Objective To investigate the clinical value of combined general and gynecological laparoscopy.Methods From March 2003 to December 2006,160 patients with abdominal and gynecological diseases were treated with laparoscopy,including laparoscopic cholecystectomy(LC)+ salpingostomy in 20,LC + ovarian cystectomy in 24 cases,LC + hysteromyomectomy in 12,LC + hysteromyomectomy and uterine artery blockage in 7,LC + subtotal hysterectomy in 19,LC + total hysterectomy in 11,LC + treatment of endometriosis in 6,laparoscopic appendectomy(LA)+ salpingostomy in 16,LA + ovarian cystectomy in 22,LA + subtotal hysterectomy and total hysterectomy in 18,decortication of liver cysts + ovarian cystectomy in 4,and laparoscopic hepatectomy + adnexectomy in 1.Results Laparoscopic procedures were completed in all the 160 cases without conversion to open surgery.The operation time ranged from 40 to 220 min(mean,120 min),and postoperative hospital stay ranged from 1 to 6 days(mean,3.4 days).No patient had perioperative complications.Among the 160 cases,143 were followed up for 3 to 24 months(mean,19.5),during which 1 developed vaginal stump hemorrhage 10 days after the operation and was cured by conservative therapy,1 experienced vaginal polypi at the stump 2 months postoperation and underwent polyp resection.Conclusions Combined general and gynecological laparoscopy is a promising method for patients with abdominal diseases complicated with gynecological diseases.It is important for surgeons from different departments to deeply understand the indications of laparoscopy,prepare well before operation,and cooperate closely.

Objective To observe the numerical characteristics of dendritic cells (DC),the DC subsets(myeloid dendritic cell,MDC; plasmacytoid dendritic cell,PDC) and CD4+ CD25 + CD127low/-Tr cells in peripheral blood of Graves disease (GD) patients.Methods According to the clinical manifestations and serum FT3,FT4 and TSH,the GD patients were divided into the untreated-group,the clinical remission group and the clinical stable group,and set normal control group as well.The flow cytometry was used to detect DC and CD4+CD25+CD127low/-Tr cells of the percentage of CD4+ T cells in subjects peripheral blood(EDTA-K2 anticoagulated).The indicators were compared among various groups,and the correlation between the indicators with serum FT3,FT4 and TSH were observed.Results (1) In the untreated-group,the clinical remission group,the clinical stable group,and normal control group,total DCs,MDCs and MDC/PDC gradually declined,untreated-group has a significant difference from the other three groups also the significant difference was found among other three groups; (2) In the untreated-group,the clinical remission group,the clinical stable group,and normal control group,PDCs declined successively,but only the difference was found between untreated-group and normal control group; (3)In the untreated-group,the clinical remission group,the clinical stable group,and normal control group,CD4+CD25+CD127low/-Tr cells gradually raised,but only the difference between untreated-group and normal control group make sense; (4)In the untreated-group,PDCs and CD4+CD25+CD127low/-Tr cells have a certain relevance; (5)There was good correlation between DCs and serum FT3,FT4 and TSH,but CD4+CD25+CD127low/-Tr cells only have correlation with FT3 and FT4.Conclusion DC,MDC,MDC/PDC increased in the untreated-GD patients,and decreased after the therapy of anti-thyroid.Therefore,DCs and the DC subsets are expected to be used to monitor GD in the course of disease.CD4+CD25+CD127low/-Tr cells can be used as a new indicator of the onset of GD.

