Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis(HCA) after preterm premature rupture of membranes (PPROM).Methods From January 2008 to January 2013,103 women with PPROM at 28-33+6 weeks of gestation undergoing deliveries were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 68 cases in histologic chorioamnionitis (HCA group) and 35 cases in non-chorioamnionitis (control group).Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C reactive protein (CRP) level at admission and before delivery,and the neonatal outcomes were compared between two groups.The risk factors were analyzed by multivariable Logistic regression analysis.Results The incidence of HCA was 66.0％ (68/103) in all cases with PPROM.The occurring ruptured membrane gestation in HCA group was (28.2 ± 1.2) weeks,which were significantly earlier than (32.3 ± 1.4) weeks in control group (P ＜ 0.05).The level of CRP of (8.3 ± 4.7) mg/L before dehvery in HCA group was significantly higher than (5.4 ± 3.2) mg/L in control group (P ＜ 0.05).The rates of oligohydramnios and cesarean sections were significantly higher than those in control group (P ＜0.01 or ＜0.05).Using multivariable Logistic regression analysis,oligohydramnios,gestational age of PPROM ＜ 32 weeks,serum CRP level ＞ 8 mg/L before delivery and latency period 48-168 h were significantly associated with HCA (P ＜ 0.01 or ＜ 0.05).The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group (P ＜ 0.05).The incidence of Apgar ＜ 7 scores,abnormal brain ultrasonography findings,neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group (P ＜ 0.05).Conclusions HCA has significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.

Objective To explore the changes of CD4~+ cell and relevant cytokines from chronic hepatitis B patients and the significance was discussed. Methods The expression of CD4,CD8 and CD28 molecules on PBMC was detected with Flow Cytometry.The levels of IL-2,IFN-?,IL-4,IL-10 and IL-12 in serum were measured with ELISA,and the liver function test including serum ALT,SB,ALP and albumin was conducted. Results Three conditions of CD4~+ ratio from PBMC in 86 patients were observed,that showed lower,similar or higher comparing with normal controls.According to CD4~+T cell ratio,the patients were divided into 3 groups.In three groups,the changes of CD28 expression paralleled to that of CD4~+T cell ratio.Except IL-4,the level of cytokines related to viral clearance such as IL-2,IFN-?,IL-10 and IL-12 in patients was elevated compared with controls(P

Objective To analyze the clinical features of systemic lupus erythematosus (SLE) com-plicated by noncirrhotic portal hypertention (NCPH),and improve the recognition of NCPH.Methods Clinical data from SLE complicated by NCPH in our hospital were retrospectively analyzed and summarized,while the related literatures were reviewed.Results Four patients diagnosed as SLE complicated by NCPH were all women.NCPH presented with the clinical features of portal hypertension with normal or slightly elevated transaminase.Anticardiolipin (ACL) antibodies were positive in 2 patients.Two patients underwent liver needle biopsy,showing nodular regenerative hyperplasia,of which,one with liver portal fibrosis.The treatment strategy was managing the primary disorder and controling of portal hypertention in four patients.Twenty-two cases of SLE complicated by NCPH were reviewed and analyzed,including 18 cases from related literatures and our 4 cases.Among the 22 cases,the mean time between the diagnosis of SLE and NCPH was eight years,of which one patient with NCPH before SLE,one diagnosed at the same time and the rest with NCPH after SLE.19％ (4/21) of patients presented with Raynaud's phenomenon and 18％ (4/22) complicated by pulmonary hypertension.In serological tests,patients presented with positive ACL anti-bodies [33％(7/21)] and anti-dsDNA [48％(10/21)],as well as increased IgG and γ-Globulin [38％(8/21)].Liver needle biopsy showed nodular regenerative hyperplasia or liver portal fibrosis with the prevalence of 80％ (16/20) and 25％ (5/20),respectively.Conclusion SLE complicated by NCPH is very rare clinically and is easily being misdiagnosed without obvious symptoms and signs in the early stage.Positive ACL antibodies and Raynaud's phenomenon maybe be closely related to SLE complicated by NCPH.

