Objective To study the risk of pregnant women with epilepsy and its appropriate treatment. Methods A retrospective medical records review was conducted in 15 pregnant women with epilepsy at Peking Union Medical College Hospital from 1984 to 2004. The data were collected including maternal age at delivery, parity, gestational weeks at delivery, types of epilepsy, occurrence of seizures during trimester,mode of delivery and neonatal outcome. Results The prevalence of pregnancy with epilepsy was 0.06%. Six cases(40%)were aged 20～29, and 9 (60%) aged 30～36. There were 14 primigravidas, and 1 multiparity. One case delivered before 37 weeks and 14 after 37 weeks. The onset of epilepsy occurred before the age of 20 in 66.7% of women. During pregnancy, the number of occurrence of seizures increased in 5 patients (33.3%), decreased in 1 patient(6.7%), 9 cases(60%)were the same to non-pregnant period and 7 cases(46.7%)had no seizures. Ten women(66.7%) were on mono-medication, while 4 (26.7%) cases were on combined medication and 1 (6.6%) patient without medication. The Apgar′s score of all children was 10 at delivery and no congenital malformation was found. Two cases had breast-feeding postpartum. Conclusions Women with epilepsy should have prepregnant counseling. The lowest dose of antiepileptic drug (AED) and folic acid supplementation should be recommended before anticipated conception. During trimester, the blood concentration of AED should be closely monitored in order to adjust the dose. The prenatal outcome will be improved with proper management.

Objective To summarize the common causes of fetal arrhythmia and explore its clinical significance and correlation with fetal prognosis. Methods The clinical situation and diagnostic procedure as well as the results of long-term follow-up of 26 cases of fetal arrthythmias were analyzed retrospectively. Results The incidence of fetal arrhythmias is 0.2%. 11.5%(3/26) of them were diagnosed fetal tachycardia, 15.4% (4/26) of them were diagnosed fetal bradycardia and 73.1% (19/26)were diagnosed irregular fetal cardiac rhythm . The average gestational age they were diagnosed was 35 +2 weeks (15 weeks to 41 +1weeks). Twenty-two cases were diagnosed by antenatal auscultation, 1 case was diagnosed by ultrasonography at 15 weeks' gestation, 3 cases were diagnosed by fetal heart monitoring. We performed fetal echocardiograms on 17 fetuses, 6 cases (35.3%)showed that premature atrial contraction with normal structure of fetal heart. All of the neonates survived postnatally and 24 of them (92.3%) accepted follow-up. Echocardiograms for16 neonates were performed and 2 of them were identified as atrial septal defects with normal heart rhythms. The incidence of structure heart disease in fetal arrhythmia is 7.7%. Conclusion The prognosis is well for most of the fetuses with arrhythmias, the incidence of heart structure disease is very low among them. We should pay attention to diagnose the fetus of heart structure disease with persistant bradycardia. Temporization for the management of arrhythmiatic fetuses should be accepted and the decision for termination of pregnancy should be made according to obstetric indication.

Objective To investigate the value and safety of colonoscopy in patients aged 80 years and over.Methods Clinical and endoscopic data of 1 249 patients aged 80 years and over collected from December 2005 to December 2015 at PLA army General Hospital were analyzed retrospectively.Results The average age was 83.03 years.Reasons for receiving colonoscopy included constipation with abdominal distension(19.38 ％)and hematochezia(10.57％).The completion rate of colonoscopy for the entire length was 94.50 ％.There were no abnormal findings in 492 cases (39.39 ％).Colonic polyps (31.62 ％) and colorectal cancer (14.25 ％) were among the major lesions detected with colonoscopy.Colorectal neoplasms were found in 58.33％ of the 132 patients with hematochezia.The total complication rate from colonoscopy and treatment was 0.72％,with the complication rate from treatment at 1.32％.Conclusions Constipation with abdominal distension and hematoehezia are the main reasons for undergoing colonoscopy for very elderly patients.Colon polyps and colorectal cancer are common disorders in elderly patients over 80 years of age and people with hematochezia in this age group are at high risk of having colorectal cancer.Colonoscopy is a safe and effective procedure and an important examination method for very elderly patients with hematochezia.