Objective To investigate the changes of B lymphocyte subsets ( naive B cells, memory B cells and plasmablasts) in peripheral blood of patients with rheumatoid arthritis ( RA) and their correla-tions with the clinical manifestation and laboratory indexes.Methods Sixty-six patients with RA were di-vided into two groups including the group with active RA and the group with inactive RA according to the dis-ease activity score in 28 Joints (DAS28).A control group with healthy subjects was set up accordingly.The distributions of B lymphocyte subsets in peripheral blood samples were detected with flow cytometry analysis and their correlations with clinical manifestations and laboratory indicators were analyzed.Results ( 1 ) Compared with healthy subjevts, the mean fluorescence intensities ( MFIs) of CD19 and the percentages of memory B cells in peripheral blood of the patients with RA were significantly decreased, while the percenta-ges of naive B cells were increased (P<0.05).The percentages of plasmablasts in the patients with active RA were significantly increased as compared with those of healthy subjects and the patients with inactive RA (P<0.05).(2) The percentages of plasmablasts in peripheral blood of the patients with RA were positively correlated with the joint tenderness count, joint swelling count and joint swelling index (P<0.05).(3) A positive correlation was found between the MFIs of CD19 and the erythrocyte sedimentation rates ( ESRs ) among the patients with RA.The percentages of plasmablasts were positively correlated with C reaction pro-tein (CRP) and anti-cyclic citrullinated peptide (anti-CCP) antibody (P<0.05).(4) The percentages of plasmablasts were also positively correlated with the DAS28 among the patients with RA ( R2=0.343, P<0.01).Conclusion The distributions of B lymphocyte subsets varied among the patients in different stages of RA, which were related to the patient′s clinical symptoms and laboratory indexes.The study suggested that different subsets of the B lymphocytes might play an important role in the pathological process of RA.

Objective To analyze TORCH infection situation in 6 027 cases of pregnant women,puerperae and neonates.Methods The TORCH IgM and IgG was detected by using ELISA for 6 027 cases of pregnant women,puerperae and neonates,and the positive rates of the antibodies to variant TORCH pathogens were analyzed.Results The positive rates of HSVⅠ-IgM,HSVⅡ-IgM,RV-IgM,TOXO-IgM and CMV-IgM were 0.02%,0.02%,0.12%,0.12% and 0.20% respectively.The positive rates of HSVⅠ-IgG,HSVⅡ-IgM,RV-IgM,TOXO-IgM,and CMV-IgM were 63.32%,13.31%,52.83%,12.68% and 58.57% respective-ly.Positive rate of CMV-IgM in neonates was higher than that in pregnant women,the difference was statistically significant(P <0.05).There were totally 28 cases of neonataes detected with acute CMV infection.Conclusion TORCH screening in pregnant women,puerperae and neonates helps the detection of infection disease in perinatal period.

Objective Breast intraductal papillary lesion ( BIPL) has a low incidence but a high rate of malignancy .This study discusses the diagnostic value of conventional ultrasonography ( US) combined with ultrasonic elastography ( UE) for breast papil-lary lesion. Methods We analyzed the preoperative ultrasound data of 48 patients with 63 BIPLs, and classified them according to the characteristics of two-dimensional ultrasound (2DUS) images.Then we compared their color Doppler ultrasound characteristics and UE features with the pathological results . Results Based on the 2DUS findings, the BIPLs were divided into 4 types.The sensitivi-ty, specificity, and accuracy of conventional US +UE in the diagnosis of BIPL were 93.2%, 88.9%, and 90.5%, respectively, markedly higher than those of conventional US (75.6%, 66.7%, and 73.0%), with statistically significant differences in the areas under the curve between the two methods (0.918 vs 0.838, P<0.05). Conclusion Conventional US combined with UE can im-prove the diagnosis of breast intraductal papillary lesion .

Objective To investigate the effect of heat stress on the expression of Toll-like receptor 4 (TLR4) and peripheral blood T regulatory cells (Treg) in splenic cells of rats.Methods Senventy-two SD rats were divided into 20 ℃ control group and 37 ℃ group.Each group was divided into non stimulation,bacterial lipopolysaccharide (LPS) stimulation and concanavin A (Con-A) stimulation subgroup.Each subgroup had 1,12,48 h and 168 h observation points,and flow cytometry was used to determine the level of TLR4 and Treg.Results The TLR4+ immunocompetent cells in the spleen was decreased from 1 h to 168 h in every subgroup of the 37 ℃ group compared to the 20 ℃ control group (P＜0.05).The level of CD4+CD25+ Treg in the peripheral blood in rats from 1 to 48 h was significantly decreased (P＜0.05) and slightly increased at 168 h in LPS stimulation subgroup in the 37 ℃ group compared to the 20 ℃ control group.The level of CD4+ CD25+ Foxp3+ Treg in the peripheral blood in rats at 12 h were significantly increased in non-stimulation and concanavalin A (Con-A) stimulation subgroups in the 37 ℃group,and were significantly decreased at 168 h in every subgroup of the 37 ℃ group compared with 20 ℃ control group (P＜0.05).The level of CD8+CD25+ Treg in the peripheral blood in rats was significantly increased at 1 h and 168 h in the 37 ℃ hot and humid group in the every subgroup whencompared with the 20 ℃ control group (P＜0.05).The level of CD8+ CD25+Foxp3+ Treg in the peripheral blood in rats was significantly decreased at 1 h and 48 h in the every subgroup,and was significantly increased at 12 h and 168 h in the non-stimulation and LPS stimulation subgroups in the 37 ℃ group compared to the 20 ℃ control group (P＜0.05).Conclusion High temperature and damp heat can destroy the innate immunity and alter the functional state of adaptive immunity in rats.

