Recurrent spontaneous abortion (RSA),which affects 1% to 5% of women of reproductive age,is difficult to treat in the clinical setting. In the investigations of immunopathogenesis,diagnosis and treatment of RSA since the late 1980s,it was found that RSA was associated with abnormal maternal local or systemic immune response,the pathogenesis of autoimmune RSA was mainly associated with antiphosphlipid antibody (APA),while that of alloimmune RSA was due to the disturbance of maternofetal immunological tolerance. Systemic etiological screening process and diagnosis systems of RSA with immune type were developed,and anticardiolipin (ACL)+? 2-GP1 combining multiple assay for effective diagnosis of RSA with immune type was initially established. According to dynamic monitoring clinical parameters before and during gestation,low-dose,short-course and individual immunosuppressive therapy and lymphocyte immunotherapy for RSA with immune type were initiated. The outcomes of the offsprings of patients with RSA were followed up,and the safety and validity of the therapies were confirmed. The research achievement leads to great progress in the diagnosis and treatment of RSA in China.

Objective To investigate the roles of transcription factor GATA-3 and T-bet at the fetal- maternal interface in the pathogenesis of unexplained recurrent spontaneous abortion(URSA).Methods The expression of GATA-3 and T-bet mRNA was examined by in situ hybridization.Decidua was obtained from 20 women with URSA and 20 normal pregnant(NP)women.Results(1)The number of GATA-3 positive cells per high power field in women with URSA(25?16)was significantly lower than those in NP women(38?16)(P

A convenient, highly sensitive and highly specific method using time-resolved fluoro immunoassay (TRFIA) for quantitative detection of hepatitis B virus is described. Using EU-DTTA as the tracer molecule, the assay showed a detection range of the standard curves of 0.2-300 ng/ml for HbsAg with a sensitivity of 0.05 ng/ml. The within-run coefficient of variations for standard samples were less than 10%, and the correlation coefficient between radioimmunoassay and TRFIA assay results reached 95% for the same sample, demonstrating the advantages of TRFIA for its wide detection range, high sensitivity and simple operation and its great potentials for clinical use.
Fluoroimmunoassay ; methods ; Hepatitis B ; blood ; Hepatitis B Surface Antigens ; blood ; Humans ; Sensitivity and Specificity

Objective To investigate the significance of the serum levels of interleukin-10 (IL-10),IL-13,IL-15 of patients with chronic hepatic failure and the correlation between those inter- leukin levels and nosocomial infections.Methods The serum levels of IL-10,IL-13,IL-15 of 58 patients with chronic hepatic failure were measured by double antibody sandwich enzyme-linked immu- nosorbent assay at the time of admission and 2 weeks after admission.Results The serum levels of IL-15 and the propotion of IL-15/IL-10 and IL-15/IL-13 in patients with chronic hepatic failure group at the time of admission were significantly higher than those in healthy control group[(358.16?290.91) ng/L vs (38.55?21.49) ng/L,12.93?14.26 vs 1.10?0.55,98.55?97.5.5 vs 9.70?5.03,respectively,all P=0.000].Those in death group were significantly higher than those in improving group[(479.93v205.52) ng/L vs (244.51?236.29) ng/L,17.65?17.78 vs 8.53?7.98,130.69?115.50 vs 68.55?65.99,respectively,all P

The pathogenesis and etiology of still remain unknown. Current evidence suggests that the occurrence of depression may be related to a reduced secretion of neurotransmitters, neuronal apoptosis, inflammation, intestinal flora and other factors. Although the commonly used antidepressants such as SSRIs, SNRIs, NaSSA, and SARIs produce some therapeutic effects, they fail to relieve the full spectrum of the symptoms of depression. In recent years, esketamine was found to produce a potent and a long-lasting antidepressant effect by acting on the NMDA receptors. Herein the authors review the progress in the study of the pathogenesis and drug therapies of depression, the efficacy of esketamine treatment and the underlying mechanism, and the prospect of esketamine treatment. Currently the mechanism of the antidepressant effect of esketamine remains indeterminate and its clinical application is limited, but its effect in rapidly alleviating the symptoms of depression suggests its bright prospect for clinical applications.
Antidepressive Agents ; pharmacology ; Depression ; drug therapy ; Humans ; Ketamine ; pharmacology ; Receptors, N-Methyl-D-Aspartate

Objective To study the indication and clinical application of lateral neck incision for the removal of cervical esophageal foreign bodies. Methods From January 1999 to January 2009, 2189 cases esophageal foreign bodies were treated. The clinical data of 137 cases (6. 25% ) with lateral neck incision were retrospectively analyzed. In these 137 cases, 114 cases were over 16-years-old (adult group) , while 23 cases were under 16-years-old( children group). In adult group, 67 cases(58. 8% ) had esophageal perforation (esophageal perforation with neck abscess 29 cases, esophageal perforation without neck abscess 38 cases); 47 cases did not have esophageal perforation ( impacted foreign body without neck abscess 40 cases, foreign body with esophageal abscess 7 cases). In children group, 19 cases (82.6%) had esophageal perforation including 15 cases with neck abscess; 4 cases without esophageal perforation, 3 cases had esophageal abscess and one case without abscess but of huge foreign body. Results All 137 patients with foreign body were cured through lateral neck incision. Nineteen cases(13. 9% ) had hoarseness and recovered in 3 months. Five adult patients had post-operative cicatrical stricture of the esophagus, but it was mild and completely recovered by the treatment of dilatation in 3 to 11 months. Nine adult patients with esophageal perforation were cured by secondary suture, the remaining esophageal perforation cases were healed by first intention. One case with common carotid artery impairement by the foreign body was successfully treated by carotid artery ligation without hemiplegia, aphasia and other sequelae. Two cases had cardiopulmonary arrest, 2 cases had febrile convulsions and 1 case had acute respiratory failure, 5 cases had septic shock, all these patients were effectively controlled and cured. Seven of the 9 cases with tracheotomy had the tracheal tube removed during hospitalization; 1 of the two obese patients had the extubation 3 months after the discharge and the other one still had the tube. All esophageal perforation cases in children group had primary healing by perforation apposition suture. Four of the 5 children had successful tracheotomy decannulation, one child had extubation by 2 months through continuously reduced tracheal tube model. Conclusion Penetrating esophageal foreign body and neck abscess were indication of the lateral neck incision, and positive prevention and cure the complications of lateral neck incision could achieve good curative effect .

