Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.

Objective To establish a method for the determination of complanatuside in Semen Astragali Complanati, and study the content change of complanatuside processed. Method HPLC was used with Apollo-C18 column (4.6 mm?250 mm, 5 ?m), acetonitrile-0.1%phosphoric acid (21∶79) as mobile phase, the flow rate at 1.0 mL/min, and detected wavelength was set at 266 nm. Result Complanatuside showed a good linearity relationship in the range of 0.041 6～0.665 6 ?g, r =0.999 9. The average recovery was 100.6%, RSD was 0.73%. Conclusion The method is simple, accurate, reproducibility and strong specificity. It can be used for the quality control of Semen Astragali Complanati. Processing with salt can lead to content decrease of complanatuside in Semen Astragali Complanati.

Objective To study the effect of nutrition supports in aged mechanically ventilated patients fol-lowing thracic trauma. Methods 48 aged mechanically ventilated patients following thracic trauma were randomly divided into two groups,patients in treatment group( n = 24) received EEN and PN,control group( n = 24) only re-ceived TPN. Compared the nutritional index, time of mechanical ventilation and compared the complications such as windy,intestine paralysis, alimentary tract heorrhage, second heavy infection, hypohepatia and high blood glucose.Results The nutritional index between treatment group and control group had no statistical difference,but the time of mechanical ventilation and the ratio of the complications in control group were higher than that in-treatment group (P < 0.01). Conclusion EEN and PN can improve nutritional condition, have less complieations, promoting the pa-tient recovers form illness.

Objective To explore the effect of psychological intervention on the mental conditions and the quality of life of patients with radiation encephalopathy(REP).Methods thirty-five patients with REP from radiotherapy for nasopharyngeal carcinoma were divided into the control group(n=17)and the experiment group(n=18)according to their registration sequence. The control group was managed with conventional nursing,and the experiment group with individualized psychological intervention in addition to routine nursing for 12 weeks.The two groups were compared in terms of depression and quality of life by Hamilton Depression rating Scale(HAMD)and The short-form health survey questionnaire(SF-36).Results The two groups before treatment showed no statistical difference in scores by HAMD and SF-36(P>0.05).The experiment group was superior to the control group after intervention in depression and quality of life(P<0.01).Conclusion Psychological intervention may alleviate REP in the patients at poor psychological status and improve their quality of life.

Objective:To explore whether microRNA-21-5p (miR-21-5p) has the effect of anti-apoptosis of human alveolar typeⅡ epithelial cells (ATⅡ).Methods:ATⅡ cells derived from the human were cultured in vitro and used for experiments when the cells were grown until the presence of lamellar bodies and microvilli were observed by light microscope. The cells were divided into blank control group (direct culture), hydrogen peroxide (H 2O 2) injury group (cultured with 0.5 mmol/L H 2O 2), and miR-21-5p overexpression group (using miR-21-5p with a multiplicity of infection (MOI) of 100 lentiviral overexpression vector with 0.5 mmol/L H 2O 2) and miR-21-5p empty virus control group (miR-21-5p lentiviral blank vector was co-cultured with 0.5 mmol/L H 2O 2). In each group, cell proliferation was detected by cell counting kit-8 (CCK-8) at 0, 12, 24, 36, and 48 hours of cell culture; cell apoptosis was detected by flow cytometry at 24 hours of culture. Results:① Cell proliferation activity test results: with the extension of cell culture time, the cell proliferation activity of the blank control group gradually increased, while the cell proliferation activity gradually decreased after the addition of 0.5 mmol/L H 2O 2. However, the cells proliferation activity in the miR-21-5p overexpression group decreased more slowly than that in the H 2O 2 injury group and the miR-21-5p empty virus control group, and the cell proliferation activity at 48 hours was significantly higher than the H 2O 2 injury group and the miR-21-5pempty virus control group ( A value: 0.295±0.005 vs. 0.184±0.005, 0.169±0.002, both P < 0.05). It showed that both H 2O 2 and lentivirus accelerated cell damage, while miR-21-5p could reduce cell apoptosis. ② Apoptosis rate test results: compared with the blank control group, the apoptosis rate increased significantly after adding 0.5 mmol/L H 2O 2; while the apoptosis rate of the miR-21-5p overexpression group was lower than that of the H 2O 2 injury group and miR-21-5p empty virus control group [early apoptosis rate: (14.31±0.12)% vs. (24.50±0.12)%, (23.41±0.13)%; late apoptosis rate: (8.12±0.13)% vs. (9.71±0.11)%, (10.41±0.15)%; overall apoptosis rate: (22.33±0.12)% vs. (34.21±0.10)%, (33.82±0.14)%; all P < 0.05], which further proved that miR-21-5p had anti-apoptotic effects. Conclusion:miR-21-5p has an anti-apoptotic effect on human ATⅡ.

