Abnormal thyroid function is high risk for pregnancy.Studies from clinical observation and animal experiments have indicated that maternal sub clinical hypothyroidism during the first gestational term may lead to impairment of brain development of offspring,and early diagnosis and effective treatment may prevent the damage.Therefore,it is suggested that screening thyroid function before gestational 8 weeks in pregnant women is initiated.The changes in thyroid function during pregnancy are related to these changes in maternal thyroid physiology can lead to confusion in the diagnosis or evaluation of thyroid abnormalities.Establishment of trimester-specific reference ranges is urgently needed.Local iodine nutritional statue and testing reagent effect the measured value of thyroid function in general population,so it is recommend that all regions and hospitals should establish their own pregnancy reference ranges.

ObjectiveTo investigate the high risk factors,etiology,diagnosis,treatment and precaution of venous thromboembolism (VTE) in pregnancy and puerperium. MethodsData of 16 cases of VTE admitted in Department of Obstetrics and Gynecology,Peking Union Medical College Hospital from January 1992 to April 2011 were analyzed retrospectively.The differences of blood routine test and coagulation function between VTE patients (study group) and normal pregnant women (control group) were compared by paired t test in this case-control study.Results All patients were diagnosed by color Doppler ultrasound or CT pulmonary artery angiography.Five cases (31.2 ％) occurred before delivery and 11 (68.8 ％) occurred during postpartum.Two cases (12.5 ％)complicated by pulmonary thromboembolism,and one of them died.Six cases (37.5％) were older than or equal to 35 years old,and 12 cases (75.0％) had gestational complications.The hematocrit in study group were lower than that in control group (0.29±0.06 vs 0.39±0.02,t=4.56,P=0.01).There was no statistical difference between the coagulation function of the two groups.After anticoagulant therapy or surgery,15 cases recovered.One pulmonary thromboembolism patients complicated with rheumatic cardiac disease remained shock after anti-coagulants was administered,then died of hemorrhage of respiratory tract after inferior vena cava filter placement. Conclusions VTE is likcly to happen in puerperium than in pregnancy.There are no good screening indicators for thromboembolism during pregnancy and puerperium.Anticoagulation is recommended to be the first line therapy.For women with high risk of thromboembolism,it is suggested to prevent actively and treat early to decrease the complications and long-term sequelea.

Objective To investigate the changes in cells on cell cycle,cell apoptosis and susceptibility to chemotherapeutic drugs of lung adenocarcinoma A549 cells under two dimensional (2D system) and three dimensional (3D system) culture conditions. Methods The three dimensional culture of A549 cells was carried out using rotatable culture bottle and desk-top water bath shake. Flow cytometer,in situ cell apoptosis detection kit,MTT and blood cell counter were employed to compare cell cycle,cell apoptosis and susceptibility to ADM of A549 cells under different culture conditions. Results The three dimensional culture system was confirmed to have been successful by the aid of observation under inverted and electron microscope. There were significant retardation of G_ 1 phase,lower cell apoptosis rate and decreased susceptibility to ADM in A549 cells in 3D system compared with those in 2D system. Conclusions There were remarkable differences in biological characteristics of A549 cells in two culture systems,indicating that A549 cells cultivated in 3D system simulated better solid tumor in vivo . The 3D system was very useful for further investigation of the behavior of solid tumor,so that anti-carcinoma chemotherapeutic drugs could be advantageously tested in vitro before clinical application.

Objective · To evaluate the clinical characteristics of endometrial pathology in postmenopausal women with asymptomatic thickened endometrium. Methods · A retrospective review was conducted of the patients between October 2013 and October 2015 in the International Peace Maternity & Child Health Hospital. The postmenopausal women with asymptomatic thickened endometrium of 5 mm or more found by transvaginal ultrasonography were recruited. They underwent hysteroscopy and endometrial sampling to analyze the relationship between endometrial pathology and endometrial thickness. Results · A total of 257 patients were recruited. The average age was 61.3 years old, the average menopause period was 122 months, and the average endometrium thickness was 8.6 mm. The endometrial pathology included normal atrophic endometrium, endometrial polyp, submucous myoma, intrauterine adhesion, uterine septum, endometrial hyperplasia and endometrial cancer. The most common pathological type was endometrial polyp, accounting for 66.9% of the all patients and 83.9% (172/205) of all pathological types. Three cases of adenocarcinoma (1.2%) were diagnosed. There was significant difference in endometrial thickness among normal endometrium, endometrial polyp and endometrial cancer (P<0.05). The endometrium in endometrial cancer was the thickest, which was (13.20±5.38) mm averagely. There was significant difference in ages among the pathological types (P=0.004). Conclusion · There are few patients of malignancy among asymptomatic postmenopausal women with thickened endometrium. Follow-up visits were recommended to these women.

