Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.

Objective To investigate the effects of remifentanil on lipopolysaccharide ( LPS)-induced acute lung injury (ALI) in rabbits.Methods Thirty healthy male New Zealand white rabbits weighing 2.5-3.5 kg were randomly divided into 5 groups ( n = 6 each) : group Ⅰ control (group C) ;group Ⅱ ALI;group Ⅲ, Ⅳ, Ⅴ low, median and high dose RF + LPS (group LR, MR, HR) . The animals were anesthetized with intravenous 3% pentobarbital sodium 30 mg/kg, tracheostomized and mechanically ventilated. The carotid artery and jugular vein were cannulated for MAP and HR monitoring, blood sampling, and fluid and drug administration. LPS 0.5 mg/kg in 10 ml of normal saline (NS) was infused over 30 min in group Ⅱ-Ⅴ. Remifentanil 0.2, 0.4 or 0.8 μg·kg~(-1)·min~(-1) was infused starting from 15 min before LPS administration until the death of the animals. MAP, HR, peak airway pressure (P_(peak) ), PaO_2 and plasma intercellular adhesion molecule 1 (ICAM-1) concentration were measured immediately before LPS infusion (T_0, baseline) and at 1, 2.5 and 5.5 h after the end of LPS infusion. The animals were killed and the lungs were immediately removed for microscopic examination and determination of W/D lung weight ratio. Results MAP, HR and PaO_2 were significantly decreased while W/D ratio and P_(peak) were significantly increased after iv LPS infusion as compared with control group. LPS significantly increased plasma ICAM-1 concentration and damaged the structure of lung tissue. Remifentanil infusion significantly attenuated the LPS-induced changes in a dose-dependent manner. Conclusion RF has protective effect against LPS-induced ALI and inhibition of ICAM-1 expression is involved in the mechanism.

Objective To investigate effect of BCG polyose nuclear acid combined with adapalene Gel in the treatment of flat wart.MethodsFrom January 2015 to May 2016, 100 flat wart patients were selected in our hospital, the patients were divided into observation group and control group, each group 50 cases, the control group was given Adapalene Gel therapy, the treatment group was treated with BCG polyose nuclear acid on the basis of control group, the therapeutic effect of the two groups were observed.ResultsThe total effective rate of the treatment group was 84.0%(42/50), and the control group was 60.0%(30/50)The treatment effect of observation group was significantly better than the control group (P< 0.05);The skin lesion score of observation group after treatment was (4.22±1.05) scores, which was significantly lower than that in the control group (P< 0.05);There was no significant difference in T lymphocyte subsets between the observation group and the control group;After treatment, the lgG and lgM in observationgroup were higher than before treatment (P< 0.05);The adverse reaction rates of the observation group and the control group were 14.0%(7/50) and 18.0%(9/50), the difference was not statistically significant.ConclusionThe therapeutic effect of BCG polyose nuclear acid combined with adapalene gel in the treatment of flat wart is better, it can improve the humoral immune function of patients, and it is safe and reliable.

Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium (within 3 days postpartum). Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy (≤12 gestation weeks), middle pregnancy (12-28 gestation weeks), late pregnancy (>28 gestation weeks), 1 postpartum (within 48 hours postpartum) and 2 postpartum (48-72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results (1) D-dimers concentrations during pregnancy were higher than the non-pregnant women (P<0.01), but there was no statistical difference between early pregnancy and late pregnancy (P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group (P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. (2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89-19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95%CI of the study population after cesarean section. Conclusions D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Objective To investigate the exact protocol eliciting the hippocampal CA1 long-term depression (LTD) of rats in vivo and the effect of amyloid β-protein (Aβ) on the LTD.Method By applying test stimulation to Schaffer collateral in hippocampal CA1 region in rats,recorded the in vivo field excitatory postsynaptic potentials (fEPSPs) ;further,observed the induction of LTD with different low frequency stimulation (LFS) and investigated the effect of Aβ25-35 on the LTD.Results Prolonged LFS (1,5 and 10 Hz) but not paired-pulse stimulus (PPS) effectively elicited the LTD in the hippocampal CA1 region,with significantly decreased amplitude of fEPSPs after LFS ; 1 Hz 900 pulses group induced a stronger LTD,being (63.7 ± 3.8) ％ at 120 min post-LFS,lower (P ＜ 0.05) than (75.1 ± 3.2) ％ in 600 pulses group ; different frequencies (1,5 and 10 Hz) of LFS with same pulses induced similar degree of LTD,the amplitude of fEPSPs were (63.7 ± 3.8) ％,(61.2 ± 3.6) ％ and (59.8 ± 3.9) ％ respectively,without significant differences between any two groups (P ＞ 0.05) ; after applying 12.5 nmol and 25 nmol Aβ25-35,the amplitude of fEPSPs decreased to (63.2 ± 3.8) ％ and (46.8 ± 3.9) ％,respectively,and lower and than that in control ((73.9 ± 3.0) ％,P ＜ 0.05).Conclusion Prolonged LFS effectively induced in vivo hippocampal LTD of rats,which provides an important electrophysiological protocol for the study of synaptic plasticity; Aβ25-35 injection dont affect the baseline synaptic transmission,but dose-dependently enhance the in vivo hippocampal LTD of rats,indicating that Aβ-induced LTD facilitation may be involved the early impairment of learning and memory in Alzheimer's disease.