Objective To evaluate our experience in the diagnosis and surgical management of papillary thyroid microcarcinoma(PTMC). Methods Clinical data of 42 PTMC cases were retrospectively analyzed. Results Twenty-five clinically nonpalpable PTMC were detected by high resohition thyroid uhrasonography preoperatively.The diagnosis of PTMC was established intraoperatively by frozen biopsy in 14 out of 19 cases undergoing this procedure.Of the 42 patients,30 underwent a lobectomy,and in 11 out of 30 patients supplemented level Ⅵ lymph node dissection was performed.None of these patients had recurrence during follow-up.The recurrence in three patients with multffocal lesions and undergoing incomplete resection were observed at follow.up.The mulifocality of PTMC and ipsilateral residual volume of the thyroid were two predicting factors that significantly influence the postoperative recurrence(P＜0.05,P＜0.01 respectively)in patients with PTMC. Candus-ions PTMC is usually occult and eludes correct preoperative diagnosis.Most PTMC are clinically nonpalpable and may be detected by hish resolution thyroid ultrasonography and diagnosed by frozen section during the operation.Surgery is the most important treatment of PTMC.Lobectomy plus level Ⅵ lymph node dissection is the therapy of choice for PTMC patients at the stage of cN0.

Objective To evaluate the clinical significance of thyroid stimulating hormone (TSH) and thyroid autoantibodies (anti-TGAb and anti-TPOAb) in cord blood of infants of mothers complicated with hypothyroidism and the influencing factors of neonatal thyroid function. Methods Clinical data of 67 singleton pregnant women complicated with hypothyroidism in Peking Union Medical College Hospital were analyzed retrospectively. Thyroid function and its autoantibody levels in maternal, cord blood and neonatal serum at 5-7 d after birth were compared. Umbilical TSH level and its affecting factors were also investigated. The results of TSH was expressed as median (25th-75th percentile). Results (1) Umbilical TSH levels were elevated in 9. 0% (6/67) of all infants born to mothers complicated with hypothyroidism. (2) No correlation was found in TSH levels between cord blood and venous blood in neonates 5-7 d after birth. Umbilical TSH levels were significantly higher in infants born vaginally than in those born abdominally [10. 20(6. 10-12. 80) mU/L vs 5. 86(4.02-7.74) mU/L,P=0.001]. Higher umbilical TSH levels were also detected in those complicated with fetal distress and preterm birth compared with those withoutere [fetal distress: (10. 36(6. 61-13. 37) mU/L and 6. 89(4. 18-9. 70) mU/L, P = 0. 046; preterm birth: 8. 90(7. 60-10. 33) mU/L and 6.84(4.17-9. 80) mU/L,P=0. 046,0. 049)]. (3) The anti-TGAb levels in cord blood were positively correlated with that in neonatal serum at 5-7 d after birth (r=0. 960, P = 0. 000), and the same was true for anti-TGPOAb levels (r= 0. 975, P = 0. 000). Maternal thyroid autoantibody levels (anti-TGAb and anti-TPOAb) had significant effect on umbilical antibody levels (P = 0. 003 and 0. 000, respectively), but not on the neonatal TSH levels (P>0. 05). Conclusions Umbilical TSH levels are affected by many delivery factors which may limit its prediction role on congenital hypothyroidism. However, there is an increased risk of elevated umbilical TSH, anti-TGAb and anti-TPOAb levels among these patients which may increase the risk of congenital hypothyroidism. Further follow up of these infants is warranted.

Objective To investigate the expression and significance of MMP-9 and Ki67 for predicting the progres-sion and prognosis of pancreatic cancer. Methods S-P immunohistochemical method was used to detect the expressions of MMP-9 and Ki67 in 100 pancreatic cancer tissue specimens. The relationship between the expressions of MMP-9 and Ki67 and patient age, tumor size, lymph node metastasis, tumor differentiation, clinical stages and prognosis were analyzed. Re-sults There were higher expressions of MMP-9 protein 46%(46/100) and Ki67 protein 53%(53/100) in 100 samples of pancreatic adenocarcinoma. And the expressions of MMP-9 and Ki67 were inversely associated with tumor differentiation, clinical stages, and lymph node metastasis of pancreatic cancer (P＜0.05). There were no significant differences in the ex-pressions of MMP-9 and Ki67 between patient age and tumor size. The expressions of MMP-9 and Ki67 were positive corre-lated (rs=0.405,P＜0.05). Moreover, the overall survival rates were correlated with patient age, lymph node metastasis, tumor differentiation and the expression of MMP-9, but no correlation with tumor size, clinical stages, and the expression of Ki67. Conclusion The expressions of MMP-9 and Ki67 were associated with pancreatic cancer progression. And the detection of expression of MMP-9 may have practical value in prognosis in patients with pancreatic cancer.