Objective To understand the iodine nutritional status of urban and rural pregnant women in Shijiazhuang.Methods Urban pregnant women were selected from 8 neighborhood committees of Chang' an District,Shijiazhuang,while the rural pregnant women were selected from 72 villages of 18 counties in Shijiazhuang.These research subjects were grouped into women with early pregnancy at 1-12 weeks,mid pregnancy at 13-28 weeks and third trimester at 32-40 weeks.Urine samples of the subjects were collected.Arsenic-cerium catalytic spectrophotometry (WS/T 107-2006) was used to determine urinary iodine concentrations (UIC).Results Seven hundred thirty-seven urban pregnant women and 898 cases from the rural areas,totally 1 635 subjects were included into the survey.The median UIC of urban subjects,rural cases,and all pregnant women in Shijiazhuang was 169.0,145.9 and 156.7 μg/L,respectively.The median UIC of the rural pregnant women was significantly lower than that of their urban peers (x2 =54.569,P ＜ 0.05).Urban pregnant women with UIC less than 150 μg/L accounted for 40.30％ (297/737) of the total cases,and rural pregnant women 51.89％ (466/898).The difference was statistically significant between these subjects (x2 =21.864,P ＜ 0.05).The median UIC of pregnant women at third trimester of the urban and the rural areas was 113.5 and 145.6 μg/L,respectively.Though their UICs were not up to the national criteria (150 μg/L),the difference was statistically significant between the urban and the rural subjects (x2 =8.365,P ＜ 0.05).UIC less than 150 μg/L of the urban and the rural pregnant women [60.19％ (65/108) vs 51.96％ (93/179)]at third trimester was not significantly different (x2 =1.844,P ＞ 0.05).Conclusions Iodine deficiency is present in pregnant women in Shijiazhuang City.Iodine deficiency among rural pregnant is more severe than that of peers of urban.The iodine deficiency is more severe in the pregnant population at late pregnancy.Besides iodized salt,food with rich iodine should be supplemented for the pregnant,especially those at the third trimester.It is important to monitor iodine nutritional status dynamically during the pregnancy to keep a proper UIC for the pregnant.

BACKGROUND: There is still no affirmative conclusion on the proliferative characteristics and the sources of neural progenitor cells after chronic compressive injury of spinal cord in adult mammals and the effects of astrocytes in this process.OBJECTIVE: To investigate the proliferative characteristics and the sources of neural progenitor cell and the effects of astrocytes by means of analyzing the changes of expression of nestin and glial fibrillary acidic protein after chronic compressive injury of spinal cord and after decompression in adult rats.DESIGN: Completely randomized control trial.SETTING: Orthopaedics Research Institute, the Second Hospital of Lanzhou University.MATERIALS: The experiment was completed in Orthopaedics Research Institute of the Second Hospital of Lanzhou University from March to October 2003. A total of 50 adult healthy Wistar rats were selected and randomly divided into normal control group, moderate chronic compressive spinal cord injury group (compressive mass occupied 40% of the diameter of spinal canal), severe compression group (compressive mass occupied 60% of the diameter of spinal canal). Three-day and 10-day decompression groups (depression after 24-hour severe compressive injury) with 10 in each group.MAIN OUTCOME MEASURES: ① Grey value of positive expression of nestin in grey and white matter in spinal cord segment near compression (5 mm to the edge of compression) in rats of each group. ② Expression of glial fibrillary acidic protein in spinal cord of rats in each group.RESULTS: All the 50 rats entered experimental analysis. ①There were significant expressions of nestin in moderate compression group (white matter 235.33±6.48, grey matter 196.28±6.55), severe compression group (white matter 190.45±4.91, grey matter 173.15±5.98), 3-day decompression after severe compressive injury group (white matter 198.39±3.24, grey matter 180.38±4.51) and 10-day decompression group (white matter 202.55±3.54) (P ＜ 0.05), especially in severe compression group (P ＜ 0.01).Compared with the normal control group, the difference between the ex pression of nestin in grey matter and that in ependymal cells on the central canal of spinal cord in 10-day decompression group has no significance (P ＞ 0.05). ②Compared with normal control group, the expression of glial fibrillary acidic protein in spinal cord increased in each injury group,and the amount of positive cells of glial fibrillary acidic protein went up and cell soma was hypertrophic, and the processes became thicker and longer.CONCLUSION: There is neural progenitor cell proliferation in the early stage of chronic compressive injury of spinal cord and after decompression in adult rats. Astrocyte participates in proliferation and migration of neural progenitor cells and has important trophic and repair effects on spinal cord.

