Objective To investigate the effects of human immunodeficiency virus (HIV) infection on the pregnancy outcome and the incidence of vertical transmission in HIV positive pregnant women Method 86 cases of HIV positive pregnant women and their infants were evaluated retrospectively, and HIV antibody in peripherial blood was detected using enzyme linked immunosorbent assay (ELISA) Results Compared with normal control group, the incidences of abortion, preterm birth, low birth weight and small for gestational age babies were 9 3%, 14 0%, 16 3% and 10 5%, respectively ( P

Objective To assess the effect of dilute pituitrin solution (0.05 U/ml) on blood loss and distention fluid intravasation during hysteroscopy. Methods From January 2003 to June 2004, 68 women with abnormal uterine hemorrhage undergoing hysteroscopic endometrial resection were randomly divided into treatment and control groups (34 cases in each). In the treatment group, dilute pituitrin solution (0.05 U/ml) was injected into the cervix before dilation of the cervix in preparation for hysteroscopy, while the patients in the control received no pituitrin injection. Results The mean operation time in the treatment group was significantly shorter than that in the control [(32.2?6.0) min vs (35.9?6.8) min; t=-2.379, P=0.020]. The amount of distention fluid infusion in the treatment group was significantly less than that of the control [(2982.1?880.5) ml vs (3461.2?795.8) ml; t=-2.354, P=0.022]. The volume of distention fluid intravasation in the treatment group was significantly less than that of the control [(225.3?81.1) ml vs (319.4?89.2) ml; t=-4.551, P=0.000]. The rate of fluid intravasation was (7.5?1.1)% in the treatment group that was significantly lower than that in the control [(9.2?1.1)%, t=-6.372, P=0.000]. The mean blood loss in the treatment group was significantly less than that of the control [(15.1?4.1) ml vs (24.7?6.6) ml; t=-7.204, P=0.000]. Conclusions Intraoperative administration of dilute pituitrin solution can reduce blood loss, operation time, and the amount of distention fluid infusion and intravasation. As a result, it is useful to avoid post-hysteroscopy complications including TURP syndrome.

Objective To investigate the surgical treatment of gastrointestinal stromal tumor (GIST) based on the clinical characteristics of GIST in different locations.Methods The clinical data of 486 GIST patients who received surgical treatment at the Peking Union Hospital from January 2003 to December 2012 were retrospectively analyzed.There were 461 patients with primary GIST and 25 with secondary GIST.The clinical characteristics and surgical treatment methods were analyzed.All data were analyzed using the chi-square test.Results Of the 461 patients with esophageal stromal tumors,6 received partial esophagectomy.Of the 234 patients with gastric stromal tumors,183 received partial gastrectomy,23 received proximal gastrectomy + cardiectomy,23 received distal gastrectomy,2 received total gastrectomy and 3 received exploratory laparotomy.Of the 51 patients with duodenal stromal tumors,34 received partial duodenectomy,9 received pancreatico-duodenectomy,5 received pylorus-preserving pancreaticoduodenectomy,3 received palliative surgery.Of the 116 patients with small intestinal stromal tumors,110 received partial small intestinal resection and 6 received palliative surgery.Of the 29 patients with rectal stromal tumors,13 received posterial transsphincteric surgery of the rectum,12 received transanal local resection of rectal tumors and 4 received abdominoperineal resection; laparotomy was performed on 25 patients with GIST in other positions.Of the 25 patients with secondary GIST,10 patients with liver metastasis of GIST received hepatic segmentectomy,1 received hepatobiopsy; 6 received abdominopelvic tumor resection; 5 received portial resection of the small intestine or colon; 1 received sigmoid colostomy; 1 received splenectomy and 1 received intracranial tumor resection.Of the 461 patients with primary GIST,patients who received combined devisceration accounted for 12.58％ (58/461),and the ratio of combined cholecystectomy was the highest,which was 34.5％ (20/58).Combined devisceration was considered for patients with duodenal stromal tumors,gastric stromal tumors and small intestinal tumors.Laparoscopic surgery accounted for 20.39％ (94/461) of all the surgery,and the ratio of laparoscopic surgery which carried out in recent 5 years was 28.52％ (77/270),which was significantly higher than 8.90％ (17/191) of the earlier 5 years (x2=36.67,P ＜ 0.05).Conclusion Different surgical treatment methods including minimally invasive surgery could be adopted according to different clinical characteristics of GIST in different locations,and radical resection of GIST is the main objective.

