Objective To explore the value of transthoracic echocardiography(TTE) combined with partial pressure of end-tidal CO2 (PETCO2) monitoring in preventing venous air embolism (VAE) during hysteroscopy operation.Methods From August 2010 to August 2012,300 cases undergoing hysteroscopic surgery under general anaesthesia were enrolled in this study.With the echocardiography combined with PETCO2 monitoring during hysteroscopic surgery,the time of VAE appearing in the right atrium,the extent of air embolism(grade 0-4),the changes of PET CO2,peripheral oxygen saturation (SpO2),blood pressure (Bp),the amount of fluid intravasation and the blood loss were recorded in detail.Take the 24 cases that the grades of VAE in grade 3 or above and a decrease in PETCO2 ≥5 mm Hg (1 mm Hg =0.133 kPa) as intervention group.Stop operation immediately,the left side and raise your right shoulder,oxygen inhalation and dexamethasone 10 mg intravenous drip were given to the intervention group; the control group (5 cases in grade 3 or above and a decrease in PETCO2 ＜ 5 mm Hg) only stop operation immediately,observation patient's condition closely.Results (1) The occurrence of VAE:air embolism occurred in 34 patients among all 300 patients,all of 34 patients had evidence of gas embolism in the inferior vena cava,right atrium(RA) and right ventricle chamber,and 29 patients had evidence of continuous groups of gas emboli.There were 32 cases with the decrease in PETCO2 ＞ 2 mm Hg,14 cases with SpO2 less than 95％,and 4 cases with a drop in Bp ≥ 20％.(2) The change of the decrease of PET CO2 and the grades of VAE:the decrease of PETCO2 and the grades of VAE were positively correlated (r =0.601,P ＜ 0.01),continuous groups of gas emboli signal in RA,when the drop of PETCO2 ≥5 mm Hg,8 of the 34 cases whose drop of PETCO2 ≥ 10 mm Hg,7 cases in grades 4.The decrease of PET CO2 [(7.5 ± 2.4) mm Hg versus (11.1 ±4.1)mm Hg],the amount of fluid intravasation[(688 ± 150) ml versus (925 ±268) ml] and the blood loss [(71 ± 36) ml versus (127 ± 56) ml] all had statistical difference in grade 3 and 4 (P ＜ 0.05).The sensitivity of PETCO2 was better than SpO2 and Bp in detecting of VAE.(3)The cases of PETCO2 continue to decline and recovery time between the two groups:2 cases' PETCO2 continued to decline in the intervention group,but 4 cases in the control group.The recovery time of the two groups was(4.8 ± 1.6) and (8.3 ±1.9) min,respectively,which reached statistical difference between (P ＜ 0.05).Conclusions TTE combined with PET CO2 monitoring can effectivelv predict the occurrence of air embolism in hysteroscopic surgery; Continuous groups of gas emboli signal in RA accompanied by a decrease in PETCO2 ≥5 mm Hgindicates that the occuTence of air embolism ; the more the amount of intravasation of distension fluid and the blood loss,the more the air into the body.Timely intewention can effectively prevent the development of air embolism when the VAE in grade 3 or above accompanied by a decrease in PETC02 ≥5 mm Hg.

Objective To obtain recombinant human stanniocalcin 1 ( STC1 ) with biological activity in Escheri.coli cells expression.Methods The gene was cloned into pET32b( +) vector by fused with thioredoxin and His tag .E.coli BL21(DE3) competent cells were transfomed by the recombinant vector .After renaturation, the fusion protein was digested with thrombin and intact STC1 protein was purified from the digested protein using Ni ion affinity chromatography .Recombi-nant humanSTC1 protein was confirmed by Western blot analysis using goat anti-STC1 antibody.The biological activity of STC1 in rat was assayed using standard method for assessment of renal function .Results The recombinant human STC 1 fu-sion protein is successfully expressed in Escherichia coli, the fusion protein was purified by affinity chromatography from the inclusion body and renaturated .Intact hSTC1 protein was released by thrombin digestion and purified by Ni ion affinity col-umn.The intact STC1 proteins was confirmed by Western blot analysis .Rat bioassay revealed that STC1 boosted phosphate reabsorption.Conclusion Recombinant STC1 protein was successfully expressed and has native biological activities .This protein could be used as an antigen for the preparation of monoclonal antibody against humanSTC 1.

Objective To study the effects of caffeic acid phenethyl ester (CAPE) on the expression of β-catenin, c-myc and cyclin D1 in colorectal cancer cell line SW480. Methods The changes of mRNA and protein expression of β-catenin, cyclin DI and c-myc were detected by RT-PCR and Western blot after culturing the colorectal cancer cell line SW400 with different concentrations of CAPE (2.5, 5.0, 10.0 mg/L) for 24 hours and 48 hours. Results After the treatment of CAPE, the mRNA expression of β-catenin, cyclin D1 and c-myc were decreased from 1.05±0. 26, 0.87±0.09, 0.63 ± 0. 09 to 0.67 ±0. 10, 0.51±0.14, 0.32±0.14, respectively, and the protein expression of β-catenin, cyclin D1 and c-myc were decreased from 204±52, 111±11, 87±7 to 52±16, 52±16, 32±12, respectively. There was a significant difference in the decrease of mRNA and protein expression of β-catenin, cyclin D1 and c-myc in colorectal cancer cell line SW480 with and without treatment of CAPE (F=5.724, 6.793, 7.026, 15.936, 14.889, 14.162, 31.147, 28.881, 6.322, 17.647, 9.584, P<0.05 ). The inhibition effect of CAPE was displayed in a dose- and time-dependent manner. Conclusions CAPE can obstruct the β-catenin pathway, and down-regulate the transcription and expression of β-catenin, cyclin D1 and c-myc. The anti-tumor effect of CAPE may be related to the decreased expression of β-catenin, cyclin DI and c-myc.