Background:Clinical and epidemiological studies revealed that estrogen replacement therapy was associated with a significant reduction in risk of colorectal cancer in postmenopausal women.In our previous studies,estrogen increased the expression of mismatch repair (MMR)gene MLH1 in colonic cancer cells,and re-expression of MLH1 in MLH-deficient colonic cancer cells significantly increased the estrogen-induced apoptosis.Aims:To investigate the signaling pathway implicated in the MLH1-mediated apoptosis in colonic cancer cells induced by estrogen and the roles of p53 and its related genes in this apoptotic pathway.Methods:Plasmid containing wild type human MLH1 (hMLH1)full length cDNA was transfected into MLH1-deficient human colonic cancer cell line HCT116.By using HCT116 cells transfected with empty plasmid as controls,the apoptotic DNA ladder was determined by electrophoresis and the expressions of p53 and other apoptosis-related proteins were assessed by Western blotting under the condition with or without estrogen stimulation. Results:17β-estradiol (E2 )at the concentration of 10 -8 mol/L induced significant apoptosis in HCT116 cells transfected with hMLH1.In HCT116 cells transfected with hMLH1 and stimulated with E2 (group D),the protein expressions of caspase-3,caspase-9,p53,Bax and cytoplasmic cytochrome C increased significantly when compared with HCT116 cells stimulated with E2 only (group B);expressions of the abovementioned proteins were also higher in group D than in group C (transfected with hMLH1 only).Conclusions:MMR gene MLH1 is involved in estrogen-induced apoptosis of human colonic cancer cell line HCT116 by activating p53 signaling and mitochondrial apoptotic pathway.

Objective To evaluate the maternal and fetal outcomes of pregnant women with lupus nephritis (LN) and the risk factors.Methods Ninety-three patients with 97 pregnancies from January 1st,1990 to December 31st,2012 in Peking Union Medical College Hospital were evaluated retrospectively.Objects of study were divided into three groups:stable lupus before pregnancy (stable group,52 cases),active lupus before pregnancy (active group,26 cases),and newly diagnosed LN during pregnancy (19 cases).Adverse maternal outcomes included exacerbated disease during pregnancy,preeclampsia,increased proteinuria and impaired renal function during pregnancy or postpartum,maternal death,thrombocytopenia and hypocomplementemia.Adverse fetal or neonatal outcomes included therapeutically termination of pregnancy,fetal loss,neonatal death,preterm labor,small gestational age and asphyxia.Statistical analysis was performed by Chi-square test or Fisher's exact test.A binary logistic regression model was used to evaluate the risk factors for adverse maternal and fetal outcomes.Results (1) Adverse maternal outcomes:There was no significant difference between exacerbated cases during pregnancies in stable group and that in active group [53.8 ％ (28/52) vs 61.5 ％ (16/26),x2 =0.417,P＞0.05].After deleting abortions before 20 weeks of gestation (5 cases in stable group and 4 cases in active group),there was no significant difference between preeclampsia incidence in stable group and that in active group [36.2％ (17/47) vs 59.1％ (13/22),x2 =3.204,P＞0.05].In nineteen newly diagnosed LN women,eighteen cases were over 20 weeks of gestation,during which preeclampsia incidence was 6/18.(2) Adverse fetal or neonatal outcomes:Therapeutically termination of pregnancy rate was higher in active group than that in stable group[42.3％(10/26) vs 7.7％(4/52),Fisher's exact test,P＜0.01].After deleting patients who required termination of pregnancy (three cases in stable group) and therapeutically termination of pregnancy (four cases in stable group and ten cases in active group),the rate of fetal loss and neonatal death was higher in active group than that in stable group [5/16 vs 6.7％(3/45),Fisher's exact test,P＜0.05].The rate of adverse fetal or neonatal outcomes was higher in active group than that in stable group [92.3％(24/26) vs50％(26/52),x2=13.483,P＜0.001].Among the nineteen newly diagnosed LN cases during pregnancy,the numbers of therapeutically termination of pregnancy and fetal loss were five and three cases respectively; among eleven live birth cases,two newborns died from severe asphyxia,and nine cases were preterm birth.(3) Binary logistic regression analysis showed that the independent risk factors for exacerbated lupus during pregnancy were hypocomplementemia (OR =0.300,95％ CI:0.104-0.863) and thrombocytopenia (OR =0.054,95％CI∶0.007-0.439).The independent risk factors for preeclampsia in LN pregnant women were thrombocytopenia (OR=0.151,95％CI:0.046-0.499) and LN recurrence or first diagnosed during pregnancy (OR=0.135,95％CI:0.027-0.679).The independent risk factors for adverse fetal or neonatal outcomes were preeclampsia (OR=0.134,95％CI:0.028-0.637) and lupus active during pregnancy (OR =0.026,95 ％ CI:0.005-0.138).Conclusions Active lupus before pregnancy is associated with poor maternal and fetal outcomes in lupus nephritis pregnancy.All pregnancies with LN should be planned,preferably after more than six months of quiescent disease.Blood pressure,renal function,proteinuria and level of platelet and serum complements should be closely monitored.

