Objective To evaluate the feasibility and effectiveness of combination chemotherapy with etoposide and cisplatin(EP)regimen on the patients with high-risk,chemorefractory and recurrent gestational trophoblastic neoplasia(GTN).Methods Thirty-nine patients with gestational trophoblastic tumors were analyzed retrospectively,25 of 39 patients were of high-risk,9 patients were chemorefractory and 5 patients were recurrent.All 39 patients were administrated with EP regimen,and 10 patients were assisted with surgery.All the patients were followed up.Clinical response,toxicity,the occurrence of secondary tumors of all patients,and the fertility of 30 patients whose fertility function was preserved were investigated. Results Thirty-nine GTN patients underwent a total of 221 cycles of the EP regimen.The average number of courses for each patient was 5.7.The total complete remission rate of the regimen was 74%(29/39). Twenty-five patients with high-risk GTN received a total of 139 cycles and the average number of courses was 5.6.Nineteen patients achieved complete remission and 6 patients showed drug-resistant.The complete remission rate of the high-risk group was 76%(19/25).Nine patients with chemorefractory GTN obtained a total of 55 cycles and the average number of courses was 6.1.Six patients achieved complete remission and 3 patients showed drug-resistant again.The complete remission rate of the chemorefractory group was 6/9. Five patients with recurrent GTN received 27 cycles and the average number of courses was 5.4.Four patients achieved complete remission,1 patient showed drug-resistance and died.Bone marrow toxicity, gastrointestinal reaction and alopecia were the main side effects of the EP regimen,but the bone marrow toxicity was slight and no grade Ⅳ side effect occurred.No fatal effect was found.Eight of 30 patients whose fertility faction was preserved had become pregnant after recovery,with a total of 8 pregnancies.Among them,2 were terminated by induced abortion,and 6 underwent normal term delivery and gained 6 infants who had no congenital malformation.All the 6 children had normal growth and development after childbirth. None of the women developed secondary tumors.Conclusion The EP regimen is effective and safe for the treatment of high-risk,chemorefractory and recurrent GTN.

CBS(Case Based Study)teaching method is given in a case requiring students to answer a series of questions surrounding the case.In the teaching process,students of small groups are required to find their own solutions.Compared with tradition method,this mothed can improve students'academic performance(P

BackgroundObstruction of aqueous humor out flow pathway or abnormality of the extracellular matrix( ECM ) of trabecular meshwork cells causes high intraocular pressure. The balance of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases(TIMPs) is critical for the metabolism of ECM. Interleukin1α(IL-1α) can influence outflow of aqueous humor by regulating MMPs level. Objective This study was to investigate the effect of interleukin-1α on the expression of MMP-2,MMP-3 and TIMP-I in cultured swine trabecular meshwork cells.Methods Swine sclera with trabecular meshwork tissue was isolated from 20 swine eyes and cultured with explant cultured method. Cultured cells were passaged and third generation cells were identified by fibronectin ( FN ) and laminin ( LN ) staining. After 24 hours of serum starvation, trabecular meshwork cells treated with IL-1α at the concentration of 10 mg/L were regarded as the IL group,and serum-free culture medium used to treat trabecular meshwork cells was regarded as the control group. The expression of MMP-2, MMP-3 and TIMP-1 proteins in trabecular meshwork cells were detected by immunohistochemistry,and the expression of MMP-2 mRNA, MMP-3 mRNA and TIMP-1 mRNA were detected by RT-PCR. The examination results were compared between the two groups. ResultsThe third generation of cells were positive for FN and LM. Compared with the control group, the expression levels of MMP-3 and TIMP-1 proteins(A value) in trabecular meshwork cells were significantly higher in the IL group than the control group(t=-7. 694,t =-5. 199,P＜0. 05) ,but no obvious difference was found in the expression of MMP-2 between the two groups( t=-2. 365, P＞0.05 ). The higher expression levels in MMP-3 mRNA and TIMP-1 mRNA (A value) in trabecular meshwork cells were seen in comparison with the control group (t =-3. 025,t=-1. 921 ,P＜0. 05). However,similar results were found in the expression of MMP-2 mRNA between the two groups(t =- 1. 173, P＞0.05 ). ConclusionsThe overexpression of MMP-3 and TIMP-1 proteins and their mRNA leads to the imbalance of MMP-3/TIMP-1 and promotes the decomposition of ECM in the trabecular meshwork, and therefore increases aqueous outflow.

