Objective To evaluated the value of hysteroscopy and dilatation and curettage (DC) in diagnosis of endometrial cancer. Methods This retrospective analysis included clinical pathologic data of 3 676 patients with endometrial cancer from Jan. 1, 2000 to Dec. 31, 2010 in hospitals of endometrial cancer prevention projects in Guangdong Province. Results A total of 3 676 patients with endometrial cancer were divided into DC group (3 211 patients) and hysteroscopy group (465 patients). Compared to the results of pathological diagnosis, the accuracy rate between DC group and in hysteroscopy group were no statistically difference was 91.00%(2 922/3 211) vs 90.75%(422/465;χ2=0.030, P=0.862). The accuracy rate, sensitivity, specificity, positive predictive value and negative predictive value of cervical involvement between DC group and hysteroscopy group were 81.28%vs 86.45%(P<0.01), 24.78%vs 23.68%(P>0.05), 93.76%vs 98.71%(P<0.01),46.75%vs 78.26%(P<0.01) and 84.95%vs 86.88%(P>0.05), respectively. Rate of positive peritoneal cytology in DC group was 4.76%(153/3 211), and the rate was 3.23%(15/465) in hysteroscopy group, which were no statistically difference (χ2=2.206, P=0.137). There were no statistically difference in 5-year overall survival (91.02% vs 92.03%;χ2=0.033, P=0.856) and 5-year progression-free survival (89.81%vs 91.83%;χ2=1.508, P=0.219) between DC group and hysteroscopy group. Conclusions Hysteroscopy and dilatation and curettage is an effective method in diagnosis of endometrial cancer, especially hysteroscopy is better in diagnosis of cervical involvement. Hysteroscopy don′t improve risks of positive peritoneal cytology and don′t affect the prognosis of patients with endometrial cancer.

Objective To investigate the clinical and pathological characteristics between types 1 and 2 endometrial uterine cancers.Methods The clinical materials of 9 437 patients with uterine cancer were collected with retrospective analysis from 62 hospitals during 2000 to 2010.Results The mean age of type 1 endometrial cancers was less than type 2.There were more young patients in type 1 endometrial cancers.The mean menopause age of type 2 endometrial cancers was greater than type 1.The mean age of menarche,obesity,diabetes,hypertension,infertility,and nulliparous were not significant differences between types 1 and 2 endometrial cancers.There were more patients with advanced tumor,deep myometrium invasion,estrogen receptor (ERs) negative,progesterone receptor (PR) negative,P53 positive,lymph vascular space involvement,cervical stromal invasion,adnexal metastasis,and lymph node metastasis in type 2 endometrial cancers.Conclusions Type 2 endometrial uterine cancers occurred in elder people with more pathological risk factors and more malignant biological activities.

Objective To observe expression and location of cannabinoid receptor 1 (CB1) in liver tissue of patients with chronic hepatitis B (CHB) ,and analyze the relationship of it with the liver fibrosis score,the serum levels of TGF-β1 and Leptin. Methods Liver biopsies were performed in 118 patients with CHB.The expression of CB1 in liver tissue was observed by immune histochemical staining, and semi-quantitative analysis was carried out to devide the CB1 score into four grades: -, +, + +, + + +. Serum levels of TGF-β1 and Leptin were determined by ABC-ELISA double-antibody sandwich method. Results The expression of CB1 in liver tissue with CHB had significant relationship with the fibrosis score. As the expression of the CB1 increased, the fibrosis score became higher ( F = 23. 369,P = 0. 000). Moreover, the expression of CB1 in liver tissue with CHB had significant relationship with the serum levels of TGF-β1 and Leptin( F values were 8. 762 and 5. 749;P values were 0. 001 and 0. 027, respectively). Conclusion CB1 may play promotive role in the process of hepatic fibrosis through regulation of TGF-β1 and Leptin.

Objective To investigate proteolipid protein 1 (PLP1) mutations in six pedigrees with Pelizaeus-Merzbacher disease (PMD),and to provide prenatal consulting and prenatal diagnosis.Methods Subjects were six probands with PMD admitted in Department of Pediatrics,Peking University First Hospital from July 2006 to November 2011 and their family members.Genomic DNA sarnples were extracted from peripheral bloods of probands and their family members.Multiplex ligation-dependent probe amplification (MLPA) technique was used to detect PLP1 duplication mutation.Direct DNA sequencing was used to detect point mutation.Genetic diagnosis were based on PLP1 mutation genotype from probands.Prenatal diagnosis of nine fetuses were performed from seven PLP1 mutation female carriers by fetuses' DNA extracted from amniocytes or villus cells.Results PLP1 duplications were found in probands 1-4 (P1-4) whose mothers and the aunt of proband 1 (P1) were PLP1 duplications carriers.The two cases of point mutation,c.96C＞G(p.F32L) and c.623G＞T (p.G208V),were found in proband 5 (P5) and proband 6 (P6).Hcterozygous changes of the same mutations were found in P5' and P6' mothers with normal phenotypes.Seven female PLP1 mutation carriers were pregnant again.Prenatal diagnosis of PLP1 for nine fetuses presented one PLP1 duplication,one point mutation,one PLP1 duplication carrier,and six wildtypes.A segmental crossing over of X chromosome was detected in one male fetus of PLP1 wildtype.Conclusions PLP1 mutation analysis could help to diagnose PMD pedigree and to identify female PLP1 mutation carrier in the family.The following prenatal diagnosis and proper genetic counseling are very important to prevent PMD child from being delivered.

