Objective To explore the optimal timing of termination of pregnancy,we analyzed the different gestational age in repeat cesarean delivery and maternal and neonatal outcomes.Methods This was a retrospective study.The information of cesarean sections was collected from maternal obstetric records in the electronic medical recording system of the First Affiliated Hospital of Chongqing Medical University from June 1,2011 to June 30,2013,and women with intrauterine viable singleton pregnancies delivered after 37 weeks of gestation without prenatal complications were selected.They were divided into five groups with different gestational weeks.Maternal general information,perioperative outcome and rate of neonatal adverse event were analyzed with one way ANOVA analysis and Chi-square test.Results A total of 579 cases of elective repeat cesarean at term were performed.The ratios of cesarean section prior to 39 and 39-39+6 weeks of gestation were 64.6％ (374/579) and 29.0％ (168/579),respectively.No fetal,neonatal or maternal death occurred.There were no statistically significant differences in the termination of pregnancy at 37-37+6 weeks,38 38+6 weeks,39-39+6 weeks,40 weeks and ≥ 41 weeks between the two time intervals for cesarean section (P＞0.05).There were statistically significant differences in the length of hospitalization [(4.9±3.0),(4.3 ± 1.3),(4.3 ± 1.0),(4.5± 1.2) and (4.0±0.7) d,respectively; F=2.849,P＜0.05].No significant difference was observed in the maternal BMI,placental membrane residue,maternal perioperative bleeding,premature rupture of membrane (PROM),intensive care unit (ICU) admission and uterine resection (P＞0.05).There were statistically significant differences among the five groups in neonatal weight [(3 082.9±479.2),(3 318.1 ±390.8),(3 415.7±431.1),(3 630.5±475.2) and (3 334.0±242.5) g,F=13.798] and length [(48.8± 1.5),(49.3± 1.5),(49.6± 1.5),(50.0± 1.5) and (47.8±3.9) cm,F=7.460; both P＜0.05].One min and 5 min Apgar scores also showed statistically significant differences [1 min:(9.7±0.7),(9.8±0.6),(9.8±0.4),(9.7±0.5) and (8.8±2.7) ; F=4.432; 5 min:(9.9±0.3),(10.0±0.3),(10.0±0.2),(10.0±0.2) and (9.2± 1.8),F=9.625; all P＜0.05].The overall rates of neonatal adverse events,including the admission to neonatal intensive care units (NICU),the rates of cardiopulmonary resuscitation or ventilator therapy,asphyxiation,as well as the length of stay in NICU ≥ 5 d among the five groups also showed statistically significant differences [overall:5.4％ (5/93),1.8％ (5/281),0.6％ (1/168),0.0％ (0/32) and 2/5,x2=16.812;NICU:3.2％ (3/93),1.1％ (3/281),0.0％ (0/168),0.0％ (0/32) and 1/5; x2=1 1.294; cardiopulmonary resuscitation or ventilator therapy:2.2％ (2/93),0.7％ (2/281),0.0％ (0/168),0.0％(0/32) and 1/5,x2=10.584; asphyxiation:1.1％ (1/93),0.7％ (2/281),0.0％ (0/168),0.0％ (0/32) and 1/5,x2=9.637; NICU ≥ 5 d:3.2％ (3/93),1.1％ (3/281),0.0％ (0/168),0.0％ (0/32) and 1/5,x2=1 1.294; P＜0.05].The risks of neonatal adverse outcomes in delivery at 37-38+6 weeks were:OR=1.1(95％CI:1.0-2.1) at 37 37+6 weeks,OR=1.3 (95％CI:0.9-1.9) at 38-38+6 weeks,compared with delivery at 39-39+6 weeks.Conclnsions The percentage of repeat cesarean delivery prior to 39 weeks of gestation is high in our hospital,early termination of pregnancy would not reduce the maternal perioperative adverse outcome,but may increase the risk of neonatal adverse events.Taking into account the maternal benefit,we suggest 39 39+6 weeks of gestation as the best time of elective repeat cesarean in order to reduce the risk of neonatal adverse events.

Objective:To investigate the clinical efficacy of mechanical solitaire AB stents thrombectomy combined with intra-arterial thrombolysis in the treatment of patient with acute ischemic stroke.Methods:Fifteen patients with acute ischemic stroke admitted into our hospital from August 2014 to August 2016 were treated with mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis.The National Institutes of Health Stroke Scale score (NIHSS) of all patients were evaluated before and after treatment to compare the clinical efficacy.The prognosis ofpatients between two groups were compared via evaluating modified Rankin score (mRS)and gelasijia coma score (GCS).Results:After mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis treatment,14 patients achieved complete or part recanalization,and 1 patient was terminated treatment due to vital signs instability,and the rate ofrecanalization was 93.3％.The NIHSS score of patients before treatment was 12.93± 4.25,which was much higher than that after treatment (4.33± 1.45,P＜0.05).After follow-up by 3 months,the good mRS scores were obtained in all 18 patients,including 2 patients with mRS score of 2,5 patients with 1,and 8 patients with 0.Additionally,there was no patient with re-obstruction during follow-up period.Conclusion:Mechanical thrombectomy with solitaire AB stents combined with intra-arterial thrombolysis had a good capability and safety in the treatment of patients with acute ischemic stroke.