Objective To analyze the CT and magnetic resonance imaging (MRI) manifestations of the pelvic osteosarcoma. Methods The CT and MRI manifestations of 15 cases with pelvic osteosarcoma from January, 2013 to December, 2015 proved by histology were ret-rospectively analyzed. Results There were 10 males and 5 females in them. The median age was 27.0 years. Ilium was involved in 11 cases. A mixed lytic/sclerotic pattern of bone destruction was found in 11 cases, and the sclerotic type in 2 cases, the osteolytic type in 2 cases. Ra-dial periosteal reaction was found in 5 cases and immature bone formation in 8 cases. Soft tissue masses were seen in 13 cases. MRI showed enhancement in 15 cases and the CT showed no enhancement in 2 cases with sclerotic type. Conclusion The typical imaging manifestations of pelvic osteosarcomainclude mixed lytic/sclerotic appearance, radial periosteal reaction, soft tissue masses and immature bone formation.

Objective To study the Gadolinium-enhanced MRI and diffusion weighted imaging (DWI) characteristics of the chondroid matrix-forming sarcomas.Methods Contrast-enhanced MRI and DWI were performed in 14 eases of chondroid matrix-forming sarcomas (10 chondrosarcomas,4 chondroblastic esteosarcomas) and 13 cases of other types of osteosarcomas.DWI was obtained with a single-shot echo-planar imaging (EPI) sequence using a 1.5 T MR imager with two different b values of 0 and 700 s/mm2.The apparent diffusion coefficient (ADC) values were obtained in GE Functiontool software.The contrast-enhancement pattern was evaluated and the ADC values of ehondroid matrix-forming sarcomas was compared with that of other types of asteosarcoma.Independent sample t-test was performed to evaluate the difference of ADC values between the group of chondroid matrix-forming sarcoma and the group of other types of osteosarcoma.In addition, nonparametrie test was used to assess the difference of ADC values between the chondrosareoma and the chondroblastic osteosarcoma.P value less than 0.05 was considered to represent a statistical significance.Results For 14 eases of ehondroid matrix-forming sarcomas, peripheral enhancement was found in all cases, septonodular enhancement was identified in 12 cases.While 13 eases of other types of osteosarcowas demonstrated heterogeneous enhancement.The mean ADC value of chondroid matrix-forming sarcomas [(2.56 ±0.35) × 10 -3 mm2/s] was significantly higher than that of other types of osteosarcoma [( 1.16±0.20) × 10-3 mm2/s] (t = 12.704,P <0.O1 ).There was no significant difference in the ADC value between the chondrosarcoma and the chondroblastie osteesarcama(Z =0.507 ,P =0.959).Conclusion Contrast-enhanced MRI and DWI can improve differentiation between chondroid matrix-forming sarcomas and other types of osteosarcomas.