Objective To investigate effects of exogenous sonic hedgehog (Shh) on proliferation of neural stem cells (NSCs) in ependymal area and recovery of motor function after spinal cord injury (SCI) in adult rats.Methods Fifty-five female SD rats were involved in the study:five were selected as normal control group and fifty as Shh group (n =25) and SCI group (n =25) after being subjected to SCI at T10 segment using the modified Allen' s method according to the random number table.At 1,3,7,14,and 28 days after operation,restoration of hindlimb motor function of SD rats was assessed with modified Tarlov scale and changes of double positive cells of Brdu and Nestin with double-stained immunofluorescence.Results Tarlov scale revealed statistical difference between Shh and SCI groups since days 7 postoperatively (P ＜ 0.05).In the double-staining test,number of double positive cells of Brdu and Nestin was greater in Shh Group than in SCI Group since day 3 postoperatively [(97.20 ± 18.23) vs (72.60± 15.60),(153.60 ±25.76) vs (112.20 ±23.63),(133.80 ±21.02) vs (94.20± 18.70),(89.80 ± 15.42) vs (43.40 ± 10.62),P ＜ 0.05].Conclusion Exogenous Shh is conducive to the proliferation of ependymal NSCs and the recovery of motor function in SCI rats.

Objective To assess the reliability and validity of the Chinese version of the neuropsychiatric inventory (CNPI). Methods The CNPI was administered to 219 caregivers of patients with Alzheimer's disease (AD). Each caregiver was retested 4 weeks after initial testing. Results The Cronbach a coefficient of the total symptom scale was 0.69. The Cronbach α coefficient of the total caregiver distress subscale was 0.72. The Cronbach α coefficient of the entire inventory was 0. 82. The test-retest coefficients ranged from 0.66 to 0.98 (P < 0.01). Principal axis factoring analysis of the symptom subscale yielded a five-factor solution which contributed to 67.0% of the cumulative variance. Factor 1, which included aberrant motor behavior, hallucinations, delusion and irritability had the most significant contribution to the cumulative variance. Principal axis factoring analysis of the caregiver distress subscale also yielded a five-factor solution which contributed to 70.2% of the cumulative variance. Factor 1, which included depression, delusion, sleep/night behavior, aberrant motor behavior, and irritability had the most significant contribution to the cumulative variance. Conclusion This Chinese version of NPI is a reliable and valid tool for measuring neuropsychiatric disturbances in patients with AD.

Objective To study the clinical char acteristics and outcome of two lymphoma patients mimicking Beh?et's disease. Methods Lymphoma was diagnosed in two patients mimicking Beh?et's disease referred to our Department in 2015. A search on published similar cases in Chinese database and the Pubmed was also performed and then analyzed. Results Eight patients were indentified in this pooled analysis, six of which were non-Hodgkin lymphoma (NHL). All of the eight cases presented with cutaneous lesion, seven cases with fever, seven cases with oral ulceration and six cases with orogenital ulceration, respectively. Ocular involvement was present in four of the eight cases, two were with a positive pathergy test. Among feverish patients, six were moderate or high fever, four were high fever, one was low-grade fever. Neutropenia was found in four patients, and lymphocytoponia in four of five patients with detailed data. All patients fulfilled the 2014 International Criteria for Beh?et's Disease (ICBD) with an average score of (5.8 ±1.5), ranging from 4 to 8. Survival period ranged from one month to 36 months, with an average of 8 months. Conclusion For patients diagnosed as Beh?et's disease are finally diagnosed as lymphoma. For patients with Beh?et's disease present-ation but also present with mediate to high fever, atypical deepseated ulcer, neutropenia or lymphocytoponia, malignancy especially lymphoma should be investigated.