Objective To investigate the value of the cold supernatant in the clinical practice. Methods 25 cases of TTP got a direct infusion of cold supernatant or plasma exchange using cold supernatant as fluid replacement and with medications at the same time. Then we observed the clinical treatment effect of all the cases. Results The clinical remission rate of 25 cases of TTP was 80%. Conclusion The cold supernatant could be used as a new blood component in clinical application,especially for the treatment of thrombotic microangiopathy (TMA). It not only can save valuable blood resources,but also can reduce the economic costs of patients.

Objective To analyze the misdiagnosed cases of the nodular goiter (NG)in real-time contrast-enhanced ultrasound(CEUS),in order to improve the diagnostic accuracy of NG.Methods Two-hundred and sixty-five cases of NG CEUS images,especially the 48 nodules in 44 misdiagnosis cases,were retrospectively analyzed to find out the main reasons of the misdiagnosis.In addition,the factors which effected the results of CEUS such as size,number and calcification of NG nodules were summarized.Results There were 42 nodules misdiagnosed as thyroid cancer,5 nodules misdiagnosed as thyroid adenoma and 1 nodular goiter misdiagnosed as subacute thyroiditis in 874 nodular goiter cases.The misdiagnosis rate of nodular goiter was 5.49% (48/874)by the diagnostic criterion of homogeneous enhancement in CEUS.The differences size and calcification of nodules had a significant impact on CEUS.The misdiagnosis rate of the NG nodules with major diameter less than 10 mm was much higher than that of more than 10 mm,the misdiagnosis rate of NG nodules with coarse calcification was much higher than the situation of microcalcification(P <0.05).Conclusions Major diameter less than 10mm and coarse calcifications of NG nodular are the main factors which influence the results of CEUS.

Background and purpose:Numerous researches indicated that the expression of pituitary tumor transforming gene1 (PTTG1) was correlated with the severity of glioma tumors. However the specific mechanism of PTTG1 is not clear in glioma. In this study, we explored the role and significance of PTTG1 in the invasion of glioma cells. Methods:Western blot was used to detect the expression of PTTG1 protein in various glioma cell lines. siRNA plasmid was used to transfect U87 cells. Western blot was used to analyze the expression of PTTG1 protein in transfected U87 cells. Matrigel invasion assay was used to detect the invasive ability in the cells being transfected in vitro. Western blot was used to analyze epithelial growth factor (EGF) induced protein phosphorylation of ARK5 and Akt in the cells being transfected PTTG1 plasmid (siPTTG1/U87) and scrambled siRNA (Scr/U87). Results:The expression of PTTG1 protein was higher in all glioma cell lines. After transfection, the invasion of siPTTG1/U87 was obviously decreased after 5 min with EGF stimulation than the Scr/U87, the phosphorylation of ARK5 and Akt was significantly enhanced. However, whether or not the existence of EGF, the phosphorylation of ARK5 and Akt had no differences in siPTTG1/U87. Conclusion:In glioma cells, PTTG1 protein is high expressed and maybe have an important function in glioma cells invasion through Akt-ARK5 signaling pathway.

Objective To investigate the reason for misdiagnosis of real-time contrast-enhanced ultrasound (CEUS) in identifying benign and malignant thyroid nodules and the impact of nodule size and calcification on CEUS result.Methods Retrospective analysis were carried out in 331 cases of thyroid disease patients with 421 nodules.All the nodules were performed CEUS and confirmed by pathology.Results In the total of 421 nodules,33 nodular goiters were misdiagnosed as thyroid carcinoma.8 nodular goiters were misdiagnosed as thyroid adenoma.8 thyroid carcinomas were misdiagnosed as nodular goiter,2 thyroid carcinomas were misdiagnosed as thyroid adenoma.The accuracy of diagnosis for thyroid benign and malignant lesions by CEUS was 87.89％,and the misdiagnosis rate was 12.11％.The size of the thyroid nodule and the form of calcification had influence on diagnosis.In the group with diameter of the nodule less than 10 mm,the misdiagnosis rate was higher compared with the other two groups,and the difference was statistically significant (P＜0.05).In addition,the misdiagnosis rate in the group with bulky calcification was higher than microcalcifications group,and the difference was statistically significant (P＜0.05).Conclusion The size of the thyroid nodule and the form of calcification have some impact on diagnosis of CEUS.To make clear the reason for misdiagnosis is beneficial to improve the diagnostic level of thyroid diseases.