Objective To investigate the therapeutic effect of the fourth ventricle tumors through lateral wall type of the transcerebellomedullary fissure approach under endoscope.Methods Clinical data of 14 cases with the fourth ventricle lesions were analyzed retrospectively.All the patients were treated by lateral wall type of the transcerebellomedullary fissure approach surgery.The endoscope was used if the lesions develop to the aqueduct and hard to be exposed.Both neurophysiological monitoring and intraoperative ultrasound were used regularly.Results Tumors were totally removed in 12 cases,subtotally in 1,and partially in 1.All the patients were diagnosed in postoperative histopathology,including 4 medulloblastoma,three epidermoid cyst,two ependymoma,two hemangioblastoma,one meningioma,one cavernous hemangioma and 1 astrocytoma.Hypopnea occurred immediate after operation in 1 patient.Ventilatory support was performed by Ventilator,and the respiration was restored 1 day later.Normal cerebrospinal fluid circulation was return in all cases.Neither aggravation of preoperative symptoms nor nuclei injury related complication had been found.The follow-up interval between 3 months to 28 months,one patient was dead with unexplained,and 1 medulloblastoma patient was relapse.Conclusion Lateral wall type of the transeerebellomedullary fissure approach,under endoscope,combined with the usage of neurophysiological monitoring and intraoperative ultrasound,can degrade the surgical related complications such as facial palsy and amblyacousia.

OBJECTIVE:To systematically review the effect of ticagrelor versus prasugrel on platelet reactivity,and provide evi-dence-based reference for clinical treatment. METHODS:Retrieved from PubMed,CJFD and Wanfang Database,randomized con-trolled trials(RCT)about the effect of ticagrelor versus prasugrel on platelet reactivity were collected. Meta-analysis was performed by using Rev Man software after data extract and quality evaluation by Cochrane 5.1.0. RESULTS:Totally 17 RCTs were enrolled,involv-ing 2 757 patients. Results of Meta-analysis showed,regardless of Verity Now(VN)detection method [MD=15.43,95%CI(-0.39, 31.25),P=0.06] or vasodilator stimulus phosphoprotein(VASP)detection method [MD=-3.04,95%CI(-8.98,2.90),P=0.32], ticagrelor and prasugrel had the same effects on platelet reactivity under loading dose,the differences were not statistically significant;regardless of VN detection method [MD=-48.94,95%CI(-58.04,-39.84),P<0.001] or VASP detection method [MD=-14.32, 95%CI(-20.45,-8.20),P<0.001],the effects of ticagrelor were better than prasugrel on platelet reactivity under maintenance dose,the differences were statistically significant. CONCLUSIONS:At the loading dose,there was no difference between ticagrelor and prasugrel,but ticagrelor has more benefits than prasugrel under maintenance dose.

Objective To investigate the correlation between non high density lipoprotein cholesterol (non-HLD-C)and cardi-ac function in patients with coronary heart disease (heart disease cardiac,CHD).Methods 162 patients with CHD were se-lected as the experimental group of CHD,100 cases of healthy physical examination qualified as the normal control group. CHD experimental group was divided into mild impairment group and severe impairment group according to the degree of impairment of the heart function.The mild impairment group include I and II levels of cardiac function classification and the severe impairment group included III and IV levels of cardiac function classification.To measure separately total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),and to calculate the content of non high density lipoprotein cholesterol (non-HDL-C).To compare the differences between CHD ex-perimental group and normal control group,and the correlation between different indexes of blood lipid and the degree of loss of cardiac function.Results The serum levels of non-HDL-C,TG and LDL in the Cardiac function in mild damage group of the CHD experimental group were significantly higher than those in the normal control group,and there were statistically significant differences between the two groups(t=2.438,2.887,5.253,P<0.05).The serum levels of non-HDL-C,TG and LDL in the severe heart function impairment group of the CHD experimental group were significantly higher than those in the normal control group,and there were statistically significant differences between the two groups (t=2.438,2.887,5.253,P<0.05).The serum level of HDL in the cardiac function in mild damage group of the CHD experimental group was significantly lower than that in the normal control group (t=-3.132,P<0.05).The serum level of HDL in the severe heart function impairment group of the CHD experimental group was significantly lower than that in the normal control group (t=-6.028,P<0.05).In the CHD group,only the serum level of TC in the severe impairment group was signifi-cantly different from that in the control group (t=3.278,P<0.05).The serum levels of non-HDL-C,TG,LDL of mild im-pairment of cardiac function in the CHD experimental group were significantly different from the serum levels of the severe impairment group (t=2.051,2.057,2.281,P<0.05).Logistic regression analysed that the OR value of serum non-HDL-C in CHD group was slightly lower than that of LDL,and significantly higher than TC and TG.With the increase of the degree of cardiac function,the value of OR increased significantly.Conclusion Serum non-HDL-C had a positive correlation with severity of CHD.To a certain extent,it can reflect the severity of CHD and is an important reference index for clinical diag-nosis and treatment of CHD.