OBJECTIVETo investigate the effect of Inonotus obliquus polysaccharides on testicular injury induced by exposure to high power microwave (HPM) in rats.

METHODSA total of 30 male Wistar rats were randomly divided into 5 groups, i.e., the normal control group, the microwave radiation model group, the treatment group, the new microwave radiation model group, and the prevention group, 6 in each group. All rats, except those in the normal control group, were exposed to microwave at an average power density of 200 mW/cm2 for 6 min. Rats in the control group and the model group were administered with normal saline by gastrogavage, once a day. Rats in the treatment group and the prevention group were given with Inonotus obliquus polysaccharides by gastrogavage, 2 mL each time (400 mg/kg body weight), once a day. All rats were sacrificed on the 11th day.The sperm density and the rate of sperm deformity were determined. Pathological changes of testis were observed by light microscope and transmission electron microscope.

RESULTSShort-term HPM irradiation could significantly reduce the sperm density and increase the sperm deformity rate (P < 0.05). Meanwhile, obvious pathological changes of testes occurred. Compared with the two model groups, the sperm density increased and the sperm deformity rate decreased in the treatment group and the prevention group (P < 0.05). Under the light microscope, injuries of spermatogenic cells and stromal cells, as well as vascular dilatation and congestion were obviously alleviated in the treatment group and the prevention group. Mitochondrial swelling and endoplasmic reticulum expansion shown by ultrastructural observation were also significantly alleviated. Of them, injuries of spermatogenic cells and inflammation response were milder in the treatment group than in the prevention group.

CONCLUSIONSInonotus obliquus polysaccharides had significant protective effect on microwave radiation induced testicular injury. Better effect was obtained by therapeutic medication than preventive medication.

Animals ; Basidiomycota ; chemistry ; Male ; Microwaves ; adverse effects ; Polysaccharides ; pharmacology ; Radiation Injuries, Experimental ; prevention & control ; Radiation-Protective Agents ; pharmacology ; Rats ; Rats, Wistar ; Testis ; drug effects ; pathology ; radiation effects

OBJECTIVETo evaluate the relationship between leukotriene expression in blood polymorphonuclear leukocytes (PMNL) and the efficacy of inhaled corticosteroids (ICS) in children with asthma.

METHODSThirty-two children with asthma (5-12 years) and ten healthy children (control group) were enrolled. The asthmatic children were subdivided into ICS well-controlled and ICS poorly-controlled groups based on their clinical symptoms and lung function. The level of leukotriene C4 synthase (LTC4S) mRNA in PMNL was detected by fluorescence quantitative polymerase chain reaction. The level of LTC4S mRNA was expressed by the value of qCt, and the value of qCt was diversely correlated with the level of LTC4S mRNA expression. The concentration of urinary leukotriene E4 (LTE4) was measured using ELISA.

RESULTSThe expression of LTC4S mRNA in PMNL was significantly higher in children with asthma (qCt: 1.12+/-0.27) than that in the control group (qCt: 1.42+/-0.12; P< 0.05). The expression of LTC4S mRNA in PMNL in the ICS poorly-controlled group (qCt: 1.03+/-0.17) was significantly higher than that in the ICS well-controlled group (qCt: 1.24+/-0.33; P< 0.05) and the control group(1.42+/-0.12; P< 0.01). There was no significant difference in the level of urinary LTE4 among the the ICS poorly-controlled, the ICS well-controlled and the control groups.

CONCLUSIONSLTC4S mRNA expression in PMNL in asthmatic children increases, and the LTC4S mRNA expression in the ICS poorly-controlled group is higher than that in the ICS well-controlled group. This suggests that an increased leukotriene expression might be associated with poorly-controlled asthma.