Objective To analyze the effect of NexusTM coils for endovascular occlusion of intracranial aneurysms. Methods In 41 patients with intracranial aneurysms, endovascular occlusion of 43 aneurysms was performed using NexusTM coils. The follow-up data of the patients for 6 to 12 months were reviewed, and the imaging data from digital subtraction angiography (DSA), CT angiography (CTA) or magnetic resonance arthrography (MRA) alter the treatment were analyzed. Results In the 41 patients, 1 died, 1 had aneurysm recurrence, 3 had cerebral infarction, 1 showed ocular paralysis, and 2 developed hydrocephalus after the surgery. Evaluation with modified Rankin Scale showed grade 0 in 8 cases, grade 1 in 19 cases, grade 2 in 7 cases, grade 3 in 3 cases, grade 4 in 1 case, grade 5 in 1 ease and grade 6 in 1 case. Conclusion Endovascular embolization with NexusTM coils is effective for treatment of intracranial aneurysms especially in cases of small aneurysms and parent artery occlusion. Caution should be taken with the coil for endovascular occlusion of the neck of anterior and middle cerebral artery aneurysms with thin parent arteries, as the fibers in the coil may cause thrombosis and potential cerebral infarction.

OBJECTIVETo analyze the therapeutic results and prognostic factors of hepatic metastases treated by ultrasound-guided percutaneous microwave coagulation.

METHODSSeventy-four patients with 149 nodules of hepatic metastases were given percutaneous microwave coagulation therapy. The longest diameter of the metastatic nodule ranged from 0.7 - 6.8 cm (mean, 3.1 +/- 1.8 cm). The cumulative survival rate was analyzed by Kaplan-Meier method and the difference between groups was compared with log-rank test. Cox proportional hazard model was used to determine potential prognostic variables.

RESULTSThe follow-up period for the 74 patients was 5 - 83 months (mean, 25.1 +/- 11.4 months). The overall 1-, 3-, and 5-year cumulative survival rates were 91.4%, 46.4% and 29.0%, respectively. The log-rank test showed that number of metastases, tumor size, tumor cell differentiation and local recurrence or new metastases were statistically significant prognostic factors; while age, sex and site of primary tumors were not significant prognostic factors. Multivariate analysis revealed that tumor differentiation, number of metastases and recurrence or new metastases were statistically significant prognostic factors.

CONCLUSIONUltrasound-guided percutaneous microwave coagulation therapy for hepatic metastases in patients with single metastasis, well-differentiated tumor, and without recurrence and new metastases could achieve long-term survival.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; pathology ; Colorectal Neoplasms ; pathology ; Electrocoagulation ; methods ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; diagnostic imaging ; secondary ; surgery ; Male ; Microwaves ; therapeutic use ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Stomach Neoplasms ; pathology ; Survival Rate ; Ultrasonography

BACKGROUNDPrimary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.

METHODSThe study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group). Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time, and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.

RESULTSBaseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P = 0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54 ± 18) minutes and (112 ± 55) minutes, P < 0.0001) and the percentage of patients with D2B < 90 minutes was increased in the DIRECT group (96.9% and 27.0%, P < 0.0001). The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P = 0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P = 0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis.

CONCLUSIONDirect ambulance transport of STEMI patients to the catheterization laboratory could significantly reduce D2B time and improve success rate of primary PCI and 30-day clinical outcomes.

Aged ; Ambulances ; statistics & numerical data ; Angioplasty, Balloon, Coronary ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Prospective Studies ; Time Factors ; Treatment Outcome

OBJECTIVETo analyze the clinical and laboratory features of chronic lymphocytic leukemia (CLL).

METHODSRetrospective investigation of 263 patients with CLL in our hospital between Feb. 2000 and Jan. 2007.

RESULTSThe median age was 60 years with male/female ratio of 2.17 : 1. Patients who were asymptomatic at diagnosis (35.4%) had low Rai grades. Fatigue and lymphadenopathy (54.8%) were the most common features at presentation. Infections, connective tissue diseases and secondary tumors frequently occurred in CLL. WBC counts were between (10 - 100) x 10(9)/L, with lymphocytes percentages more than 0.50 in 97.1% patients. Bone marrow was normal- to hyper-cellularity with lymphocytes percentages more than 0.300 in 99.4% patients. Diffuse infiltrations in bone marrow section were found in 72.2% patients. There were lower CD5 (85.1%) and higher CD25 (78.9%) positivities in the present series as compared with that in other reports. Hypogammaglobulinemia, especially hypo-IgM, usually occurred. Chromosome abnormality were rarely found by routine chromosome examination.

CONCLUSIONSThere were some clinical and laboratory characteristics different from that of abroad data. Further exploration of new markers is required for prognosis prediction and treatment choice.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell ; genetics ; pathology ; Male ; Middle Aged ; Retrospective Studies