Objective To investigate the effects of resveratrol on inhibiting proliferation and inducing apoptosis of U251 cells. Methods The proliferation activity was detected by MTT assay, and apoptosis of early and late period by method of Annexin V-FITC apoptosis assay, and the cell morphological changes were observed by microscopy after U251 cells being treated with resveratrol. Results Resveratrol could significantly inhibite the proliferation and induce the apoptosis of early and late period of U251 cell in a time-and does-dependent manner. Conclusion Resveratrol can significantly inhibite the proliferation and induce the apoptosis of early and late period of U251 cell.

Objective To study the effect of Xin Kang Injection on cardiac function of rats with adriamycin-induced myocarditis and to explore its pharmacological mechanism.Methods Seventy Wistar rats were randomly divided into seven groups:normal control group,model group,three-dosage Xin Kang Injection groups(high-,moderate-and low-dosage respectively),deslanoside group,and Huangqi group.The myocarditis rat model was established by intraperitoneal injection of adriamycin.Left ventricular end-diastolic pressure(LVEDP),left ventricular systolic pressure(LVSP),heart rate(HR),T value,and ? DP/DTmax were observed.Results LVSP,+ DP/DTmax in the treatment groups were higher and-DP/DTmax lower than those in the model group(P

Objective To analyze the phenotype and genotype of a Chinese family with inherited hypofibrinogenemia,and to investigate its molecular mechanism.Methods Peripheral blood was collected from seven people of this family and then plasma was separated.Activated partial thromboplastin time ( APTT),prothrombin time ( PT),thrombin time ( TT),reptilase time ( RT),the activities of antithrombin( AT∶ A ),protein C ( PC ∶ A ) and protein S ( PS ∶ A ) were tested.The activity and antigen of plasma fibrinogen were analyzed by Clauss method and immunoturbidimetry method,respectively.The fibrinogen peptide chain of the proband was semiquantitatively assessed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE).Thrombin generation test was performed by calibrated automated thromhogram.The dynamic process of blood coagulation was evaluated by the thrombelastography (TEG).Genomic DNA was extracted from the peripheral blood.The sequences of all the exons and exon-intron boundaries of the three fibrinogen genes FGA,FGB and FGG were amplified by polymerase chain reaction ( PCR ) and analyzed by direct sequen(c)ing.Results The activity and the antigen levels of the proband' s plasma fibrinogen were reduced to 0.48 g/L and 0.68 g/L,respectively.TT prolonged to 29.2 s and RT prolonged to 75.8 s.The assays of SDS-PAGE showed no abnormal molecular weight of fibrinogen.Peak height of thrombin generation was reduced to 249.93 nmol/L and endogenous thrombin potential was reduced to 1007.0 nmol · L-1 · min.Hypocoagulability state of the whole blood was found by TEG test.The coagulation index was - 8.6.The proband was diagnosed as inherited hypofibrinogenemia by phenotype analysis.Two mutations (Gln143Pro and g.4642delC) were found in the proband's fibrinogen Aa-chain gene,Gln143Pro came from her mother and g.4642delC came form her father.Conclusion Compound Heterozygous Mutations (Gln143Pro and g.4642delC ) of fibrinogen Aa-chain causes the proband congenital hypofibrinogenemia.

Objective Rheumatoid arthritis (RA) is a systemic autoimmune disease, which mainly involves joints across the body, resulting in joint stiffness and loss of daily activity. Recent evidence suggests that numerous self-reacting T cells, including Th1 and Th17, infiltrate the synovium in RA patients, accompanied by functionally-compromised Treg. Iguratimod, a new small molecule with anti-inflammatory and immunomodulatory effects, has shown curative effects in animal models of arthritis. In this study, we aimed to test the clinical effects of Iguratimodˊs on RA patients and its role in immunoregulation. Methods We examined the clinical effects of iguratimod on RA patients in a random controlled clinical trials and analyzed its effects on Th1, Th17 and Treg as well as their associated cytokines and transcription factors by flow cytometry and real-time polymerase chain reaction (PCR). Then t-test, chi-square test and rank sum test were used to conduct statistical analysis. Results Our results revealed that iguratimod therapy provided significantly greater clinical benefit [ACR20, ACR50, ACR70 reached 50%, 20%, 15% respectively in iguratimod treatment group, Z=-2.216,P=0.027] than placebo group with the reduction of Th1 and Th17 but increment of Treg after iguratimod treatment [Th1: week 0 (26.5 ±8.0)%, week 24 (14.2 ±7.3)%, P<0.01; Th17:week 0 (1.7±0.7)%, week 24 (1.3±0.4)%, P<0.05;Treg:week 0 (6.8±1.6)%, week 24 (8.9±2.9)%, P<0.05], which was statistically significant. Conclusion Our results provide theoretical and clinical based evidence for the impact of iguratimod on immunomodulation of RA.