagnosis ranged from 28 to 36 weeks [ mean (31.5 ±4.7) weeks],and gestational age at delivery ranged from 28+3 to 38 weeks [ mean (32.9 ±2.9)weeks].There were no significant differences between the gestational age at diagnosis and at delivery in consistented with severe preeclampsia group and mild preeclampsia group [ (31.8 ± 2.3 ) weeks vs.(30.9 ± 7.2) weeks,(32.5 ± 2.3 ) weeks vs.(33.5 ± 3.9 ) weeks,P ＞ 0.05 ].( 3 ) The patients with obstetric mirror syndrome can present a preeclampsia-like syndrome:maternal extremity edema in 12 cases,headache and visual disturbance in 1 case,proteinuria in 11 cases,elevated blood pressure in 5 cases,elevated uric acid in 9 cases,hypoproteinemia in 12 cases,elevated creatinine in 3 case,elevated liver enzyme in 1 case,thrombocytopenia in 2 cases.The major complications included 1 case of HELLP syndrome,acute pulmonary edema,placental abruption,amnionic fluid embolism,DIC respectively,3 cases of acute kidney failure and 6 cases of postpartum hemorrhage.(4) Sonographic findings:① Hydrops fetalis:fetal ultrasound revealed pleural fluid,fetal ascites,skin edema,scalp edema,encephalocolele enlargement, hydropericardium and increased cardio-chest ratio.②Placenta megaly:the placental pathological examination revealed edematous and large in 12 cases.Placental thickness was beyond 4 cm in all cases [ (6.3 ± 1.9) cm ].③Hydramnios:hydramnios could be found in 11 cases [ amniotic fluid index ( 19.7 ± 3.1 ) cm ]. (5) Postnatal conditions:all blood pressure and laboratory findings including urine protein normalized within 5 to 7 days after delivery. (6) Pregnancy outcome:all 12 patients survived,however the perinatal mortality rate was 100％.Two of 12 cases with mirror syndrome underwent cesarean section,and 10 were vaginal delivery,of which 1 need uterine artery embolisom due to postpartum hemorrhage.Conclusions Obstetric mirror syndrome seems to simulate preeclampsia although there are distinguishing features,such as hemodilution,placental edema,and polyhydramnios.When the specific cause of obstetric mirror syndrome can not be identified and corrected,the decision for delivery should be made as soon as possibly.

5 cm and portal vein tumor thrombus significantly affect the tumor-free survival of the patients.

Objective To study the early diagnosis and management of the patients with acute respiratory distress syndrome (ARDS) caused by cytomegalovirus (CMV) pneumonia after liver transplantation.Methods The clinical data of 8 patients with ARDS caused by CMV pneumonia after liver transplantation in our hospital from April 2001 to May 2004 was retrospectively analyzed. All cases were treated with intravenous infusion of gancyclovir, reduced dosage of cyclosporine A or tacrolimus to 1/3~1/2 of baseline and withdrawal of MMF and prednisone. The patients were subjected to breathing machine assist ventilation and nutrition supply.Results Five patients recovered and 3 died. No one developed acute rejection. Conclusions The key of early diagnosis lies in combining chest X-ray or CT scan with clinical presentation. Administration with anti-viral drugs, adjustment of immunosuppressive agents, management with breathing machine assist ventilation and effective nutrition supply are important for the treatment of patients with ARDS caused by CMV pneumonia after liver transplantation.

Congenital bile duct cysts, which is a kind of malformation of bile duct, will lead to the inflammation in the bile duct system for a long time. Therefore, patients with cholelithiasis and cyst canceration have a risk. Surgical operation is the only treatment option for the congenital bile duct cysts patients. Resection of the cysts and complete " biliary-pancreatic duct shunt" are the key points of the standardized treatment of congenital bile duct cysts. The non-standard surgical treatment will bring the postoperative complications such as the stricture of choledochojejunostomy, the remnant cysts and even the canceration of cysts, which will seriously affect the quality of life and threaten the health of patients. Based on the retrospective study of congenital bile duct cysts patients in Eastern Hepatobiliary Hospital, the author proposed a new classification system according to the pathological and anatomical characteristics of congenital bile duct cysts. The congenital bile duct cysts can be divided into three regions and five types, i. e. localized type and diffuse type of extrahepatic bile duct cysts of hilar, trunk and terminal type; central type; and intrahepatic bile duct cysts of limited and diffuse type. It is our hope that this typing system will accurately guide the design and implementation of surgical treatment plans for congenital bile duct cysts and reduce the risk of long-term postoperative complications for patients.