Objective To observe the incidence of acute gastrointestinal injury (AGI) in intensive care unit (ICU) patients, and to approach the value of serum citrulline and intestinal fatty acid binding protein (IFABP) on diagnosis of AGI in critical patients. Methods A prospective study was conducted. 576 critical patients admitted to ICU of Yantai Yuhuangding Hospital from February 2016 to February 2017 were enrolled. According to the AGI classification proposed by European Society of Intensive Care Medicine (ESICM) in 2012, the AGI and severity of the patients were observed. The general data, severity and prognosis of patients with different AGI grades were recorded. According to the random number table, 20 patients with normal kidney function from AGI Ⅰ to Ⅳ were selected. The femoral artery blood was collected within 12 hours of ICU admission, and serum citrulline level was detected by high performance liquid chromatography (HPLC). Serum IFABP level was determined by enzyme-linked immunosorbent assay (ELISA). Twenty healthy subjects were selected as controls. The receiver operating characteristic curve (ROC) was drawn, and the predictive values of citrulline and IFABP for AGI diagnosis were evaluated. Results ① 576 patients were enrolled in the analysis. Of which 530 patients (92.0%) had AGI, and 289 patients with gradeⅠ (54.5%), 154 with grade Ⅱ (29.1%),64 with grade Ⅲ (12.1%), and 23 with grade Ⅳ (4.3%). With the increase in AGI classification, acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score, sequential organ failure score (SOFA), the length of ICU stay and 28-day mortality were gradually increased. ② Compared with health control group, the levels of serum citrulline in patients with different AGI grades were significantly decreased, and IFABP was significantly increased. With the increase in AGI classification, the citrulline level was gradually decreased, and IFABP level was gradually increased [citrulline levels (μmol/L) in AGIⅠ,Ⅱ,Ⅲ,Ⅳ groups were 14.1±3.6, 12.7±3.1, 8.3±2.7, and 5.6±3.4, F = 3.287, P = 0.027, and IFABP levels (ng/L) were 526.7±204.9, 698.4±273.8, 894.7±455.9, and 1 062.8±532.2, F = 2.903, P = 0.043]. ROC curve analysis showed that citrulline had a higher predictive value for AGI diagnosis. The area under the ROC curve (AUC) was 0.927. When the cut-off value of citrulline was 9.7 μmol/L, the sensitivity and specificity were 87.5% and 87.5%, respectively. The AUC of IFABP was 0.043, which has no predictive value for the diagnosis of AGI. Conclusions The AGI is extremely common in ICU. The higher the AGI grade is, the worse the prognosis is. Citrulline has high diagnostic value for AGI in critical patients, but IFABP has no predictive value on the diagnosis of AGI.

Objective To explore CT features of ectopic pancreas in the gastrointestinal tract,and to compare and analyze with the pathological findings.Methods The clinical data of 20 cases with ectopic pancreas in gastrointestinal tract proved by surgery pathology or endoscopic biopsy were analyzed retrospectively,and the characteristics were summarized.Results Ectopic pancreas in gastrointestinal tract-20 single lesions,4 cases at lesser curvature of gastric body,7 cases at greater curvature of gastric antrum,6 cases at lesser curvature of gastric antrum,1 case at gastric angle and 2 cases at duodenum.The longest diameter of ectopic pancreas was from 0.8 to 3.5 cm,while the shortest one was from 0.6 to 2.5 cm.The axis of the lesions was parallel to the wall of the gastrointestinal tract. For 1 8 ectopic pancreas in gastrointestinal tract,1 6 were ovoid or round in shape,and the other 2 were slight lobulated.2 lesions in duodenum were ovoid in shape.1 2 lesions'margins were well-defined and ill-defined in other 8.Plain CT showed the ectopic pancreas with homogeneous density,1 8 lesions with endoluminal growth and exophytic growth of other 2 cases.The cystic change was also found in 2 cases.Enhanced CT showed 2 lesions with significant homogeneous enhancement,mainly composed of pancreatic acini in pathology;14 with medium enhancement close to the normal pancreas,composed by pancreatic acini,islet and ducts,and 2 with slight enhancement,composed with mature differentiated mucous glands with ducts.Two lesions'center cystic change areas show no enhancement result.Conclusion The CT features,such as direction of its organic axis,endoluminal growth and enhancement patterns have its useful characteristics.Different enhanced patterns of ectopic pancreas in gastrointestinal tract are related with the pathologic change.