Objective:To optimize the ethanol precipitation technique for Fufang Shenqi soft capsules. Methods: An orthogonal design was used to optimize the technique with the relative density of the concentrated solution, ethanol concentration, standing time, temperature of ethanol precipitation as the influencing factors and the yield of dry extract and the content of total polysaccharides as the indices. Results:The best ethanol precipitation technique was as follows:the relative density of the concentrated solution was 1. 10, 95% ethanol was used to obtain 60% ethanol concentration, and the standing time was 48 h under the temperature of 10-30℃. Con-clusion:The optimized ethanol precipitation technique for Fufang Shenqi soft capsules is simple and practicable, and suitable for prac-tical production.

Objective To investigate the effect of sleeve gastrectomy on the intestinal barrier of obesity rats fed with high-fat diet.Methods Thirty obesity rats fed with high-fat diet were randomly divided into three groups including common diet group (CD,n=10),sham operation group (SO,n=10) and sleeve gastrectomy group (SG,n=10).The lactulose/mannitol ratios (L/M) in 24-hour urine and endotoxin in portal vein were evaluated four weeks after surgery.The levels of tight junction proteins including claudin-1 and occludin in intestinal mucosa were analyzed by western blot.Results The body weight of SG group was significantly decreased than those of CD group (P<0.001) and SO group (P<0.001) four weeks after surgery.The L/M ratio in 24-hour urine of SG group was significantly lower than those of CD group (P<0.001) and SO group (P<0.01).The endotoxin level in portal vein of SG group was significantly lower than those of CD group (P<0.01) and SO group (P<0.05).The claudin-1 level in intestinal mucosa of SG group was significantly higher than those of CD group (P<0.001) and SO group (P<0.01) four weeks after surgery.The occludin level in intestinal mucosa of SG group was significantly higherthan those of CD group (P<0.001) and SO group (P<0.001).Conclusions Sleeve gastrectomy can reduce body weight,L/M ratio in 24-hour urine and endotoxin level in portal vein of obesity rat fed with high-fat diet and increase the levels of claudin-1 and occludin in intestinal mucosa.

Objective To investigate the multidisciplinary modality for obesity treatment and evaluate the safety and long-term efficacy of laparoscopic adjustable gastric banding(LAGB) on weight loss and obesity related metabolic diseases in obesity patients.Methods The clinical and follow-up data of 28 consecutive morbid obesity patients receiving LAGB in Dept.General Surgery of PUMC hospital in a multidisciplinary modality from Oct 2009 to May 2012 were retrospectively analyzed.The strategy of perioperative and follow-up management was summarized and the safety and long-term efficacy of LAGB on weight loss and comorbidity were evaluated.Results Mean body weight of the subjects was 129.1kg and mean body mass index(BMI)44.9 kg/m2.All patients underwent LAGB successfully without perioperative mortality.Early postoperative complications included 1 case (3.6％) of pulmonary infection and long-term complications included 2 cases (7.1％)of port infection.Mean body weight and BMI decreased gradually after LAGB.The mean percentage of excess weight loss(％ EWL)at postoperative 24 months was 41.3％.％ EWL of the group with regular follow-up and good compliance was significantly better than the other group.Complete or partial remission was observed in obesity related metabolic diseases at the last follow-up.Conclusions LAGB is safe and has good long-term efficacy on weight loss and comorbidity improvement of obesity patients.Better services can be provided for obesity patients in a multidisciplinary modality,It is important for the patients to follow up regularly after surgery in order to maintain long-term weight loss.