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; Asthma ; drug therapy ; Child ; Child, Preschool ; Female ; Glutathione Transferase ; genetics ; Humans ; Leukotriene E4 ; urine ; Male ; RNA, Messenger ; blood

OBJECTIVETo investigate the accuracy and potential error range of noninvasive estimation of CO2 pressure (PCO2), arterial O2 pressure (PaO2), and oxygenation index (OI) by measuring the end-tidal CO2 pressure (PETCO2) and pulse oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure, and assess the feasibility of this method for dynamic monitoring of arterial CO2 pressure (PaCO2) and PaO2 in the primary care facilities where arterial blood gases analysis is not available.

METHODSAll the 30 patients with COPD and respiratory failure received routine clinical treatment including bronchodilators, mucolytics, glucocorticosteroid, antibiotics and oxygen therapy (titrated to keep SpO2 above 90%) for 5-7 days. A subgroup of the patients also received NIPPV treatment. All the patients were tested with both the eupnea method and prolonged expiratory method before and after the treatment to obtain the data of PCO2 and SpO2 were respectively performed before and after treatment.

RESULTSThe PETCO2 with eupnea (PETCO2(Q)) was 50.72-/+8.93 mmHg, significantly lower than PaCO2 (71.25-/+9.08 mmHg, Plt;0.01), but the PETCO2(P) (70.35-/+8.91 mmHg) was comparable with PaCO2 (P>0.05). Similar results were obtained after the treatment. The PETCO2(P) before treatment and after treatment was positively correlated to PaCO2 (r=0.96 and 0.97, respectively, P<0.01). The PaO2(Y) before the treatment derived from the oxygen dissociation curve based on SpO2 measurement was close to SpO2 (59.96-/+1.42 mmHg vs 59.07-/+2.22 mmHg, P>0.05). The OI derived from PaO2 and OI(Y) from PaO2 (Y) was also similar (215.70-/+22.77 vs 219.15-/+24.63, P>0.05). Linear regression analysis showed positive correlations between PaO2(Y) to PaO2 (r=0.81, P<0.01) and between OI(Y) and OI (r=0.95, P<0.01).

CONCLUSIONSIn patients with COPD (especially those with also type II respiratory failure), the modified monitoring method of PCO2 and maintenance of SpO2 above 90% can precisely estimate PaCO2 and PaO2. This method is feasible for clinical noninvasive and dynamic evaluation of respiratory failure in COPD patients, especially in primary care facilities where arterial blood gases analysis is not available.

Aged ; Aged, 80 and over ; Blood Gas Monitoring, Transcutaneous ; Capnography ; Humans ; Male ; Middle Aged ; Oximetry ; Pulmonary Disease, Chronic Obstructive ; blood ; complications ; physiopathology ; Respiratory Insufficiency ; blood ; etiology ; physiopathology ; Tidal Volume

[Objective]To explore the prevalence trend and pathogenic characteristics of hand-food-mouth disease (HFMD) in Jiading District of Shanghai from 2007 to 2016. [Methods] Information on cases of hand-food-mouth disease in Jiading District from 2007 to 2016 was collected and analyzed. [Results]There were 37 520 reported cases from 2007 to 2016 with average age of 2.81 years old, in which 92.05％ cases were aged 5 years old or below. The incidence rate showed fluctuation over years was from the lowest incidence of 217.03/105 in 2015 to the highest of 461.83/105 in 2016. There were 55.95％ of reported cases from the period of April to July and 94.98％ were from rural and urban-rural areas. Samples from 799 patients as pharynx swab and anal swab, etc. were found to be enterovirus 71 (EV71) , the dominant pathogen, accounting for 44.56％ of total isolation. There were 0.59％ severe cases, 96.23％ of which were positive of EV71. [Conclusion] The HFMD prevalence in Jiading District of Shanghai showed periodicity and seasonality. Children aged 5 years old below and living in non-urban areas showed higher incidence risk. EV71 is the dominant pathogen, especially for the severe cases. These findings suggested that targeted measures should be carried out according to the prevalence and pathogenic characteristics, strengthening the prevention and control of HFMD among preschool children in rural and urban-rural areas.

OBJECTIVEThe fact that the acute lower respiratory infections (ALRI) are associated with a newly discovered virus, human metapneumovirus (hMPV), has been shown in several studies. The authors conducted this study to understand the etiological and clinical characteristics of bronchiolitis, one of the most common ALRI in infants, caused by hMPV.