Objective To investigate the protective effects and mechanisms of granulocyte-colony-stimulating factor (G-CSF)on a rabbit model of chronic myocardial ischemia.Methods Myocardial ischemia models were created by partial ligation of the left anterior descending coronary artery in Japanese white male rabbits.Rabbits were subcutaneously injected with G-CSF (G-CSF group)or saline (control group)for 6 days after myocardial ischemia.The percentage of CD34-positive cells in the peripheral blood was evaluated by flow cytometry,and CD34-positive cells homing and vWF expression in the ischemic myocardium were determined by immunohistochemistry.Results Rabbits in G-CSF group had a higher survival rate than those in control group (P <0.05).Immunohistochemistry of the ischemic myocardium showed that compared with control group,G-CSF group had increased homing of CD34-positive cells on day 7 post-surgery,and more vessels on day 28 post-surgery by anti-von Willebrand factor staining.In addition,we observed an increase in the percentage of CD34-positive cells in the peripheral blood in G-CSF group.Conclusion G-CSF produces an obvious protective effect against chronic myocardial ischemia in rabbits by increasing stem cell mobilization,homing to ischemic myocardium and accelerating neovascularization.

Objective:There is definite therapeutic effect in tuina treating low back pain.The comparative observation was performed on the two types of tuina manipulation for degenerative lumbar spondylolisthesis,in order to explore the best tuina manipulation for lumbar spondylolisthesis.Methods:All of 121 cases with degenerative lumbar spondylolisthesis were divided into the experimental group and control group randomly by the visit orders and pathological gradations,61 cases in the experimental group,including 34 cases of grade Ⅰ and 27 cases of grade Ⅱ,and 60 in the control group,including 34 cases of grade Ⅰ and 26 cases of grade Ⅱ.There was no significant difference in the general materials of the two groups.Based upon the similar tuina therapy applied on the soft tissues in the two groups,micro-regulating manual technique of the spine was applied in the experimental group,and the hip and knee-flexed and pillow method was applied in the control group.The treatment was given 3 sessions a week,with 10 sessions as one course of the treatments.The therapeutic effects were assessed after one course of the treatments.Results:There was significant difference (P＜0.01) in the total effective rate and in the remarkable effective rate and curative rate of the patients with grade Ⅰ between the experimental group and control group,also there was significant difference (P＜0.05) in the total effective rate of the patients with grade Ⅱ.Conclusions:The therapeutic effects by the micro-regulatory manual technique are comparatively better for degenerative lumbar spondylolisthesis,and the milder the pathological condition is,the better the therapeutic effects would be.

Objective To investigate the risk factors for postoperative liver failure of patients with hepatocellular carcinoma (HCC) and bile duct tumor thrombus through a risk evaluation model.Methods The clinical data of 107 patients with HCC and bile duct tumor thrombus who received hepatic resection at the Eastern Hepatobiliary Surgery Hospital from March 2002 to February 2011 were retrospectively analyzed.All patients were divided into the non-liver failure group (98 patients) and liver failure group (9 patients).Risk factors associated with liver failure were analyzed and a risk evaluation model was established.All data were analyzed using the bivariate regression model,and factors with significance were further analyzed using the multivariate regression model.Results Of the 107 patients,105 received hepatic resection + choledochotomy + thrombectomy and 2 received hepatic resection + extrahepatic bile duct resection + cholangiojejunostomy.The operation time was 2.0-5.5 hours,and the intraoperative blood loss was 200-3500 ml.In the non-liver failure group,5 patients had pleural and peritoneal effusion,3 had biliary bleeding,2 had incisional infection,1 had biliary infection,1 had bile leakage,1 had stress-induced ulcer of upper digestive tract and 1 had thoracic epidural hematoma.The bleeding of the patients with thoracic epidural hematoma was stopped after thoracic spinal decompression,but subsequent paraplegia occurred.In the liver failure group,2 patients died of postoperative acute liver failure,and 7 patients died of postoperative subacute liver failure (death caused by tumor recurrence or medicine was excluded).The results of univariate analysis showed that preoperative total bilirubin,albumin,pre-albumin,albumin/globulin ratio,distribution of tumor thrombus,operative blood loss and ratio of postoperative residual liver volume to the total liver volume were correlated with the postoperative liver failure in patients with HCC and bile duct tumor thrombus (OR =3.017,0.191,0.248,2.681,9.048,4.759,13.714,P ＜ 0.05).The results of multivariate analysis showed that preoperative total bilirubin ＞ 256.5 μmol/L,albumin/globulin ratio ≤ 1.3 and postoperative residual liver volume ＜ 50％ were the independent risk factors of postoperative liver failure (OR =5.537,11.107,172.450,P ＜ 0.05).The risk evaluation model was Z =1.77 × preoperative total bilirubin + 2.408 × preoperative albumin/globulin ratio + 5.150 × ratio of postoperative residual liver volume to the total liver volume-17.288.The risk of postoperative liver failure increased as the increase of Z value.The risk of postoperative liver failure ＞ 50％ when the Z value ＞ 0.Conclusions Preoperative total bilirubin ＞ 256.5μmol/L,albumin/globulin ratio ≤ 1.3 and postoperative residual liver volume ＜ 50％ were the independent risk factors of postoperative liver failure.Risk evaluation model is helpful in screening the risk factors so as to decrease the incidence of postoperative liver failure.