ObjectiveTo detect the value of ultrasound-guided steroids injection for the treatment of plantar fasciitis.MethodsThirty-eight physical therapy ineffective plantar fasciitis patients were enrolled in this study, and randomly divided into ultrasound-guided and palpation-guided groups. Pain intensity was measured using a visual analog scale (VAS) and plantar fasciitis were evaluated by high frequency ultrasound including assessment of the thickness before injection and at 4 weeks, 12 weeks post injection.ResultsThirty-eight patients who received either ultrasound guided or palpation-guided injection had significantly lower visual analog scale scores and lower plantar fascia thickness (bothP<0.01) at 4 weeks, 12 weeks post injection. The differences in plantar fascia thickness, VAS score between the two groups before, and at the 4 weeks follow-up were not statistically significant [2.52±0.77vs 2.68±0.82,P>0.05; (4.56±0.25) mmvs (4.72±0.38) mm, P>0.05]. However, the ultrasound guided group had lower mean visual analog scale score (1.47±0.77vs 2.37±0.68,P<0.01) and lower mean plantar fascia thickness [(4.02±0.24) mmvs (4.53±0.35) mm,P<0.01] than the palpation-guided group at 12 weeks post injection. The calcification of the plantar fascia at 12 weeks post injection in ultrasound guided group was completely disappeared or significantly decreased.ConclusionUltrasound-guided injection for treating plantar fasciitis is more accurate and effective than palpation-guided injection, and is of great clinical value for both patients and doctors.

Objective To evaluate the vulnerability of carotid arteriosclerosis plaque by ultrasound real-time tissue elastography in patients with SSS-TOAST1 style cerebral infarction, and discussing the value of the technique in assessment of the clinical course after cerebral infarction. Methods There were 113 patients of SSS-TOAST1 style cerebral infarction who had carotid arteriosclerosis plaque and 48 patients of contrast group who had carotid arteriosclerosis plaque selected by ultrasound in Department of Ultrasound, Beijing Tiantan Hospital, Capital University of Medical Sciences. The results between two groups were compared. The cerebral infarction group was divided into two sub-groups according to the clinical course of patients after cerebral infarction, and the difference between them was compared. Results The size had no significant difference between cerebral infarction group and contrast group as well as between aggravated group and non-aggravated group (t=15.61, 10.77, 4.52, P<0.05). The real-time tissue elastography of carotid arteriosclerosis plaques were red-green in most patients of cerebral infarction group. The real-time tissue elastography of carotid arteriosclerosis plaques were green-blue in most patients of in control group. The value of elasticity of plaque, vessel wall and stiffness of carotid arteriosclerosis plaque between cerebral infarction group and control group had significant differences (t=15.61, 10.77, 4.52, P<0.05). The value of real-time tissue elastography between aggravated group and non-aggravated group had significant difference (t=6.39, 2.30, 3.80, P<0.05). Conclusion Real-time tissue elastography could evaluate the stiffness of carotid arteriosclerosis plaque, which was related with the vulnerability of carotid arteriosclerosis plaque. The values of elasticity of plaque, vessel wall and stiffness of carotid arteriosclerosis plaque in patients with SSS-TOAST1 style cerebral infarction were lower, and the vulnerability of carotid arteriosclerosis plaque was higher. Real-time tissue elastography had some worth in evaluating the clinical course of patients after cerebral infarction.

Objective To observe the clinical effect of transforaminal endoscopic surgical system (TESSYS) technique for atypical lumbar disc herniation. Methods Eighteen patients with atypical lumbar disc herniation underwent TESSYS technique under local anesthesia. Numerical rating scale (NRS) was used to evaluate the sciatica and/or back pain. The outcomes were evaluated by Oswestry disability index (ODI) and the Macnab score. Results The postoperative NRS scales were significantly lower than preoperative one (P<0.01). The postoperative ODI was lower than preoperative one (P < 0.05). Good rate of modified Macnab criteria was 88.89%. One patient occurred right hip pain and disappeared after partial closure. one patient turned to open surgery at 1 week. Conclusion The TESSYS technique was an effective method for atypical lumbar disc herniation. It has satisfactory clinical effect which is worthy of spreading for clinical application.

Objective To investigate the feasibility of fine needle aspiration cytopathology in the diagosis of lymphoma.Methods To compare cytopathology with histopathology of 72 lymphoma cases and analyse immunochemistry stain of 3 cases.Results 61 of 72 cases were diagnosised as lymphoma in cytopathology,while 58 of 61 cases were diagnosised as lymphoma in histopathology.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value rates of cytopathology were 89.2 ％ (58/65),57.1％ (4/7),86.1％ (62/72),95.1％ (58/61),and 36.4 ％ (4/11) respectively.Conclusion Fine needle aspiration cytopathology is significant to the diagnosis of lymphoma.It should greatly improve the accuracy of lymphoma diagnosis and make it possible to subclassify lymphoma,combined cytopathology with other auxilary detection.

The Arteria dorsalis pedis of 50 lower limbs of adult Chinese cadavers were injected with the chloroform solution of red pigment.Then the cutaneous arteries of the Ar- teria dorsalis pedis were dissected,observed and measured under an operating microscope. The arteria dorsalis pedis was divided into proximal,intermediate and distal portions. In all cases this artery gives off direct cutaneous arteries which are more concentrated in the proximal and distal portions. In the proximal portion,the cutaneous arteries are constantly provided with larger caliber and longer length of extension.The percentage of the presence of the cutaneous arteries of the distal portion is rather high,yet both their caliber and length of extension are smaller than the branches of the proximal portion. There are certain anastomoses between the neighboring cutaneous arteries.Most of the cutaneous arteries run along the course of the medial dorsal cutaneous nerves.This nerve may be considered as a guide to find those cutaneous arteries. The caliber of the most cutaneous arteries is large enough for microsurgical vaso- anastomosis.Thus the data of this article may be helpful to clinicians who want to make a vascularized free dorsalis pedis skin flap.