METHODSNasopharyngeal aspirate specimens from 54 out of 126 infants with bronchiolitis admitted to the Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing from November 2002 to February 2003 were examined for hMPV gene fragments by reverse transcription-polymerase chain reaction (RT-PCR). Prior to the detection, the specimens were confirmed as negative for the common respiratory pathogens including RSV, influenza A and B, parainfluenza I, II, III, adenovirus, Mycoplasma pneumoniae by indirect immunofluorescence test, virus isolation and ELISA test. The clinical data of the patients diagnosed etiologically as hMPV infection analyzed included the infants' age, sex, the degree of fever, the severity of wheezing and clinical Lowell score, the findings of chest examination and chest X-ray, the white blood cell count and blood gas analysis, the course of the disease, the major treatments and the outcome of the disease.

RESULTSTwenty-one specimens showed the predicted 213 bp PCR products in agarose gel and the positive rate was 16.7% of all patients (21/126) and 39% of the patients with negative results for common respiratory pathogens detections (21/54). The range of patients' age was 2 - 15 months and the young infants with hMPV bronchiolitis (1 - 6 month of age) accounted for 62% and the male:female ratio was 3.2:1. The patients presented a low-medium grade fever (T < 39 degrees C) accounted for 86%; 81.0% of patients had a white blood cell count lower than 10.0 x 10(9)/L. The radiological findings were patchey opacity in both lungs (68%) and(or) hyperinflation (62%). Assessed by the Lowell score system, 5 out of 21 cases were considered as severe cases. The major clinical findings of hMPV bronchiolitis had no significant difference compared with that of subgroup A hRSV bronchiolitis, and showed longer course of disease than that of subgroup B hRSV bronchiolitis (P < 0.01).

CONCLUSIONSOf the infants with bronchiolitis hospitalized in our hospital from November of 2002 through February of 2003, 16.7% were caused by hMPV infection. These data showed that the major clinical characteristics and the outcome of treatment of hMPV bronchiolitis had no statistically significant difference compared to the cases with either subgroup A or subgroup B hRSV infection.

Bronchiolitis ; therapy ; virology ; China ; Female ; Humans ; Infant ; Male ; Metapneumovirus ; genetics ; Mucus ; virology ; Paramyxoviridae Infections ; therapy ; virology ; Prognosis ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVEA new respiratory virus, human metapneumovirus (HMPV) was recently identified by scientists in the Netherlands first and then in a few other countries. To investigate if this newly discovered virus is associated with the acute respiratory infections in pediatric patients in Beijing, tests were developed to detect HPMV gene fragments from nasopharyngeal aspirates collected from infants and young children hospitalized for acute respiratory infections from November 2002 to March 2003.

METHODSThe HMPV was screened by reverse transcription-polymerase chain reaction (RT-PCR). RNAs were extracted by Trizol from 247 specimens which had been determined as negative for conventional respiratory viruses including RSV, influenza A and B, parainfluenza I, II, III and adenovirus by indirect immunofluorescence test as well as virus isolation. The HMPV RNAs were detected by reverse transcription tests using random primer and M-MLV reverse transcriptase followed by PCR using the primers designed from the published sequence of the N protein-encoding gene from the first HMPV identified in the Netherlands. PCR products were visualized by 1.2% agarose gel electrophoresis. Selected positive PCR products were sequenced and the sequences of the nucleotides and deduced amino acids were compared with those in the GenBank.

RESULTSAmong those 247 specimens negative for common respiratory viruses, 74 (30.0%) showed the predicted 213 bp PCR products in agarose gel. Most of clinical diagnoses for these 58 patients were pneumonia (36, 48.6%), bronchiolitis (21, 28.4%), and bronchitis and asthma in some patients. Nearly 90 percent of positive specimens were from patients under 2 years of age. Ten out of 74 amplicons were randomly selected for sequence analysis. When compared with the sequences in the GenBank, the nucleotide sequences of these 10 amplicons shared high homology only with those of HMPVs. The nucleotide sequence identities of these 10 samples with those from the Netherlands and Canada were 87% - 99%. When compared with the nucleotide sequence from the first reported strain by Van den Hoogen (strain HMPV 00-1), the sequence identities of these 10 fragments ranged from 88.7% to 99.1%. Among the 10 amplicons from the specimens, the nucleotide identities were 87.3% - 100%. One of the 10 amplicons (No. 1816) shared lower identity with others (87.3% - 89.7%), whereas the other 9 shared higher identities (95.8% - 100%) with each other. The comparison of amino acids showed that these 10 amplicons showed high homology (95.8% - 100%). Again, amplicon No.1816 shared lower homology (95.8% - 97.2%) with others, whereas the other 9 shared higher homology (98.6% - 100%). The amino acid homology between No.1816 and HMPV 00-1 was 95.8%, whereas that of the other 9 with HMPV 00-1 was 98.6% - 100%.