Objective To evaluate T cell and CD4+ CD28-T in the development and progression of abdominal aortic aneurysms (AAAs).Methods Fifty Wistar rats were randomly divided into 5 groups (n =10 each).An AAA animal model is established by enhancing perfusing elastase to the infrarenal abdominal aorta of the rats.The levels of T cell,B cell and macrophage cell of abdominal aorta of the rats on days 3,7,14 and 28,were detected by enzyme linked immunosorbent assay(ELISA).CD4+ CD28-T cell of the peripheral blood were measured by flow cytometry.Result There was significant T-lymphocyte infiltration both in middle and outer membrane of the artery of the rats on day 7 after surgery.T-lymphocyte,B-lymphocyte and macrophage cell infiltration were on the peak in middle and outer membrane of the artery on day 14 after surgery.The ratio of CD4+ CD28-T cell in rat peripheral blood reached peak on day 7(P ＜0.05).Conclusions T cell and CD4+ CD28-T cell expression increased in peripheral blood and abdominal aorta in AAA rat model,suggesting a potential role of T cell and CD4+ CD28-T cells in the pathogenesis of AAAs,especially during the early development of AAAs.

ObjectiveTo investigate the morning blood pressure surge(MBPS) and its relationship with 24-hour blood pressure variability and anti-hypertensive drugs in middle-aged and elderly hypertensive patients.Methods A total of 521 middle-age and elderly men were surveyed with ambulatory blood pressure monitoring and ambulatory electrocardiograms recordings as well as questionnaire investigation from January 2009 to December 2010.Subjects were divided into MBPS positive group and MBPS negative group according to the level of MBPS[ ＞35 mm Hg (1 mm Hg=0.133 kPa) or ≤35 mm Hg].ResultsIn all the cases,the prevalence of MBPS was 19.4％,of which the elderly and very elderly had higher prevalences ( 18.9％ and 21.8％,respectively) than the middle-aged (5.6％,both P ＜0.01 ).Significant differences could be found in age [ ( 81.6 ± 6.4 ) years vs ( 78.7 ± 9.7 ) years ],day mean systolic blood pressure [ ( 132.8 ± 13.3) mm Hg vs ( 128.8 ±13.3) mm Hg],fasting blood glucose [ (5.96 ± 1.59) mmol/L vs (5.68 ± 1.22) mmol/L] and 24-hour blood pressure variability between the two groups ( all P ＜ 0.05 ).Significant difference could be observed in the prevalence of MBPS between the diuretics-taking group and non-taking group (27.4％ vs 17.6％,P ＜0.05 ).ConclusionsThe elderly hypertensive patients are prone to appear MBPS phenomenon.Fasting blood glucose level,24-hour blood pressure variability may be associated with MBPS.Diuretic antihypertensive treatment may not be conductive for MBPS control.

Objective To summarize the clinical experienee in surgical treatment for hepatocellular carcinoma (HCC). Methods The clinical data of 7566 HCC patients who had been admitted to Research Institute of Liver Cancer of Fudan University from January 1988 to Deeember 2007 were retrospectively analyzed. The overall survival and recurrence free survival (RFS) rates were eaeulated with Kaplan-Meier survival curve. All the data were analyzed using Log-rank test and Cox regression model. Results The 3-, 5-, 10-year overall survival and RFS rates of 7164 patients with HCC resection were 56.29%, 41.76%, 26.70%, and 63.92%, 56.12%, 42.97%, respectively, and the perioperative mortality was 1.54%. The 5- and 10-year overall survival rates of patients with small HCC (diameter<5 era) were 58.20% and 38.47%, which were significantly higher than 31.42% and 20.43% of patients with large HCC (diameter >5 cm) (X2 =535. 568, P <0.01). The 5-year overall survival rotes of HCC patients with resection after down-staging (n = 110), re-resection after recurrence (n = 515), and tumor thrombus in portal vein (n = 168) were 51.26%, 67.28% and 26.81%, respectively; nd the 5-year DFS rotes were 77.44%, 13.01% (calculated from the first operation) and 34.90%, respectively. The 3- and 5-year overall survival and DFS rates of 402 patients who had undergone liver transplantation were 60.81%, 55.63% and 64.47%, 58.52%. The independent prognostic factors influencing the overall survival and DFS rates were the size, number and differentiation of HCC and intrahepatic vessel invasion (X2 = 200.539, 27. 536, 96.964,216. 156, P <0.01). Conclusions Early screening, improved safety of surgery, combined therapy and breakthrough in the reseaeh of preventing HCC metastasis and reeurrenee will significantly improve the treatment outcome of HCC.