AIM: To elucidate the mechanism of fibrin in cholesterol gallstone disease. METHODS: Hemostatic indices were systemically examined in the gallbladder bile obtained from 26 patients with gallstones and 17 without gallstones. RESULTS: Significant increases were found in tissue factor (TF) concentration( P

Objective To explore the epidemiology characteristics of endometrial cancer (EC).Methods We retrospectively analyzed 10081 patients diagnosed with EC from 62 hospitals between 2000 and 2010 in Guangdong province.Results The mean age at diagnosis was 52.8 ± 9.3.The proportion were 19.3％,64.2％,16.6％ in patients with ages ≤45,＞ 45-60,＞ 60 respectively.From 2000 to 2010,the mean ages at each year were no statistic significance.The number of cases of EC were positively correlated with years(r =0.964,P ＜ 0.001).The number of cases of patients with ≤ 30 years old (r =0.857,P =0.001),≤35 years old (r =0.866,P =0.001),≤40 years old (r =0.952,P ＜ 0.001),≤ 45 years old (r =0.952,P ＜0.001) were positively correlated with years.The ratios of patients with ≤30 years old (x2 =10.390,P =0.407),≤35 years old (x2 =11.651,P =0.309),≤ 40 years old (x2 =17.329,P =0.067),≤45 years old (x2 =5.154,P =0.881) during these eleven years were no statistic significance.The ratios of type Ⅰ EC at 2000-2010 were no statistic significance.Conclusions EC often present in patients aged from ＞ 45-60 years old.The case number of EC showed an increasing trend.However,the proportion of young patients was stable.The endometroid adenocarcinoma was the main histological type of EC.

Objectives To provide genetic counseling and prenatal molecular diagnosis for two families with megalencephalic leukoencephalopathy with subcortical cysts (MLC).Methods Two MLC patients (probands 1 and 2) were admitted to the Department of Pediatrics of Peking University First Hospital in June 2011 and June 2009,respectively.Peripheral blood was collected and DNA sequencing was performed for genetic analysis for the two MLC patients and their parents.Amniotic fluid and villus of two fetuses (fetus 1 and 2) were collected at 21+4 and 12+3 weeks of gestational age from their mothers when they were pregnant again.The genomic DNA of the two fetuses was extracted and corresponding sites of MLC1 gene were sequenced.Haplotype analysis using a combination of 3 microsatellite markers (AR,DXS6807 and DXS6797) on chromosome X and sex determining region of Y chromosome was performed to detect maternal cell contamination.Verification of the prenatal molecular diagnosis and follow up study after birth were conducted for both fetuses.Results Macrocephaly,motor development delay and typical findings on brain MRI were identified in the two probands,and were clinically diagnosed with MLC.Compound heterozygous mutations were detected in proband 1 [c.353C＞T (p.T118M) and c.803C＞G (p.T268R)] and proband 2 [c.353C＞T (p.T118M) and c.836T＞C(p.L279P)],respectively.MLC was genetically diagnosed.Heterozygous variation in c.353[c.353C＞T (p.T118M)] and wild c.803C were identified in fetus 1,and both wild c.353C and c.836T were found in fetus 2.No maternal cell contamination was detected in both fetuses.Sequencing the corresponding sites after birth confirmed the prenatal diagnosis,and the head circumference and motor development were normal in fetus 1 at 5 months old.No macrocephaly was found and no DNA sequencing was done in fetus 2 at one month old.Conclusions Genetic counseling and prenatal molecular diagnosis for MLC families combined with clinical and genetic diagnosis are important in preventing MLC.Haplotype analysis with a combination of three microsatellite markers on chromosome X and sex determining region of Y chromosome is useful in detecting maternal cell contamination and avoiding its influence on prenatal diagnosis,and confirming the reliability of prenatal diagnosis.