Objective: To investigate the spectrum of mutations in families with benign familial neonatal-infantile epilepsy (BFNIE) . Methods: Clinical data and peripheral blood DNA samples of all BFNIE probands and their family members were collected from Peking University First Hospital between December 2012 and April 2016. Clinical phenotypes of affected members were analyzed. Genomic DNA was extracted from peripheral blood samples with standard protoco1. Mutations in PRRT2 were screened using Sanger sequencing. For families that PRRT2 mutations were not detected by Sanger sequencing, candidate gene mutations were further screened by next-generation sequencing for epilepsy. Results: A total of 7 families were collected. Of the 30 affected members, 15 were male and 15 were female. The age of epilepsy onset was from 2 days to 6 months. Genetic testing led to the identification of gene mutations in all families. One family had the PRRT2 hotspot mutation (c.649dupC). Three families had missense SCN2A mutations (c.2674G>A/p.V892I, c.2872A>G/p.M958V, and c.2627A>G/p.N876S) . Both c.2872A>G/p.M958V and c.2627A>G/p.N876S were novel SCN2A mutations. Three families had KCNQ2 mutations. Two of them had missense mutations (c.958G>A/p.V320I and c.998G>A/p.R333Q) . The KCNQ2 mutation c.958G>A/p.V320I was novel. One family had a gene deletion of KCNQ2, which also extended to the adjacent gene, CHRNA4; and the deletion involved all the exons of KCNQ2 and CHRNA4. Conclusions Mutations in KCNQ2, SCN2A, and PRRT2 are genetic causes of BFNIE in Chinese families. The detection rate for gene mutations is high in BFNIE families. KCNQ2 and SCN2A mutations are common in BFNIE families. SCN2A mutations (c.2872A>G/p.M958V and c.2627A>G/p.N876S) and KCNQ2 mutation (c.958G>A/p.V320I) are novel mutations.

Objective This study compares a dual-freeze protocol with a triple freeze protocol for hepatic cryoablation in the Tibetan pig model.Method Cryoablation with a dual-(10-5-10-5 min)and triple-freeze (5-5-5-5-10-5 min) protocol for the normal livers of 9 Tibet pigs was performed under exposed operation.Temperature changes of cryoprobes and diameter changes of iceballs were measured during the ablation,and seven days later the pathological changes of cryozones were reviewed and the surface and depth cryolesions were measured.Results Compared with cryoablation with two freeze-thaw cycles,there was a greater iceball diameter for cryoablation by three freeze-thaw cycles.Also,seven days after cryosurgery,there were similar surface and deep cryolesions in dual-and triple-freeze protocols.Pathologically,the triple freezing protocol was associated with a longer zone of complete necrosis.Conclusions With the same freezing time (20 min),the triple-freeze protocol may become a more powerful liver-ablation method in cryosurgical application.