AIM:To investigate the effect of TSM tablet on rat' s atherosclerotic model' s endothelial cell and explore the mechanism of it.METHODS:Fifty Wistar rats were randomly assigned into five groups:control group,model group,Simvastatin group,TSM high group,TSM low group.All groups were fed with high fat diet and vitamin D_3 except for control group to set up atherosclerosis model.After 12 weeks we detected circle endothelial cell,angiotensin Ⅱ and electron microscopy morphology of arteries.RESULTS:Level of circulating enthelia cell(CEC)and Ang Ⅱ in model rats were significantly higher.TSM can reduce level of the CEC and Ang Ⅱ.Model group rat' s artery endothelial cells were severely damaged under electron microscopy;rat's artery endothelial cells in TSM group were basically intact and its internal elastic membrane was unbroken on it thickness was even,without significant lesion.CONCLUSION:TSM by reducing the number of CEC,the level of Ang Ⅱ used for experimental atherosclerotic endothelial cell in rats has the protective effect.

ObjectiveTo investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).MethodsThe clinical features,therapies,pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital,from January 2005 to April 2011.ResultsThere were 8 pregnant womenwith 21-OHD including 5siinplevirilizing patientsand 3nonclassical 21-OHD women.Eightpatientswereacceptedprogestationalandprenatalcontinuallowerglucocorticoid treatment.During the gestational period,the dosage of glucocorticoid was adjusted in one pregnancy.The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [ (70 ± 38 ) versus (24 ±23) nmol/L,P ＜ 0.05].The fertility and offspring rate of 8 patients was 8/12,the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7).Four patients were accepted genital reconstructive surgery ( clitorectomy,clitoroplasty,vulvoplasty) before pregnancy.The incidence of GDM was 1/8.All patients selected caesarean at from 37 +6 gestation weeks to 39+6 gestation weeks.The average newborn birth weight was (3210 ± 447 ) g,and height was (48 ±2) cm of 8 neonates,none of them was CAH.Conclusions Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD.It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment.The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

Purpose To explore the features of 99Tcm-AnnexinⅤscintigraphy of venous thrombus and its feasibility of discriminating fresh venous thrombus from old one. Materials and Methods The rabbits (n=15) were randomly divided into three groups (fresh thrombus group, old thrombus group and control group). The inferior vena cava thrombus models were developed in the rabbits of thrombus groups by inserting screw cooper wire into inferior vena cava. The rabbits of control group received sham operation. 99Tcm-AnnexinⅤwas injected in the rabbits of fresh thrombus group and control group one day after operation;the same was done in the rabbits of old thrombus group 14 days after operation. Planar anterior abdominal images were obtained at 30, 60, 90 and 120 min after 99Tcm-AnnexinⅤinjection in all groups respectively. The ratios of thrombus to background of the two thrombus groups and the ratios of the area correspondent to the thrombus groups to background of the control group were calculated by ROIs counts. Then rabbits were executed, and thrombus was used for pathology examination. Results 99Tcm-AnnexinⅤuptake in thrombi was clearly visualized in all rabbits of the fresh thrombus group;whilst negative images showed in all rabbits of the old thrombus group and control group. The thrombus to background ratios of the fresh thrombus group (4.06±0.49) were higher than that of the old thrombus group (2.46±0.38), and also higher than the inferior vena cava below inferior pole of right kidney level to background ratios (2.27±0.24) of the control group (t=5.746, 7.318;P<0.05). All the thrombi of the fresh thrombus group were confirmed as fresh mixed thrombi by HE staining, and those of the old thrombus group were confirmed as old mixed organized thrombi. Conclusion 99Tcm-AnnexinⅤmay become a new acute venous thrombus imaging tracer used to discriminate fresh venous thrombus from old one.

