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.

Beckwith-Wiedemann Syndrome ; Female ; Humans ; Infant, Newborn

Adolescent ; Blood Vessels ; pathology ; Female ; Femur Head ; blood supply ; pathology ; Femur Head Necrosis ; pathology ; Humans ; Male

Objective To investigate the effect of one-lung ventilation (OLV) on the occurrence of subcutanous emphysema during retroperitoneal laparoscopic urologic surgery (RPLUS).Methods Twenty-seven ASA Ⅰor Ⅱ patients,aged 29-64 yr,with body mass index 19-25 kg/m2,scheduled for elective RPLUS,were randomly divided into 2 groups:two-lung ventilation (TLV) group (group Ⅰ,n =15) and OLV group (group Ⅱ,n =12).In group Ⅰ,the patients were tracheal intubated and TLV was performed.In group Ⅱ,the left-sided double lumen endobronchial tube was inserted and TLV was performed,OLV on the non-operated side was performed starting from 10-15 min before pneumoperitoneum and TLV resumed at the end of pneumoperitoneum.The end-tidal CO2 partial pressure and minute ventilation volume were measured before pneumoperitoneum (T1),at 30 and 60 min of pneumoperitoneum (T2,3),and at 30 min after the end of pneumoperitoneum (T4).The CO2 absorption capacity was calculated.The degree of pneumoderma was assessed and the occurance of pneumoderma was recorded at the end of pneumoperitoneum.Results Compared with group Ⅰ,the CO2 absorption capacity was significantly reduced,and the degree and incidence of pneumoderma were significantly decreased in group Ⅱ (P ＜ 0.05).Conclusion OLV on the non-operated side can reduce the CO2 absorption capacity,decrease the degree of subcutaneous emphysema and reduce the occurrence of subcutanous emphysema during pneumoperitoneum in patients undergoing RPLUS.

Objective To explore the correlation between the patients with hypopharyngeal squamous cell carcinoma of the selective neck lymph dissection of lymph nodes detected quantity and prognosis.Methods Retrospective analysis of the clinical data of 96 cases underwent selective dissection of cervical lymph node in patients with squamous cell carcinoma of the hypopharynx.Results All patients with unilateral selective neck dissection of lymph nodes detected a number of 19.3 ± 11.0,the number of positive lymph nodes 0.8 ± 0.6.Preoperative radiotherapy patients (43 eases) was detected in lymph nodes and the number of positive lymph nodes was 13.8 ± 7.9 and 0.2 ± 0.2,without radiotherapy patients (53 cases) of lymph nodes detected number 23.2 ± 11.9 and 1.0 ± 0.2,the comparison between the two (P ＜ 0.01).According to the number of positive lymph nodes were divided into ≤ 15 group (42 cases) and ＞ 15 group (54 cases),＞ 15 group,the overall survival rate at 3 years and 3 years disease free survival rate and neck control rate was significandy higher than that of ≤ 15 group [70.4％(38/54) vs.38.1％(16/42),61.1％(33/54) vs.33.3％ (14/42),96.3％(52/54) vs.76.2％(32/42)] (P ＜ 0.01 or ＜ 0.05).Multivariate analysis showed that lymph nodes detected a number ＞ 15 was the survival rate of the independent risk factors for overall survival in patients with and without effect (P ＜ 0.05).Conclusion Selective neck dissection of lymph nodes detected number can be used to predict prognosis in patients with squamous cell carcinoma of the hypopharynx.

Objective:To observe the effect of electroacupuncture (EA) for Alzheimer’s disease (AD). Methods:A total of 30 eligible cases were treated by needling Shenting (GV 24), Baihui (GV 20), Dazhui (GV 14), Fengfu (GV 16), Mingmen (GV 1) and Yongquan (KI 1). Upon arrival of qi, the G6805-II electric stimulator was connected to Shenting (GV 24) and Baihui (GV 20) (one pair), to Dazhui (GV 14) and Fengfu (GV 16) (one pair) and to bilateral Yongquan (KI 1) (one pair) for 25 min, using continuous wave at the frequency of 2-100 Hz and voltage of 2-4 V. With a tolerable intensity, the EA was conducted once a day for 10 d (one treatment course). There was a 3-day interval between two courses. After three courses, the therapeutic efficacies were evaluated using the mini-mental state examination (MMSE), revised Hasegawa dementia scale (HDS-R), activities of daily living (ADL) and neurological function defect scale (NFDS). Results:After EA treatment, the MMSE and HDS-R scores were significantly increased (P<0.01) and the ADL and NFDS scores were significantly decreased (P<0.01). Conclusion:EA is effective for AD and can improve the overall intelligence and repair neurologic deficits in AD patients.