Objective To explore the relationship between the polymorphism of methionine synthase reductase(MTRR) A66G and the susceptibility to unexplained repeated spontaneous abortion (URSA).Methods Total of 200 Henan Han couples with URSA (URSA group) and 76 Henan Han healthy couples without URSA (control group)were enrolled in this study.Their MTRR A66G genotypes were determined by PCR restriction fragment length polymorphism (PCR-RFLP).Results (1) The allele frequencies of MTRR A66G:the frequencies of allele A and allele G in URSA group were 76.5％ (153/200)in husband and 72.8％ (146/200) in wife,23.5％ (47/200) in husband and 27.2％ (54/200) in wife,respectively.The frequencies of allele A and allele G in control group were 78.9％ (60/76) in husband and 78.3％ (59/76) in wife,21.1％ (16/76) in husband and 21.7％ (16/76) in wife,respectively.The frequencies of allele A and allele G were not significantly different between female and male subjects within the same experimental group (P ＞ 0.05),and also there were not significantly different between the same gender subjects at URAS and control groups(P ＞ 0.05).(2) The genotype frequencies of MTRR A66G:the frequencies of genotype AA,AG and GG in URSA group were 57.0％ (114/200) in husband and 52.0％ (104/200) in wife,39.0％ (78/200) in husband and 41.5％ (83/200) in wife,4.0％ (8/200) in husband and 6.5％ (13/200) in wife,prepectively.The frequencies of genotype AA,AG and GG in control group were 59.2％ (45/76) in husband and 59.2％ (50/76) in wife,39.5％ (30/76) in husband and 38.2％ (29/76) in wife;1.3 ％ (1/76) in husband and 2.6％ (2/76) in wife,prepectively.The frequencies of genotype AA,AG and GG were not significantly different between female and male subjects within the same group (P ＞ 0.05),and also there were not significantly different between the same gender subjects at URSA and control groups (P ＞0.05).(3) Combined genotype of couples:the combined genotype frequencies of GG + GG,GG + AG,GG +AA,AG + AG,AG + AA and AA + AA in URSA group were 1.0％ (2/200),2.5％ (5/200),6.0％ (12/200),20.0％ (40/200),38.0％ (76/200),and 32.5 ％ (65/200),prepectively ; the combined genotype frequencies in control group were 0,1.3％ (1/76),2.6％ (2/76),17.1％ (13/76),42.1％ (32/76),36.8％ (28/76),prepectively.The combined genotype analysis between the two groups were also not significantly different (P ＞ 0.05).Conclusion The polymorphism of MTRR A66G gene was not associated with the susceptibility to URSA (P ＞ 0.05),and so it was not the inherited genetic risk factor of URSA.

Objective To investigate the clinical value of non-invasive prenatal diagnosis using cell free fetal DNA(cff-DNA)in maternal blood.Methods From Sep.2010 to Mar.2012,103 pregnant women who came to Henan Province People's Hospital in the first trimestcr for prenatal diagnosis of scx-linked inherited diseases were included in the first trimester group.From Oct.2010 to Jan.2012,205 pregnant women undergoing amniotic fluid sampling for fetal karyotype analysis in the same hospital were included in the second trimester group.Real time quantitative PCR and fluorescent PCR were used to detect sex determining region of Y chromosome gene(SRY)and amelogenin gene(AML)on cff-DNA of the first trimester group.Moreover,12 Y chromosome STR loci analysis were performed for 33 male fetuses and their fathers.Massively Parallel Signature Sequencing(MPSS)was used for aneuploidy analysis in cff-DNA of the second trimester group.Results(1)In the first trimester group,there were 53 SRY positive and 50 SRY negative.Compared with the results of cff-DNA of chorionic villus samples,there was one SRY false positive and one false negative results,with a sensitivity of 98％ and specificity of 98％.For the AML gene test,there were two PCR products of male fetuses:102 bp fragment originating from X chromosome(AML X)and 108 bp fragment from Y chromosome(AML Y);but only AML X was found in products from female fetuses.In the first trimester group,102 bp and 108 bp fragments were detected in 52 cases,and only 102 bp fragment was found in the other cases.Compared to AML results from chorionic villus samples,there were 2 false negative results,with a sensitivity of 96％ and specificity of 100％.(2)For cff-DNA with plasma SRY over 30 copy/ml,Y STR loci were analyzed on cff-DNA of 33 fetuses and their fathers.The Y STR loci less then 200 bp were successfully detected,while Y STR loci with PCR products between 200-300 bp showed low signal or could not be amplicated;and no PCR products more than 300 bp were detected from cff-DNA.Comparing the detected Y STR loci of cff-DNA to the fathers,32 fetuses were concordant with their fathers'.Exogenous contamination was found in the rest one sample.(3)In the second trimester group,6 fetuses with abnormal karyotype(two trisomy 21,three trisomy 18 and one 45,XO)were detected by cff-DNA and were proved by karyotype analysis.Moreover,the MPSS results of cff-DNA revealed one 45,Y and one trisomy 16 whose karyotype analysis showed normal results.And in one case,MPSS suggested less chrX or chrY,that was proved to be 47,XYY by karyotype analysis.Conclusions(1)Cff-DNA in maternal blood can be used to determine fetal gender in early prenancy with considerable sensitivity and specificity.But the trace cff-DNA and the high maternal DNA background might have impact on the result.(2)Analysis of cff-DNA in maternal blood of the second trimester women showed that MPSS could be used for prenatal screening of trisomy 21 and trisomy 18.However,further research should be done for other chromosomes aneuploidy detection.