Objective To compare the clinical efficacy between standard sequential early enteral nutrition (EEN) plus parenteral nutrition (PN) and PN alone in patients undergoing gastrointestinal surgery. Methods Werandomly divided 126 patients who underwent laparotomy gastrointestinal surgery into EEN + PN group (n = 62) and PN group (n = 64). The levels of blood nutrition-related indicators, biochemical indicators, and inflammatory indicators were determined before surgery and 3 and 7 days after surgery, and the gastrointestinal function recovery time, complications, nutritional support cost, and length of hospital stay were compared between two groups. Results The preoperative nutrition-related indicators, biochemical indicators, and inflammatory indicators showed no significant differences between two groups (P >0. 05). Three days after operation, however, the levels of prealbumin in EEN + PN group were significantly higher than those in PN group [(160. 3 ±23. 0) g/L vs. (137.0±28.7) g/L, P=0.000]. Seven days after operation, the levels of albumin [(33.6±3.8) g/L vs. (31.8±4.7) g/L, P = 0.042], prealbumin [(210.6±34.6) g/L vs. (154.8 ±36.9) g/L, P=0.000], and lymphocyte cell count [(2.33±0.53) x 109/L vs. (1.04±0.36) × 109/L, P = 0. 046] in EEN + PN group were significantly higher than those in PN group, and the levels of serum γ-glutamyltransferase [(48. 12 ± 33.84) U/L vs. (71.54±34.00)U/L, P=0.048], C-reactive protein [(31.15 ± 19.00) mmol/L vs. (45.90 ± 23.21) mmol/L, P=0.042], total cholesterol [(3.09±0.83) mmol/L vs. (3.29±0.91) mmol/L, P = 0. 045] and low density lipoprotein [(2.01 ± 0. 39) mmol/L vs. (2. 31 ± 0. 72 ) mmol/L, P = 0. 049] were significantly lower than those in PN group. The postoperative gastrointestinal function recovery time in EEN + PN group was significantly shorter than that in PN group [(65. 7 ± 15. 6) hours vs. (75. 1 ± 27. 0) hours, P = 0. 036], and the total cost of perioperative nutrition in EEN + PN group was also significantly lower than in PN [(2634. 5 ±1306. 8) RMB vs. (3058. 6 ± 1216. 0) RMB, P= 0.046]. Conclusion Standard sequential EEN plus PN can increase the post-operative prealbumin level, improve the immune function, promote the recovery of gastrointestinal function, and decrease the cost of nutritional support.

Objective To investigate the correlation between the prognostic nutritional index (PNI) and clinicopathological features and long-term prognosis of gastric cancer patients after radical gastrectomy.Methods The clinical data of 135 gastric cancer patients who underwent radical gastrectomy in this hospital from 2002 to 2006 was analyzed retrospectively.The PNI value was calculated by serum albumin (g/L) + 5 x lymphocyte count (× 109/L).The receiver operating characteristic (ROC) curve and Youden index was used to determine the cutoff value of the PNI.Survival curves were described by the Kaplan-Meier method and compared by the Log-rank test.The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.Result The mean PNI value was 47.3 ± 5.9.The mean values of the PNI in age (t =2.909,P =0.004),tumor size (t =2.227,P =0.028),tumor depth (t =3.314,P =0.001),negative lymph node (t =2.381,P =0.019),negative lymphovascular invasion (t =2.781,P =0.006) were significantly higher than those in patients without such factors.When the PNI was 47,the Youden index was maximal,with a sensitivity of 70％ and specificity of 63％.The mean age in high PNI group was significantly lower than that in low PNI group (x2 =6.443,P =0.011).Tumor infiltration depth in high PNI group was less than in low PNI group (x2 =7.394,P =0.007).The proportion of lymphovascular invasion in high PNI group was significantly lower than in low PNI group (x2 =4.540,P =0.033).The overall survival rate in high PNI group was higher than in low PNI group (P =0.002).The univariate and multivariate analyses showed that tumor location (OR,2.144 ; 95 ％ CI 1.239-3.712 ; P =0.006),lymph node metastasis (OR,4.887 ; 95 ％ CI 1.856-12.866 ; P =0.001),lymphovascular invasion (OR,1.842 ; 95％ CI 1.078-3.145 ; P =0.025) and the PNI value (OR,2.282 ; 95 ％ CI 1.344-3.874 ; P =0.002) were independent factors for predicting overall survival rate.Conclusions The PNI value is a simple and useful tool to predict the prognosis of patients with gastric cancer.