Objective To investigate the relationship between abnormalities of maternal serum markers in Down syndrome screening in second trimester and adverse pregnancy outcome.Methods Totally,1935 pregnant women were screened for Down syndrome with maternal serum tri marker with time-resolved fluorescence assay,including alpha fetoprotein (AFP),free β-human chorionic gonadotropin (β-hCG) and unconjugated estriol (uE3),between 15 and 20+6 gestational weeks at Peking Union Hospital from January 1,2009 to January 31,2011,and were followed up till delivery.The relationship between incidence of adverse pregnancy outcomes and women with normal or abnormal levels of serum markers in Down syndrome screening was investigated.T-test or Chi-square test were applied for statistical comparison.Results (1) Among the 1935 pregnant women,normal levels of serum markers were found in 1255(normal group) and 680 were abnormal(abnormal group),in which 577 with only one abnormal serum marker,89 with two and 14 with three abnormal serum markers.According to the serum marker level,the 577 women with one abnormal serum marker were further divided into five groups,including high AFP group (n=17),low AFP group (n=114),high β-hCG group (n=242),low β-hCG group (n=139) and low uE3 group (n=65).The birth weight of infants in lower AFP group and the gestational age at delivery in low β-hCG group were greater than those in normal group [(61.3±9.1) kg vs (59.5±8.3) kg,(272.6±11.8) d vs (274.4±10.1) d,t=2.21 and 1.99,both P＜0.01].(2) The incidence of adverse pregnancy outcome in normal group was 42.8％(537/1255),while comparing with the abnormal group(43.7％,297/680),no statistical significance was shown (RR =1.02,P =0.71).While comparing with the normal group,the incidences of placenta previa [25.5％ (32/1255) vs 2/17,RR=4.61,P＜0.05] and abnormal placental morphology were higher in high AFP group [4.1％ (51/1255) vs 5/17,RR=7.24,P＜ 0.05],the incidence of gestational diabetes mellitus (GDM) was higher in low AFP group [8.1％ (101/1255) vs 14.4％(16/114),RR=1.74,P＜0.05],the incidence of placenta and membrane retention was higher in high β-hCG group [3.5％ (44/1255) vs 6.2％(15/242),RR=1.77,P＜0.05],the incidence of pre-eclampsia was higher in low β-hCG group [1.7％ (21/1255) vs 6.5％ (9/ 139),RR=3.87,P＜0.05].(3) There were 89 women with two abnormal serum markers.Comparing with the normal group,the incidences of small for gestional age (SGA) infants,oligohydramnios,abruptio placenta were higher in women with low AFP but high β-hCG [SGA infants:6.9％(2/29) vs 1.8％(22/1255),RR=3.94; oligohydramnios:20.7％(6/29) vs 6.4％(80/ 1255),RR=3.24; both P＜0.05],the incidences of oligohydramnios was higher in women with both low AFP and low uE3[3/14 vs 6.4％(80/1255),RR=3.36,P＜0.05],the incidence of premature birth and GDM were higher in women with both low β-hCG and low uE3 [premature birth:2/6 vs 4.3％(54/1255),RR=7.75; GDM:3/6 vs 8.0％ (101/1255),RR=6.21; both P＜0.05].(4) There were 14 women with three abnormal serum markers.The relationship between adverse outcome and abnormal serum markers did not show any statistical significance.Conclusions The abnormality of serum markers of Down syndrome screening is closely related to adverse pregnancy outcomes,and women with abnormal serum markers should be carefully monitored during pregnancy.

Objective To investigate the feasibility of monitoring the tumor's hypoxic changes by 99Tcm-2-(2-methyl-5-nitro-1H-imidazol-1-yl) ethyl eihydrogen phosphate (MNLS) imaging after radiotherapy.Methods (1) H22 cells were cultured and mice model with liver cancer xenografte was made.The mice were imaged at 0.5,1,2,3,4,6 and 8 h (six mice in each group) after injected with 7.4 MBq 99TcmMNLS when the tumor size reach about 1 cm.Then the mice were sacrificed.The T/NT and ％ID/g of each time point was calculated.(2) The liver cancer bearing mice of radiotherapy group (25 Gy) and control group were imaged at 0,24,48 h,and then the technique of ROI was adopted to calculate the T/NT at each time point in the two groups.Immunohistochemical stain method was used to evaluate the expression level of HIF-1α in liver cancer.(3) One-way analysis of variance,the least significant difference t test,two-sample t test and Spearman correlation analysis were performed.Results (1) The uptake of 99TcmMNLS in the liver cancer bearing mice was significant at 2 h after injection and the ％ID/g was the highest.99Tcm-MNLS was excreted mainly through kidneys.(2) The T/NT and HIF-1α expression level in radiotherapy group at 24 h (2.65±0.27,(50.62±3.78)％) were lower than those at the instant (3.35±0.19,(85.32±0.94)％,t=5.640,6.701,both P＜0.05),but higher than those at 48 h (2.23±0.52,(21.69±0.75)％,t=7.674,4.911,both P＜0.05).The T/NT and HIF-1α expression in the radiotherapy group were significantly higher than those in the control group at the instant (2.74 ± 0.29,(28.26 ± 1.70) ％,t =4.235,3.473,both P＜0.05) but lower at 48 h (3.15±0.88,(67.64±3.55) ％,t =7.902,3.258,both P＜0.05).However,no significant difference was observed at 24 h between radiotherapy group and the control group (2.98±0.16,(58.45±0.98) ％,t =0.525,2.043,both P＞0.05).The change of T/NT closely correlated with the expression of HIF-1α in both the radiotherapy group and control group(r,=0.793,0.756,both P＜0.05).Conclusion 99Tcm-MNLS hypoxia imaging has potential to monitor changes of hypoxia in tumor after radiotherapy.