The incidence of acute kidney injury(AKI) in neonate is not low,it occurs in many cases such as ischemic-hypoxic injury,infection,administration of nephrotoxicity drugs and urinary tract obstruction,of which perinatal asphyxia ranked first in China.Due to the severe food security crisis,the occurrence of urinary tract obstruction is rising in recent years.The child health care should pay attention to prevent and screen this kind of disease for the high risk group.The diagnosis of AKI is difficult for newborn because serum creatinine and urine are hard to make a definite boundary.So study of early markers of AKI seems to be of great importance,of which neutrophil gelatinase associated lipocalin and cystatin C are research focuses,treatments should aim at solving primary disease such as ischemic,and so on.Renal replacement therapy is recommended when it comes to severe cases,but mortality still remains high,corresponding to severe primary disease and complications.

Objective To explore the differentially expressed genes (DEG) involved in the pathogenesis of preeclampsia(PE). Methods The gene expression profiles of placental tissues from 7 severe PE patients and 7 preterm controls from June to December 2012 were assessed using microarray. Gene ontology(GO)enrichment analysis and pathway analysis were performed to explore the genes and pathways involved in the pathogenesis of PE. Four DEG involved in these biological processes were further verified by quantitative real-time PCR. Results A total of 308 transcripts were significantly differentially expressed. Of these DEG,81 genes(LEPTIN,PAPPA2,CRH,PLIN2,INHA,BCL6,FLT1,CCR7,etc)were up-regulated,and 227 genes(CXCL12,CXCL9,etc)were down-regulated. GO enrichment analysis indicated that the top 3 GO molecular functions were immune response(GO: 0006955,17 DEG),positive regulation of apoptosis(GO: 0043065,11 DEG)and inflammatory response(GO: 0006954,11 DEG). Pathway analysis showed that the top 3 pathways were cell adhesion molecules(11 DEG),cytokine-cytokine receptor interaction(11 DEG),chemokine signaling pathway(8 DEG). Many genes(LEP,FLT1,TFRC,SH3PXD2A, CYP11A1,SEPP1,and so on)involved in oxidative stress were found to be significantly changed. Of these genes,LEP were significantly up-regulated with a fold change of 61.5. The fold changes of FLT1, SH3PXD2A,SEPP1,CYP11A1,TFRC were 8.6,2.2,-2.0,2.7 and-2.8. Four DEG involved in oxidative stress were further verified by quantitative real-time PCR. Conclusions A DEG signature was identified in severe preeclampsia placentas compared with normal controls. The DEG mainly involved in the molecular mechanisms of immune response,oxidative stress and inflammatory response,and were closely associated with the pathogenesis of PE.