Objective To study interaction proteins with secreted apoptosis-related protein 1 (SARP1) in fibroblasts of hypertrophic scar and to analyze its molecular mechanisms.Methods The recombinant adenovirus Ad-SARP1 was successfully constructed and transfected into the fibroblasts of hypertrophic scar in culture.The proteins were precipitated by immunoprecipitation and separated by SDS-PAGE,then it was stained with Coomassie blue and proteins from SDS-PAGE gel electrophoresis strip were analyzed with enzymolysis and mass spectrometric in turn.The peptide sequences were obtained according to mass spectrometry and the database were searched automatically.Results The results showed that in control cells,Ad-SARP1 and Ad-EGFP infected cells,were precipitated 7 protein bands,their molecular weights were about 93 × 103,43 × 103,40 × 103,37 × 103,31 × 103,26 × 103 and 12× 103,respectively; without SARP1 antibody the protein bands did not precipitate.Analysis of the 6 protein bands showed that proteins that might interact with SARP1 included periostin precursor (OSF-2),asporin precursor (PLAP1),phosphoglycerate kinase 1,rCG50690,apolipoprotein A-I precursor (Apo-AI),and thioredoxin 1 (TRX1).Conclusions The interaction proteins of SARP1 can be obtained by immunoprecipitation combined with liquid chromatography/mass spectrometry and ion trap detection technology.These results provide new clues for the mechanism of SARP1 regulates the apoptosis signal pathway of HSFb.

Objective To investigate the relationship between isolated systolic high-normal blood pressure and cor-onary heart disease (CHD) in the middle-aged and elderly population. Methods A total of 236 patients over 50 years old and undergone coronary angiography were enrolled and divided into isolated systolic high-normal blood pressure (ISHNBP) group (n=135) and non-ISHNBP (NISHNBP) group (n=101) according to their systolic and diastolic blood pressure levels. All clinical data and angiographic data were collected. Results There was no significant difference in systolic blood pres-sure between NISHNBP group and ISHNBP group (P>0.05). There were significantly lower levels of diastolic blood pres-sure and higher pulse pressure in ISHNBP group (P＜0.01). Results of multivariate logistic analysis showed that isolated sys-tolic high-normal blood pressure was the independent risk factor for CHD (OR=2.67,95%CI:1.50-4.75, P＜0.01). And the distribution of diseased coronary vessel numbers was more extensive in the ISHNBP group (P＜0.01). Conclusion The iso-lated systolic blood pressure in the middle-aged and elderly population with high risk of coronary heart disease should be paid attention to, and make appropriate interventions, which may help reduce the incidence of cardiovascular disease.

Objective:To investigate the role of clinical pharmacists in the anti-infective treatment of one patient with complexity urinary tract infection with septic shock induced by cellulitis. Methods:Clinical pharmacists participated in one case of complexity uri-nary tract infection with septic shock induced by cellulitis, and according to the clinical curative effect and the patient' s condition change, clinical pharmacists adjusted the medication nine times and provided individualized pharmaceutical care and service in the whole process. Results:Physician accepted the suggestions of clinical pharmacists, the infection was controlled after the 38-day treat-ment, and then the patient was discharged from the hospital. Conclusion:Clinical pharmacists should participate in the clinical treat-ment, provide whole process of pharmaceutical care for severe patients and assist physician in drug treatment decisions to promote safe, effective and economical drug use.

Objective To investigate the value of urine liver?type fatty acid?binding proteins(L?FABP) for early diagnosis and progress predicting of acute kidney injury(AKI)after lung transplantation. Methods Urine L?FABP and Scr blood samples in perioperative periods of 119 lung transplant recipients (hospitalized between 2013?2014)were involved in the research. Patients were divided into AKI group and non?AKI group according to KDIGO. Changes in urine L?FABP and Scr of two groups at various time points were recorded. Results Of 119 patients,57 developed AKI after surgery. Urine L?FABP from 0 h to 48 h in the two groups increased significantly, and the difference at 6 h to 48 h between the two groups is significant. In terms of diagnostic value,ROC area of urine L?FABP at 6h is 0.818. When 2254.52 ng/mg Cr was taken as diagnostic dividing line ,sensitivity and specificity was 0.782 and 0.814. In predicting AKI progression ,AUC below AUC of urine L?FABP 0.852. When 4313.17 ng/mgCr was taken as diagnostic dividing line ,sensitivity and specificity was 0.867 and 0.700. Conclusion Urinary L?FABP appears to be a sensitive and specific marker of AKI in lung transplant recipients ,could be a biological marker in the early diagnosis and progression tendency of AKI.