Objective To study the postpartum pelvic floor rehabilitation on the improvement of pelvic floor electrical physiological indexes and the prevention of female pelvic floor dysfunction in China. Methods A multicenter prospective randomized controlled study was carried out. From October 2011, postpartum women in five provinces were randomly assigned into treatment group and control group. The women in treatment group received electrical stimulation and biofeedback treatment. The women in control group performed pelvic floor muscle exercise at home. When 6 months and 12 months after delivery, comparing two groups of patients with pelvic floor electrical physiological indexes and pelvic organ prolapse quantitation measurements (POP-Q), to evaluate the effect of postpartum pelvic floor rehabilitation on the prevention of pelvic floor dysfunction. Pelvic floor impact questionnaire short form (PFIQ-7) and pelvic organ prolapse/incontinence sexual questionnaire-12 (PISQ-12) were used to evaluate the influence on quality of life and sexual life. Results Until June 2013, 324 women were participated, 124 in control group, 200 in treatment group. According to the baseline results, there was statistical significance in the results of pelvic floor electrical physiological indexes between the treatment and control groups in postpartum 6 months and 12 months; the proportion above level Ⅲ of type Ⅰ and type Ⅱ muscle fibers strength in the treatment group, it was from 41.5% (83/200) and 40.5% (81/200) to 76.3% (145/190) and 79.5% (151/190) in postpartum 6 weeks and postpartum 6 months, increased to 80.6%(58/72) and 80.6%(58/72) in postpartum 12 months, improved significantly comparing with the control group (P<0.01). According to Point Aa, treatment group and control group in the postpartum 6 weeks was (-2.2 ± 0.7) versus (-2.4 ± 0.6) cm, in postpartum 12 months (-2.5 ± 1.1) versus (-2.7 ± 0.6) cm, the improvement in treatment group was statistically significant (P<0.01). And the other points were not significantly different (P>0.05). There was no significant difference in the questionnaires in quality of life and quality of sexual life (P>0.05). Conclusion Neuromuscular electrical stimulation and biofeedback therapy in the early postpartum period could obviously improve pelvic floor electrical physiological indexes, and is beneficial to prevent the pelvic floor dysfunction.

Objective:To explore the application effects of standardized patient (SP) and breast visual palpation simulation system on clinical probation of breast surgery for medical students.Methods:A total of 110 students were randomly divided into experimental group and control group, and each group was further divided into 5 subgroups. In the experimental group, SP scripts of five common diseases in breast surgery department were designed according to the syllabus before probation, and the teachers were trained. During the probation, we first talked about the characteristics of disease diagnosis and treatment, and then the five subgroups collected the history of the disease according to the SP of different diseases mentioned above, and checked the corresponding lesions on the breast visual palpation simulation system. In the physical examination, SP responded to the students' questions. The control group also talked about the above-mentioned five diseases during the probation, and then the five subgroups carried out history collection and physical examination for specific patients in the hospital. Finally, the teaching effects were analyzed through medical record writing, theoretical examination, physical examination and student evaluation. SPSS 26.0 was used for chi-square test (or Fisher exact test) and Mann-Whitney U test. Results:There was no significant difference in the theoretical examination between the two groups. It was demonstrated that the correct rate of experimental group was significantly higher than that of the control group in medical history collection, especially in the main symptoms, incentives, aggravation and remission factors, accompanying and differential symptoms and so on. And the positive results of breast, nipple and axillary lymph node palpation in the experimental group were significantly higher than those in the control group through the physical examination operation of breast visual palpation simulation system. The analysis of students' evaluation showed that the teaching efficiency of the experimental group increased, and the students' satisfaction was improved (satisfaction rate: 92.73% vs. 76.36%).Conclusion:The application of SP and breast visual palpation simulation system in breast surgery probation teaching can not only protect the privacy of clinical patients, but also improve the teaching effects, which can be popularized in the clinical teaching of breast surgery.