Objective To investigate the risk factors of reoperation in patients with Crohn's disease recurrence.Methods The clinical data of 108 patients with Crohn's disease who were admitted to the Peking Union Medical College Hospital from March 2004 to September 2013 were retrospectively analyzed.Of the 108 patients,82 received single operation and 26 received reoperation.Twenty-five factors which might influence the reoperation were analyzed,which were gender,age,blood type,preoperative levels of white blood cells,neutrophils,lymphocytes hemoglobin,albumin,prealbumin,high sensitive-C reactive protein (hs-CRP),anti-saccharomyces cerevisiae antibody (ASCA),anti-neutrophil cytoplasmic antibody (ANCA),location and type of the lesions,extraintestinal manifestation,perianal lesions,history of smoking,appendectomy,course of the disease before the first operation,pre-operative administration of immunosuppressants,body mass index (BMI) before the first operation,onodera prognostic nutrition index (OPNI),enteral nutrition,emergent operation,complications after the first operation.The univariate analysis was done using the chi-square test or Fisher exact probability,and the multivariate analysis was done using the Logistic regression model.Results The results of univariate analysis showed that the level of preoperative prealbumin,hs-CRP,location and type of the lesion,the history of smoking,preoperative administration of immunosuppressants,enteral nutrition before the first operation were the risk factors of reoperation in patients with Crohn's disease (x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P ＜ 0.05).The results of multivariate analysis showed that the lesion located at the ileocolon,administration of immunosuppressants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal/d before the first operation were the independent risk factors of reoperation (OR =1.908,3.535,5.489,95％ confidence interval:1.035-3.518,1.087-11.494,1.816-16.590,P＜0.05).Conclusions Patients with lesions located at the ileocolon,administration of immunosuppresants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal before the first operation have higher risk of Crohn's disease recurrence and reoperation.

Objective To observe the effect of preoperative oral administration of carbohydrate on blood glucose,insulin resistance(IR) and inflammatory reaction after gastrointestinal operation.Methods 48 patients receiving gastrointestinal operation were randomly divided into the study group(n =23)and the control group(n =25).Patients in the study group were orally given 25％ glucose solution 300 ml 3 hours before operation.Before anesthesia induction,gastric contents were aspirated through nasogastric tube to examine its volume and pH.Serum high sensitivity C-reactive protein(hsCRP),fasting blood glucose,insulin level and homeostasis model assessment-insulin resistance(HOMA-IR) were detected before operation and on the first morning after operation between the two groups.Results No anesthesia or operation related complications occurred in either groups.Patients had similar gastric contents volume and the PH value of gastric contents.There was no significant difference in serum hsCRP,fasting blood glucose and HOMA-IR between the two groups before operation.But on the first day,fasting blood glucose,HOMA-IR and hsCRP were significantly lower in the study group than in the control group(6.51 ±1.15 vs 7.49 ±0.57 mmol/L,P =0.038;4.34 ± 1.60 vs 6.09 ±2.81,P =0.043;40.45 ± 27.02 vs 80.02 ± 38.98 mg/L,P =0.03).Conclusion Preoperative oral administration of carbohydrate can obviously lower the postoperative blood glucose level and insulin resistance and alleviate postoperative inflammatory reaction.