Objective To summarize the clinical features of patients with ovarian tumor associated anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis,and to explore the influence of operation patterns on the prognosis.Methods The clinical data of ovarian tumors with anti-NMDAR encephalitis in the Third Affiliated Hospital of Sun Yat-sen University from January 2009 to December 2018 were collected,and the clinical characteristics,treatment and prognosis were analyzed.Results A total of 110 patients with ovarian tumors and anti-NMDAR encephalitis were collected.All patients were positive for anti-NMDAR antibodies in serum and/or cerebrospinal fluid.The age of onset ranged from 10 to 35 years (24.6 ±5.7).About 60.9％ patients'initial symptom was psychosis.The main clinical features were psychosis (97.3％),seizures (83.6％),conscious disturbance (72.7％),autonomic dysfunction (64.5％),dyskinesia (64.5％),central hypoventilation (54.5％) and impaired memory (31.8％).Most patients'symptoms were relieved after surgery and immunotherapy.Postoperative pathological results revealed that ovarian teratoma accounted for 97.8％ of the ovarian tumor.The prognosis of patients with surgery was better than the patients without surgery,with statistically significant difference (P ＜ 0.05).The prognosis of patients with adnexectomy was better than the patients with ovarian tumor excision,with statistically significant difference (P ＜ 0.05).Conclusions Anti-NMDAR encephalitis,with psycho-neurological symptoms as dominant manifestation,is usually associated with ovarian tumor.For young female patients with psychosis,clinicians should be alert to the possibility of anti-NMDAR encephalitis and screen for tumor.Patients with adnexectomy and immunotherapy can get a better prognosis.

Amniotic fluid embolism(AFE) is a fatal intrapartum complication. Typical AFE is characterized by respiratory and circulatory failure, followed by disseminated intravascular coagulation(DIC), while atypical AFE, which had a higher survival possibility, presents with unexplained DIC only. Recent findings support an anaphylactoid inflammatory mechanism underlying the pathophysiology of AFE. Milrinone is currently the first choice for AFE due to its several functions, such as reducing pulmonary artery pressure, and improving right ventricular function through lowering heart rate and positive inotropic action. A multidisciplinary team is required in the rescue of AFE and medical staff who are skilled in critical medicine (such as anesthesiologists) often play a pivotal role.

Objective To analyze insulin resistance (IR) level and pregnancy outcomes in women with gestational diabetes mellitus (GDM) complicated by chronic hypertension (CHT).Methods This is a retrospective case-control study involving 2 457 singleton pregnant women complicated by GDM who received regular prenatal examinations and participated in the one-day-care clinic of GDM in Peking University First Hospital from January 1,2014 to December 31,2016.Clinical data were collected and homeostasis model assessment insulin resistance (HOMA-IR) was calculated.All subjects were divided into two groups:GDM with CHT group (CHT group,n=47) and GDM without CHT group (non-CHT group,n=2 410).Based on their pre-pregnancy body mass index (BMI),they were also grouped into normal pre-pregnancy BMI group (n=1 590) and overweight and obese group (n=863).Two-sample independent t test and Chi-square test were used to compared the age,HOMA-IR,pre-pregnancy BMI,weight gain during pregnancy and glucose levels between groups,and logistic regression model was used to analyze the effects of HOMA-IR on pregnancy outcomes.Results HOMA-IR (3.5± 1.8 vs 2.6± 1.5,t=-3.290),fasting plasma glucose [(5.4±0.5) vs (5.2 ±0.5) mmol/L,t=-3.005],pre-pregnancy BMI [(26.7 ±4.7) vs (23.3± 3.4) kg/m2,t=-4.842] and the incidence of preeclampsia [14.9％ (7/47) vs 2.5％ (61/2 410),x2=21.790] were significantly higher in GDM women with CHT than those without (all P＜0.01).The weight gain during pregnancy was less[(9.6±5.8) vs (12.2±4.7) kg,t=3.790,P＜0.001].The incidence of preeclampsia was higher in GDM with CHT group than the non-CHT group [15.2％ (5/33) vs 4.2％ (35/830),x2=6.290,P=0.012] among overweight and obese pregnant women,but no significant difference in HOMA-IR was shown (P＞0.05).For pregnant women with normal pre-pregnancy BMI,HOMA-IR (3.0± 1.5 vs 2.3± 1.2,t=-2.217),fasting plasma glucose [(5.4±0.5) vs (5.1±0.5) mmol/L,t=-2.299] and the incidence of preeclampsia [2/14 vs 1.6％ (26/1 576),x2=6.545] were higher in the CHT group than the non-CHT group (all P＜0.05).HOMA-IR did not significantly increase the risk of caesarean section,premature birth,large for gestational age,small for gestational age or macrosomia in the CHT group (all P＞0.05).After adjusting for age,fasting plasma glucose,pre-pregnancy BMI and weight gain during pregnancy,the elevated HOMA-IR level increased the risk of preterm birth (OR=1.223,95％CI:1.093-1.369,P＜0.001) in GDM women without CHT.Conclusions GDM gravida complicated by CHT have severe insulin resistance and a higher incidence of preeclampsia,but the risk of other pregnancy outcomes are not increased.