Objective: To investigate the clinical and neuroimaging characteristics of acute encephalopathy (AE) after status epilepticus (SE) of patients with Dravet syndrome (DS). Method: The clinical data of DS patients who had AE (coma ≥24 h) after SE were retrospectively collected from February 2005 to August 2016 in Peking University First Hospital and SCN1A gene tests were performed.The clinical and neuroimaging features were summarized. Result: Twenty-two patients (9 males and 13 females) with AE were collected among 412 DS patients during follow-up.Of which 18 patients had SCN1A gene mutations while the remaining 4 patients had no SCN1A gene mutations.The onset age of AE was between 6 months and 10 years.The duration of SE varied between 40 minutes and 9 hours.Prior to the onset of SE, twenty-one patients had high fever, and one patient had normal temperature.Coma lasted from 2 days to 20 days.Nine patients died after the AE, and 13 patients survived with massive neurological regression.From AE to the last visit, the median time of follow-up was 2 years and 3 months (from 7 months to 4 years and 4 months). Nine of 13 survivors had varied improvement in motor, language and cognition, while the remaining 4 patients had no significant improvement.After AE, there were 6 patients with seizure-free, 4 patients with reduced seizures, and 3 patients with no change in seizure frequency, moreover, spasm occurred in 2 patients.Six patients had brain magnetic resonance imaging (MRI) in acute phase and showed bilateral (2 patients) or unilateral (4 patients) hemisphere edema, accompanied by subcortical white matter hyperintense signal in T1 and T2 weighted images in two patients.The neuroimaging of 13 survivors demonstrated diverse cortical atrophy during recovery phase, among which 4 patients showed cerebellar atrophy, one patient had right pontine atrophy, 4 patients accompanied by signal abnormalities in subcortical and periventricular white matter, 2 patients showed right hippocampal sclerosis, and one patient showed signal abnormalities in bilateral basal ganglia. Conclusion SE is more prone to occur in Dravet patients who have high fever.It may result in AE or even death in severe cases.Survivors will leave severe neurological sequelae.The neuroimaging shows brain edema in acute phase.In recovery phase the neuroimaging shows diverse brain atrophy, moreover, a few patients may be associated with cerebellar or pontine atrophy, hippocampal sclerosis or abnormal signals in white matter or basal ganglia.

Objective To investigate the gene mutations in benign familial infantile epilepsy(BFIE)in Chi-na. Methods Data of all BFIE probands and their family members were collected from Peking University First Hospital and other three hospitals between October 2006 and June 2017. Clinical phenotypes of affected members were analyzed. Genomic DNA was extracted from peripheral blood samples with standard protocol. Mutations in PRRT2 were screened using Sanger sequencing. For families that PRRT2 mutations were not detected by Sanger sequencing,candidate gene mutations were further screened by next - generation sequencing. Results A total of 71 families including 227 affected members were collected. Genetic testing led to the identification of gene mutations in 52 families (52 / 71,73. 2％). Forty - three families had PRRT2 mutations (43 / 71,60. 6％),including 40 families with frameshift mutations(hotspot mutations c. 649_650insC and c. 649delC were detected in 29 families and 6 families,respectively),one family with nonsense mutation,one family with a loss of a stop codon,and one family with a microdeletion of the gene. C. 560_561insT and c. 679C > T were novel PRRT2 mutations. Five families had SCN2A mutations. All SCN2A mutations were missense mutations(c. 668G > A,c. 752T > C,c. 1307T > C,c. 4835C > G,c. 1737C > G). Mutation c. 752T > C, c. 1307T > C,c. 4835C > G,and c. 1737C > G were novel mutations. Three families had KCNQ2 mutations. All KCNQ2 mutations were missense mutations(c. 775G > A,c. 237T > G,c. 1510C > T). Mutation c. 237T > G and c. 1510C > T were novel mutations. One family had a novel GABRA6 mutation c. 523G > T. In 71 BFIE families,16 families had mem-bers who showed paroxysmal kinesigenic dyskinesias(PKD)and subclassified as infantile convulsions with paroxysmal choreoathetosis syndrome(ICCA). Fifteen ICCA families were found having PRRT2 mutations (15 / 16,93. 8％). The remaining ICCA family was not detected with any pathogenic mutation. Conclusion There is high frequency of gene mutations in BFIE families. Mutations in KCNQ2,SCN2A,and PRRT2 are genetic causes of BFIE. PRRT2 is the main gene responsible for BFIE. GABRA6 mutation might be a new cause of BFIE.