CONCLUSIONThese data suggested that some of acute respiratory infections in pediatric patients in Beijing area are related to the newly identified human metapneumovirus. The HMPV circulating in Beijing may have different genotypes.

Acute Disease ; Child ; Child, Preschool ; China ; Female ; Fluorescent Antibody Technique, Indirect ; Humans ; Infant ; Male ; Metapneumovirus ; genetics ; Nucleocapsid Proteins ; genetics ; Paramyxoviridae Infections ; pathology ; virology ; RNA, Viral ; genetics ; Respiratory Tract Infections ; pathology ; virology ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA

OBJECTIVEThe severe acute respiratory syndrome (SARS) is a highly contagious infection caused by a newly discovered strain of coronavirus (SARS-CoV). During the outbreak of SARS in the first half of 2003, children appeared to be less susceptible to the SARS coronavirus and pediatric patients presented with a less aggressive clinical course than adult patients did, demonstrating the traits which were rarely observed in other viral contagious disease. The present study aimed to preliminarily examine the presence of serum specific antibodies against severe acute respiratory syndrome (SARS)-associated coronavirus virus (SARS-CoV) in pediatric SARS patients and explore the possibility of subclinical infection in children/adults through close association with SARS cases.

METHODS(1) Clinicians and nurses visited families and collected general and epidemiological information about the subjects using a standard questionnaire and took serum specimens. (2) Specific antibodies against SARS-CoV were assayed with two methods, indirect immunofluorescence assay (IFA) for detecting IgG antibodies and enzyme linked immunosorbent assay (ELISA) for mixed antibodies. Serum specimens tested included those from 21 clinically confirmed pediatric SARS cases (aged from 8 months to 14 years, 11 male and 10 female) and their 23 parents who had close contact with the children, 36 adult patients in convalescence stage of SARS, 24 children (aged 1.5 to 14 years) and other 34 adults who had close contact with infected adults.

RESULTS(1) The positive rates of specific IgG and mixed antibodies against SARS-CoV were 38% (8/21) and 33% (7/21) in pediatric cases; whereas the rates were 75% (27/36) and 69% (25/36) in adult patients. (2) The proportion of the patients who had close contact to SARS patients was 7/8 among the antibody-positive group vs. 1/13 for the antibody-negative group (P < 0.05). (3) The IgG antibody emerged in one of 24 children, whose mother, a nurse, had suffered from SARS (4%). (4) Among 23 parents of children with SARS, one was positive for IgG and the mixed antibodies, whose grandson and husband suffered from SARS; The IgG antibody and the mixed antibodies were also positive in another adult who had close contact with adult SARS cases (3%).

CONCLUSIONS(1) SARS-CoV infection was confirmed by serological methods in 38.1% of clinically diagnosed pediatric SARS cases, which leads to the assumption that correct diagnosis of pediatric SARS requires more accurate and efficient ways, for example, screening for antigen or gene of SARS-CoV. (2) The proportion of the patients who had close contact to SARS patients among antibody-positive cases was higher than that in antibody-negative cases. (3) It is possible that subclinical SARS CoV infection exists in children and adults, although the rate of occurrence is low. The data of the present study did not confirm that SARS had subclinical infection among adults who had close contact to pediatric SARS cases.

Adolescent ; Adult ; Antibodies, Viral ; blood ; immunology ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Female ; Fluorescent Antibody Technique, Indirect ; Humans ; Immunoglobulin G ; blood ; immunology ; Infant ; Male ; SARS Virus ; immunology ; Severe Acute Respiratory Syndrome ; blood ; epidemiology ; immunology